Lower Back Pain Exercise: Is All Movement Equal?

Welcome to the Back Pain Solutions Podcast – Lower Back Pain Exercise: Is All Movement Equal?

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Listen To The Episode Below

Episode Introduction

It is now common practice for healthcare practitioners to advise against bed rest and encourage a return to activity when managing lower back pain. Bed rest has long been considered to have deleterious effects on recovery from injury and indeed can increase pain due to the osmotic effects on the intervertebral discs as increased hydration results in additional stretch of the localised soft tissues. Furthermore, research demonstrates that prescribing bed rest can have a negative impact on the strength and flexibility of supporting musculature within only a few days when they are not being used. Given the importance of the muscles in supporting the spine this is clearly an outcome we want to avoid. However, whilst research confirms the benefits of taking an active recovery, is all movement equal? And just what activities should you return to as part of your recovery?!

In this episode we ask if all movement is equal when taking an active approach to recovery and identify some fundamental considerations you should take when returning to activity. We demonstrate some of the mistakes people make when they’re recovering from injury and what you can do to avoid them. We discuss some key exercises that you should consider as part of your rehabilitation program as well as some key exercises to avoid. Furthermore, we discuss how important it is to optimise your environment to support your recovery and need you to tune in to your back pain to guide your recovery.

Some of the things you’ll discover…

Why not all movement is equal & why you shouldn’t always be influenced by what others have done
That everyone is individual and why you should not simply follow what others have found successful
Why you need to identify the movements that you can tolerate as part of your recovery
What we mean by quality of movement & how this applies to simply activities of daily living
Why making a diary throughout the day can be so beneficial as part of your recovery
Don’t underestimate some of the simple things you do everyday that can influence your back health
Why understanding neutral spine is a foundation in your recovery & for your long term back health
Some of the fundamental mistakes people make when trying to overcome back injury

Episode Highlights

Don’t be fooled when you’re advised to keep moving and taking an active approach to recovery, especially when you are given no direction on what movements you should be considering as part of your rehabilitation. Time and time again people are given poor, or at least unclear, advice about the exercises they should undertake as part of their treatment plan. Inevitably this leads to many instances of recurring, and chronic, pain which could be avoided with better advice. Just because someone else has had success with certain exercises it doesn’t mean that you should follow their lead as it may have a deleterious effect for you. Always seek out sound advice to give you the confidence you need to overcome your injury.

Episode Transcription

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 a stronger back the smartway.

Ben James 0:28
Okay, welcome back to the back pain solutions podcast with me Ben James and my co host, Jacob stain morning, Jacob.

Good morning Ben

So today we’re talking is movement or is all movement equal? That’s the question for today’s podcast. But before we start, as always, head over to the website, www dot smart, strong co.uk. Take advantage of our free ebook, start to get a good sense of the exercises, the movements the things you need to do to start taking back control. Have your back health in the next seven days, really helpful advice and video content as well, to support you on your journey to better back health, and getting you back to the activities you love, which is the aim of the podcast and the work that we do. So Jacob, is all movement equal? Where’s this question come from? Because I know, it’s a question that you are asking. And we were discussing the other day, and we thought it would make for an interesting show.

Jacob Steyn 1:27
Oh Yeah. Just to add to the question, and like we have discussed, you know, why do some people get injured and others not when they when they perform the same movement, or the same amount of that movement and whether it’s in the garden or in the gym, or maybe doing their hobbies? And I think the main thing that we have to discuss here today is the fact that you know, everybody’s individual and suddenly, more suddenly less. I hope we can dive a little bit deeper into that.

Ben James 1:59
Yeah. I think that there’s a point there that you make that, you know, people we often follow people don’t mean. So if if someone’s doing something, we kind of look at that and say, Well, okay, that’s working for them, let me do that. And you know, back pain is no different. If someone’s suffering back pain, and they speak to someone who also suffered back pain and they did a certain thing, then naturally, if they’re, if they’re not having any success with their strategies, currently or previously, then they’re likely to try and follow the advice from somebody else that has had success, but actually, is that a problem? And is that going to cause you more issues? Well, potentially? I guess the answer is yes. So I think it’s an interesting and interesting topic, particularly when we’re talking about kind of daily activities and those kind of things that that people are doing repetitively these things that people probably think are quite subtle, but ultimately have a big impact on back health for for for many people.

