Your Back Pain Questions, Answered Part I – Exercise

When can I start exercising if I have back pain?

Immediately!

It is important to note that roughly 90% of all back pain falls into the category of “non-specific back pain”. This descriptor does not mean that your pain is not real or even debilitating for you. What it does mean in simple terms is that the cause is not clear, is not something that will cause long-term medical complications, and that it is very unlikely any one single factor has led to your back-pain experience.

The other 10% of back pain can be determined and is caused by a clearly identifiable source, such as significant nerve root compression, spinal fracture, infection, or cancer. Of that 10% of “specific back pain”, less than 1% is in the category of cancer, meaning that your odds of having a serious issue in your back are very low.

In the case of “non-specific low back pain” the overwhelming majority of research has shown that staying moving, keeping as calm and positive as you can, and continuing to gently exercise with gradual progression over time are the most effective actions you can take. In most cases, your back pain will resolve within 2-6 weeks if you stay moving and stay confident it is just a transient issue.

If you were to sprain your ankle, the general medical guidelines are to let it rest for a day or so and then immediately start working on very gradually progressive movement. The movement helps to keep your ankle from stiffening up and giving your tissues light loading aids their healing and prevents strength loss.

Having a low back strain or sprain is no different than spraining your ankle. If your back pain started after a large increase in activity or lifting something a bit too heavy, it may be prudent to reduce the amount and intensity of your activity in the very short term, but continue to remain active and exercise at a lower intensity until your symptoms subside.

Keeping your muscles and joints moving and gradually increasing loading to the back is the best way to recover from back pain and keep your back healthy in the long term.

Back pain can be very scary and intense, but it is important to know and remind yourself that it will go away and that the intensity of pain you are having is not a good indicator of the severity of the injury.

Should I stop exercising if I have back pain?

When you find yourself dealing with a bout of back pain it can be very frightening, as back pain can be quite debilitating.

However, it is important to know that the vast majority (around 90%) of back pain is nothing serious or to worry about.

Most episodes of back pain will resolve on their own in 2-6 weeks. Large research trials and systematic reviews of the best evidence have shown that staying active and exercising while you have an onset of back pain is the best choice of management. This includes simple activities like walking.

In fact, it is possible that if you stop moving and exercising you could lead yourself down a negative path. It could take longer for your back to recover as muscles tend to lose strength and joints become stiff in times of immobilization. Additionally, when you exercise you open up the door to your body’s own internal medicine cabinet that can help you feel better and heal faster (link to Butler’s description of medicine cabinet)

Exercising allows your body to release various feel-good pain suppressing hormones and growth factors that may be helpful with healing if you have an injury. If your back pain started after a large increase in activity, it may be wise to reduce the amount and intensity of your activity, but continue to remain active and exercise at a lower intensity until your symptoms subside.

Sometimes big changes in activity or trying something new can lead a new onset of back pain simply because you haven’t given your body enough time to adjust to the new activity. In cases like this, even though your pain might be quite intense, the odds are that there is nothing serious going on and your body is simply trying to let you know that it needs more time to grow accustomed to whatever you have recently started.

Does lifting weights damage my spine?

As we continue to learn more about the human body, we are finding that resistance exercise such as weightlifting is beneficial and healthy. It appears to preserve function, improve cardiovascular health, increase strength, increase bone density, and maintain the health of our joints.

Just like doing push-ups or bicep curls can make your pec and bicep muscles bigger and stronger, weightlifting like squats, lunges, and deadlifts can make your back stronger, more resilient, and protect against injury.

Traditionally it was thought that the human body would wear down like a car with many miles on the road. The key difference between humans and cars is that humans have the capacity to heal, change, and adapt to different stimuli.

With this in mind, we now know it is safe to say that weightlifting performed in a gradual and progressive manner is very safe for the spine, and in fact just may be a potent protector of the spine in many ways such as increasing healthy lean body mass, increasing strength, improving metabolic health, increasing bone density, and maintaining function.

Of course, if you have limited experience with weight lifting it is always a good idea to consult with a trained professional to help you build a plan to gradually acclimate your body to weight lifting.

Does stretching help low back pain?

Mindful movement, done in a relaxed and comfortable way, can feel wonderful. It can also feel horrible if you have a sensitive back but you think you “have to” stretch it out.

Exploring movement and flexibility in a manner that promotes relaxation while not forcing yourself to move into pain can be very helpful if you have ongoing pain.

It can help you find new, pain-free ways to move, feel more confident with everyday movements, and regain your strength and flexibility. If you enjoy activities like yoga or tai chi, or other forms of movement with flexibility, and you have a good coach that you trust to help you, then stretching can help you feel good.

Tightness and stiffness are normal protective mechanisms. After an injury, they are good things! In the few weeks after an injury, they’re helpful guides to tell us about healing. If you have an ankle sprain, for example, you will have a sore, puffy ankle that’s hard to move, feels weak and is difficult to walk on. As normal healing does its job, flexibility comes back (sometimes with a little help from stretching exercises.)

Stretching can help back pain for reasons you may not have considered.

Sometimes we feel there is a tight muscle that we need to stretch to reduce back pain. Activities such as Yoga or other stretching-based movement practices can be very helpful for back pain. Sometimes tightness can be good and helpful, as with the ankle sprain example mentioned above. 

What science tells us is that tightness can be a protective response from your body that is taking the danger messages from the tissues that were injured and protecting the tissues by making the muscles tighten up to reduce movement.

This kind of tensioning is protective, because it keeps the injured area from moving around or being loaded too much while it heals, sort of like a natural splint. The key is that as healing progresses, this muscle tension should be decreasing. Sometimes assisting this natural progression with stretching and movement can be very helpful.

It is also worth noting that sometimes, stretching might feel good temporarily, but is actually making the problem worse. Stretching places tissues under tension (pulls them apart), and certain injuries or sources of pain, such as tendons, nerves, and muscle tears, may be aggravated by stretching.

You should monitor your body’s response to stretching and see if it is actually helping out in the long term.

If stretching feels good briefly, but the pain quickly resumes and you find yourself needing to stretch the same area over and over again for temporary relief, then stretching is probably not helping the painful area heal in any meaningful way.

When it comes to stretching, it is usually safe to just do what feels good. But if stretching seems to make the problem worse or not help it at all, you might benefit from working with a qualified instructor or therapist.