Post No.: 0190
If you suffer from chronic back pain or osteoarthritis then you should definitely do at least some regular exercise – ‘if you don’t use it then you’ll lose it!’ The cure for a weak back or joint is to make it stronger, and exercise is logically what will make it stronger. So if you experience back pain or joint pain then get moving more; although do consult your doctor first to see if there are any precautions you must personally take, and start off gently before building up your strength, flexibility and endurance. You’re not in competition with anyone else here – just your own previous day or session.
Many people with chronic lower back pain believe that they should not move too much or too intensively in order to not make their lower back pain worse or to not exacerbate a former lower back injury, but not moving and not exercising the back will precisely make it (even) weaker and therefore more prone to lower back injuries in a vicious cycle! Their beliefs and behaviours therefore need to change to see a long-term improvement in their partly self-inflicted or self-sustained ‘chronic’ situation.
‘Kinesiophobia’ is the fear of pain or re-injury due to movement, and this fear is a factor that hinders rehabilitation and physical therapy. It thus prolongs disability, pain and the time it takes to return to pre-injury activities. This fear can even mean some never return to their pre-injury activities ever again. A serious injury may require surgery and professional guidance for its rehabilitation. An injury certainly needs a period of rest for it to heal first (the duration will depend on the scale of the injury). But some take this to mean a rest duration that lasts the rest of their life(!)
Pain is not always a reliable indicator of whether a body part is (still) damaged – some people with significant tissue damage can report no pain, and some people with seemingly normal tissue scans can report tremendous pain. Many people erroneously believe that many forms of activity (e.g. running or bending), which aren’t harmful to their bodies, are dangerous and are potential causes for ‘wear and tear’, when it should be the case of ‘if you don’t use it then you’ll lose it’. Many people also erroneously believe that recovery from chronic lower back pain is more in the hands of pills, needles, scans and scalpels administered by a clinician (i.e. relatively quick and/or lazy fixes), rather than self-management strategies such as regular physical activity, stress management, adequate sleep and changes to maladaptive attitudes and beliefs. (I just want to insert here that glucosamine and/or chondroitin supplements have shown modest to no benefits for relieving pain or joint damage compared to placebos.)
Lower back pain is often associated with an initial actual tissue injury, but with typical back injuries this eventually heals and lower back pain only becomes recurrent or persistent if people avoid doing regular physical activities to strengthen their backs. Any subsequent pain is not usually the pain from tissue injury per se but from the pain of normal muscle soreness (which goes away after a few days), a sign of muscle tiredness (which can be due to a temporary overuse and/or due to weak muscles that would benefit from being stronger via regularly exercising these muscles) and is actually a sign of muscle training – athletes or people who go to the gym can typically feel muscle soreness (or delayed onset muscle soreness (DOMS)) for up to a few days after a tough training session or competition, but this is not a sign of injury per se – just the normal processes of growth and physical conditioning. Not all inflammation is bad.
Physical activities after an injury and after an initial necessary period of rest and healing may be difficult at first but they are not dangerous if slowly and gradually built up in intensity (with the guidance of a physical therapist if required). So the fuzzy pain is not related to actual tissue injury (beyond micro-tears, which when rested actually lead to improved conditioning, as that’s the mechanism for how muscles grow larger and stronger) but just weak tissues – weak because they have been typically underused and under-conditioned during one’s normal daily routine.
Injury and soreness may both be associated with pain but they are different – one is related to ‘destructive damage’ and the other is related to ‘constructive damage’ or an improved conditioning if adequately rested afterwards. Experience will eventually let you understand when you’re merely feeling sore in recovery or if you are actually injured (the former still allows you to do stuff but just far more slowly and with lower resistances, whereas the latter sends sharp shooting pains and severely reduces your range of movement no matter how hard you try to move the area). ‘Constructive damage’ is where the term ‘no pain, no gain’ properly applies. Woof!