Jacob Steyn 2:58
Yeah, exactly. And There’s numerous factors that we can discuss if we want to really go into depth. And that’s, you know, a couple dimension a couple it would be, like we just said, you know, everybody’s individual. Some people will tolerate more of a flexion based program when it comes to exercise or movement and other people just can’t have any flexion in their low back. So they will be better with more extension extension type movements or holding their spine in a sort of slightly extended posture. But you know, ultimately it comes what we want to discuss today it goes back to quality of movement. And when we discuss quality of movement, we we want to try and grade movement to either be good or bad. I don’t like to use these terms. But we can break down movement into movement that is safe and that is not safe. And when we think of safe, we want to think of actually isolating the movement and giving the movement to the, to the joints that are supposed to perform the movement and make sure that we have or limit unwanted movement in areas that we don’t want to move at.

Ben James 4:17
Yeah, and if for someone listening that hasn’t listened before, you know, there’s a lot of there’s a lot of things that people are doing everyday daily activities, exercises, work, etc, etc. You know, how do you really where do you start with that? You know, as an individual, where do you start with, well, what’s safe? What’s not safe?

Jacob Steyn 4:34
Yeah. I mean, if we, if we just take, for example, a low back injury and we go out with a point that most people are flexible and tolerant, which means bending forward would be a problem for them. We would like to limit flexion so simple things like standing out, standing up from a chair, you know, are you flexing through your low back? If you’re sitting in a chair, are you pushing a bump? And sitting nice upright, or are you sitting more forward and actually slouching. So, you know that those are static postures, but just standing up from a chair actually flexing through the low back. That would be a problem if you’re flexion. intolerant.

Ben James 5:16
Sure. Yeah. And actually, you know, it’s, it’s taken that advice to the extreme. And I say taking it to the extreme, it’s, it’s not actually taking it to the extreme, but for certain for certain patients, for certain individuals, they think it’s, and they think it’s, it’s quite a difficult to look at all these different scenarios. I was having a discussion with the patient the other day, a friend of mine, in fact, so it was a little bit more, a little bit less serious, shall we say? But sitting on the toilet, you know, he’s a guy. We like to. We like to sometimes sit and read when we’re on the toilet, but he was talking about how slightly In that position, you know, and that is a serious problem. If you’ve got a flexion intolerant back, which he has, and then he’s going and sitting in that position slouched, then that’s causing him issues like it is when he’s sitting on the chair sitting on a sofa, whenever you’re sitting during the day, that posture become becomes relevant if you’re, if you’re flexion intolerant. And it’s an it’s kind of looking at all those different scenarios through the day and making that diary of when things could be problematic for you, because it is that repetition that keeps these individuals often in a in a in a bad place.

Jacob Steyn 6:35
Exactly. And, you know, just to add to that I have a patient or I had the patient a little while ago, and we did everything, you know, we went through the exercises, we we worked with his nutrition, and I think I slipped up there, obviously, you know, I have to give myself some of the blame as well. But then he mentioned at some point that he was he was gaming a lot and That means sitting, and also how do you sit and he showed me, he sat with these elbows on his knees in a very flexed forward posture for hours, and that was just keeping him from recovering. And when we changed that, quite quickly, we saw a change, but erm..

Ben James 7:19
And that just shows the importance of the question and doesn’t it during examination, initial history taking because, you know, sometimes we, you know, we don’t all patients certainly don’t see the significance and the relevance of things like that because, you know, he might be he might explain a story and I don’t know the background of the patient but of of work and, you know, it’s quite manual and everything else but actually, you know, if that manual work for somebody is, is changing their posture throughout the day and they keep a relatively healthy neutral spine that might be pretty good for them compared to someone that’s just that school day. But if that person is then going home and spending hours gaming In that position, then that’s a problem. But then they might make, they might not see it as that issue. And I think that’s the, that’s a key takeaway for people is to really think and tune in to what you’re doing on a daily basis that is aggravating that problem. And we’ve mentioned this before, but it’s so important to try and identify those triggers.

Jacob Steyn 8:18
That’s it. And another point that I want to make is I quite often have patients on the older side, you know, they do gardening, or they have hobbies, or maybe they’re, you know, the guy would do some work at home. And he’d hurt his back, go to the GP go to the doctor. And the doctor would just, you know, would say to him, generally, you know, you got to keep moving, keep doing it. You know, when it gets a little bit better, take it easy when it gets a little bit better, keep moving, keep doing what you’re doing, as if there’s this need to keep moving because they’re getting old, you know, just don’t stop moving and That’s quite often the wrong advice.

Ben James 9:02
Yeah, it’s kind of it’s good advice. But it’s it’s bad advice in the sense that yes, we want people to keep moving because we know that bedrest can be certainly have a deleterious effect on on back health in general health, obviously, a sedentary lifestyle and a lack of movement is a bad thing. so great that we’re encouraging people to move. But if we’re just encouraging people to continue doing the things they were doing before, and just get back to it, as it were, because, you know, that’s the, that’s the kind of active approach that that this society wants to recommend. But again, back to the point previously made, if getting back to movement means repeating something that is an aggravating factor, then that’s a problem. So it’s kind of that sweeping generalization, like you say, of, of just move. That could be a problem, even though ironically, we don’t want people to just not move. So here’s the challenge.

