In every episode we share valuable insights from systematic research and clinical guidelines, as well as advice from experts dedicated to helping people recover from chronic low back pain. My Back Recovery promotes evidence based treatment options, safe training and expert strategies to help you make smart decisions about your rehabilitation process.
Interview by Darcy Coss from Back2Basketball
Darcy Coss interviewed me for his really cool podcast “Back2Basketball”. Having an amazing rehabilitation journey by himself we had a nice talk about:
the biggest thing people get wrong about their backpain (11:55) the importance of movement (24:36) the importance of posture (28:10) how to change your sitting behaviour (30:27) mindfulness (42:21) first steps to start your rehabilitation and feeling better (48:26)
Please check out Back2Basketball:
Getting an MRI-Scan or X-Ray for Your Back Pain? – Listen to This First!
- What you should know about MRI and Xray when you have low back pain - Most of typical imaging (making an mri, ct or xray) findings of people with LBP are part of normal aging and are not related to back pain. Using these images to explain your pain without an accurate examination and a carefully guided clinical history interview, is not supported by current scientific evidence!
Clinical guidelines say imaging should be avoided unless signs that raise suspicion for a serious underlying condition like malignancy, spinal fracture, infection of the spine, or cauda equina syndrome are present.1,2,3,4
These signs are usually called 'red flags'. And only a very small percentage of LBP categorises for this group of severe pathology, usually around 1% -> Most people do not show such signs.
Are you having serious disease? (red flags) A potential serious disease is identified by your medical doctor while taking a focused history and looking/listening for so called "red flags". "Red flags are features from the patient’s clinical history and physical examination which are thought to be associated with a higher risk of serious pathology."5 There is no definite list of red flags, but the most commonly used are2:
aged over 50 years old history of cancer steroid use Other commonly suggested “red flags” in clinical practice guidelines are5,2:
faecal incontinence urinary retention widespread neurologic symptoms (could be a palsy, marked weakness of muscles, decreased sensation (feeling numb on your skin), something seriously wrong with your reflexes and your medical doctor will know how to look for that) no improvement in symptoms after one month unexplained weight loss fever being systematically unwell Whilst the use of red flags is recommended by all clinical guidelines there is still little empirical data for its diagnostic accuracy.5,6 If a combination of red flags raises the suspicion of your clinician he or she should assess prognostic factors such as X-rays and blood tests or magnetic resonance imaging to rule out or identify serious disease (malignancy, spinal fracture, infection of the spine, cauda equina syndrome). The so often mentioned slipped disc by itself is not considered a severe pathology!
So why is imaging of your spine not recomended in the absence of red flags?
To put it simple: People with no LBP can have worse mri´s, ct`s or xray´s than people with LBP.
Most of typical imaging findings of people with LBP (such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy) are part of normal aging and are also present in 90% of individuals 60 years of age or older without even having LBP. Also more than 50% of people without any LBP between 30-39 years of age have disk degeneration, height loss, or bulging in their imaging findings.7
Furthermore no association was identified between findings like spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the the occurrence of LBP.8 No association between lumbar spine facet joint osteoarthritis, identified by multi-detector CT, at any spinal level and LBP.9
Findings on mri are also not predictive of the development or duration of low-back pain.10 Individuals with the longest duration of LBP did not have the greatest degree of anatomical abnormality.11
A recent systematic review concluded that in the acute setting of sciatica (pain radiating down the leg), evidence for the diagnostic accuracy of MRI is not conclusive.12
Let´s put in an example:
If you randomly choose 100 people above 30 years of age that do not have LBP and feel perfectly fine, more than 50 of them will show the typical signs of degeneration that are often (mis)used to explain the cause of LBP.
The same stands true for people with LBP. They too have a good chance to show those signs, but it is just a normal picture, your skin too does not look like the skin of a 10 year old. It´s in most cases a normal
Stress Management as a Top Priority in Your Rehabilitation Process
Through relaxation you can break the vicious circle of pain and stress. This podcast takes you through some easy to learn methods of relaxation, helping it to become part of your daily life and improving your wellbeing. It also lists the benefits of meditation and looks at the supporting scientific evidence, examining why relaxation should be an integral component in your recovery.
Relaxation Relaxation is an integral component of cognitive behavioral treatment programs for chronic pain.1 Taking care of stress and anxiety as a chronic pain patient is crucial for your recovery.
Meditation is also a great way to built relaxation into your daily life. There are many different ways of practicing meditation and you have to find what works best for you.
Many people enrich their lives through practicing meditation.
When you read interviews with successful CEO´s, entrepreneurs or celebrities who have incorporated meditation routines in their lives it is astonishing to see the huge benefits they experience.
