There aren’t many universal truths in life but let me tell you what, if you just work your butt off and clinch through the searing pain that feels like your whole leg is engulfed in flames, your core strength will abolish all of your symptoms, cure diabetes, and ensure you maintain a statuesque physique until you die. No Pain No Gain is the clear-cut way of getting rid of the pain. It’s like when the backup sensor on your car starts beeping at you, who does it think it is telling you what to do?! You crank that music and punch that gas pedal, show that sensor who is boss! The only way to deal with spine pain is to karate chop that mofo straight in the trachea!
Or maybe, just maybe you should look at your pain as your body's way of telling you that something is not quite right and you should adjust the body mechanics that caused it in the first place. Now this is super oversimplified and there are always outliers but as a general rule, I would say that No Pain No Gain is a moronic way of viewing spine pain. I also think that any healthcare practitioner that tells you that you just need to “strengthen your core” is really just telling you that they do not have any answers for you. Take control of your health and wellness and find someone with answers or at the bare minimum someone that takes the time to understand your unique situation.
Don’t get me wrong having a strong/stable core will help you with your long-term pain management. My issue is that stating that core strength will help your pain implies that a lack of core strength is the cause of your pain. Want to know a secret? It isn’t. There is no one causative factor that has led to this pain you are experiencing. I firmly believe that we begin the journey to spine issues at a very young age, probably around the time we stop listening to our parents and sit slumped over for hours on end watching TV, playing games, or even studying.
Again, do not hear what I am not saying. Piss poor posture as a kid did not cause your pain. Piss poor posture as a kid, adolescent, and adult did cause repetitive microtrauma to the structures that maintain spinal integrity. The ligaments that line the spine and resist the extremes of motion, the disks that are being squashed and strained, the terrible body mechanics when engaging in activities of daily living, and a general lack of physical activity have all played a role in your spines demise. You see, when we are young these structures heal up quickly once we move to get out of the compromising position. As we age the accumulation of this microtrauma as these structures repair themselves makes them more rigid which limits the functional range of motion.
Let’s look at a common example I see in the clinic.
Patient: “I didn’t even do anything; I just woke up and I couldn’t get out of bed because the pain was so severe!” -as said patient sits as if they have melted into the chair before my very eyes
PT: “Okay, tell me about the activities you did the day before.”
Patient: “All I did was yard work for 1000 hours, moved a refrigerator up 10 flights of stairs wearing a blindfold, and then I sat and relaxed for a few hours at the end of the night in my super comfy recliner.”
PT: “And you had no pain throughout any of this?”
Patient: “Well I had some soreness and stiffness but I took an Advil and was fine when I went to sleep.”
What we have here is the most common story people tell me when dealing with spine pain. In the patient’s head, they didn’t hurt when they went to sleep so it couldn’t have been anything they did. In my head, I have now found out that they engaged in a significant amount of activities that likely involved terrible body mechanics. If we think about the microtrauma I spoke of, this is when it starts to be a problem. You have now traumatized the structures within the spine and did nothing to offset any forces/pressures that may have been built up. The Advil helped so it can’t be too serious, right? False. It can only help reduce the acute inflammation which reduces the intensity of symptoms you felt at that time by eliminating some pressure. Your downfall was going from a couch where it is impossible to keep good postural support to a bed where you have no control and likely slept in a wonderful fetal-like position. Now those structures that were trying to heal are being strained as the pressure is building from whatever spinal position you are sustaining while sleeping.
The problem is that you are asleep so you don’t even realize that the discomfort is building, your sensor may be going off, you just can’t hear it. So, you stay in the same position with the same direction of stress being applied to structures within the spine. As the pressure builds, space for the nerve root decreases. This continues until.. BAM you wake up in the middle of the night with searing pain racing down your leg for no F@#%ING reason! You try to stand up to find relief but instead as your leg hits the ground, the pain instantly bursts out of your toes, and WHAMMY the leg buckles, you hit the ground writhing in pain, certain someone is trying to kill you. You now require someone on both sides of you to carry you back to bed where you will spend the next few days “letting it pass”.
Ohhhhhhh the irony!!!! Little did you know that all of this could have easily been avoided had you only learned about proper body mechanics, proper pain management stretching, and proper core activation. The easiest way to look at a case such as this is to analyze the consistencies to determine which stretch is appropriate. As in; where does it hurt when you sit slumped compared to upright, does it feel better to walk vs. sit, do house chores and yard work increase your pain? The list goes on but the important part is understanding the mechanical implications of each activity (what forces are being absorbed by the spine?
Most people, especially nowadays, sit way too much. This wouldn’t be a huge problem if they maintained a good neutral spine and changed positions often to avoid the sustained strain of compromised structures. The even better news is that you don’t need crazy core strength to do this. Hop on Amazon, spend $20-30 on a good lumbar roll, I’m partial to the McKenzie rolls. This simple tool can be taken with you anytime you plan to sit for an extended period and when used correctly can make postural awareness a breeze. A straight back firm chair with a lumbar roll can't be beaten by the most expensive ergonomic chair. Another simple trick is to break up your sitting by changing positions, check out the post about slouch overcorrects for an easy and effective stretch to reduce pressure within the spine.