We've all been there: you've bent over to tie your shoes, and now you're stuck and saying to yourself, "how did I hurt my back tying my shoes?!" Regardless of how you hurt it, you need to know how to fix it. In this article, I'm breaking down what 3 things you need to stop doing when it comes to back pain, and what to do instead, with the help of Hamilton Registered Massage Therapist (RMT), Sarah Morgan.
#1: STOP Laying Down After years of telling people to stay in bed after a back injury, experts have learned that one of the best things we can do to help speed up our recovery process is to keep moving (1). The trick is to be selective with your movement choices so that you can help reassure your brain that moving is safe. The safer the brain feels, the fewer protective responses it will produce (such as an increase in pain or muscle tension) (2).
START Introducing Pain Free Movement
Before you try anything else, you need to know what movements increase your back pain, and what movements ease it. A good place to start is to think back to what you were doing when you first injured your back. That movement is likely going to cause more pain. For example, if bending down to tie your shoes was what caused your back to give out, other movements that involve rounding the spine are also likely to bother you. That might include daily activities such as leaning over the sink while brushing your teeth, washing the dishes, sitting in certain positions, or trying to lay down onto your back from a seated position.
During the first few days of your injury, avoid or alter those movements as much as you can (3). For example, while I wouldn't recommend you stop brushing your teeth, you can change your posture and minimize the rounding of your back by placing one foot on a stool in front of the sink. (But definitely let someone else take over dish duty while you're recovering!)
Once you've figured out what movements to avoid, try slowly introducing other movements and see how they feel. Be sure to take it very slowly when trying out a new movement, as your brain is likely to be on high alert and may send out some warning signals (read: pain) if you try to move too quickly.
Trainer Tip: If most movements cause too much pain to tolerate, get into whatever position feels most comfortable for you, and take some deep belly breaths. Breathing deeply into the belly expands the torso, and your vertebra will experience very gentle mobilizations without you having to actively move your body. Revisit trying very slow movement again later.
#2: STOP Doing Yoga
As a yoga instructor, I regularly hear from new students that they've been told to start doing yoga as a way to heal their back pain. But if you're new to yoga, the time to try it is *not* when you're experiencing back pain. It's important to remember that even in a beginners or gentle yoga class, not all yoga postures are going to work for you, and many postures can actually make your back pain worse. For example, if your instructor invites you to take child's pose at the start of the class, and you hurt your back by bending over, this posture will likely lead to an increase in back pain. And, depending on the class, you might be repeatedly putting yourself into other postures that also involve rounding the back. Each time you do, your brain is going to get more and more reactive. That reactivity typically looks a steady increase in pain and muscle spasms, leading to prolonged pain and a potential setback in your recovery (4).
START Walking
One of the best things you can do for your body, including when you're experiencing back pain, is to walk more. RMT Sarah says, "within the first 24 hours [following an acute back injury], your muscles are in spasm to protect your spinal cord and surrounding structures. The best thing you can do is ice the area and keep moving!" To help with pain and inflammation, Sarah recommends walking regularly, and icing for 20 minutes at a time. Before you lace up your shoes and go, keep these recommendations in mind:
Try to maintain good posture while you're walking. When we feel anxious about feeling pain, we sometimes alter our posture or movements as a way to try to protect ourselves. Unfortunately, that apprehension is often what makes things feel worse. As much as possible, try to walk normally, swinging your arms, and looking forward (not down at your feet!).
Start with a small walking goal and increase your distance when you're ready. Remember that it's easier to add some distance to the end of your walk, than to get halfway out and realize you're too sore to walk all the way back.
Take breaks whenever you experience pain. Especially as your distance increases, there's a chance you might experience some pain as you begin to fatigue. As soon as you notice pain, stop and rest. It's important not to push through pain, as we want to remind the brain that walking is safe (5, 6).
#3: STOP Only Trying to Fix Your Back When You're in Pain
When someone says "I can't believe it! I threw my back out by sneezing!", it's important to remember that it likely wasn't just that one instance of sneezing that created the problem. We need to consider our posture, how often we're moving, our spinal hygiene (7) (how well we're moving), our core endurance, and even our sleeping habits - all of which can play a role in our spinal health. That final sneeze was just the last action after a series of cumulative actions impacting the spine. Ice, heat, muscle relaxants, physio exercises, and massage therapy can be great tools to use during a back pain event. But if you're not also taking steps to improve your back when it's *not* in pain, you'll never break free of the cycle of recurring back pain.
START Taking Preventative Steps Now
"Maintenance massage and strengthening exercises are best to prevent the likelihood of severe recurring back injuries," says Sarah. One massage every 4-6 weeks is generally recommended for maintenance massage, however Sarah cautions that it may be more frequent for some people. "I always recommend listening to your body and increasing your appointments as needed", she says.
In addition to maintenance massage, I recommend incorporating core strengthening exercises such as dead bug, bird dog, and plank variations, because they are all performed with a neutral spine (when done correctly), and because there are a variety of ways to modify them to suit your individual needs. Other exercise recommendations depend on a variety of factors that are a little more unique to you, such as: what caused your back pain, what movements make it worse, what movements make it better, your previous exercise history, your current spine hygiene, and what your recovery journey has been like so far. (Psst! Stay tuned for a few programs I'll be releasing soon on how to figure this out for yourself!)
Oh, And One More Thing... Don't Book That Massage (Yet!) It's common for people to jump right to calling their massage therapist after an injury to their back, but it's likely you'll have a better experience if you wait a few days before getting treatment. "Generally speaking, massage is better after a couple days of healing. Acute injury is likely too sensitive to touch for most people", Sarah explains.
RMT Tip: When you do get in for treatment, Sarah suggests taking a hot shower or bath after your massage, and to increase your water intake. "Even just a couple glasses of water will help reduce any rebound pain or discomfort from a deep tissue massage", she says.
References
(1, 3, 5, 7) McGill, S. (2015). Back mechanic: The step by step McGill Method to fix back pain. Backfitpro
Inc.
(2, 4, 6) Cobb, E. (n.d). Introduction to Pain Neurobiology. [Lecture recording].
www.university.zhealtheducation.com