“I will never be the same” is the sentiment often shared with me from patients who have suffered a back injury, to which I usually reply, “That’s not entirely true.” And it is with this statement that the rehabilitation process begins.
Rehabilitation mindset is almost as important, if not more so, than the actual rehabilitation itself. One of the first actions in successful rehabilitation is to alter the patient’s paradigm of thought process relating to exercise, rehabilitation, and their back injury/pain. To do that, I’ve outlined 4 simple steps, that when followed will serve to facilitate a more successful rehabilitation outcome.
Rule 1: No Pain No Gain
When exercising/rehabilitating a back injury the thought process of “No pain, no gain” must be immediately thrown to the curb. The new rule is, “If it hurts, stop!” Many patients suffer a flare-up or an exacerbation of their injury/pain when they exercise to the point of pain. If you are working with a therapist, doctor, or personal trainer and are experiencing pain during or after a session, it is imperative that you speak up and let them know. If they do not know you are in pain they will not modify your program. If you share that you are in pain and they do not change your program or you are getting worse, it’s time to change therapists/trainers.
Rule 2: Focus On Yourself
There is no competition. Stop comparing yourself to others who may have experienced the same injury. No two disc herniations are alike. No two people are alike and no two people heal or adapt the same way. If the guy next to you is walking or running on a treadmill at a certain speed, it does not mean that you have to do the same. Do what you can do at the given time. Those of us who suffer with lower back pain have good days and bad days. When you feel good, do more; however, when you do not feel good, lighten your workout. There is no reason to create an exacerbation of pain, which may lead to the inability to exercise altogether. It’s better to exercise a little by modifying your program for any given time than to not exercise at all.
Rule 3: The “Sweet Spot” For Exercise
Exercise in the “sweet spot” and start slow. Exercising in the “sweet spot” is the act of exercising in your pain-free range of motion. Exercise should not hurt. Experiencing post-exercise soreness is a good goal (you’ve worked out hard) but experiencing pain while you are actually working out can create further injury or inflammation. Start slow and keep a journal of the exercises you are performing, i.e. sets, reps and more importantly how you felt. Who cares if it takes you six months to be able to walk two miles? Remember, there is no competition.
Rule 4: Deal With The New “Normal”
You will have a new normal. Some patients never return to their description of “normal”. Instead of mulling over the past, focusing on what you were able to do prior to injury or pain, create a new normal. Work on what you can do now and how you can improve your activities of daily living. Personally, I still exercise 4-5 days a week, yet there are some movements I can no longer perform because they cause immediate back or leg pain. Learn to modify your movements to avoid pain and you will still be able to participate in an exercise program.
Now that the mindset has changed, it is time to start moving again. To avoid re-injuring your back, it is important to properly warm up before you perform any exercises. The “old school” guide to exercise would have you stretch first followed by your choice of movements. Unfortunately, that is no longer true. It is proper to stretch only after the muscles have been properly “warmed up.” Warming up the muscles may consist of walking, jogging in place, marching in place, jumping jacks or some push-ups. Warm-up time should last at least 8-10 minutes.
Your exercise program should consist of 5 components: Flexibility, Balance, Core, Strengthening, and Conditioning. When initially starting to exercise after a back injury or back pain, choose one movement pattern from each component. For example: for Flexibility, try neck rotations; for Balance, march in place while standing; to work the Core, complete a standing lunge with arm raise; to Strengthen, perform shoulder shrugs with or without resistance; and for Conditioning, try seated marching for 3-5 minutes.
There are many different movements for all these categories. I recommend experimenting with a variety of exercises to determine which ones are right for you and your injury. With respect to sets, repetitions, or the length of time to hold a stretch, I created the rule of “Three to Five keeps you alive”. Flexibility and balance movements are to be held for three to five seconds, core and strengthening movements are performed for three to five repetitions (or holding a core movement for three to five seconds), and conditioning movements are performed for three to five minutes. I know three to five does not sound like much, however, when you first return to exercise it’s a great rule to follow to prevent further injury.
After performing any exercise routine, it’s important to cool down. Just as warming up helps to prevent injury, cooling down also prevents injury and exacerbation. If you decide to skip the cool down process you may experience significant spasms occurring in the injured areas. As part of the cool down process you can also consider self-treatment such as ice, moist heat or a hot shower.
We are meant to move. The longer one stays inactive, the more deconditioning occurs, the more pain one may experience, along with a further decline in health. Remember, it does not matter the type of exercise you perform for your back, all that matters is that you do exercise. It may be a tough row to hoe in the beginning and you will have your ups and downs, but if start with a positive mindset and the willingness to work, you will hopefully feel stronger, do more, and experience less pain in the long run.
To Your Health,
Dr. Michael J. Kaye