How to Cure Back Pain – Building Movement Resilience

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Welcome to the Back Pain Solutions Podcast – How to Cure Back Pain – Building Movement Resilience

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Introducing How to Cure Back Pain – Building Movement Resilience

Building resilience, building core strength, and developing a healthy spine takes effort. For some people, getting out of pain, establishing the required movement patterns, and understanding how they remain pain free, is the key goal. But like with other pursuits, some people will be focussed on mastery, and continuing the journey to advanced movement resilience. Advanced resilience is not required to prevent back pain, and build a healthy spine, but for those that want to progress, what are the key things that need to be considered? This is the question we answer in todays episode of the Back Pain Solutions podcast.

In this episode we firstly discuss the time it takes to build the required foundations to be in a position to move forward. In some cases there will be movement patterns that have been conditioned over many years, incorrectly, which take time to restore. Similarly, there will be people that have never undertaken a consistent programme of exercise and who must be patient before they can consider progression. We also discuss some of the equipment considerations that are required to continue to progress towards advanced resilience, and movement mastery.

Show Highlights for How to Cure Back Pain – Building Movement Resilience

You don’t need a gym membership or lots of equipment to build movement resilience. All you need is the right advice and the commitment to doing the exercises required to improve your movement and build your core strength.

Interview Transcription for How to Cure Back Pain – Building Movement Resilience

Ben James 0:00

When we’re young, we move with freedom and confidence with a great resilience to injury. Somewhere along the line, we’ve developed poor habits and become more vulnerable to back pain, smart, strong 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 health. So join us as we demystify some of the commonly held beliefs about back pain. build your confidence. We’re stronger back the smart Hello, good morning and welcome back to the smart strong podcast with me Ben James and my good friend and co host Jacob stain. Today we’re talking further about movement resilient. What exactly is movement resilience? How do we start with movement resilience and how do we make strides towards better movement overall? So Jacob, what are the foundational components to consider when we’re looking at movement resilience? What should people be thinking about?

Jacob Steyn 0:56

I think the foundation and in other words, The first things we have to think about us removing pain triggers. Yeah, we need to we need to think about not jumping straight into a training program, but first fixing that daily routine. So I think an awareness of what is causing the pain, what is making it worse, what’s standing in the way of beginning better. So looking at that daily routine, from the morning to evening, I think that would be the foundation instead of first.

Ben James 1:34

Yeah. And I think it’s interesting that you that you say that because this is something that I would discuss with patients, friends, family in terms of those, the kind of daily routine How many people do you think honestly, get advice from therapists about the daily things they’re doing and the habits throughout the day? And how many people are actually tapped into what they do outside of the doctor’s office, shall we say? You know what I mean? Because the patient know that going in seeing somebody getting a getting a passive treatment, whether that be massage, whether that be adjustments, or medication or pain medication, and then they leave that office, and they go back to doing what they normally do, which are likely the things that are causing the problem in the first place.

Jacob Steyn 2:21

Yeah, and basically hoping for the best. Yeah, I think not many people are actually getting any advice for, for what they’re going to do at home, and, you know, with their daily routine or even being asked about what they’re doing at home. Now, I think that I think that’s a big missing link.

Ben James 2:41

And so what are some of these things that people could be considering? straightaway? So they’ve listening in, they’ve got back pain. What are some of the key things that they could be doing in terms of this? I guess, baseline, this is our starting point. Are we saying right, let’s let’s reflect on the things you do. Engage And that includes exercise at the gym. You know, for it for a time, are we saying stop doing your exercise. And these are the five or six things that you need to consider all day every day.

Jacob Steyn 3:14

So I think starting off with looking at the morning, it’s all about what you do in the first 3045 minutes. So instead of getting up and triggering that back pain, you want to try and stay upright, as we’ve mentioned before, stay upright until the discs are a little bit less under pressure. So it enables you to to move more through the spine so you increase the mobility through the spine. And that’s going to make it easier after the initial 45 minutes to for example, tie your shoelaces or you know picking up your your your your suitcase from the ground or taking a seat you know going closer to the ground. That’s an important thing. You wanted five things many?

