Back Pain? Do Your Squats & Eat Your Fish Oil

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If you can’t fix it with squats or fish oil, you are probably going to die
Rapid and early return to exercise and physical activity is one of the most important aspects in the self-management of simple mechanical low back pain, which about 80% of individuals experience sometime throughout their life. Unfortunately, conventional medicine and conventional wisdom perpetuate the belief that when someone is experiencing pain, they must rest and thus avoid all of the activities that cause their pain or discomfort. 
In a sense, that statement is true. That is, of course, if the pain is arising from the viscera (i.e. stomach, kidneys, colon, gallbladder, etc), if there are any red flags upon a doctors initial history or examination, or if there is a pathology that requires medical or surgical intervention.  The assessment of “red flags” will identify the small number of patients who need referral to a specialist, special testing/imaging (MRI, X-ray, CT, etc.) or for an urgent medical procedure. In the event of moderate-severe trauma, which isn’t too common in the gym as it pertains to back pain, imaging is most certainly warranted before advising to return to exercise. For the common complaint of back pain [or neck pain] in the absence of red flags and trauma, the best advice I can give an athlete is to get up, move around and get back to hitting those weights. You certainly might have to modify specific movements or technique but go lift something. Squat something. Overdose on some Vitamin D and fish oil. Rub fish oil on your back. Sprinkle several thousand International Units of Vitamin D over the problematic area to increase tissue healing and thus reduce pain. I’m lying on the latter part. Don’t sprinkle. Eat it.  Eat it with fat since Vitamin D is a fat-soluble vitamin. I digress.
Rapidly returning to physical activity decreases the likelihood of the athlete developing long-term or chronic issues. In many cases, getting back into the gym is the wisest decision one can make since bed rest and avoidance of activities quite often perpetuates the pain experience. Typically, the longer an injured athlete keeps from engaging in activity due to their back pain, the longer they will experience such pain. In other words, the amount of time an athlete stays away from activity is directly related to the success he or she will have in overcoming their spinal [low back] pain issues. 
When someone is experiencing low back pain in the absence of trauma, and no red-flags have been established, there are typically four (4) tissues to where the pain is arising from. These tissues, also known as pain generators, are the disc, nerve, muscle, or joint. Most people always assume their low back pain is muscular in origin.  Primary muscle pain is not as common as we all like to think. Throughout the body, our joints- including the facet joints in the vertebrae- contain a high number of pain receptors and often times are the contributing factor behind low back pain. On a side note, the lumbar vertebral joints also have pain referral patterns that are known to manifest as flank pain, buttock pain, and/or posterior leg pain. Intervertebral discs can also exhibit this same pattern. This phenomenon of referred pain is similar to an individual experiencing jaw pain or left arm pain while having a heart attack. Pain does not always arise from the specific area where the individual experiences it. It is thus a complex mechanism that is still not fully understood. Again, I digress.

Disc pain is also quite a common occurrence and often times a substrate for low back pain. Without getting too deep into the pathophysiology, when a disc is injured, specific blood cells flood the area, essentially creating inflammation and releasing specific compounds that increase pain.

Rapid return to physical activity following an injury and/or spinal pain is not always an easy process. Athletes are often fearful about returning to activity or to the same environment in which they were injured. Also, many individuals are under the impression that if they have pain, they must have damaged tissues, and they assume any form of activity can cause further damage and/or prolong the healing process. This impression is typically reinforced by their physician, friends, or conventional wisdom which, as stated above, usually recommends rest and avoidance of painful activities as part of the recovery.
 
Among the most important factors in returning to physical activity are fear of re-injury, catastrophizing (Oh my, I have back pain and I can’t do deadlifts or squats ever again), general psychological distress due to current lack of exercise or taking time off (Oh my, I haven’t squatted or deadlifted in days and I am getting fat and weak), and the athletes’ low expectations of recovery or hindrance of improvement.  After an injury, it is quite typical for an athlete to become fearful about further injury which results in avoidance behavior. Pain-related fear is associated with increased bodily awareness and hypersensitivity to pain, which can lead to an increase in time needed to return back to the gym. As a result, this causes the injured athlete to lose confidence and self-efficacy in his or her ability to recover and return to normal activities. The simple remedy for this would be returning to physical activity. 
Back pain does not have to be a serious disease; in fact it is quite common. Almost all of us will experience back pain throughout our life and it is often recurring. It should not cripple you nor really interfere with your ability to perform unless you let it. The important thing is for you to get on with your life. How your backache affects you depends on how you react to the pain and what you do about it yourself. Acute low back pain is best treated with minimal rest and rapid return to exercise and normal activities. There are no instant answers. You will have your ups and downs for a while—that is normal. But look at it this way. There are two types of sufferers: The avoider and the coper. Which one are you?

- The avoider gets frightened by the pain, refrains from any physical activity, and worries about the future. Their perception of health change as a result of the injury is usually negative.
- The avoider is afraid that pain always means further damage—it doesn’t. They do not “challenge” their pain. In their mind they have a serious condition.
- The avoider rests a lot, harps on their pain, uses it as an excuse, and waits for the pain to get better.
- The coper knows that the pain will get better, deals with it accordingly, and does not fear the future.     They “get it”.
- The coper carries on as normally as possible, goes about their daily activities, and wants to get back to   the gym as quickly as possible.
- The coper deals with the pain by being positive, “challenging” the pain, and staying active.
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Dr. Wayne J. Broth earned a Bachelor of Science degree in Animal Science, pre-veterinary medicine, from Rutgers University, New Brunswick, NJ, and is a graduate from Palmer College of Chiropractic Florida. He was a recipient of the Clinical Excellence Award, Clinical Service Award, nominated for the Virgil Strang Philosophy Award, and also served as a Clinical Teaching Assistant at the Palmer College of Chiropractic Florida outpatient clinic. He obtained certification in electrodiagnosis and acupuncture and completed his clinical internship at the Rhode Island Spine Center under the guidance of renowned physician, Donald R. Murphy, DC, DACAN.


  Dr. Broth’s clinical focus is the diagnosis and treatment of spine pain including headache, neck pain, and back pain. He has a keen interest particularly in low back pain, active rehabilitation, nutrition, and exercise. He utilizes the most current evidence-based approach to treat patients non-surgically. Dr. Broth currently maintains his practice, Florida Spine and Rehab, in North Palm Beach. He is also the co-owner of Gardens CrossFit, a CrossFit affiliate located in Palm Beach Gardens, Florida. When he is not at his Chiropractic office he is coaching many of the athletes at Gardens CrossFit in nutrition and its implications for improved health, disease prevention, and increased performance both inside and outside of the gym. He has taken the CrossFit Level 1 Trainer course and the CrossFit Endurance course. In April, 2012, Dr. Broth will be starting coursework for his masters degree in nutrition and functional medicine through University of Western States.

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Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskeletal Disorders 2007.
Picavet H Vlaeyen J, Schouten J; Pain catastrophizing and kinesiophobia predictors of chronic low back pain; Am J Epidemiol, 2002;156:1028-34.
Liddle SD, Baxter GD, Gracey JH. Pain. Exercise and chronic low back pain: what works?  2004 Jan;107(1-2):176-90.
Hayden JA, van Tulder MW, Tomlinson G. Ann Intern Med. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. 2005 May 3;142(9):776-85.