How to exercise with pain (lower back, shoulder, knee, hip)

In the last blog I discussed how to tell if your back pain is serious (to view this article click here). This time we will explore how to go about exercising within tolerable levels of pain because we know that, after being cleared from red flag's, regular movement is one of the best ways to help your pain (please seek help if you are not comfortable doing this). Below are some of the main training variables that can be modified to help you find a way to keep moving within your tolerance.

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Firstly, let's start with some definitions so you understand some commonly used terms and why some things are modified over others.

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Frequency

This refers to how many times you are exercising within the week. If you are doing an exercise session every day perhaps you might need to drop the frequency for a period to allow for increased recovery. Conversely, perhaps you may need more frequent exposure to certain activities or movements that you are currently avoiding. This will allow a period of desensitisation to the painful movement to occur and allow your body to adapt.

Volume

This can be defined in a number of ways. For resistance training it can be defined as the number of “hard” sets per week or for running could be the total number of km’s per week.

Sometimes a reduction of training volume can be a good idea to allow for increased recovery and less “stress” on the system. A good starting point would be to half your training volume for a week or a small period and see how your body responds. This is what is known as a deload week.

Intensity

This is how “hard” you are exerting yourself. An RPE (rate of perceived exertion) is a great example of a subjective measure of intensity that can be applied. The RPE scale is from 1-10, with 10 being a maximal effort. Prolonged periods of training at maximal intensity can place quite a stress on the body and therefore a period of lower intensity may be beneficial every now and then.

Load

In the context of weight training this is the amount of weight that you lift.

Range of motion

This is how much you move a certain part of a body during a movement.

Now that we understand these variables, let’s work through an example of how to put all of this together and maybe you can apply it to yourself? In the below scenario we are going to use a case study.

Case Study Example: Lower back pain that is fairly constant, squatting hurts currently. Previous squats were 80kg for 5 reps the week prior.

1. First thing to try is to reduce the load on the bar: Go from 80kg to 50kg and squat as normal.

If this first step is no better, next option is:

2. Reduce volume: Half the amount of sets normally done. For example - if 4 sets of 5 squats are normally done, do 2 sets of 5 squats.

If still no better:

3. Reduce load & volume & range of motion: If a normal squat is getting as low to the ground as you can go then try squatting 45kg now onto a box

If this is tolerable then this is now where you start your training. In each subsequent session you can try to do a little more if symptoms are the same or no worse the day after.

In following this approach you will still be able to train and progress towards your goals! It will also help desensitize your body, increase your confidence to move and allow you to still be active. (Almeida 2018, Koes, 2010) It is best to start with one modification at a time and assess how you respond. After this you can modify other variables in conjunction as shown above. This approach is also in line with most up to date evidence and guidelines surrounding back pain which discourage rest and encourage activity. (Oliveira 2018, Guevara 2011)

If you are still unsure about your pain and would like some guidance, reach out to us at info@thebiomechanics or call 1300 920 520 to organise an initial consultation with one of our allied health team who will be able to help.

References

Almeida M, Saragiotto B, Richards B, Maher CG. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust. 2018 Apr 2;208(6):272-275.

Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 Dec;19(12):2075-94.

Oliveira, C.B., Maher, C.G., Pinto, R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;2791–2803(27)

Guevara-Lopez U, Covarrubias-Gomez A, Elias-Dib J, Reyes-Sanchez A, Rodriguez-Reyna TS. Consensus group of practice parameters to manage low back P. Practice guidelines for the management of low back pain. Cir Cir. 2011;79(3):264–279.

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