Ben James 4:07

Well, not necessarily five, but I guess the, the, you know, are there a set few things or key things people should be doing because we’ve talked a lot about bracing. And we’ve talked a lot about hip hinge throughout the series of podcasts so far. So we know that we want to avoid sitting, or going to get jumping in the car within the first half an hour. And then, you know, we’ve talked about how walking is beneficial, and helps keep us up, right, but also, you know, if we’re, if we’re doing it properly and will be focused, it helps us to activate those glutes, for example, and really kind of start to try and extend the hip and try and engage that hip and use that large joint we’ve discussed previously to start powering some movement rather than twisting a move in through the back.

Jacob Steyn 4:52

So that’s that would be the second thing, actually going for a walk and if you have to get up earlier in the morning, then that’s what you gotta do. Go for a 15 minute walk. Lucky you’ve mentioned a few things that walking benefits. But also a main thing that it does is it actually pumps away the swelling in the low back is any residual swelling when you wake up, then walking will pump that away and it also turn on the small muscles along the spine will actually give you more stability.

Ben James 5:22

Yes, and we’re saying walking is healthy, it’s beneficial. If you if you’re in serious pain at the moment and you start to walk and you get discomfort, then people should stop. It’s all about small progressions to build a build on that and yours.

Jacob Steyn 5:39

Exactly. And if you’re if you’ve really got a lot of pain then we mentioned relaxation techniques. You can also do that even before you go to work in the morning, ideally at something you do throughout the day. But for example lying flat on the tummy on the floor. We mentioned This in the previous podcast actually trying to find that the neutral in the low back, you might have to use a towel folded up underneath the belly. But then taking the pressure off the spine. That’s another very good way of relieving that that continuous chronic pain.

Ben James 6:14

So people could do that as a kind of daily exercise, they’ve got up, they stood up, got out of bed safely. And they could be incorporating that that relaxation exercise first thing in the morning, whether they’re in pain or whether they’re not, this wouldn’t be a bad habit to get into in order to take away some of that pressure in the low back.

Jacob Steyn 6:36

Absolutely. It’s a great habit. And people do it all over the world, especially in third world countries where in the afternoon after lunch, they’d be lying on the grass for an hour sleeping and get up after that continue working or doing whatever they do. But that’s actually a moment of recovery, healing the discs drawing up fluid All the muscles relaxing. So it’s a great technique.

Ben James 7:05

Yeah. And so people are maybe doing the relaxation exercise definitely taken a walk within within their own individual tolerances at that specific moment in time. And then is there anything let’s say before we go to work meant you know, maybe some people will walk into work and that’s where they get in there. And then walking exercise, shall we say, for for their back health? Let’s say before we’ve left for work, can we be doing anything else? We’ve talked about the hip hinge, would it be a good time in the morning to be practicing that exercise Do you think or is it very much dependent on the individual and their pressures as well? You know, we don’t necessarily have to follow a set order for for certain exercises and routines.

Jacob Steyn 7:50

I think for most people, using the hip hinge, you know, doing a doing a box squat, for example, or the shortstop squat you know, halfway squatting to the floor. While bracing while gripping the legs and letting hand slide to the knee, these are great techniques to get the body to loosen up and to get the brain to communicate to the right muscles just to initiate that stability we need throughout the day in the core. So, you know using this for example, if you want to do a box squat, you know 10 times off a chair or a bench and the the other the other place where you can incorporate this as actually when you brush your teeth Of course, yes, making sure that you take the load off the spine and give it to the glutes and the hamstrings so you incorporate that hip hinge we talked about the great great ways to try and stay away from the from the pain triggers in the morning is where the most vulnerable in the morning because of the increased pressure disk pressure in the spine

Ben James 8:57

Yeah. And I mean, one thing I would say is, you know, you mentioned about getting up earlier and I found that and this is with with regards to anything really in life, anything we want to try and achieve or you know, try and take action on setting a little bit more time in the morning, getting up maybe half an hour earlier is really quite a beneficial way of approaching you know, your back health particularly if you’ve got an issue, you know, taking that time to focus on those movements focus on that relaxation, time, have a little bit of time to take a walk. And, you know, start your day and start your you can back routine for the day in a in a healthy way. If you do if you can develop that habit, then it’s much more likely to become something subconsciously that you just do every day. Whereas if you leave it often work in life takes over and then you get home and you’re home later than you expect. And then all of a sudden, you know, you’re you’re, you’re not doing these exercises, and you’re not doing what you need to do to help your own back because there is absolutely a requirement from the individual, you know, to take ownership. So I think everybody listening, trying for the next week, couple of weeks, set your arm half an hour earlier and just take that time to do some of these things, focus on some of these things, and develop those habits because it will absolutely have an impact in the long term. No doubt.

