Back Pain Exercises – When to Exercise When in Pain

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Welcome to the Back Pain Solutions Podcast – Back Pain Exercises – When to Exercise When in Pain

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Introducing Back Pain Exercises – When to Exercise When in Pain

Bed rest has been well documented to have a negative impact on the recovery from back injury and indeed the research demonstrates that this approach can worsen the underlying issue. But should we be resting as part of our recovery? Is exercise always beneficial, and should we be doing exercise at all? What is the difference between doing exercise and taking an active approach to managing back pain?

In this episode we discuss what is meant by an active approach to recovery versus exercise. We identify the best approach to active recovery including rest; hydration; nutrition and healthy movement. We discuss when rest may be important but understanding what considerations need to be made when resting as part of your recovery. Not only that but we discuss why its important not to rush into exercise after injury and how this can lead to neurological changes which can lead to chronic pain. Finally, we make considerations for hydration, as well as nutrition, and how they play a key role in tissue repair.

Show Highlights Back Pain Exercises – When to Exercise When in Pain

We discuss the best approach to managing lower back pain using an active based approach to care whilst ensuring listeners understand the importance not to rush back into sporting activities. We discuss exactly what is an active based approach to care and why rest can play a role if adopted for the right individuals, and for the right reasons. We highlight the difference between bed rest and tissue rest, which is an important distinction, and why tissue rest is fundamental to recovery.

Interview Transcription for Back Pain Exercises – When to Exercise When in Pain

Unknown Speaker 0:00

When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain, back pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to be stronger back the smart way.

Ben James 0:28

Welcome back to the back pain solutions podcast. And as always, thank you guys for listening in on Ben James. I’m your host and I’m again as always with my co host Jacobs day morning, Jacob. Good morning, man. So we talked a lot so far about active recovery. We talked a lot about the different muscles that stabilize the spine, and very much focused on this this active approach. But that leads the natural question from a lot of people well, should I just be exercising even if it’s painful? Should I be exercising if I’ve had an acute injury? Where do we begin I think Jacob, we talked about an interesting study here. That would be a good place to start as off not focused specifically about the low back, but about neck pain and whiplash, which I think would be good, interesting point to open the podcast today. So do you want to just take a minute or two just to go through that, and then we’ll we’ll kind of dive in and dissect that.

Jacob Steyn 1:19

Sure. This study, it’s not a recent study, it’s actually 1996. And it was called a study of neck injury arising from motor vehicle accidents, and it’s clinical management. So what they was was actually a thesis of a PhD student about what they did is they took three groups and all of them had a whiplash cervical whiplash. And so they took one group and they they gave them the standard physiotherapy treatment, you know, the typical soft tissue, some exercises, took another group and they didn’t do anything to them. And as a control group, and then I took a third group and they just immobilized their necks with a neck brace. And if I remember correctly, they didn’t wear it at night, but they wore during most of the day, and I’m not sure if it was four or six weeks, but it was a significant duration that they had to keep the brace on. Yeah. And, and the interesting thing was, you know, my natural thought would be, well, the the guys who the exercises were recovering better and had better outcomes, but actually the group who immobilized who were immobilized, had much better tissue repair, which they checked with MRIs afterwards, they had better pain scores, and they had better function.

Ben James 2:46

Interesting. So that leads to the natural question then if you’ve got a low back, acute injury, should I immobilize that back for four to six weeks, and actually, how do I do that? Does that become more complicated to do because of the location of the injury compared to the neck, which we know is easily mobile mobile immobilize with a neck brace. Is that the reason why you may not do that? Or is that wrong for the low back?

Jacob Steyn 3:13

Yeah. So see, that’s where it becomes very interesting. We, I don’t think we can really put a brace around the low back, like you said, and so it’s a little bit more difficult. But it comes back to what we we’ve been saying also another podcast, but the spinal hygiene, understanding how to keep the core still how to keep it fixed between the shoulders and the hips. Think that’s where we would put our emphasis in actually allowing that healing to happen. And I think a lot of people think, okay, if they understand that they have to not rotate through the spine, but how important is that? Really, it’s, it’s a big deal to make sure that you understand how to not move through the spine.

