5 Pain Treatments That Could Make Pain Worse

People looking for help with treating pain or an injury are often given this advice by health and fitness professionals:

• "You need to brace your core and make it stronger"
• "Stretch muscles that are tight or inflexible"
• "Strengthen weak muscles"
• "Take anti-inflammatories to settle the pain"
• "Avoid the movements that are causing you pain"

These strategies often provide short relief but no long term resolution. Over time, symptoms often reappear or even get worse.

Why don't these commonplace and seemingly sensible treatments work in reality?

Let's dive into each one in turn......

1) "You need to brace your core and make it stronger"

If I had £1 for every time I've heard someone say that you need to strengthen your core to relieve back pain I'd been retired and living the good life right now!

Traditionally the core is thought of a cylinder made up of the following muscles:

• Diaphragm
• Transverse abdominus (TVA)
• External and Internal Obliques (EO and IO)
• Multifidus
• Pelvic floor

Industry dogma is that these muscles stabilise the trunk and pelvis for balance and stability. If they're 'weak' the spine becomes unstable, resulting in back pain.

It's a neat idea, and if it was 100& accurate all you'd need to do to get rid of your back pain is attend a core strengthening course and, hey presto, no more pain!

But that doesn't actually happen does it?

You do your core exercises as prescribed, you get stronger but that pesky back pain keeps coming back. WTF?!!

Did you know that my personal best for holding a hover (a plank on the forearms and toes) is 16 mins? So you could say that my core is pretty strong, and yet at the time I was still getting regular flare ups of back pain. How much stronger did I need to be before my core was strong enough?!?

In simple terms, the pelvis acts as the master controller of load management and movement in the body. Pretty much all movement patterns will go through the pelvis. 

And you might think of the core as a party pooper. When you brace your core you effectively make your body stiffer and put the handbrake on movement.

So if you get into the habit of bracing in order to make your core you interfere with your natural movements, setting up compensatory patterns and increasing stiffness.

Injury and wear and tear are often caused by instability somewhere in the body, but bracing your core unnecessarily isn't the answer to getting out of pain.

2) "Stretch muscles that are tight or inflexible"

This is another massive industry myth!

I'm mostly talking about passive or static stretches here. Stretching has long been a controversial topic in the health and fitness world, especially these types of stretches.

The evidence for passive / static stretches to improve athletic performance or prevent injury is very inconclusive at best. Many studies are limited and of low quality, their results unable to be reproduced in follow up research.

Many people do report feeling less pain after stretching, but typically these effects are short-lived, often lasting just a few hours or days.

There is evidence that passive / static stretching does increase muscle length and joint range of motion (ROM), which could be of benefit in certain circumstances.

For example, strongly stretching the hamstring muscles has been shown to increase knee extension ROM in people aged 60+. This could be helpful in improving their standing stability and balance, assisting in fall prevention. 

The knee joint is designed to "screw home" when in full extension (ie. straight). This "screw home" mechanism of the knee makes the joint extremely strong and stable. 

But the hamstring muscles also have a role in assisting the Glutes to extend the hip joint when standing. You might think of the hamstrings as acting like guy ropes to help with stabilising the pelvis on the hip joints. 

Typically when they start signalling 'tight' or 'tense' they're doing something they weren't designed to do. 

Simply stretching that muscle without understanding why it's irritated doesn't address the root cause. So you get temporary relief, and then the tension just returns a few days later. Before you know it, you're in a Groundhog Day cycle of having tight muscles, stretching to find relief, then getting the tension back and starting all over again....and again.....and again.....

Personally I've moved away from passively or statically stretching single muscles, and now use mostly dynamic, active movements explorations to reset and retrain the nervous system.

Because muscles are controlled by the brain and nervous system this approach changes muscle behaviour and movement patterns from the top down, providing long-lasting pain relief and improved resilience to injury and wear and tear.

3) "Strengthen weak muscles"

A LOT of people with lower back pain will say to me that they think they have or been told they've got 'weak' Glutes. Most industry professionals would prescribe Glute strengthening exercises, such as Bridge, to alleviate back pain.

So why might strengthening a 'weak' muscle not be the answer to getting out of pain?

Let's run through a hypothetical, yet common, scenario.....

Your lower back starts hurting and you go to see a soft tissue therapist. They examine you and declare you have weak Glutes. They give you a home routine of Bridges to do.

Sounds logical, right? And yet why doesn't strengthening the Glutes resolve back pain?

• The feet have a direct line of communication with the Glutes - the orientation of the feet and how they interact with the ground talks to whether the Glutes are turned on or switched off. If you're not addressing these factors you may not be effectively training the Glutes, if at all.
• Can you clearly feel if your Glutes are on or off? Do they turn on and off smoothly and progressively, or in a more flickering, phasic manner? If you've lost sensory and motor awareness (Sensory Motor Amnesia) of the Glutes, it's very hard to know if you're working them effectively or at all.
• Define 'weak'? If you have Sensory Motor Amnesia of the Glutes, it's possible that they're in a mild state of activity, say 20% or 30% all the time. So when you try to contract them you only notice the remaining 70-80%, so they feel weak to you. But actually they're quite strong because they're working at low intensity all the time. Therefore you need to train the Glutes to switch OFF fully, before trying to strengthen them!
• Movement happens as a result of body systems connecting and communicating with each other, not single muscles moving single joints. Therefore rather than trying to simply fix 'weak' Glutes, explore how the lumbo-sacral-hip complex talks to the feet / ankles / knees below, and to the thorax (ribs / thoracic spine / shoulder girdle) and neck / head above.