Jacob Steyn 10:33

Absolutely. It’s all about preparation, isn’t it?

Ben James 10:35

Yeah. Yeah. And during the day, we’ve, we’ve talked about relaxation exercise, if someone’s working at home, it’s very easy to lie in their, their tummy and get that relaxation exercise. You know, going out for a brief walk, you know, when someone’s at work in an office is the advice to say, Well, look, you know, you got to speak to maybe HR occupational health depending on the size of the company and say, well, you need to find somewhere where you can do this You know, at least in the short term, when you’re really experiencing an acute back pain, you know, we’ve got to do what we’ve got to do to try and give ourselves the best opportunity to recover, I guess.

Jacob Steyn 11:12

Yeah, absolutely. Absolutely. That’s what I also advise my patients is even before you’re at the stage that is that bad, that you can’t do anything more, is have a discussion with the law with this the superior around or, like you say, maybe to HR, if it’s both you have to go and free up the space to either do your tummy line throughout the day at work multiple times, and maybe do a couple of bird dogs or exercises that helps that that’s the ability factor. But it’s really needed if you want to not get to the point where it’s too late, and then you’re home for a few weeks. And that’s what you’re trying to avoid.

Ben James 11:54

So Exactly. And there’s an argument to say, Well, look, you know, you have that conversation with work. Because ultimately, if they’re not supporting you, before you’ve got a problem, then there’s, there’s a chance that you might certainly if you’re doing manual work, and, and you rely on, you know, physically moving and physical exertion during the day, then you could be off work and that’s going to cost them money. So there’s always, it’s always trying to position it and, and sell it, I suppose into the company, but it is something that that that should be considered because actually, you know, you’re, you’re proactively trying to prevent your need to have time off work. So you would hope that in 2019, a lot of companies would support, you know, what support what you need to do. Yes, yeah. And there’s another technique that for office workers, I’m sure we’ve discussed previously, but it’s a good opportunity to talk again, is the kind of burger relief position, you know, from particularly if you’re sitting in a chair, you know, that’s something that will, will share in the show notes because it’s a very simple relaxation, movement exercise that you can be doing, particularly for your office based. And if you can get that into your daily habit every 30 minutes an hour again, form those daily habits form those patterns, then that as well will just help you to rethink, reset that posture, give you back a break. And then you can go again and continue working and it takes you know, 30 seconds maximum really shouldn’t be a problem with everyone doing doing that exercise. So make sure you look in the show notes and we’ll have we’ll have a link to that for you to follow. So, let’s say Jacob, we’re moving at a pain, we’re developing these habits and these habits are things that we want people to develop for the long term. You know, we’re not just talking. Do it while you’re in back pain, do it for a short period of time trying to get into the process of doing this, you know, forevermore. And but then, where do we start in terms of progression and starting to develop some muscular endurance in the core muscles that were Introduced before the chest, the lats, the abdominal anterior abdominal wall, the posterior group of muscles. Where do we start? Where do we need to people need equipment? Do they need a gym? What can they be?

Jacob Steyn 14:13

No, absolutely not need a gym, they need a floormat. When you advanced a little bit, maybe you need a jumble. And I would say you know, the key areas we want to focus on is mainly the core. So between the shoulder blades and hips, and we definitely want to do some glute and hamstrings exercises and some level of shoulder girdle. In other words, where the shoulders are working in combination with the core exercises, because if we can cover those basis we can we can not only we don’t only develop strength around you know the low back, but we also developing strength from the shoulder, all the way to the glutes. And that’s what we need. We want those three areas if we can separate them to work together, when we are picking stuff up or when we aren’t getting into a car or when we’re making unpredicted movements or movements where we’re out of alignment.

