BACK PAIN, EXERCISE, AND COMMON MISTAKES

The biggest mistake made by people with back pain is to not exercise at all, even after a course of physical therapy. Immediately after the therapy ends, so does any attempt at exercise. This is often the result of the underlying approach to exercise in which people with persistent back pain try to strengthen their back with exercise, increase their pain dramatically, and then stop exercising altogether, having learned that exercise hurts. The years pass with episodic attempts at exercising the injured back, usually in physical therapy, with only increased pain to show for their efforts.

The second biggest mistake people in pain make is to focus all their exercise efforts on their painful back or legs and ignore the rest of their body, which gets as weak as their back over time. With persistent pain, focus on your noninjured body parts first and only months later your injured back. Get some aerobic exercise through a stationary bike or in the pool - not so much that your pain increases. Then focus on strengthening your noninjured, non-back body parts so they can compensate for your injured back - not so much that your pain increases. Only then should you exercise your with the main goal of maintaining range of motion through gentle stretching - not so much that your pain increases. This is the most effective strategy for rehabilitating a persistently painful back. You should be doing some type of exercise 1-2 times every day. Are you?

BACK PAIN MISUNDERSTANDING AND POOR TREATMENT

Recently, I was asked why I created this blog with almost daily posts. The two main reasons are at the core of back pain relief and treatment and may be worth reading.

First, I know that the longer you've had back pain the more likely it is that what you do to help yourself is more important than what the doctors do to help you. This is a terrifying, frustrating, wonderful reality that places the responsibility for pain relief squarely in your hands. I know that numerous treatments for back pain will make the pain worse, not better. I know that the treatments for persistent back pain must be different than those for short term or acute back pain. I know that thoughts, feelings, and behaviors can open or close pain gates and make back pain bettter or worse. I know that people in pain must be educated about medical treatments for pain and communicate more effectively with their doctors in partnership. And I know that even if you are receiving the best possible medical treatment, you probably have more back pain than is necessary for the amount of tissue damage present. You can absolutely hurt less.


Second, after providing webcam and telephone assessment, treatment, and coaching across the U.S. and other English speaking contries for several years, I have learned how bad much of the medical care is for back pain patients across the U.S. and the world. I have learned that most people in pain are not treated in multidisciplinary pain management clinics, are not being treated by pain physicians and pain psychologists, have not been educated thoroughly about their back pain, and deal with the various conflicting agendas of their treating doctors.

Thus was born the need for this blog. My career has been dedicated for a quarter century to relieving medical pain and suffering. This blog is a logical, if unpaid, extension of that dedication for a worldwide audience. If you haven't been treated for several years in a multidisciplinary pain clinic including biofeedback and pain psychology, you can conclude that you have more pain than is necessary or inevitable. If you don't have a thorough understanding of "multifactoral back pain" with hundreds of strategies for self management, you have more pain than you should. If you are not in an agressive partnership with your pain doctor, you hurt more than you have to. If you don't understand that pain relief is largely your choice once you have the knowledge, then you can hurt less.

Some pain is inevitable; how much pain, and how much suffering, is something we can discover together. I promise to work hard for you. You have to work hard for you too.

Dr. Tim

BACK PAIN TREATMENT IS A NEGOTIATION BETWEEN PARTNERS

Back pain treatment is not and should not be a one sided dictation from the top of the mount. You and your doctor are partners in pain working together to achieve the greatest pain relief and increased function. Every treatment decision your doctor makes is based upon his medical expertise, his understanding of your back pain, and value judgements he makes about you related to costs, benefits, and risks of treatment. You must learn about the eleven step hierarchy of back pain treatment. You must learn from and educate your doctor about your back pain treatment, diagnoses, causes, and triggers. You must educate your physician at every appointment about the costs and benefits of the treatments you are receiving and the risks you are willing to take. You should make suggestions for treatment as you vigorously explore "cutting edge" options for treatment and pain management. Don't rely on your doctor to come up with new treatments, that's what the internet and other people in pain are for. Communicate effectively. Ask for what you want. Decline treatments you don't want. Take notes, write down questions and answers. Research topics you have discussed with your pain doctor. If your doctor has a problem with your partnership, or you have a problem with any other aspect of your doctor's treatment, you have the right to find a new doctor. Always. And your doctor has the right to terminate you as a patient. Always. Ultimately, both parties can walk away from a negotiation.