Chronic lower back pain can also be due to synergistic muscles (muscles that work together during a movement) or antagonistic muscles (muscles that work opposite each other during a movement) being imbalanced or tight (e.g. an overemphasis on training the abdominal muscles and not the back muscles, or tight hamstrings that need dedicated stretching sessions).
Many people with chronic lower back pain don’t do any other exercises (e.g. swimming) that don’t particularly intensively involve their lower backs anyway! Thus these people use their backs as excuses for giving up on exercising altogether, rather than as reasons for needing to do even more(!)
The risk of developing osteoarthritis in the knees or hips from running only seems to be high if one runs when injured or runs intensively for too long without adequate and timely rest periods. A high body mass index (BMI) and/or a previous knee or hip injury (e.g. a meniscus injury) will increase the risk too. Again it’s all about achieving the right balance between the physical activity and rest time – too much of either won’t help.
Overall, running is better than not running at all (of course up to a sensible point) when it comes to preventing arthritis or damage to the knee joints. It’s important to wear shoes you are personally comfortable running in (whatever the price, technology, brand, marketing hype about pronation or supination, what other people like, etc. – wear whatever you find comfortable). And warm up gradually and sufficiently before going hard. Listen to your body too (after intimately understanding the differences between soreness and injury), and get enough rest if you’re somebody who runs for hundreds of miles every week.
Often, when adults demand medical scans after they get injured (e.g. X-rays, CT scans, MRI scans), and then get them – they start to enter into a mindset of thinking that their well-being and recovery is outside of their own control; as if they’re helpless to do anything themselves to improve their own situation and it’s down to surgeons to make things better for them rather than their own self-management and regular physical exercise. Whereas those who don’t make as much fuss and simply try to get back to their normal activities as soon as they safely can tend to get back to normal more positively, rapidly and completely. So it’s often all about our positive and proactive attitudes towards recovering from a temporary injury (and understanding that it’s only temporary, like you did whenever you sustained any sprain or strain injuries as a child) that makes us better in the long-term, rather than thinking that any injured part must be perpetually ‘protected’ from hereon in. There’s therefore a mental or psychological element to back or joint pain recovery, and help for this may be offered by certain health services. It’s not to say that the fears, stresses and pains generated purely from one’s own mind aren’t real – it’s to say that there is a genuine solution for most people’s back or joint pains if one chooses to take it.
So the vast majority of people who have chronic lower back pain don’t need and won’t benefit from surgery, and opioid painkillers aren’t the best way to treat chronic pain either – they need to sit less, stress less if possible, and have a more physically active lifestyle (walking more often will do for most people).
Doctors also need to prescribe exercise (and a healthful diet) as medicine more often (Post No.: 0082 talks more about this), and the healthcare environment and general environment we live in needs to encourage and facilitate desirable physically active habits more too, such as via nudging (e.g. making the stairs more immediately prominent than the elevators when it comes to architecture), more cycling and pedestrian friendly areas, more playgrounds for children, and arguably maybe even direct incentives or taxes.
(I’ve personally suffered from several excruciating back injuries in my past due to weight training (of the type you accidentally tear a baluster off because a spasm hits you so hard whilst you’re trying to crawl up the stairs!) But my attitude has always been to think ‘it’s not going to end like this’ – and so every time I got injured, I gradually got better and stronger again (and eventually learnt from my mistakes of not listening to my body and over-training, which caused most of those injuries in the first place). So I’m very experienced at being at a relatively low level of fitness (and mental state) for being injured but then building it all back up to a high level of fitness again, and again – higher than before even. This means that I now always have the confidence to get back to complete physical fitness again despite what state I may currently find myself in. It’s an attitude and experience that not only helped with my lower back but with other facets of my life too. So if you suffer from chronic back pain – you will get stronger and will at least reduce that pain and improve your quality of life if only you get active and build your fitness and abilities (back) up in the right way i.e. gradually but with enough to challenge you each time.)