Ben James 15:23

And is there, are there any key exercises that you always start with? You always start with your 123 exercises? Or is it very much dependent on the individual to find?

Jacob Steyn 15:38

Well, yeah, there are definitely some exercises you always almost always start with, depending on whether the person’s able to do them. If they have a knee injury, they’re going to struggle to go on to their hands and knees for example, if they have for some reason, there’s a difficulty laying on their back and doing the glute bridge. So thrusting the hips up, which is unlikely, but maybe there’s something up with the upper back, then they might be able to do it or, you know, if, if they have excruciating radiation from the low back down the leg, then doing a glute clam trying to work on the on the buttock muscles on the side, then maybe that might irritate the nerve radiating down the leg, so then, you know, you’ll ease off and you won’t start with those straightaway. Generally, within a few weeks, then you can go to to do all these exercises. But I think the main ones would be bird dog. So on the hands and knees. Yeah. You know, which is a very gentle low back, core anti rotation, exercise. Of course, you can make it very difficult but we start with it. Pretty, pretty easy. And I think the second one that’s very good as the glute bridge So lying on the back and pulling the feet up and thrusting the hips up, I have to have to say that it’s not as simple as that these exercises have small little pointers where you have to make sure that you’re doing it correct. And you can’t just you can’t just push the hips up. And generally what happens is pulling the low back hollow, so you’re not actually doing anything with the glutes, but you’re doing everything with the low back muscles. That’s not what we want.

Ben James 17:27

Now, I was going to say that the focus is very much on, you know, not kind of powering through exercises and saying these are Yeah, I’ve done my exercises and very much about form, slow, steady, and very much thought through movements, which you know, you need, you need a bit of advice on in terms of how you’re performing those exercises correctly, because a lot of this is about glute activation, getting those big muscles in the buttock fire and again because they’re so supportive For the low back, and so, you know, it’s all about quality rather than quantity of movement.

Jacob Steyn 18:07

Yeah, and, you know, something I have to mention is that usually with the, with with my patients this, you give them exercises and almost always at the second appointment after giving you that giving them those exercises, you have to correct the exercises This generally people have their own ideal, they, you know, they change it a little bit and so you just have to lay the emphasis back on Okay, now we need to we need to focus on changing the movement a little bit over here and you got up a little bit more pressure through the thumb pushing onto the ground so we can actually let you know whatever it is. I think you need to make sure you’re doing it correctly.

Ben James 18:48

Yeah, and I suppose With that in mind, you know, we’ve got a lot of videos, obviously the program online. What are some things that people can do themselves? To be, I guess, trying to be conscious of that movement. If they’re not in the position necessarily to get that one to one advice, or they’re not confident in the person, we’ve discussed this before, they’re not confident enough in the therapist, that they’re going to direct them. Because I think this is one of the big challenges. You know, when we talk about a movement based approach to to rehabilitation, there are very few people out there that given the level of advice that we would want to see, and to ensure that people are doing doing things properly. So is there anything that you can advise for the individual, obviously, you know, referring to the videos and things but in terms of their own self reflection and evaluation, I guess, or is that something that is just difficult, and it’s something that is just going to require practice over time?

Jacob Steyn 19:51

Well, it’s always good to as a first step, have someone showing you whether you know, yeah, online guidance, like what we’re what we’re offering. Or if you have a one on one session with somebody, the best, the best starting point is to have somebody to tell you you’re doing it correctly, you know, because they’re seeing from a distance, what you’re doing. The second thing you have to try and do is to make sure you focus on those key points of the movement. You know, you have to you have to try and maybe sometimes you need to use a mirror, see what you’re actually doing. That’s a very good thing to do. And then you got it. You know, some people are a little bit more switched on when it comes to this fact. You got to try and feel the movement. You know, if, if we’re training and isolated glute exercise, then you’ve got to walk at least feel the glutes. In some cases, you won’t feel it in the beginning because you might be compensating, trying to use a different muscle if you haven’t been using the glutes for a while. But you gotta eventually, quite quickly feel the muscle that you’re training or you gotta, if it’s a complex movement standing on the feet, doing your hip inch, you gotta feel the things that are being mentioned. And you’re being told to do you got to feel that in your body and that’s at least the goal.

