Self-Management: How to manage your pain

Back Pain Self-Management

How To Look After Your Back Outside Of The Treatment Room  

As a chiropractor, the most common issue I see in clinic is lower back pain, which is not surprising considering 1 in 10 people suffer. I want my patients to feel empowered to take control of their pain and look after their spines outside of the treatment room. It is important to maintain the changes that have occurred through treatment by also helping yourself. Not only is being able to self-manage your pain a valuable aspect of your recovery but it is also important in the longer term. 

When managing your pain outside of the treatment room you need to have an understanding of where the pain is coming from. This doesn’t necessarily mean a specific anatomical structure, as damage doesn’t equate to pain. People can have severe injuries and feel no pain at all while others can be in intense pain with minor or even no structural damage.  

For example, The British Medical Journal wrote about a 29-year old construction worker that had suffered a work place injury where a 7 inch nail had pierced straight through his boot. As the man was crying out in pain, he was rushed to A&E and pumped full of pain killers. When the Doctors removed his boot they discovered that the nail had miraculously passed between his toes without penetrating his skin. There was no blood, no open wound, not even a single scratch!! While there was no injury, his pain was very real.  

So where does Pain come from? 

This is a HUGE question to answer and quite frankly can’t be covered in one blog, maybe we’ll save that topic for a rainy day. Pain originates from your brain and, although a phrase I don’t like to use and some don’t like to hear, pain is quite literally in your head.  

Understanding Pain 

How can we understand our pain? Pain is a protection mechanism that our bodies use when the brain perceives a threat. Like in the case study where the man’s brain had registered the nail in the boot as dangerous and a threat.  

Our nerves act like sensors but they are not specific to pain, they respond to everything and are only switched on and fire when there is a lot going on. So not necessarily one event or one singular occurrence. It is the brains job to evaluate what is going on and output it as pain. When you get this pain response it is a real and valid response (not like the phrase suggests as ‘in your head’). It is part of a protection mechanism to signal to your brain to stop what is triggering the pain, so not always meaning tissue damage.  

With this brief explanation we now understand that a pain experience isn’t just through one stand alone event. It is multiple triggering experiences. This is why it is essential to know what causes the pain and what helps ease it.  

Common Triggers 

Recognising the triggers of your back pain allows us to discuss in our treatment session what might work for you as an individual. We can work together to incorporate these activities to help throughout your day, outside of the treatment room.  

Below are some common triggers. Sometimes it is easier (for me as a clinician and you) to make a note of what you feel on a daily basis by keeping a pain diary. This way we can work through each trigger and how to develop a coping strategy. 

• Physical triggers: 
• Worse after a specific activity? e.g. putting your shoes on 
• Working longer shifts at work?   
• Restful day sitting on the sofa?  
• Being on your feet all day?  

• Dietary Triggers:
• Eating fatty foods?  
• A high sugar intake? 
• Eating foods containing gluten and/or lactose 

• Mental Triggers:  
• Stressful day at work?  
• Lots going on at home?  
• Family stressors? 
• Poor mental health or anxious feelings?  

Our lifestyles, environment, diet and exercise are all possible factors in your experience of pain. 

But what can you try to help manage your Pain?

What works for one person may not work for you. Creating your own protocol is essential to maintain long term and long-lasting changes. Try the advice below and form your own protocol from what works.  

Remember don’t be afraid of the pain!! 

• Trigger ball:

  The dreaded trigger ball… To begin with, wedge the ball between you and a wall (be careful not to mark the wall (I don’t want to be held accountable if a freshly painted bedroom is ruined). It can be hard to keep the ball against the wall, putting the ball in a sock gives you something to hold onto if you are struggling. Work the ball up and down your back, pausing on tender spots and making small circular motions around the sore spot.  

  

Alternatively, lie on the ball and do the same as above. Also use the ball to get into your glutes (buttocks). It is better to lie down on the ball for the glutes as they are a big muscle group and need a greater intensity.  

• Strength exercises:

These exercises are based on McGills big 3. They may increase your pain momentarily, but your back will thank you in the long run.  

• Curl up

(Be careful with this one if you also have neck pain) 

STEP 1: 

Lie flat on your back, ensuring your core is engaged and there is no space between your lower back and the floor.  

Place your hands under your buttocks. 

STEP 2:

Slowly and controlled, lift yourself off the floor. This movement should be through your core and not through your neck/head. 
Your shoulder blades should be off the floor. To do this push down into your elbows.  

Then relax and repeat 10 times.  

• Dead bug 

STEP 1: 

In the neutral/starting position everything should be at 90 degrees i.e. shoulders, hips and knees.  

As above, lie flat on the floor with your core engaged, ensuring there is no gap between your lower back and the ground.  

STEP 2: 

Maintaining the contact between your lower back and the floor, extend one arm and the opposite leg down.  

Return to the neutral position and repeat with the other arm and opposite leg.  

Repeat this 5 times on each side to begin with, then try increasing to 10 times each side.  

• Side Plank 

Beginners:  

Lie on one side with your hips stacked on top of each other. Make sure there is a slight bend in the knees.  

Lift your hips up off the ground and push them forward to engage the core and glutes.  

Progression:  

Same as above, except straighten your legs.  

Again, lift the hips up and gently pushing them forward.  

• Treatment 
  Keeping up to date with your treatments, whether that be Chiropractic, Physiotherapy or massage therapy.

• Diet 
  A healthy balanced diet is always recommended to keep your body functioning at its optimum. This is even more relevant when going through a phase of recovery.

Increasing the amount of fruit and veg you consume is always a good place to start. 

• Positive attitude 
  Enforce a positive mindset. Creating a negative space whether that be towards your back or towards life in general this can have implications on your physical pain. 

Try using positive affirmations, the more frequently you repeat these words you will eventually believe them. There are plenty of pre-recorded affirmations available on Spotify and even weekly podcasts. However, some of you may find it easier to make your own up. 

• Exercise
  Exercise that is right for you.

• MOVE!

Like I mentioned earlier, do not be afraid of the pain.  

Have the same attitude towards self-help and exercise as the same way you drink water. Don’t wait until you are thirsty to have a glass of water, but drink little and often. Try not to leave exercises till the end of the day but do little and often throughout the day.  

Remember it is normal to have both good and not so good days with your pain. Very rarely is the journey to recovery A to B, it is okay to be up and down. 

If you have any questions about creating a self-management protocol that is right for YOU, please get in touch! We would love to help. Feel free to email Kelly at kelly@tivolichiropractic.co.uk.

Read our next article by Physiotherapist and Pilates instructor, Philippa, to learn what Pilates actually is and why we should all be doing it.