no brain - no gain (II)

The previous entry made the claim that "no pain - no gain" is a half-truth. Yes, it's cool that the words pain and gain rhyme, but there's a lot of other words that end in -ain that maybe we should give more attention. Besides, you don't see wheat farmers walking around in T-shirts that proclaim in bold script "no rain - no grain!!!"

It's easy, you see?

"Well, no pain - no gain" is never an acceptable answer or motivational statement. Pain informs! Knowing a few details is tremendously beneficial to the pursuit of health and fitness.

Of course there are gainful pains associated with discomfort as well as bad pains associated with injury and regression. While the "just work it out" philosophy is rarely beneficial, it also holds potential for damage. On the other hand, more than a few days of rest is a less-than-proactive way of dealing with pain. Two weeks of rest does little to get a person moving toward their goals.

Since about 9 out of 10 people will experience varying degrees of spine pain at some point in their life, it may be good to know:

Case in point 2 - Centralization is less pain here, more pain there 

While pain in and immediately around the spine can certainly be miserable, the prognosis for short-term recovery is usually quite good. On the other hand, pain that starts to migrate away from the neck and back is bad news. Call it sciatica or radiculopathy or radiating; the tingly and numb feeling down an arm or leg, the stabbing shoulder blade or buttock pain, and a rapid onset of weakness are all symptoms of nerve root compression associated with significant spine issues. That ain't no muscle spasm.

When it comes to activities and movement that increase symptoms peripherally, no pain - no gain is just about the last philosophy you want to live by. On the other hand, positions and movements that decrease peripheral symptoms should be encouraged, even though that often comes with an increase in pain near the spine.

Lets say you do one of the simplest tests for the lumbar spine, standing and bending forward toward your toes. If ten or twenty movements in that direction cause an increase in peripheral pain or makes the back or buttock pain feel like it's migrating down to the knee or foot, avoid that direction of movement, at least for now. But if repeated bending forward or backward happens to cause centralization of symptoms (a reduction in peripheral pain or numbness), we explore that direction of movement further even if it causes an increase in central back pain.

Generally speaking, anything that causes peripheral pain gets a red light. Activities that cause peripheral pain to "move" to a more central region get a yellow light (proceed with caution). Systematically applying basic, gentle movements allows you to gradually hone in on appropriate loading strategies.

There's an art to "tweaking" the basic movements, and that's where qualified orthopedic care -ahem- comes in. The process allows us rehab people to perform manipulations and other hands-on procedures without fear of making the problem worse, as random cranking often does.

Systematic force progression sounds a lot less impressive than dramatic cracks and pops and requires quite a bit more time, but there's much less risk of harm than trying to jam that baby "back in." An added benefit is that many times patients suffering back pain can learn how to treat themselves, independently, without needing to be "adjusted" 3 times per week for 3 or 30 weeks. In the very least, clients learn how to reinforce the hands-on work of their rehab provider, which often goes a long way toward that independence.

The ability or inability to get peripheral pain to centralize is important. Researchers examine a wide range of factors involved with back and neck pain, from the patients flexibility and strength to their body weight to their work environment to their tendencies toward depression, and it turns out that centralization is one of the only things that is predictive of good long-term recovery. That's why I sometimes tell clients that I'd be happy to give them MORE back pain, especially when that goes along with less peripheral pain.

A specific type of pain = a specific type of gain. This is not cheesy 80's sentiment or the opinion of one wack-o PT. It's evidence-based medicine that actually helps someone beyond the rehab provider trying to justify endless "adjustments".

[The final installment of this series will talk about pain and sports performance.]

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