Jacob Steyn 10:00
Exactly, and quite a lot of old people are, are quite vulnerable. So I feel that, you know, we can take, we can make a little bit of effort to get them to move better improve the quality of movement, and so we will ensure for a big part that they are not going to get injured or fall back to having paint.

Ben James 10:18
Yeah, absolutely. Yeah, absolutely. So, on that note, then we want people to keep moving, we’re saying not all movement is, is the same. It’s not all equal. So largely, could we could we make the recommendation that as long as you keep that back in neutral, then you’re going to find it very difficult to injure a damage or aggravate that back? To a large extent, and therefore that’s kind of the foundation for then trying to keep moving. Would that be a place to start? Do you think because advice?

Jacob Steyn 10:51
Absolutely. Absolutely. And that’s absolutely I agree with that. And that’s something I want to discuss, you know, when we look at our environment, That’s something we can change so we can optimize our environment. If we would work in a garden, for example, you know, and we have to do a lot of work on the ground. So we want to pick some weeds or, or plant some seeds, then it’s all about how you go to the ground, how you perform the movement that you have to in order while the awkward movements. And so optimize your environment by getting a little stool outside so you can if you if you’re struggling just to do a lunge, keeping your back upright and in neutral, you know, use the support of a stool so put one hand on a stool and then lunch down with that so you have an extra bit of support. Same way, use this to get up, you know, or go onto your knees and onto your hand. So you have this extra leg, which is your arm to rest on when you pick weeds or you work on the ground. So you Don’t actually just rest on your knees and hang on your back. So I think that’s, that’s a big key for a lot of people, you know, optimize your environments. Similarly, with, if you have a physical job, you know, make sure you’re able to lunge squat. And if the weight is too much, then ask for help. You know, don’t do stuff. Don’t put your back in awkward movement where you’re really running the risk. I think like you said, In the beginning, it’s all about the awareness. If you know that it’s there. Prepare yourself for it. So that you don’t don’t run the risk of actually putting it back out.

Ben James 12:34
Yeah, I think I think that’s a great kind of take home message is optimize your environment. Because, again, back to kind of how we introduce the show and that kind of complacency or just feeling that certain things shouldn’t be a problem or I’m just sitting down playing on the computer. You know, all these things could be a problem for you as the individual and it’s and it’s reflecting On those things, and setting yourself up for success, it’s understanding that we say what neutral spine is because that that forms a great foundation for better back health. And you’ll find that information in the book that we talked about at the beginning of the show, that that provides a platform to avoid pain triggers and to to make your back healthier. So how can I keep in that position throughout the day, we know if you’re sat at a desk a lot, you tend to kind of creep into those poor postures. So set an alarm every 20 minutes, you’re going to have a break and you’re going to stand up you’re going to make phone calls, standing up walking around the house or even walking around the office. If practical wine why not why would you not do that? Why do we just end up sitting in that one position all day, keep hydrated, keep a glass of water by side all these little things that make for a more productive day. But a better day for your for your health and, and optimizing your environment is a is a great point. To make on that, because so often, we’re just get into the routine of life and we don’t reflect on the things that we’re doing, that are causing us a problem. And without focusing on that without changing that, then how’s that going to improve your back health, because just going and seeing someone for treatment, and then going back to the things that you do every single day that the problem is not going to lead to a successful outcome. And that’s something that people really need to think about and reflect on.

Jacob Steyn 14:31
Yeah, and I want to add to that, that’s a good point. And I want to add to that, you know, all the movement that we make, whether it’s in the gym, doing a hobby working in the garden, or having a physical job, you know, we are, we have a physical biological capacity. So, we, we have to consider all the work or the movement we make or do see it as, what the term we’re looking for is actually it’s called those two pendant. And what I mean with that is the fact that there’s a breaking point. So we can do a certain amount of work. And we will be fine. If we do too much, we go into the danger zone. So whether that’s a repetitive strain injury, or whether that’s making big movements, but lifting heavy things, a certain point is just too much. So figuring out and knowing what you what dose you can handle is also very important.

Ben James 15:30
Yeah, and that’s where and an active and collaborative approach is so important because you as the back sufferer need to provide that feedback and input because only you know, it’s a very subjective, you know, and that’s the same for exercises. If you’re given rehabilitation exercises, people always ask the question, and you all have experienced this Jacob Okay, how many repetitions how many times a day how many times a week, should I be doing these exercises? And the answer to that question is whatever’s right for you and what’s tolerated by you. So if you’re doing those exercises, and you know they’re safe, and you know that you’re doing them, well, that’s a great starting point, obviously, you need to know that. But if after 10 repetitions, you start to feel a bit of an ache that’s too much for you. If you start to, if you do three repetitions and it starts to feel an ache, then that’s too much for you. So it’s, it’s the graded exposure that is important, but it has to be based on the individual and the individual tolerances, and that requires their input and their feedback.