Takeaway = Think of  exploring systems, rather than fixing single muscles, joints and symptoms. 

4) "Take anti-inflammatories to manage the pain"

Anti-inflammatories are drugs that stop inflammation and it's unpleasant symptoms of pain, swelling and heat. NSAID's are non-steroidal drugs, such as Ibuprofen.

Why would regular usage of NSAID's contribute to pain?

It's important to recognise that inflammation is an essential function of the body's immune response and a natural part of the healing process. The painful symptoms of inflammation tell us that's something's wrong and to take care in order to reduce further damage.

Reducing inflammation prematurely can delay recovery by interfering with the body's natural healing process and tempting you to be too active too soon after the initial injury.

There's a fascinating research study that showed endurance runners who took Ibuprofen before and during their race had higher markers of inflammation in their post-race blood sample than runners who raced without medication. Both groups posted similar race times and they self reported similar levels of post-race muscle soreness.

The inflammatory markers noted in the post-race blood samples were LPS (lipopolysaccharides), C-Reactive Protein (CRP) and cytokines.

The presence of elevated plasma LPS levels indicates that Ibuprofen may be damaging the gut wall, increasing it's permeability and allowing LPS to leak into the bloodstream. LPS acts like an accelerator pedal on inflammation by setting off a chain reaction in the cell that ultimately tells the nucleus to produce more pro-inflammatory proteins,

So you have this weird situation where Ibuprofen is stopping inflammation by halting the production of pro-inflammatory proteins, yet also contributing to inflammation by damaging the gut wall and triggering pro-inflammatory pathways in the cell!

5) "Avoid the movements that are causing you pain"

Initially, you may need to stop doing movements that are provoking symptoms and pain. This is also one of the roles of inflammation - loss of function to reduce movement and potentially further damage.

But if you stop doing those movements for too long, that loss of function may become permanent. This is when you start feeling stiff, less mobile and less confident, so you do even less and become more de-conditioned.

As professionals we need to be wary of telling someone they shouldn't do a movement. For example, a well meaning "You shouldn't bend forwards because that'll hurt your back" can become embedded as a subconscious belief that bending is harmful to their spine. Therefore whenever they go to bend forwards they feel nervous, their muscles tense up and the movement becomes painful, reinforcing that belief and setting up a fear-avoidance response to movement (catastrophising and kinesiophobia).

Rather than completely avoid painful movements, I prefer to reframe them and present them to the body in a different context. For example, if someone is afraid of bending forwards because they're worried about their back you could recreate a similar movement pattern by having them:

• lie on their back with knees to chest
• do a Child's Pose
• fold from a seated position
• bend forwards from standing with their hands placed on their legs, a chair or other support

Have you ever been given or heard these 5 common pain solutions? Did any of them work for you and provide long-lasting, consistent and repeatable pain relief?

If you've found permanent relief from pain using these 5 standard strategies that's awesome! But if you're one of the many who have been left disappointed by the long-term results of these commonly prescribed treatments, then take heart!

There's another way that will quickly rebalance your body and dial down pain. Repeated and practiced regularly over time this method will retrain your brain and nervous system to change muscle behaviour so you move with more ease, freedom and confidence. 

NEXT STEPS

1) Have you got your free copy of my new E-guide "How To Get Relief From Back Pain & Muscle Tension in Just 10 mins a Day"?

If not get access HERE.

2) Get on the early bird wait list for my brand new weekend workshop retreats: EARLY BIRD LIST 

.Over 2 half days you will learn the knowledge and skills to be able to

- find stability, balance and safety in your body to reduce joint wear and tear, lower your risk of getting injured by falling and increase your resilience to injury

- reduce pain and release muscle tension quickly in the comfort of your home without expensive kit or waiting for an emergency appointment

- move with ease and freedom so you can stay active and live life as you want without pain slowing you down.

The workshop retreats will be a deeply relaxing, fully immersive mind-body experience with a restorative movement practice, guided meditation and a sound bath at the end of each day.

As well as the weekend workshop retreat you'll also have 30 days of 1:1 support with me to help you build your own home care movement routine that works for your body - no cookie cutter, one size fits all approach here! 

There are just 6 spaces for each weekend workshop retreat. This first one kicks off in February 2024.

Get on the early bird list here to receive all the details first:

EARLY BIRD LIST 

3) You can also:

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method and take the first steps to your pain-free body.
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreats are "Rest & Reflect" half-day winter retreat on Sunday 3rd December (FULL) and "Sun & Moon" mini retreat on Sunday 17th December (last 4x spaces left). Click HERE to read more about them,
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

If you would like help with managing pain or an injury please reach out to me on any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.

Study Link

Nieman DC, Henson DA, Dumke CL, Oley K, McAnulty SR, Davis JM, Murphy EA, Utter AC, Lind RH, McAnulty LS, Morrow JD. Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain Behav Immun. 2006 Nov;20(6):578-84. doi: 10.1016/j.bbi.2006.02.001. Epub 2006 Mar 22. PMID: 16554145. https://doi.org/10.1016/j.bbi.2006.02.001