Ben James 3:57

Yeah, and it’s an interesting point Actually, no, you will Now you start to, now we start to discuss it because actually what we are saying is, you do want to put that brace around the low back in exactly the same way you would immobilize the neck, but you’re doing it naturally with your muscles and your movement and your healthy spine hygiene. Because that’s far more difficult to do with the neck to stop yourself reacting and turning around, for example, is a very natural reaction maybe so to immobilize the neck, are we actually getting the same outcome if we immobilize the low back, but we’re just doing it with the muscles and the right movement and healthy spine, Heidi?

Jacob Steyn 4:38

Yes. And I think, you know, considering that the the whiplash that was an acute injury, but you most likely have a fair bit of tissue damage at the ligaments and maybe add parts of the spine as well. Maybe some muscles also, so….

Ben James 4:55

It would be fascinating to do a study sorry to jump in there Jacob. no sure. it’d be fascinating to do a study which would be incredibly difficult to achieve. But the whiplash study with immobilization without the neck brace, but applying what we’ve talked about a lot with the low back to the neck now how do you do that because that involves stopping or or training someone not to turn their head to react to someone calling them and etc. but would a an active base recovery with some of the right exercises in terms of deep neck flexors stimulus ation and building the endurance there with that braced immobilization naturally, would that actually lead to a better outcome than immobilization completely with a brace? If that makes sense?

Jacob Steyn 5:43

Yeah, yeah, very difficult, right?

Ben James 5:45

Absolutely. But it evokes an interesting point, doesn’t it? Because what we’re saying is actually with the low back, we do want to immobilize it, but we’re just not going to achieve that with a brace because there’s not going to be a brace that that can truly do that. But Healthy movement and right activation of the appropriate muscles and bracing, as we’ve talked about before, will allow you to achieve that.

Jacob Steyn 6:11

Exactly. And that that’s, that’s our goal actually is to, you know, if you would move too much through the low back constantly, then you’re obviously going to take the tissue in one direction. And that would probably be leading to a sort of instability, lack of tissue and endurance, you know, and if we use a spinal hygiene and the correct movement, then we’re taking it the other direction, and that’s giving stiffness strength to the tissue and that’s our goal.

Ben James 6:41

Yeah, and I guess the with regards to acute pain and low back or neck, the neck brace there is is preventing movement. So in theory that’s preventing any of those potential pain triggers or unhealthy movements that could lead to further damage. And that allows the inflammation to do its job. And for the tissue to heal in the low back. The aim, presumably of what we call exercise, or so we say an active based approach is in the acute phase is to learn to brace and move appropriately. So when, again, not aggravating those tissues, we’re just doing it in a different way. So we’re not necessarily saying do exercise at this point. It’s more about the healthy movements. Is that a fair summary? Do you think? Or we say, Well, actually, we can apply some of those exercises, even in the acute phase that there are more considered exercises.

Jacob Steyn 7:41

I think it’s important to realize the exercises we use in the acute phase at the beginning is actually, to create that brace.

Ben James 7:50

Great point.Yeah.

Jacob Steyn 7:50

You know what I mean? Yeah. And that means that we’re using those exercises to get the brain to understand how to isolate the movement. And I think that’s what a lot of people Forget they they think, Okay, well, I gotta move through my spine. No, we got to move through the ball and socket joints, the shoulders and the hips. But we got to actively teach the brain through the correct exercises to create that brace around the core, which then allows the tissue to heal.

