The BackPain.online Blog

The Information Centre that acts as a focal point for anyone seeking education, advice and help on both preventing, and dealing with, back pain.

 

Learn more by signing up to our newsletter

Do you know what you're doing?

activity back pain back pain advice exercise rehabilitation Feb 15, 2021
doing an exercise on the floor

A common conception of injuries such as back pain is that there are exercises or stretches that can be done to help stimulate or speed up recovery.

The expectation from many patients is that a therapist will tell them what's wrong with them, and subsequently give them exercises to solve the problem.

But let's think about this:

  • Do you need exercises, or would a period of rest be better?
  • Do you need to be more flexible, have better strength, or display improved control in order to consider your problem solved? Do your exercises fulfil these goals?
  • Do you know when the exercises have done the job? Must you do them forever to prevent a relapse?

 

Shooting in the dark

All too often, patients are doing exercises that have been given to them, but they don't know what they're doing. It's commendable that some patients religiously plug away at their exercise plans, but the simple fact is that a lot of exercises are either:

  • Not helping, and perhaps even aggravating the condition
  • Mismatched to the patient's needs or even treating the wrong condition
  • Out of date - the exercise fulfilled its purpose and is now ineffective

Sadly, a lot of people are wasting their time, working on strength when they have no flexibility, or trying to get flexible when they have no balance.

 

Accompanying recovery

There's a case to say that therapy, whether hands-on or exercise-based, exists merely to accompany patients through a natural recovery. Perhaps the only real value of a therapist is to smooth out any lumps in the process and offer education and reassurance as they progress.

But hang on, a very real value of giving people things to do is that it enables patients to re-build confidence in their capabilities. By carefully exposing patients to increased levels of activity, they build up tolerance. Whether that's specific muscles around a knee or shoulder, or more global activities as walking to help back pain, the patient is restoring resilience.

So activity and exercise prescription must be a valuable tool in helping people. But a scattergun approach of giving everyone lots of exercises in the hope that something will help sounds rather speculative, doesn't it?

 

A better way 

There may be specific exercises that an individual needs. These need to be chosen according to the condition of the patient. 

Inevitably, this is going to be a bespoke process. This is why generic sheets of exercises for certain conditions sounds like a clumsy approach. 

Instead of relying on a "comprehensive" set of exercises, dished out quickly and with the belief that the patient will, of course, perform them like a model student, why not take the opposite approach?

  • Explain what is wrong.
  • Identify areas that the individual might need to tackle and those they don't.
  • Choose one of them to start with. 
  • Try some methods to see which one addresses that single issue the best.
  • Ensure that the patient agrees that they now have a potentially successful tactic * to use.
  • Agree on the result the patient is after and what they should do it they hit that target.
  • When it's time for review, discuss whether the tactic has been successful, and either remove it, swap it, or add to it.

 

One small step

Especially when working with children, we should perhaps satisfy ourselves with the target of giving one great exercise that engages the patient, works on an area that needs addressing, and does this in a way that the patient can appreciate. 

This way, we have a better chance of getting compliance from the patient. We'll get better results, and perhaps best of all, we produce a patient who is proud of their achievement and pleased that they have made progress.

 

Repeat after me...

So next time you do an exercise you've been given, ask yourself:

  • Why am I doing this? What is it solving?
  • How does it work? How do I get the best result?
  • What result are we after? What do I do then?

If you can't answer these questions, then you're wasting your time. Ask for a better plan.

 

But I'd rather do the same thing as before

No plan ever survives the battlefield.
Be prepared to put a tactic aside, and try another.
Work through the problem, learn what works, keep what you need.

 

* Strategy and tactics are not the same.

  • A strategy is a goal - to win a war, to fix a patient.
  • A tactic is a means towards the goal.
    We attack from the left. And when it fails, we attack from the right.
  • We keep our strategies fixed, but we can change our tactics. And perhaps we should always look to change our tactics for something better.

 

 

Learn more by signing up to our newsletter

Join Now

Explore our other blogs

Missing the Simple

A swift lesson about PAIN - part three

Repetition, repetition, repetition

Show me more