Alex Simotas, MD

Hospital for Special Surgery
Board Certified Physiatrist
Specializing In Spine & Sports Medicine

Home > Wellness & Exercise > Wellness Strategies > 15 Items To Know About Back Pain

15 Items To Know About Back Pain

  1. Think about your spine as being healthy. Dispel the ideas you may have a “damaged” or weak spine. Remind yourself that your spine is strong. Even if you have pain—it is stable and wont fall apart.
  2. Pain does not equal harm or injury. Most pain is better understood as “sensitivity” rather than harm or injury.
  3. Exercise is safe to the spine. Only more extreme sports (contact sports, and repetitive heavy lifting) appear to contribute to injury and wear and tear to the spine. Most research evidence suggests exercise prevents injury and may, in fact, help prevent degenerative disease. So even if you have pain stay active! It won’t harm your back.
  4. Understand that cell aging and not trauma is the main cause of degenerative spine conditions. Disc bulges, Disc herniations, “Degenerative disc disease”, and Spondylolisthesis to name a few are all anatomical findings that are caused primarily by cell aging and not trauma. They are to some extent a natural part of aging of the spine.
  5. MRI findings on the radiologists report don’t equal pain. Disc bulges, spurs and even herniations can be seen in individuals that have no back pain whatsoever. So these findings aren’t necessarily “abnormal”. The presence of these doesn’t necessarily lead to pain problems.
  6. While pain certainly can be caused by trauma, pain is also caused and controlled by sensitivity. Complex feedback networks in the nervous system maintain, and govern sensitivity. These networks embedded in our nervous system are not under voluntary control. So you can’t suddenly turn them on or off. However the pain system is dynamic. The severity of pain sensitivity can be modulated by many factors.
  7. Pain (pain threshold level), is trainable. Although not under conscious control, pain is positively impacted by increased exercise and activity. Pain is also impacted by reducing negative (i.e. fear, stress) and increasing positive emotional (i.e. confidence), cognitive (belief systems), and cultural factors.
  8. Exercise has many benefits. Strengthen, and desensitize your spine, while you increase your confidence. Resume your active lifestyle. This will also desensitize your back. Use a “quota based” strategy. This is a gradual and progressive approach to activity. Create goals based on performance of preset amounts that are not pain based. Try to finish the activity irrespective of pain.
  9. Avoidance of pain has big pitfalls. The advise “if it hurts don’t do it” can be misleading. Fear-avoidance (also referred to Kinesiophobia) is a subtle or flagrant pattern of avoiding activities that might cause pain. A natural survival instinct in life threatening or injurious situations (i.e. jumping off a high ledge), it can become an obstructive, often pathological pattern in rehabilitation from pain. Fear-Avoidance is a well-established pattern of chronic pain sufferers. This can have a long-term multiplying effect on pain and sensitivity.
  10. Secrets of quota based exercise:
    • Decide on specific goals in advance of starting a routine. The targets can have a reasonable time and intensity for each part of the session.
    • Start small and comfortable, and build slowly. Add no more than 5 or 10 % at each session.
    • Make sessions frequent (several times a week) and consistent (don’t change).
    • Try to reach each goal and finish the routine with or without pain. Remind yourself that you wont harm yourself by performing exercise.

11.  Learn the what and how of exercise:

    • The type of exercise is not that important as long as it uses the spine in different stressful patterns.
    • Combine core strengthening with endurance training (i.e. running, bike, elliptical, or swimming with Pilates).
    • Consider using a heart monitor to more objectively measure your intensity and effort.

12.  Use gradual activity exposure to get your life back:

    • Make a list of all the activities that you avoid as a result of your back pain.
    • First recognize that the activities are not harmful even if they seem painful. ie. sitting, standing, bending, running.
    • Take on difficult or painful activities in slow gradual amounts (quota-based).
    • Think wellness thoughts during activities.

13.  It’s all connected: Understand the brain and how your beliefs and perceptions can influence your pain.

    • First remember pain of all causes ultimately exists in the brain.
    • Kinesiophobia—the fear of movement—is a big part of back pain.
    • Severe back pain episodes can create a post traumatic stress (a fear of reoccurrence).
    • Develop a positive personal story for yourself and your spine. Slowly replace an ill, weak back self-image with a strong resilient one.
    • Chronic back pain may lead to sleep deprivation, anxiety, and/or depression. These problems may necessitate additional treatment.

14.  Stop all narcotics. Limit long-term narcotic use. Narcotics and other pain medications over a prolonged period of time will probably have some detrimental effect on pain experiences. These will disarm your body’s endorphin and pain balancing system and hinder your recovery systems.

15. Other components of good health have a strong correlation with back pain. Smoking has a strong correlation both with back pain and has been linked to causing spinal degeneration so stop smoking ASAP. Obesity is also an independent risk for more back pain. Weight and nutritional balance are influences on pain.