Ben James 8:18

Yeah, and I think there’s a great little summary for us there is that when we’re when we’re talking exercise, specifically in the acute phase for lower back. Yes, we want to immobilize but we want to immobilize through bracing and correct movement and healthy spine hygiene, rather than it being exercise as in, go for a run. go swimming, do the normal things that you do. Yes, we don’t want to promote bedrest as it were. So we’re this active approach to recovery involves healthy movement and learning the spine hygiene and bracing as opposed to overt exercise. I think that’s the clear distinction there is that we’re not saying exercise to recover. We’re saying in active based recovery. And just to clear that point up that active based recovery is about that healthy movement, embracing and hygiene. So I think that’s a really fair point. And that study with regards to whiplash is a, I think, is a really interesting way to kind of drive that home because really, we’re getting the same result. We’ve just got to do it in a different way.

Jacob Steyn 9:26

Exactly, exactly. I also want to make a little bit of a distinction here between the acute low back injury and the chronic low back injury, yes, and the difference in approach that we will take for that. So quite often with a chronic low back injury, you will end up with a sensitization so that’s where the we’ve spoken about that before. It’s where in other podcasts where the nervous system will also become a little bit more sensitive to feeling the pain of the earth. Now there’s multiple changes that happens and that can lead to this. When this happens, we take an approach where the active recovery as is of such, even more so than just an acute injury to really limit the triggering or that to limit that pain trigger. Because if we keep that pain trigger going, and we keep picking that scab, we we keep that sensitization active and that’s that’s the first thing we want to do with chronic low back injuries we want to desensitize.

Ben James 10:35

Yeah, so again, we’ve we’ve really got to be careful with picking the right exercises to be able to start to retrain that nervous system to to kind of regulate that pain dampen down that, that pain and that sensitization. And so are we saying there for even some of the exercises that we would say are safe, neutral spine, if they’re causing discomfort should they be avoided? Or should we work into it a little bit? If we know they’re a safe exercise?

Jacob Steyn 11:07

They should they think? Yeah, they should definitely be avoided? Of course, surely, we don’t That was the question you started with, in the very beginning, when and that’s a very good point. I mean, we want to avoid anything that’s gonna cause pain, especially when we have a sensitization going.

Ben James 11:26

Yes, and it might, but it might be that that exercise is not painful for maybe three or four repetitions. And that’s where the other element is, you know, maybe the the intensity of the exercises that you do have also got to be regulated. It’s not just about one exercise or another being an aggravator. For one of a better term. It’s also about the intensity so you might do an exercise that is advised that is safe. That for four reps is okay. But once you start to get to five or six repetitions, it starts to get a bit uncomfortable. Well work within that. That pain tolerance. But certainly if it’s causing discomfort immediately, then for now that exercise is the wrong one, at least at this point.

Jacob Steyn 12:07

Yes. And,

Ben James 12:09

Again, these exercises often have progressions. So we start at the baseline of these exercises and try and progress through so that they become more and more difficult or more and more progressive and challenging. But again, we start at a baseline at a simple level and then work up. But again, if it’s causing that pain and discomfort, then for the time being, it’s the wrong exercise for you.

Jacob Steyn 12:36

Yeah, and similarly, with walking, a lot of patients, I would advise to go for a walk three times a day. Sometimes they will go for a long walk, and they’ll be like, yeah, you know, I can walk until 2025 minutes and it starts getting painful. Well, that’s your tolerance, that’s your tissue tolerance, or maybe the sensitization tolerance that you have at that at that moment. So Keep it below that 2025 minutes, keep it on 15 minutes. And as it gets better, you’ll be able to increase that time that you actually walk.

Ben James 13:09

Yeah, and again, you know, as with any any exercises, walking isn’t just a simple case of, of walking as you may be doing it because naturally when we’re in pain, we often become intelligent. So we may bend forward bend to the side. So if we’re in those unhealthy positions, then that that walking may be uncomfortable anyway. So it’s important to be intentional with how you’re walking. But absolutely, like you say, if you’re doing it in the right way with the with good posture, and after eight minutes, it’s uncomfortable, then eight minutes is your limit. But maybe try and do that three times a day, and then gradually increase as always. So when we when we’re talking about an active recovery, Jacob basically what we’re saying is we’re not necessarily talking about exercises that people may get confused when we’re talking about active bass recovery is held The movement learning to brace learns to those things every day that are going to be beneficial in keeping that spine, spine in neutral. And then progressing through that, that core and joints as we’ve talked before, but not overtly exercising, that’s clearly not the aim.

