Taking a brief pause again until Monday, Dec 7th before offering up some evening practices. If you’ve been following along you might want to return to some of the daytime options below.
Again, this is not to say you should be doing “ALL OF THE THINGS”. Particularly as some of THE THINGSlikely won’t resonate or feel right for you in your life as it is today. We all have different lives, environments, needs, bodies, histories.
Which is why getting curious and exploratory can be useful rather than having someone tell you this is THE THING that will work for you. In my experience, if THE THING worked for everyone we wouldn’t have 1 in 4 people living with chronic pain, or so many other conditions or concerns. What if you’re told ‘just do this’ and it doesn’t work? Maybe you end up feeling like you failed in some way (once again), rather than perhaps it wasn’t what was right for you.
If you’d like the opportunity to work with me, I currently offer private 1:1 sessions. Stay tuned for new offerings coming your way in the New Year! Sign up on the yogatoolsforlife website, or follow along on Facebook or Instagram.
Previously I wrote about the first in a series of published papers in the Lancet regarding the global burden of disability caused by low back pain and why we need to pay attention. You can read it here.
My hope is perhaps you’ll come to see for yourself there are promising directions for those disabled and suffering from low back pain.
I. Prevention
Most of the widely promoted interventions to prevent low back pain do NOT have a firm evidence base.
A surprising statement, isn’t it? These include what you have likely been told over and over again to do, yet evidence of their success is not there. Strategies about workplace education, no-lift policies, ergonomic furniture, mattresses, back belts, lifting devices. How often have you heard about most or many of these in terms of how we might prevent low back pain?
What then, seems to work?
II. Treatments
First, is the recommended use of a biopsychosocial model.
I suggest most of the general public has never heard of this term or model of care. I surely didn’t just a couple years ago when I was first started to dig into the overarching problem of chronic or persistent pain that affects so many people.
What is this? Well, as often defined it encompasses “a dynamic interaction among and within the biological, psychological, and social factors unique to each individual.” My emphasis on the ‘unique to each individual’, as that’s turning out to be an important piece of the complexity of pain.
Second, greater emphasis is needed on
Self-management
Physical and psychological therapies
Some forms of complementary medicine,
Along with less emphasis on
Pharmacological and surgical treatments.
What’s actually being utilized in our clinics?
Surprisingly, the treatments with less emphasis and effectiveness = pharmacological and surgical treatments.
Countries such as Denmark, the USA, and the UK do have guidelines around this. They are supposed to utilize exercise and a range of other nonpharmacological therapies such as massage, acupuncture, spinal manipulation, Tai Chi, and yoga.
Clinicians are meant to provide people with
Advice and education about the nature of their pain;
Reassurance that they do NOT have a serious disease and their symptoms will improve over time;
Encouragement to stay active and continue with usual activities.
Self-Management
I understand even the notion of engaging in movement and exercise is difficult for people who are experiencing pain. How do you keep active when you are in pain? How much does advice, education, reassurance really help? People typically go to their health care providers and want something to ‘fix’ the problem. Not more advice. However, evidence shows this does help. And, evidence shows that the pharmaceuticals and surgeries we’ve come to rely on, don’t. In the long-term, particularly. If they worked, we wouldn’t find ourselves in this predicament. Understanding that you have a part to play, in getting better, is critical.
Movement or Exercise Therapy
Going back to the problem of trying to move, when you’re in pain. Something that people may or may not be familiar with is the term graded exposure. Basically, it means you start where you can, and gradually, over time, work to increase your overall capacity.
I tell my clients it will help to do even the smallest of movements. Use your imagination and even just visualize movement if you must, but you CAN start somewhere. Move your feet, or hands, or arms an inch, if that’s what you can do today. Just begin.
It has been shown to be useful if you can tie in your exercise or movement with something you want or need to do, rather than just some kind of exercise that is not motivational for you.
It’s not really so much WHAT you do, but that you DO something.
“Since evidence showing that one form of exercise is better than another is NOT available, guidelines recommend programmes that take individual needs, references, and capabilities into account in deciding about the type of exercise.
I use tools that yoga offers and work to help keep clients joints moving in all the many ranges of motion they might need in their life. This does not mean they need to have a life-long love or commitment to yoga.
Yet, yoga does offer an important first step of building awareness and subsequently using gentle movement, breath awareness, and tools to ‘ease into a movement’ that may have be feared in the past. People can learn to calm their nervous system, work in a safe pain-free range of motion (or not increase pain). From there we work to build stability strength and power in whatever it is they want to do … be that swimming, walking, biking, skiing, playing with kids, sitting at a desk all day. Whatever it is they want to do in their life.
Passive Therapies
It should be noted that some guidelines DO NOT recommend passive therapies, such as manipulation or mobilization (think chiropractor, massage, acupuncture). Some guidelines consider these short-term options, optional. The same goes for other passive treatments received in a physical therapists office like ultrasound, nerve stimulation, etc.
Though these passive types of therapy may help to temporarily feel better, they often have many returning again and again, becoming dependent on them for relief. Much of the current research shows the need to get a person ‘involved’ in the treatment. Get their brain and nervous system participating in movements or other practices, so passively ‘being worked on’ might not be a long-term solution.
