exercise in pain
Should I Stop Exercising When I Have Back or Neck Pain?
The answer is, “Not at all, but sometimes…..yes.”
How do you know the right thing to do? Let us talk through it. I will give you some general guidelines and thought processes to consider. These are random thoughts and are not particularly well-organized. But, there should still be plenty takeaways to learn from.
Let us start with the obvious. If an injury is severe and you suspect it to be an emergency, go to the emergency department.
Outside Of Emergent Conditions
Have you ever known someone that had surgery? Surgery such as having the appendix removed, a hernia repair, or a new mother that had a C-section. If you know of someone that has gone through these things, you may recall something that is shocking to some. I am referring to the fact that the medical staff has them out of bed and walking the hospital halls the very next day. This sounds like ancient medieval torture on a scale with what Mel Gibson endured at the end of Braveheart. But I assure you it is not.
Research has been very clear. Movement is healing. Those that lay in bed awaiting some magical healing actually do worse in the long run. Not only do they do worse, but the recovery takes much longer to achieve. That is why, no matter how detrimental it may seem, new surgical patients are up and moving.
We can correlate that thought process with back and neck pain as well. Research has an answer on spinal pain too. Those that have painful backs need to be moving. They need to exercise to the extent they can exercise. But they need to exercise correctly and safely. Going back to the gym and muscling through a bunch of the stuff you always do may actually make things worse. You need a trained professional’s advice to get you back to being active safely. Active in a way that does not cause the pain to come right back or even get worse than the original injury.
A good start is to recognize the difference between ‘hurt’ and ‘harm’. Many times, when we are recovering, certain activities can hurt. As long as they do not seem harmful, they are typically acceptable and encouraged. If a patient feels a particular activity is actually harmful, they are expected to stop that activity and/or modify it to the point it can be tolerated.
The last thing we as practitioners want is for the patient to fall into what we term 'fear-avoidance’. This is where patients begin to avoid normal activities of daily living. When patients start avoiding normal activities because they are afraid that ‘hurt’ equals ‘harm’, then the patient begins a long slow downward spiral into chronic pain syndrome. It is vital to push through many of the things that may be painful in the beginning.
Pain and movement are as many mental games as they are physical. Once one convinces themselves they can’t do something or that it is unsafe for their body to try it, then we lose more and more capability. This loss only continues to get worse and worse as time passes.
What Kind Of Exercises Are OK?
We have established the general concepts that movement is healing, that movement builds confidence in your abilities to recover, and that movement helps avoid fear avoidance. Knowing that movement is usually encouraged, let us now talk about what movements make the most sense.
If the pain shoots into a limb (arm or leg), you should visit your closest evidence-based chiropractic office that does exercise rehabilitation so they can offer you exercises based on the concept of nerve flossing or nerve gliding combined with McKenzie exercises. Maybe even some over the door traction or non-surgical spinal decompression to help calm the nerves down.
These are great options but let’s face it, we don’t exercise our necks all that much. The more used area in a gym is the low back. If the area is in the low back, the key is to nail the diagnosis and to remove the trigger.
We know that patients under 50 years old that present to a clinic of any kind with low back pain breaks down as follows:
  • Disc herniation or bulge = 40%
  • Facet pain = 30%
  • Pelvic pain = 22.5%
Then we can break that down even further.
Typically, low back disc injuries hurt over the midline in the back, they like to extend at the waist, walking helps, sitting is the worst, and lying down is usually the best position. And on and on and on.
Facet pain does not like extension at the trunk. Especially when you add rotation to the extension. They hurt a little out to the side of the spine and they don’t like it when you apply a little bit of pressure to them.
For the pelvis, sitting to standing hurts, they locate their pain below the beltline and further out to the side, and walking is not good for these patients.
There are other conditions of the low back like sprain/strain, stenosis, and more but these are the three big ones.
As you can see, an expert would prescribe different exercises for different conditions based on being able to nail the diagnosis. The determining factor in the resolution of a complaint is getting the diagnosis right because that is what you base your exercises on.
For example, in a disc herniation patient, the majority are what we call extension biased. I would recommend a good healthy dose of extension biased exercises that enable the patient to mitigate pain at their home. Many disc herniation patients have pain, numbness, or tingling into a leg. There are nerve flossing and nerve gliding exercises that can help control it from home.
In these patients, we do not want them in a car for a long time. We do not want any patients doing traditional sit-ups. Ever. For any reason. We do not want these patients doing leg presses or squats that apply load to an already injured disc. However, walking is an excellent activity for these patients.
Key Takeaways
There are too many variables to try to give recommendations here in a blog. However, here are some key takeaways:
  • Movement is healing
  • Movement builds confidence in your ability to recover
  • Movement helps avoid fear avoidance
  • Recognize the difference between ‘hurt’ and ‘harm’
  • Continue moving through an injury but it’s best to speak to an expert, evidence-based chiropractor first
  • Each type of injury requires different kinds of exercise to perform as well as to avoid.
  • For a low back injury, learning to keep your spine stiff, straight, strong, and neutral goes a long way toward removing the triggers that probably started the issue in the first place. Thank you to Dr. Stu McGill and Dr. Tim Bertelsman
  • Abdominal bracing. When preparing for load, be sure you are properly bracing your abdomen commensurate to the activity about to take place. The same amount of bracing is not required to lift a car as is required for bending over to pick up a small box. Brace for the occasion.
I hope I have helped answer some of your questions. The biggest points to stress are to not stay at home laying in bed and avoiding things you love because you are afraid it will hurt. Get out there, start slow and steady, progress 10% each week if possible, and do not….whatever you do….do not let pain take control. Fight it back by remembering that motion is the lotion for your joints and though it may be a bit sore in the beginning, this too shall pass.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast. Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]
Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109
Jeff S Williams, DC, FIANM, DABFP

Jeff S Williams, DC, FIANM, DABFP


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