| What did this man do wrong to make his pain worse? |
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By: By Dr. MARK KESTNER
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A middle age man came to see me using a cane to walk. I didn't have to ask if he had a spinal problem; he was leaning 20 degrees to the left and a little forward when he walked in the door.
Judging by his clothes he was a businessman, although the shirt was untucked and he was beltless. He was also unshaven, which was my clue that he was having difficulty carrying out the basic self-care activities we all take for granted.
He had begun experiencing low back pain about a month earlier. Initially he had moderate pain that seemed to be worse with standing for more than a few minutes. He figured that he had overdone it in the yard or perhaps the extra 18 holes of golf one Saturday was to blame.
He rested for a few days and applied a heating pad for relief. He began to feel a little better and reasoned that since activity had worsened his pain, he must just be out of shape.
Being a competitive businessman with a military history, his response to the thought of being out of shape was to begin a vigorous workout routine in the local gym. He actually felt a little better for a few days, and then the pain returned, this time also shooting into his right leg.
He again applied a heating pad and found relief… as long as the heat was on. He took pain relievers to get by, and repeating the "no pain- no gain" mantra, persisted in his workouts. After about a month, he realized that he was getting worse and his wife convinced him to come into the office.
This chain of events has been repeated numerous times by numerous patients, male and female over the years. Let me offer a couple of suggestions to keep you from joining that not-so-exclusive club.
First, although exercise can be a great help in maintaining overall fitness and offers some help in injury prevention, it is generally not a good idea to exercise during or immediately following an acute injury.
Second, although applying heat can bring comfort and relief, I recommend that patients avoid heat during an acute episode. The reason is that although it feels better, heat can actually make an inflamed condition worse.
What usually happens is that the patient will apply heat and feel some relief. The next day, the inflammation is worse because of the heat and there is more pain. The patient reasons that it felt better when he/she applied heat, so he will repeat the process, thus making their situation worse.
A few years ago I took a course to become a certified strength and conditioning specialist. This is an advanced certification recognized in the strength coaching profession. This is not because I wanted to become a NCAA strength coach, but because I wanted to better understand the science of exercise.
I learned a lot about professional strength building and body conditioning. As a result of taking the course, I recommend that if you want to start a workout program, work closely with a certified personal trainer. You will be amazed at how much more you can accomplish and lessen your chances of injury at the same time.
The example above shows that exercise in an acute injury setting is usually a bad idea. However, for chronic low back pain, improving your strength and flexibility can be helpful. Because there are so many variables that might affect how specific exercises will affect you personally, I would recommend you do not simply tear a page from some well-meaning popular magazine and get started. You have a one-in-three chance of injury from doing that.
Instead, find a professional trained in exercise science or therapeutic rehab to make specific recommendations that are suited for your current condition.
Next week I'll tell you about one mother's healing traditions. Until then, keep moving, stretching and strengthening.
Dr. Mark Kestner
mkestner@DrKestner.com
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