Weekly musings, 10/8/17: the inverted U conundrum

Weekly musings, 10/8/17: the inverted U conundrum
For the last several years, I have been under the impression exercise and chronic low back pain correlated in the shape of an inverted U. People who are inactive have a higher risk of developing pain, moderate exercise has a protective effect against pain, and eventually, a tipping point exists where high levels of exercise are correlated with higher likelihood of chronic low back pain.

It turns out, I may have been misinformed.* A very large Norwegian study that spanned 11 years did not find high levels of physical activity correlated with higher risk of chronic low back pain (defined as pain lasting three months or longer). What the researchers were able to conclude was there is no added protective benefit when individuals get more than three hours of strenuous physical activity a week.

I regularly work with active individuals struggling with chronic pain issues. Pain, as I have noted before, is multi-faceted. Those of us that are already active tend to think we can exercise the chronic pain away through a myriad of self inflicted exercises and ideas we find on the internet. This doesn’t always work, and if my clients are any indication, can occasionally make things worse. The two interventions I can generally do to make things feel better is a) give them movement options that differ from their current patterns and b) calm things down, through breathing, rolling, or rocking. What I don’t do is tell people to stop the activities they enjoy; instead, I try and help them find alternative ways of doing them that don’t cause pain. 

Professionals that work with pain are often quick to vilify specific activities. It appears cyclical; one month, Crossfit is awful, the next, yoga is ruining your back, and the next, running is destroying your joints. What if it isn’t the activities that are causing the pain as much as it’s the sameness with which we perform the exercises? If we regularly added variability of movement into our routines, through different cueing and alternating periods of hard work with periods of moving easily, would pain in active populations decrease?

Maybe, instead of telling people, “if it hurts, don’t do that,” we asked them, “can you find a way to do it so that it doesn’t hurt?” people would feel more empowered and in control of their experience and their bodies. And that, it seems, would be a good thing.

*Article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827170/