Psychological Therapy
Guidelines also recommend Cognitive Behavioral Therapy (CBT), progressive relaxation and mindfulness-based stress reduction (MBSR).
This again is where yoga can play a part in terms of relaxation. I’ll often incorporate strategies from MBSR when working with clients.
Pharmacological Treatment
Guidelines now recommend pharmacological treatment ONLY following an inadequate response to (the above mentioned) first line non-pharmacological interventions.
Paracetamol was once the recommended first-line medicine for low back pain; however evidence of absence of effectiveness in acute low back pain and potential for harm has led to recommendations against its use.
Health professionals are guided to consider oral non-steroidal anti-inflammatory drugs (NSAIDS), taking into account risks … and if using, to prescribe the lowest effective dose for the shortest possible time.
Routine use of opioids is NOT recommended, since benefits are small and substantial risks exists…
The role of gabaergic drugs, such as pregabaline, is now being reconsidered after a 2017 trial showed it to be ineffective for radicular pain … guidelines generally suggest consideration of muscle relaxants for short-term use, although further research is recommended.
Surgery
The role of interventional therapies and surgery is LIMITED and recommendations in clinical guidelines vary.
Recent guidelines DO NOT recommend spinal epidural injections or facet joint injections for low back pain… they DO NOT seem to provide long-term benefits or reduce the long-term risk of surgery and have been associated with serious adverse events.
Benefits of spinal fusion surgery … are similar to those of intensive multidisciplinary rehabilitation and only modestly greater than non-surgical management.
UK guidelines recommend that patients are not offered disc replacement or spinal fusion surgery for low back pain.
For spinal stenosis … patients tend to improve with or without surgery and therefore non-surgical management is an appropriate option for patients who wish to defer or avoid surgery.
So why the GAP between evidence and practice?
Stay tuned and we’ll look to see how this is played out and why it’s imperative that we change it.
I’ve written about this before, here. But I think it’s important to talk about again.
People associate yoga with flexibility.
I do associate the word flexibility with yoga, but it’s in how we apply flexibility to our life.
That is, we have lots of choices available to us.
People often get stuck and then their choices become smaller, and smaller, and smaller… until they feel something a little like this; boxed in.
What I’m really looking for is this:
Freedom.
Do you have freedom, to do what you want in your life?
Do you have the freedom to BE you?
Skills that may aid in this might be strength. Physical strength if you want to move around in the world. Be able to go jogging, walking, cycling. Even to simply pick up and play with your kids/grandkids.
Maybe you are an office worker or writer and need to sit a lot of the day. What skills might be useful to do that?
A skill may be the ability to voice your opinions at work?
Or the skills required to get a good night’s sleep, so you have the energy for the coming day.
A useful skill may be noticing what creates tension in your body.
Try sitting in a dentist chair for any length of time and notice how you feel? A sore jaw, perhaps, makes sense. But what might your shoulders feel like? Or your leg muscles? Imagine doing this, unknowingly creating tension throughout the day, and what it might create? Pain, fatigue, stiff or sore muscles.
Yoga, is all about the noticing.
Which helps guide our life, …
out of the box, and toward spaciousness and freedom.
Consider the ways you need to use and move your body every day.
Depending on your life, how much you move throughout the day may be fairly limited or alternatively, you might go through a whole range of movements.
Do you work in an office? Sitting, walking, reaching, writing might be some of the things you do in a day. I suspect sitting, is a primary one. Do you work as a plumber? Your movement needs are different than the office worker. As are what a doctor, teacher, hairstylist, service worker, etc. will be, who are often on their feet much of the day.
What you need to ‘train for’ is different than what anyone else needs to ‘train for’.
What a person needs who sits at a desk all day, is different than what a parent with toddlers needs, versus what a teacher might need.
We sometimes get into trouble when we’re doing exercises, that don’t always or altogether correlate so well to what’s actually required in our life. If you’re exercising for basic fitness and enjoyment, that’s fantastic. That in itself is an achievement. But perhaps you might consider adding more to the mix if you’re someone who also experiences pain, fatigue, etc.
This is important:
If you’re hitting the gym every day, building strength and stamina but suffer from low back pain because you’re also sitting in a chair for 8 hours a day, perhaps you need to train differently or add something to your training routine.
If you are the most amazing yogi but suffer from hip strain or other pain symptoms because during the rest of the day you’re standing on your feet, perhaps you need to look at what you’re training for.
If you’re out on the golf course getting your exercise and fresh air daily, but cannot ‘do, or manage’ the rest of your life, perhaps you need to do something else as well.
What happens all too often is the hour of exercise we get at the gym, yoga studio or out on the golf course doesn’t quite support all the rest of what we need to do in our day.
If you need to sit, train as best you can so your body can adapt for this.
If you need to stand, train what’s required in order to stand a lot.
If you are the golfer, train for whatever it is you need to do, besides golf.
But how can you do this and where to find the time?
It’s not always easy, but you can learn to build it into your day. It doesn’t always have to take another hour going to the gym, paying for a babysitter, driving through the snow. There are simple tools, you can use. Anywhere, really. That don’t take up a lot of time.