Ben James 21:16

Yes, yeah, it is. Again, it’s back to that kind of education, awareness. Once you start to feel some of the movement and and some of these muscles in action, then you develop those patterns in your develop that that knowledge and understanding to be able to be far more focused and efficient, I guess. And another thing I know you mentioned the mirror, you know, we live in a world of smartphones now. You know, it. If you are following some of the videos that we have online, maybe one of the programs ultimately, then, you know, when you perform in one of these key exercises, have somebody just take a quick video with your smartphone for exam. So you can just compare to some of the guidance that we have out there because again, that’s just about self reflection and, and putting in the work required to perform the exercises correctly, which ultimately, undoubtedly, will help your core and help help you rehabilitation.

Jacob Steyn 22:19

Yeah, and I want to add to that, and I want to say that these the exercises we do, you have to see it as layers. You know, we always start with the base, we want to get certain muscles activated, we want the brain to communicate to these muscles. And then when we start building strengthen, and then the exercise gets more complex. And eventually, if you would, for example, look at a high level athlete. The movement that they perform, something that’s developed over time, maybe they developed the movement as a as a child, you know, from very early stages, but because they did, you’d have a layer of development on top of another layer on top of another layer and so eventually you get this incredibly high quality movement, very protective of joints and you know on their case baby serving their goal but it’s something you have to keep in mind so if you if you want to get to walking properly again you know you want for example to fix the core and and and thrust through the glutes and and feel strong and understand that you have a good walking technique and it’s going to require those very basic exercises we start with when we activate the glutes for example.

Ben James 23:39

Yeah, and I think you know, there’s a lot of you know, people think I fleets and layers and but you know that it’s all about progression, and there’s absolutely the opportunity to really develop that, that muscle control that muscle endurance ultimate, ultimately that you know that muscle strength and and the capability To be able to do so much more. So it’s it’s a journey, it’s not a quick fix. This isn’t a, you know, kind of a, again out of pain quick system, shall we say it does take time it takes effort, but it absolutely works but it’s about forming those habits and those baselines first and then and then like you say layering up and progressing from there. And I suppose With that in mind, you know, someone right in the beginning, that is starting to do some of these exercises that we recommend, you know, how often are we saying that people should be doing exercises and, and, and performing these kind of exercise routines?

Jacob Steyn 24:45

Yeah, so it just depends on where you are in your rehabilitation program. But if you if you start out and you have a fair bit of pain and you’re very limited in the intensity of your exercises, so we we started with very low level intensity exercises, then the idea is to do them every day. Yeah, and we want to want to do a fair amount of repetitions. So, you know, for example, the glute bridge, maybe you do five second holds, and you do four sets of five every day. So it’s a very low level intensity exercise. You know, eventually, when you progress in the rehab, the rehabilitation of your injury and the pain gets less you can do more than we want to progress to higher intensity, not very high, but we want to take gradual steps. And then we make the exercise a little bit more difficult. And we decrease the repetitions or we go to doing it every second day. So we have a resting day.

Ben James 25:51

Yeah. Makes a lot of sense. Excellent. And I guess, if people are a lot of these exercises that they’re very much about Keeping that back in neutral, and very, shall we say spine saving for want of a better term? What if these movements or any of these exercises are causing pain? Are we saying stop them? Or are we saying you’re probably doing something wrong? What do you think is the most common thing that you find?

Jacob Steyn 26:20

Yeah, so we have to distinguish between pain, real pain and a little bit of little bit of discomfort,

Ben James 26:28

As in kind of muscular ache,

Jacob Steyn 26:31

Muscular ache, or if it’s been very stiff and people locked up for a while, you know, getting movement through that joint again, maybe there’s some swelling we have to be very clear on this because we do not want to push through pain but we want we have to understand that sometimes you have to know maybe you know if it’s been there for a little while it’s been chronic then you have to you have to get you have to take small steps to get through the discomfort.