Personal benefits of people who meditate regularly: more happiness
having more energy
having more creativity
living more efficiently
a better understanding of ones own emotions
more sensitivity to the feelings and emotions of others
more control over ones own emotions
less pressured by your experiences
feeling more relaxed
more calming thoughts
control over your sensory filtering
improved memory and executive function
increased ability to concentrate
increased emotional intelligence
Thinking about relaxation, mindfulness and awareness during our recovery can’t be done without looking at some important evidence and thoughts about meditational practices:
Mindfulness meditation programs improve anxiety, depression and pain over the course of 2–6 months. The effects are comparable with those you can expect after taking antidepressants for the same period of time, but without the associated toxicities.2
47 placebo-controlled trials all found small to moderate improvements in pain, anxiety and depression. What is really great about this review (Meditation programs for psychological stress and well-being from 2013) is that it demonstrates that the meditation group attained better results compared to the control group undertaking an equally intense treatment regarding focus and time, such as lectures, talks and art therapy sessions.
If we consider this evidence, then it seems a good reason to check out mindfulness for yourself and see if meditation could be something for you to try.
A definition of mindfulness Mindfulness has been described as a “non-elaborative, non-judgmental awareness” of present moment experience.3
Maybe you have heard of Zen, it´s very closely related to the mindfulness approach.
In general mindfulness techniques can be divided into two styles:
focused attention "Focused attention is associated with maintaining focus on a specific object, often the changing sensation or flow of the breath or an external object. When attention drifts from the object of focus to a distracting sensory, cognitive or emotional event, the practitioner is taught to acknowledge the event and to disengage from it by gently returning the attention back to the object of meditation".3
open monitoring "By contrast, open monitoring is associated with a non-directed acknowledgement of any sensory, emotional or cognitive event that arises in the mind. Zen meditation is considered to be one form of open monitoring practice. While practicing open monitoring, the practitioner experiences the current sensory or cognitive ‘event’ without evaluation, interpretation, or preference".3
Many guided meditation programs consist of a mix of those two styles. Often changing from one to the other within a meditation session.
I also think that it’s really important to know that clinical research into mindfulness has been going on since the early 1980s. For m
Setting Goals to Boost Your Recovery from Back Pain - Part 2
Goal-setting can support your recovery from back pain and lead you to a better quality of life. Part 2 of this episode shows you proven techniques that help you in achieving what you aim for. + download your personal goal-setting sheet for free!!!
Get your free Personal-Goal-Setting-Sheet here
Part 1 was about what you should aim for in your recovery:
Increasing physical activity1,2,3,4 improving sleep quality4,5 managing stress4,6 Now let´s dig in how goal-setting can help us in achieving that.
In their Article from 2002 Edwin Locke from University of Maryland and Gary Latham from Univerity of Toronto sum up the evidence about what science knows about the mechanisms of goal-setting.7
Goals affect performance through four mechanisms: direct attention and effort energizing function goals affect persistence, hard goals prolong effort (important for us, recovery process is a long term comittment) goals affect action indirectly by leading to the arousal, discovery, and/or use of task-relevant knowledge and strategies
To sum it up: "Effects of Goal-Setting are very reliable. Goal-setting theory is among the most valid and practical theories in organizational psychology."7
Those with high specific goals reach higher performance than those who tried to do their best. It´s not always that easy and we will talk about what research tells us, what is important in defining goals that help reaching higher performance. And thats exactly what we are looking for.
They further conclude:7
a goal should be specific,
proximal goals should be added,
proper use of learning goals should be made.
What does this mean?
A general goal would be: Increasing physical activity.
A specific goal would be: Increase walking distance up to 20 min a day. Translated into a proximal goal: Walk 20 min every day for one week starting today.
And you could also add a strategy: Walk 20 min every day, before a get into the car driving to work starting today, or getting out of the bus-stop one station before my destinantion and walk there. Be creative!
So thinking about activity:
Set specific Goals.
Add a proximal goal and add a strategy
Be clear about why you are doing this!
You are not doing this right now to become instantly pain free, you want to increase physical activity, increase quality of sleep and manage stress because in the long run that is what you will benefit from and as aresult will increase your quality of life.
Start with something that you are confident to achieve.8
No doubt there should be some challenge within your set goals. Sucess in reaching your goals will feed your confidence and step by step you can start set higher goals for your self. Goal setting is also about self efficacy, which means confidence in that you can achieve your goals. So thats a reward on it´s own, and we need that in roder to go on with our recovery.
Goals lead to higher performance when people are committed to their goals and receive summary feedback.
And there are several ways you can enhance commitment.
Through factors that make goal attainment important for you
First of all write your goal down. Put your Goals somewhere where you can see them, so that you stay focused and you reflect upon them.
Having an accountability buddy helps in multiple ways. The announcement to another person will raise the importance of xour goals for you and if you hold a weekly conversation where you report about your progress or difficulties you will have a fixed time to reflect upon your situation and this feedback will enable you to find better strategies to overcome difficulties.
Resource Section: Goal-Setting-Sheet
Get your free Personal-Goal-Setting-Sheet here
Set your goals for each day and at the end of the day reflect on them. Did you made it? Great! If not reflect about the reasons for it. Can you think of any strategy how to achieve your goal the next time you will be in the same situation? Could you ask
Setting Goals to Boost Your Recovery from Back Pain - Part 1
8.1 Setting Goals to Boost Your Recovery from Back Pain - Part 1 What we should aim for in our recovery process and how setting the right goals can help us with that.