Jacob Steyn 14:18

Exactly. And I think that you can be, you can much better be on the cautious side, not rushing that recovery plan. And so when either someone’s guiding you through this or you’re following our program, you will know when you’re supposed to go to the next step. And I think that’s something that’s very important, you know, there’s, there’s much, it’s much more to your advantage to take your time. Let the cut recovery, you know, especially if you’re someone who’s working at the same time as wanting your back to get better, allow it to desensitize and then gradually work with your pain tolerance and slowly build up the exercise and the stability.

Ben James 15:03

Yeah, absolutely. Absolutely. So when we’re looking at the best recovery plan, what does that best recovery plan look like. And clearly, that’s going to be slightly different for different people in terms of the, the exercises that you may be asked to do or that you should do. But in terms of a bit of a process, just to break it down. And I guess, again, splitting that down with acute and chronic to some degree.

Jacob Steyn 15:32

I think for both chronic and acute in a nutshell, as a summary, we would say and we want to include, we want to include the rest, enough rest, especially for the injured body part, and what do we mean by rest. So, if I’m sitting for example, I’m having more pressure going through my low back then when I would be standing and if I’m lying down, especially on my tummy And I don’t feel any discomfort in my low back, I most likely have the mic the least pressure through my my desk or an injured back. So that would be your best wrist for the tissue or relaxation exercise.

Ben James 16:15

And I think that’s the key point, isn’t it rest for the tissue, not necessarily rest as in I’m just going to lie on the sofa all day or the or my couch, whatever you call it all are in bed all day. It’s rest for the tissue specific.

Jacob Steyn 16:28

Yeah, yes, yes, absolutely. I mean, if you’re very busy working 6060 plus hours a week then I think we would have to most likely consider you actually taking some rest as well. From what you’re doing, otherwise, your body’s not gonna support you in that healing process.

Ben James 16:46

Yes, because there’s there’s there’s the get enough sleep and nutrition and other things that go alongside us. So if you if you give those tissues arrest by bracing and good hygiene, great, but if you’re still working together Keep it as a week and certainly doing some manual work then. Yeah, we’ve we’ve got to factor that in. Sure.

Jacob Steyn 17:05

Exactly. The body has a tolerance and we have to respect that.

Ben James 17:09

Absolutely. Okay, so rest.

Jacob Steyn 17:12

Next point would be hydration. Okay, a lot, a lot of people are actually dehydrated. And quite often that comes from not drinking enough water. Having four small cups of coffee a day is definitely not going to give you enough fluid. And I think when we get into the specifics of swelling and tissue healing inflammation, then we realize how important it is for the cells doing the job, the recovery work to have a good function at the capillary level between the cells, and that process has a lot to do with being hydrated and also with the fact that you’re a healthy individual And not experiencing any low grade inflammation. That’s another topic of course.

Ben James 18:04

Yeah, absolutely. Yeah, hydration is I mean, that would be another interesting study how much what is the average amount that people are drinking on a daily basis water we’re talking about here because like you say, it’s just so easy for people to become distracted and and not drink that water or they drink the coffee for a pick me up. So it’s, it’s definitely got to be a consideration for overall health for everybody in general, has as has your nutritional needs. And that’s another key point. Right?

Jacob Steyn 18:34

Exactly. That’s the next point is to, to have that sort of reference to know that you’re getting all the nutrients into your body that you’re going to need for that recovery. And I think not only having the nutrients for the recovery, but also limiting the things that’s going to cause a sort of have a sort of inflammatory process or effect in your body. And, you know, we can talk about Eric hedonic said and all sorts of negative effects of eating too many omega six and on saturated fats, things that will stand in a way of the inflammation or inflammatory process doing its job properly.

