Some people say “It hurts so it must be working!” and others say “It hurts so it must be bad for me!”
The most important first step in the self treatment of your low back is understanding how to interpret what you feel as a good or bad result from an exercise or activity. There’s more to it than just increasing and decreasing pain. Watch the video to find the most common ways symptoms change following exercises and whether the changes are good or bad. If you prefer a written description of how to interpret changes in low back pain then continue reading.
This is the first video in the Back Self Assessment and Treatment series based upon the McKenzie Method. To find out more about the series click here.
*The content in this series is meant as guidance for self assessment and treatment, however it should not be considered official medical advice.*
The most important first step in self treatment of low back pain is understanding how your symptoms change and whether the changes are good or bad. It may seem obvious but many people’s intuitions of good vs. bad changes in symptoms disagree with one another. Let’s start with the obvious:
1. If your pain increases in intensity, it’s bad. If it decreases in intensity, it’s good.
Unfortunately, usually tracking symptomatic changes is more complicated than that.
2. Pain which encompasses a broader area, or increased surface area is worse than pain which encompasses a more narrow, or smaller surface area.
This is regardless of how intense the pain is. This seems easy to understand when put so simply, however in reality it can be hard to follow.
If you sit up straight to improve your posture and as a result you get a sharp pain in the center of your back that wasn’t there before, most people would come right back out of the upright posture. However, if you pay attention then you may find that in a slouched posture your pain (while it may be less) is more dispersed across your whole back. Broader pain, however, is worse then focal pain.
3. Symptoms which peripheralizes are bad. Symptoms which centralize are good.
Symptoms from your back can refer all the was down to your feet. The farther down symptoms from your back are referred (peripheralized), the worse the problem. If you do an exercise and symptoms move from your knee to your hip (centralize or move closer to your spine) then that is a positive change. Again, this is regardless of how intense your pain/numbness/tingling/burning your symptoms are. The intensity of your symptoms may decrease as they centralize, they also might stay the same, and, unfortunately, they may also increase. Location of symptoms trump intensity of symptoms.
4. The last common change in symptoms important to understand is: Unilateral (one sided) symptoms are worse than symmetrical (double sided) symptoms.
If you have pain that travels as far down as your left knee then after an exercise the pain travels down to both knees, this is a positive change. The reason is that symmetrical symptoms indicate a more central problem in your back, which is why is affects both sides. As a general rule, central problems are easier to get rid of through a series of exercises than asymmetrical problems.
How many of these rules did you know? Does this change any of the exercises you’ve been doing?
The next post in the series describes the traffic light analogy of tracking the benefits of an exercise. This concept is crucial to understand before attempting any activities which may affect your low back symptoms.
Dr. Charles Baldi
Ortho and spine specialist
Doctor of physical therapy
Baldi Movement Group LLC
www.baldimovementgroup.com
ContactUs@baldimovementgroup.com
(610) 484-4487