Pacing with back and neck pain rehabilitation – Necessary and unnecessary evils!

I want to point out some of the issues we see daily in our clinics when patients “try too hard” to accelerate their rehabilitation programs.

When we injure our back or neck, pain often is the biggest concerning factor, and one we want to tackle ASAP, to ensure we can get on with life.

It is well known now that evidence is shifting away from medication, rest, avoidance and low-value healthcare (scan and surgeries), and more focused towards graded exercise rehabilitation that is specific to one’s daily activities.

Whether it be general mobility, muscular or neural flexibility, core stability, global strength or functional training – all good rehabilitation program should be shaped by a blend of same aspects, with firm guidelines on frequency and recovery periods to ensure best outcomes. How often have you been told “if you don’t do your exercises, then you wont improve”.

However, to be clear and ensure progressive patient gains, what is often overlooked is the concept of “pacing” our approach to such self-management programs.

When it comes to managing back pain, pacing yourself with completing exercise components is an absolute virtue. Whether you’re highly motivated to overcome your injury, or overtly wary to commence anything through fear of further pain – the irony is your progress and ultimate outcome may be the same.

For the Type A group that’s always on the go, the conception that “much is good, but more is better” unfortunately often results in patients over-doing it, and (when severe enough) causing flare-up of their symptoms, and then rushed medical investigations/procedures “to see and treat what’s really wrong”. If this patient type can channel their motivations and efforts to focus on exercise quality and not quantity, then their outcomes from back and neck rehab are often superior then the alternative.

In contrast, for those “waiting for their pain levels to improve, before they do anything”, prompts an unfortunate reality. This is known as “fear-avoidance” behavior, and such misconceptions only guarantees patients to become progressively more disabled over time. At the risk of sound pre-historic with cliche, in this instance after red flags have been ruled out it’s time to “move it or lose it.”

To appreciate the programs shaped by your Physiotherapist, we must learn to break down everyday activities to what may seem like very simple exercise components, to allow us to identify possible aspects that have been impacted significantly from our pain – and as such this will shape our subsequent rehabilitation program.

Your Physiotherapist will ensure an appropriate blend of exercise and stretch types are geared progressively towards regaining lost function. However, the execution of same requires each individual’s upmost efforts in refining the art-form that is pacing.

For more information on examples or strategies on how to systemise a graded rehabilitation program through progressive pacing, feel free to reach out via email or our 1300 number, and myself or one of our clinical team can assist further.

Drew Singleton
APA Pain Physiotherapist