Ben James 19:15

Yeah, and I think that’s a great point because we often think of inflammation as a bad thing. But actually, it’s there naturally, yes, it causes pain that’s to, to make our bodies aware of a problem. But inflammation is there to help promote the tissue healing. And so nutrition and what we eat is going to contribute to the healthy, physiologic physiology and within that inflammation, so if we’re eating the right things to support the body, then the body’s going to respond much more effectively, much more efficiently and it’s going to help with the tissue tissue repairs and nutrition is, is a big, big subject that that again, is, is underestimated, particularly when you’re looking at so Tonight low back pain because for the majority of people, and and for a fair reason that there’s not that link, because we’re just not taught or educated to make that consideration.

Jacob Steyn 20:12

But, exactly.

Ben James 20:14

And then obviously the the last point correc movement and the right amount.

Jacob Steyn 20:19

Yes, exactly correct movement on the right and the right amount. And we just we just covered that, I think.

Ben James 20:26

Yeah, absolutely. Absolutely. And so, why should we not rush into it? And this is probably more for the, for the athletes that are more inclined to say, right, I’m, I’m active, I’m healthy. I’ve got this problem. I’m just gonna work through it. I’m just gonna go for it.

Jacob Steyn 20:40

I think the biggest reason why we don’t want to do something like that, if you realize that you have a serious injury is the the sensitization we just talked about. It’s the injury becoming chronic, and then having the potential to become more sensitive in the nerves. And so the actual injury changing to a neuropathic problem.

Ben James 21:04

Yeah, so what we’re saying there is you’re, you’re taking active recovery great, but actually what you’re doing is maybe a either doing the wrong exercises, choosing the wrong exercises or doing doing too much of them, or probably even worse, you’re doing your normal exercise or maybe a normal training, which is going to be potentially far more demanding. But if you’re continuing aggravating those tissues, so inflammation is there to help recovery, but you’re continually aggravating the tissue. So that inflammatory response continues. And then gradually, like you say, that leads to this sensitization and this neuropathic pain potentially, that is then going to be more difficult to remove because then some of the healthy exercises that instigated at the beginning at the right level at the right time, would have been beneficial may also be causing some aggravation and discomfort, and that’s where we’ve got to start to wind down that pain and dampen down that pain. So rushing into it is great. It’s in the in the sense of motivation and determination to to take an active approach, but potentially very risky.

Jacob Steyn 22:12

Yeah. Yeah. I think that’s the first point and the second one I think that a lot of people overlook because it’s quite often underneath the surface and that is the complexity of the injury increases to not only being or not only the injury or injured tissue but also surrounding tissues or surrounding muscles cramping up and becoming a real a real problem. So now you don’t only have a for example, a shoulder capsule irritation, but you’ve got all the rotator cuff muscles and maybe the you know, your traps cramping up and now you’ve got radiating pain going down your arm and, you know, a similar thing can happen in the low back of course.

Ben James 23:00

Yeah, so now we’re not, we’re not just talking about potentially aggravating the tissue already damaged, we’re now starting to aggravate and cause a problem in other tissues and then, like you say, becomes far more complex and far more difficult to manage, and then work our way out of which is a really, I think, important point for those people that are naturally inclined to just work through the pain.

Jacob Steyn 23:24

Yeah, and I think the the key there is to recognize the faulty movement and realize that okay, or ask yourself, Is there a way how I can go in on this injury and actually fix the movement, fix the stability, get the joint centration working from my shoulder again, in this example. And so you you avoided becoming more complex and you can get back to functioning in a normal way?

Ben James 23:50

Yeah. And again, that’s back to the education and understanding what those right things should be, as opposed to just thinking well, I go to the gym or I’ll just I’ll just do shoulder press and work through the pain that that’s, that’s not going to be beneficial. So it’s important to, to get the right insight and input in terms of what what those exercises should be, which is where hopefully, we’re, we’re helping and contributing. So the consequences of that neuropathic pain, we know in terms of that central nervous system changes. So the first step in that sense is that desensitization, as we’ve, as we’ve discussed, the first step to these guys, and again, that’s back to the right things. The right, intensity.

