After going through the steps to get rid of back pain, it’s tempting to heave a sigh of relief, and dive straight back into life as you have always known it. So many patients have bounced back to the clinic after this, in pain again! They thought they were better, that they could do a full day of gardening, or lift boxes at work as previously.
Please understand that scar tissue needs training as it forms. If it’s allowed to be laid down without training, it will be as weak as a piece of cotton wool – easily pulled apart. The fibres will be laid down haphazardly, in no particular direction. The exercises below will gently stretch the scar tissue as it forms, and the fibres being laid down will line up along the lines of stress. So when you need to bend and stretch your back under load, the scar will stretch with you instead of giving way.
This post follows on from Treat your back pain now (1), after the five days of treatment have finished. It takes about five days for scar tissue to develop around the strained area in the back, a little more if perhaps you haven’t been careful enough to keep the spine in a good position, or the scar tissue just isn’t strong enough yet to take the strain of being stretched.
Below is the sequence of stretches which will progressively stretch the injured tissue as it heals. It’s really important to go through the whole program because if you don’t, the newly healed tissue will not be strong and flexible. If and when you do have to stretch it, you want it to hold firm. You’ll notice that the ‘pushups’ are done before and after the flexion (curling) stretches. This helps to keep the soft disc material in the bowl of the disc, so it doesn’t squeeze backward. If you don’t do the pushups as shown, the flexion movement will squeeze the disc material out of the disc, as it was when you first injured your back. (If you find the pushups difficult or painful, do the extension-in-standing stretches instead.)
A word of caution: Don’t do the flexion (curling) stretches early in the morning. Wait until you’ve been up and around for an hour or two before attempting these. During the night while there is no weight on the spine, the discs swell a little, and that makes them more vulnerable to pressure. It takes a little while for them to normalize.
Also, as in the early days of treatment, please don’t push through pain! If you do have a twinge, stop at that point. It will loosen up, just don’t force it. If at any point you feel pain increasing, or moving away from the centre, stop. Try again the next day, with the same stretches.
Day 1 of recovery phase:
(1) Do ten ‘pushups’: (2) Pull knees up to chest ten times: (3) Do ten ‘pushups’:
Do these exercises in the same way that you did the exercises during the first phase of your treatment. Say to yourself, “Pressure on…pressure off…” as you do these, to give yourself the rhythm of the movement. (Don’t hold the end position, but continue moving through the range, with each exercise.)
You may feel an initial twinge with the flexion stretch (knees to chest), but it should ease off, as you progress through the set of 10, and become pain-free. Do this sequence a couple of times during the first day you start the programme.
Day 2 of recovery phase:
(1) Do ten ‘pushups’: (2) Sitting, bend forward ten times: (3) Do ten ‘pushups’:
Again, you may feel an initial twinge with the flexion stretch (sitting, bending forward), but it should ease off, as you progress through the set of 10, and become pain-free. Do this sequence a couple of times during the day.
Day 3 of recovery phase:
(1) Do ten ‘pushups’: (2) Standing, bend forward ten times: (3) Do ten ‘pushups’:
Again, you may feel an initial twinge with the flexion stretch (standing, bending forward), but it should ease off, as you progress through the set of 10, and become pain-free. Don’t hold any position at the end of range. Keep moving, (“pressure on…pressure off…”) Do this sequence a couple of times during the day.
You’ve come to the end of the programme! Congratulations. I hope you’re now pain free and have full range of movement. Even so, be aware that once you’ve had an episode of pain such as this, it can recur. The inner disc fibres do not fully recover, although the tissue seals off remarkably quickly. If you repeatedly stress the discs without relief, there will be more episodes, and each one will cause more damage to the inner part of the disc.
To help prevent further episodes, avoid prolonged pressure on the spine. When doing an activity (such as gardening), stop frequently and do the extension in standing exercise (as described in my post ‘Treat your postural pain now’).
Five backward stretches done frequently during an activity, before you feel any soreness in your back, will help to prevent further episodes of back pain. When you do start back into normal activities of daily life, be very careful with your positioning. For example, when vacuuming, use a lunge position (one foot well in front of the other) while pushing the machine. Use your legs, not your back! It might be a good idea to revise the post ‘Treat your postural pain now’ for more ideas on how to protect your back against further injury.
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