What to aim for The most effective treatments for low back pain include exercise or multidisciplinary rehabilitation (also see Episode 06).
Passive treatments, on the other hand, have not been demonstrated to induce long-term improvements.1
Physical Activity and Therapeutic Exercise 2,3,4,5 This is what we know what will help in the long term. Increasing activity. Developing a set of active coping strategies.
Improve Sleep5 Improving sleep also makes total sense, since over 50% of people living with chronic pain suffer from depression and there is a strong correlation between quality of sleep and depression. And depression has an impact on your recovery process.5
"Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP"6
According to the "2015 sleep in america poll", making sleep a priority is linked to better sleep, even among those with pain. Setting the right goals has a direct impact on your life.7
Check out the videos of the national sleep foundation about sleep and chronic pain:
Sleep and Pain: Beat the Cycle and Improve Your Sleep Today
Chronic Pain and Sleep
What is Sleep Hygiene
Manage Stress5 Relaxation is an integral component of cognitive behavioral treatment programs for chronic pain.8
-formal interventions are for example: therapy, counceling classes, support group,
relaxation techniques, meditation, yoga, breathing exercices, autogenic trainingcreative activity....-
There is a lot of research how people living with chronic pain can benefit from meditation and relaxation techniques. Watch out for the next episode!
Part 1 of this episode examined what you should be aiming for in your recovery and why this is important.
Part-2 will show you proven techniques that help you in achieving what you aim for.
find out more on www.mybackrecovery.com
Scheermesser M, Bachmann S, Schämann A, et al. A qualitative study on the role of cultural background in patients’ perspectives on rehabilitation. BMC Musculoskelet Disord. 2012;13(5):5. doi:10.1186/1471-2474-13-5. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3-5. http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461-473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012. Hooten W, Timming R, Belgrade M, et al. Assessment and Management of Chronic Pain.; 2013. Pakpour AH, Yaghoubidoust M, Campbell P. Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain. Pain Pract. 2017:1-2. doi:10.1111/papr.12584. 2015 Sleep in America Poll. Sleep Heal. 2015;1(2):e14-e375. doi:10.1016/j.sleh.2015.02.005. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175.
Strength Training for People with Low Back Pain
Training and activity is your no1 option when recovering from low back pain.
This episode introduces two of the most important exercises for building up strength within your lower back and practice movement control.
Strength Training for People with Low Back Pain Always check with your medical professional if it is save for you to exercise! This exercises are not a substitute for individual medical treatment but aim to complement and support your recovery process.
Find all videos for this episode on:
video episode 07
The exercises we are going to explore on this episode build up on your basic movement control skills and are both:
challenging your movement control skills helping you building up strength and strength endurance within your back muscles If you have listened to episode 06 you already have come to learn that clinical guidelines recomend therapeutic exercise and activity with strong supporting evidence for the management of chronic low back pain.
A recent review concluded that: "The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported." meaning: weak back muscles could cause LBP.1
It further says: "It is by no means the only causative factor and further research should more rigorously test this hypothesis (...) however specific exercise may be a worthwhile preventative and rehabilitative approach."
In this episode i will share some of my most favorite exercises for building up strength within your back extensor muscles and practice movement control. These classis exercises will give you more options with your training, and will take your training to the next level.
Training introduced on 'my Back recovery' so far: Episode 03:
Easy and back specific circle training with save loading profiles in terms of exercising. A first step in starting to work on strength and strength endurance as well as stability. Also a great way of improving blood flow in your muscles.
Movement control exercises - basic skills for exercising - moving your pelvis/hip influences the posture of your lower back - being able of keeping a neutral position during certain exercises.
As you learned the basics for movement control (ep 5) and started to get familiar with a back specific circle training (ep 3) it´s time for you to take the next step!
'Good Morning' & Squat Video
The good morning and the squat are static exercises for your back. This means no movement in the back while you are doing the exercises. They are more difficult to perform than the exercise-set from episode 03.
It really pays of focusing on doing the good morning and the squat with correct posture! Once you got this you can do most of other exercises in a correct way and will have more options to adjust exercises to your own needs. Remember to always adjust your exercises to your individual situation so that you are able to perform pain free and without aggravation of your symptoms.
Good Morning The 'good morning' is great for building strength2 and movement control. Actually the 'good morning' is also used as a part of a validated test series used to detect impaired movement control within people with LBP.3
It works the gluteus, hamstrings and lower back.
Basically the 'good morning' is about bending forward with a straight (neutral) back.
Remember the last movement control exercise from episode 05: sitting and rocking forward and backward while keeping a moderate arch of your lower back with no movement in the back. The good morning exercise is the same in a standing position.
Stay upright, bend your knees slightly. This will help you doing the movement from your hips (because your hamstrings are not that much stretched when you are bending your knees).
Bend forward while you are keeping a straight back (remember straight means slightly curved, we wanna see a moderate arch (like a
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Your back coach
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