Jacob Steyn 24:34

Exactly, exactly. I think that’s the big emphasis for today is understanding the intensity understanding what you have to do, especially in the beginning to avoid that sensitization.

Ben James 24:45

Yes, and and and understanding the clear distinction between an active recovery versus exercise being your active recovery. That’s an important point. So what are the most common mistakes for you Jacob that you see? We do discuss a lot here. But some of the common mistakes, obviously people rushing into it, people make it or getting it wrong in terms of exercise been an active based approach. That’s not what we’re saying we’re saying an act based approach is going to be a safe approach. What are some of the other things that that, that you’ll see?

Jacob Steyn 25:21

I think probably the most common thing is ignoring the pain triggers. Yes, you know, and I think you’ll agree, people, and quite often it’s, it’s the right way to go, you know, you have a small you feel something and you carry on and the body picks picks up where it left off, and you recover from that. As soon as it it’s sticking its neck out a little bit too much. Maybe you should, you should consider backing off a bit.

Ben James 25:46

Yeah. And I think some of it’s about as well, your awareness of those triggers, because sometimes we’re not, we’re not focusing on them are we where we’re kind of a lot of times you people would say, I just don’t really know when it comes. I don’t really know anything. experience of pain is just there or it’s not. Actually if you really focus in on it, then those pain triggers may become more clear, which is why, you know, doing a pain diary. Yes, making a pain diary is not not necessarily a bad thing.

Jacob Steyn 26:13

I think that’s it. It’s, it’s where you put your focus. And I think, quite often we’re so busy every day with the things that we feel is important, of course, work, for example, and that we don’t actually focus on those pain triggers. And we, we ignore them. We suppress them, but the moment we start paying attention to them will realize, okay, oh, well, you know, every time I stand up, I feel at my back, for example.

Ben James 26:38

Yeah. And I think that’s a great conclusion. conclusive point is that even a word on that point is pay attention and be aware of the pain triggers, because if you don’t, then ultimately, those pain triggers are going to make you aware by just becoming more problematic and our pains gonna get worse, so that maybe you have a good consideration. For people so we’re saying ignoring the pain triggers, like we’ve said not giving the body the resources to recover so doing the wrong things and and too little rest for irritated tissues. And again, what we’re saying there is too little rest because we’re we’re constantly aggravating those tissues. Yeah, the the poor movement or not enough good movement and then building up too fast as well. Trying to progress too quickly is that you’ve got to be patient. You’ve got to be patient. Yeah. And what also, what about the kind of farmer cultural side? I know, we just kind of said, jumping straight into the end sets. What’s the risk level? The non steroidal anti inflammatories, other medications as well?

Jacob Steyn 27:43

Yeah, that’s a good question. I think we quite often go too quickly for the N Zed or the ibuprofen. You know, just because we think that first of all, a lot of people think that inflammation is not our friend. I think our way of swelling Traditionally, especially a few years ago, we were told, you know, you’ve got swelling, you got to get that swelling down. But like we just mentioned, if your body has the resources, you’re hydrated, you have a relatively good stability factor going on throughout the body, then your body should be able to take care of itself. And if it does, without the end sets, you’ll in most cases actually get a better recovery. You know, the physiological process quite often. And that’s been shown in some studies as well. Also with whiplash is that you you have a better tissue repair, if you don’t have the interference of the inflammation blocking medication.

Ben James 28:43

Yeah, and again, the big danger there is that the inserts or the medications, take take the edge off the pain, great. Now I can just go and continue doing what I was doing before and the problem there is that it’s aggravating that tissue and then it’s allowing it to become more sensitized and that that issue that we’ve talked about before Comes a problem without even necessarily realizing it as much because you’re taking the edge off the pain with the pain medication. So we’re not saying never use them. We’re not saying that they, they are always bad, but the reality is our, our body is incredible at healing itself and with the right nutrition with the right movement with the right active approach, support that inflammatory response. Don’t try and take it away and mask the problem.