Ben James 26:58

Yeah, but it kind of build it That, that tolerance without like you say, pushing through pain.

Jacob Steyn 27:05

Exactly. So and if, let’s say it’s really painful, you’re experiencing some real discomfort, then the exercises most likely not. right for you at that point, then you have to, you have to divert to something else and, you know, work around the painful movement and eventually we get back to that.

Ben James 27:27

Yes. Yeah. And I suppose the next natural question, there is, you know, what are some of the common mistakes that you see, you know, I think, you know, from my point of view, it’s often people it, it’s, it’s that kind of motivation that people just want to push through and kind of convince themselves I’ve done exercises rather than focusing on the, the quality and the importance of them. Do you find the same thing in terms of some of the common mistakes that that you see?

Jacob Steyn 27:59

Yes, I think it usually takes people a little while before they really get into it. And, you know, I usually check we check the exercises over and over and over and I lay the emphasis on, look, you know, take your time, feel what you’re doing. There’s, you know, there’s no need to rush. If you don’t have a lot of time, then just do less. But make sure the quality is really good. Because if you do the bird dog, for example, and you just taking your leg out back and your hips are swinging to the side, then we’re not actually we’re not training the brain here. We’re not building that first layer. So then, you know, I’ll get them back to Okay, let’s focus, let’s set the posture, really lock up the the core and now just focus on isolating that movement through the hip. No movement in the in the pelvis, so no, no shifting of the pelvis. You know, so just making them aware like you say that it’s not just getting through the routine. It’s Taking time feeling it, focusing on the quality because we got to prepare you for the next step.

Ben James 29:06

Absolutely, yeah. And I think, again, it’s back to that education, it’s back to that, you know, almost selling in this concept to them to a degree because I think a lot of people, you know, as we said before, they, they kind of have this expectation that they have back pain or they might experience back pain, go and see the doctor first. Expect maybe some pills or kind of a miracle cure, shall we say, maybe then go see a physio. Again, expect them to do something actively with them, massage, ultrasound, all these different modalities that people are probably aware of, and then they kind of leave that that treatment room and expect not to have to do anything themselves. And unfortunately, if you’re really going to develop that resilience, you have to buy into the fact that a movement based approach and developing that core, starting with an understanding of how it moves and moving well and number In the endurance is is absolutely important if you’re going to resist back pain over the longer term, so I think, you know, like you say, you got to really focus on the quality of the movements once you bought into this this concept because it evidence shows that it is absolutely the right way to go. And it does take time on the part of the patient, in terms of you know, that investment of time to do this well, to do this consistently. And to focus on your your back health and the progression of your back health over the longer term. Because that’s really what we should all be striving to achieve. If we want to look after ourselves. There’s got to be an onus on ourselves to, you know, to put that time in and put that effort in. If we truly want to get out of pain and we truly want to get back to those activities that that we love. And you know, that does take Take time, and it takes. And it takes patience. I think it’s fair to say.

Jacob Steyn 31:07

Yeah. Yeah.

Ben James 31:09

Awesome. Well, I think, you know, it’s a natural close there in terms of, you know what people need to be considering some of the things that they can be doing. Soon, certainly at the initial stages of rehabilitation, form those habits, take action, take small steps, focus on quality, not quantity. And then in time, you’ll start to get a much better idea of how your your body moves and how you can control it. And as we progress through we can start to build much more resilient resilience. And that’s the focus of the next podcast is building up the resilience what are the next steps from one of the movement patterns that we’ve established to allow us to take take that next step and get to that next level. So, listening again for the next podcast within this series, as we start to focus on the progression and how you start to build endurance and build up that strength. As always take a look on the show notes, follow some of the links for some of the activities that we advise in the podcast and take a look over the website. So a lot of valuable resources that we’re going to continually add to that will will help you on your journey help you to understand some of these exercises. And as always, take the time to head over to iTunes give us a rating just helps us get the message out there helps us share the podcast with other people that that could benefit from this information could benefit from an active based approach to back rehabilitation, which, which we’re passionate about, and we know we’re going to help a lot of people. So Jacob, thanks again. And we’ll speak again soon when we’re talking about next steps to build a movement resilience.

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