By Dr. Mark Bodnar, B.Sc., D.C., FCCRS(c) 

Even without any treatment, most back pain episodes will resolve on their own within about 6 weeks. Unfortunately the pain often returns and you find yourself on a rollercoaster of painful episodes and recoveries.  The statistics are not great, after the first episode of pain, there is a high probability of  another episode within a year.  We often see patients who have suffered episodes on and off for years, who are gradually getting worse and worse. 

One such example is a patient we'll call “Dave”. He came back to the clinic recently when cleaning up after the first big winter snowfall had left him in a lot of pain.  We had initially treated Dave years ago, then a few times on and off since for minor episodes. This episode however had him laid out, with pain so severe he couldn't sleep at night and could hardly dress himself. Fortunately for Dave and others like him, there is a ray of hope.  With the right treatment we can often break the pain cycle, then with the right exercises we can help it stay away.  

The first goal is pain relief.  Using a comprehensive evaluation we try to identify the underlying source of pain. In Dave's case we determined he had re-injured a disc in his lower back, a common problem that if left untreated could turn into a real mess! Initially treatment was aimed at restoring normal mobility in his lower back, allowing the spasms to relax and the inflammation to settle around the sciatic nerve.  In this case we were able to localize the pain using McKenzie extension exercises – where, by arching gently backwards, Dave was able to shift the pressure off the injured area and help speed healing.  Combined with deep soft tissue therapy and manipulation he started getting relief right away. 

As the pain started to settle treatment focus shifted to functional recovery.  More than just pain relief we also want to regain function – the ability to do things, there's no point in being pain-free if you're stuck lying on the couch. Long term recovery in Dave's case will require core stability.  The core is the space between the rib cage and the pelvis or hip bones and good stability or muscle tone helps to protect the spine from injury.  You have likely heard of core stability, but like many people are not clear on how to get it. – the trick is how you achieve stability without causing injury. 

Believe it or not, stomach crunches are a terrible option. Crunches are a great way to activate the abdominal muscles, but at a price.  The normal crunch movement forces the spine back and forth, like bending a piece of plastic repeatedly, gradually it will fatigue and start to breakdown.  Research tells us that crunches will do the same thing to the spinal discs, exactly the spot Dave has already injured, and adding in an “oblique” twist will only accelerate the damage. A better option is to find exercises that keep the spine in a neutral position, about halfway between fully arched back and fully bent forward.  In past articles I have talked about 2 great exercises that do just that. Maintaining that safe position while holding a front plank/pillar or during a “curl-up” lowers the risk of injury while still gaining important stability. Exercising after an injury can be tricky.  It's not a “no pain, no gain” process.  It's fine to feel some tension or muscle soreness after exercise, but we don't want sharp or stabbing pain that might warn of tissue re-injury. 

In the end, recovery is a multi-factoral process.  We have to figure out where the injury is coming from and learn to avoid it, use the right treatment to get ahead of the problem, and then stick to the proper exercises to keep the risk of re-injury to a minimum.  Dave is showing signs of recovery, if all continues smoothly, by the time you are reading this article his episode will just be a bad memory and hopefully enough of a reminder to keep him on his exercises! 

If you have any questions about the exercises or treatments discussed in this article please contact Dr. Bodnar at 835-6865.

Bedford Chiropractic, based in Bedford, Nova Scotia,  offers full-service consultations, diagnosis and treatment plans for a variety of workplace, repetitive and other injuries. We treat pain to the head, neck, jaw, arm, shoulders, upper body, chest, lower back, legs and feet.  Contact us today 835-6865. We serve Halifax Regional Municipality, including Halifax, Dartmouth, Bedford, Sackville and surrounding areas.