We all know the importance of keeping active in the fight against back pain.

Regular exercise should keep up healthy, not just preventing mechanical issues such as back pain, but also helping to reduce the likelihood of conditions such as diabetes and heart disease. It also contributes to a better immune system and improved mental health.

Yet we see plenty of patients who exercise regularly (or are at least very active - not quite the same thing!) but who have been affected by back pain. So what's going on? What's missing?

Three Pillars

In the rehabilitation we provide for our users, we divide tasks into three categories: movement, strength and control.

• Movement is important. Joints need to move enough that we can get our bodies into the shapes and positions we need. You can't brush your teeth if you can't bend your elbow, and you can't sit comfortably if you can't flex from your hips.
• Strength is important so we can generate enough force to move ourselves and objects around us. We don't need to be bodybuilders, but we need to be able to climb stairs and carry our shopping.
• Control is the element that people forget about. Without control, movement becomes clumsy, and strength is misdirected. This can cause problems.

Does activity need to be mindful?

During the current lockdown, a lot of people are relying on a daily walk to keep themselves fit and active. Great - it gets blood flowing, lubricates joints, and gets us out into nature (even the wet, rainy variety).

But are we doing anything to work on our control? Are we minding how we move? Perhaps not.

The same can be said for running and even cycling. Yes, they are forms of exercise, but the movements are predictable and repetitive, so once they've been learnt, a whole aspect of our movement needs - the control element - are left unfulfilled.
(Ok, so I'm being tough here - of course, runners might work on their technique, and cyclists can address any issues they have. But these are examples of fine-tuning, not learning new vocabulary)

How can we improve control?

This brings us to Pilates, yoga and the like. Will they cure all back pain and prevent future occurrences? No. They couldn't possibly stake that claim. 

But if a person is having their movement skill monitored and coached for at least a proportion of the time they spend being active, then we start to realise that we now have a contribution towards their skill. Bad habits are being trained away, and good teachers will raise awareness about areas of stiffness or weakness.

I don't use the word "mindful" in the complete context of meditation, but having self-awareness of what you're doing is important (and is an element of meditation).
"Mind your language" is what our parents all told us, and they meant the same thing. 

What to do?

Ideally, having one-to-one coaching is ideal. The next offer available is a group class. These are all harder to facilitate in the current lockdown conditions - we are sadly at the mercy of internet connections, image resolution, and frame rates in order that what we're doing can be monitored on a 2-dimensional screen. Not very satisfactory.

But still, learning a new skill, by watching Pilates or yoga on one of the many available channels can only be a valuable contribution to increasing our skills. And it's not just those two disciplines. There's Tai Chi, Qi Gong, martial arts, dance in many varieties, Alexander technique and many, many more. 

You don't need to stick to one of them forever. It's probably best to keep learning new things. Learn to ride a horse, incorporate new movements into a gym routine, try a new sport.

Time to explore, and learn new skills.