Jacob Steyn 29:28

Yes, and I just want to add something there. like myself, I’ve had numerous rugby injuries, you know, and then you have a fair bit of swelling and you can’t turn your head, stiff neck or you know, maybe I rolled an ankle. But I know and I knew back then that if I just stick to it, and I go through sometimes a little bit of a wall actually excruciating pain for a couple of hours, and I start moving again and I get going within a couple of days. Quite often that injury would have recovered at 90%. Yes, you know, a knife. So I’ve had myself very good experiences with where I specifically chose not to use ends it.

Ben James 30:13

Yeah. And it’s interesting you mentioned about the sprained ankle, because a lot of the advice often is, is to put pressure on it and start to move. But what you’re not going to do naturally, and quite obviously, or more, obviously, I would say, for a lot of people is invert that ankle or turn it in, and therefore stretch those tissues, that that wouldn’t make sense to most people. But walking with it in neutral and putting some pressure on it probably makes most sense. So you’re, you’re active recovery, but you’re not stressing those tissues. And it’s applying that same logic to the back. But it’s just sometimes a little bit more complex, because it’s not so obvious where the problem is, and therefore which movements you should avoid. So I think that’s a really interesting example that you that you talk about there in terms of response to inflammation and not taking medications. But that active approach is beneficial. And it kind of explains in details and clarifies a little bit what we’re talking about with the low back. And I guess any any final point stretching we know is a big one, we often see people want to stretch joints and muscles and things that that feels comfortable. But really, we want to avoid that.

Jacob Steyn 31:26

Exactly. So that comes back to our very, the very beginning of our discussion where we mentioned, you know, usually we want to go for an isolating effect with our exercises. So we don’t want to mobilize we don’t want to stretch, you know, quite often, I use the example with my patients, I will say, well, so we have a very badly injured knee, are we going to stretch the knee and like No, of course, we’re not going to stretch the knee. And similarly, we don’t want to stretch any disk tissue or any, you know, irritated tissue. In the low back, but I think the the problem there is, is often that we have tightened up low back muscles. So we get this perception that we have to stretch the low back muscles, we have to hang forward or I have to rotate my shoulders on my hips and because it makes me feel better, but in reality, that stiffness is only a reaction to the actual injury, and the brain is initiating that stiffness. And we should allow that allow the stiffness. I mean, I’m not saying you should be still going for a walk would might loosen it up, you know, maybe lying on your tummy will loosen that up, but don’t go and stretch through the low back.

Ben James 32:37

No. And I think it’s interesting, again, that you mentioned about the knee. Often these things seem more obvious with some of the extremities like the ankle, we mentioned in the knee that you mentioned just then the low back where we don’t seem to be applying the same logic sometimes. So I think that’s a great, a great point. And again, stretching that back is doing all those things that we’ve talked about the, the ignoring the pain triggers, because you’re going to be stretching through. So it might feel a bit of a pain relief initially. But actually, the problem afterwards is going to potentially be worse. And it’s not giving those tissues enough rest, because we’re aggravating them by doing the stretching. So again, as always avoid those stretches. So Jacob, anything more you want to add there before we we draw this episode to a close?

Jacob Steyn 33:24

The only thing I want to add and what I want to say maybe, as part of the take home message, Ben, is that we should not rush it. There’s no need to rush it.

Ben James 33:33

Great point. Yeah, I think a great point to end guys that, look, active recovery is the best approach. But that’s not to be confused with exercise, specifically, and avoid those triggers. Give those tissues time to rest. But like Jacob says, You’ve got to be patient, these things take time. And if we want to get it right, we’ve got to be prepared to put that time in and allow and support those tissues to heal approach. Really. So as always, Jacob Thank you. And guys, thanks for listening. As always, please take the time to go over to iTunes give us a rating. We’re getting a few ratings on there now which is great to see it helps to spread the message, spread the word, and some support more sufferers of back pain. And we’ll continue get over to the website. Take advantage of the resources there. And we’ll catch you again soon on the next episode.

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