Jacob Steyn 16:43
Exactly. And you know that that’s especially if we look at rehabilitation, but also when we look at high performance training. If we do too many reps, we lose the neurological drive to perform the exercise or the movement at a high quality. In other words, we’re not actually training that high quality movement anymore. Specifically when we look at something like weightlifting or fighting movements, and…

Ben James 17:08
Yeah, and that’s particularly where there’s a danger when when we look at the fitness world, particularly, because there’s often that that mentality of right, I do five sets of 10, or I do three sets of 10, or whatever that might be. So for somebody that’s in a gym setting, that that isn’t quite at that level of that person, they’re watching on YouTube, or the athlete that they follow. And they try and repeat the same training regime. And like you say, they lose that neural drive, then that’s where the injury risks come. So that’s where again, it’s about graded tolerance and being sensible about our approach, particularly when we extend this to the kind of athletic setting because otherwise, you’re you’re just increasing your risk of injury. needlessly, because in time, yes, you could maybe repeat that same training regime, but you’ve got to start. Where’s right for you?

Jacob Steyn 18:03
Exactly. And so I want to add to that, you know, we had a good question, how can one know if they’re moving is of good quality? And I think that’s what a lot of listeners are thinking, How do I know when I’m moving? Well, and I think, you know, we can’t explain all of that right here now. But as a general rule, we want to make sure that we move through the big levers. So we want to give the work to the big joints, and those are the knees, the hips and the shoulders. And like Ben mentioned, we want to focus on that neutral spine. So we want to limit movement through the back. And we want to be able to give the movement to the big muscles, the buttocks, the glutes, at the hips, for example, when we bend or knee, go through our knees to make a squat to pick something up. And if we can follow these, all these rules, then we’re already doing ourselves a big favor in terms of good quality movement.

Ben James 18:59
Yeah. I think it’s back to that as well. The proximal stiffness alongside moving through those those big joints because if you’ve got that stability then your movement the extremities is is a more efficient but far safer and I always think back Jacob to the example that you provided from the tennis world if you look at the likes of you know Roger Federer compared to Rafa Nadal when you explain that and it was so resonate resonated with me so much that that proximal stiffness in that movement is so so fantastic from Roger Federer. Nadal is far bigger, muscular. So you would think he’s, he’s is better trained, he’s stronger and clearly he is he’s a professional athlete is a professional tennis player, but he has had far more injuries and that is something that does make you think it does really make you think it’s not all about building power, and these in the shoulders and in the chest, which is What a lot of people from it again, going to the gym setting look to do from an aesthetic point of view. But if you build that proximal stiffness and you move through those big leavers through the hips, through the shoulders, then you let you, you’re just going to be in a much better and more stable, strong, healthy position, then if you just look at power distally, and you’re not focused on that, because that is where a lot of problems are. For a lot of people. It is about that core strength, that stiffness in that healthy movement. And that’s what’s going to avoid injury.

Jacob Steyn 20:35
Yes. So I agree with you there. And it’s all about understanding what the neutral spine is and make sure you’re able to move and twist through the hips and if needed, bend through the knees. And, you know, we’ll speak later again, about probably how we can make the shoulder stronger and how the shoulder adds to the to the core, but that’s all part of good movement.

Ben James 20:59
Yeah, and I think You know, really, the take home message here I think from from this episode is not all movement is equal. Make sure that you optimize your environment, you reflect on the things you’re doing every day, that could be problematic. Because undoubtedly, in most instances, 99% of cases, something that patient is doing every single day is causing that problem, then we’re looking at starting with a neutral spine, that’s where all healthy movement does become more equal. Because if we can get into that neutral position, then that’s a good base, it’s a good start. And then it’s about graded exposure to the right exercise in the right movements for you and your specific condition as the starting point to then build better and healthier movement. So, Jake, thanks. As always, guys, head over to the website for the ebook, because that gives a lot of exercises, advice and information about some of these key principles, some of the fundamentals that so So important to better back health. And as always, we ask you to head on over to iTunes and give us a review. Give us a rating. It always helps to spread the message and feel free to get in touch with us via the website. Send us any questions and there’s any specific individual requests you’ve got for information and advice, happy to answer those and maybe we, as always can look at answering them on the show as well. And just be mindful of what you’re doing every day for that back in health. Thanks for listening guys. We’ll catch you on the next show.

Transcribed by https://otter.ai