I have always had back pain
I was told my pelvic pain would go away eventually after childbirth
My whole family has bad backs
My back hurts because I am overweight
I know the doctor says I should exercise but I just can't seem to motivate when I am in pain
If you have said or thought any of these statements, you are not alone. But hear me now... You are not destined to a life of back pain, pelvic pain, peeing or a life without exercise and freedom of movement just because you have been told you will. If movement causes pain, it can be so hard to see a way that movement can be a positive experience. Clearly chronic pain is complex. But as we learn more about the brain body connection, it is clear that there is not only more to uncover about the brain's ability to reroute motor plans when there has been an injury but how active work can override ineffective motor plans and overeactive central nervous system responses to pain.
Benefits Of Movement On Chronic Pain
Studies have compared the effects of traditional exercise, yoga, mind body relaxation and psychotherapy on chronic pain. Many studies look at conditions like low back pain or fibromyalgia. Results are promising for some improvement with each of these interventions. Often regular exercise is recommended for chronic conditions such as back pain, endometriosis, PMDD (premenstrual dysmorphic disorder) and more. The idea of exercise and yoga is to increase strength and mobility. Yoga has the added benefit of promoting a brain body connection via breath. The added bonus of movement for chronic pain is to improve mood by increasing serotonin levels in the body. However, for many these options are pain provoking or simply not enough to reduce pain appreciably. If you can't exercise you can't improve your mood with exercise either.
The Brain's Response To Chronic Pain
There are three factors that don't often get discussed when it comes to chronic pain (pain that lasts longer than 3 months)
1. You brain literally reconfigures the connection with the injured body part and this can result in a shift on how you use your body during movement. For example, in patients with low back pain, it was found that the area in the brain where a key core muscle is represented shifts from its original position. In addition, it is delayed in activation with motion. Similar findings have been found with other body parts post injury.
2. In a study looking at injury, it was noted that within 24 hours of an arm becoming immobile, the brain began to disconnect neural connections with the body part.
3. If your body has found an alternate way to get the job done, exercising a weak muscle will not change the faulty pattern. this means that straight up exercise is not the best solution to injury recovery.
What This all Means
To put it all simply it means this:
The sooner you address a pain, injury or dysfunction the better. Postpartum pain and dysfunction should not be considered as a natural consequence to "having a baby." Take time for self care now.
If you have struggled chronic pain or dysfunction and have not found success with traditional strengthening you may need a new motor plan instead. Reconnecting with an efficient motor plan is critical. Keep in mind that you can strengthen a muscle all day long, but if you don't use it properly, it doesn't matter how strong it is. These studies also indicate that it doesn't take long after an injury for your body to move to plan B. Meaning it finds a new way to get the job done. So for all of the times I have heard my clients say that they only had an episode or two of back pain or stress incontinence and then all of a sudden it got bad, we need to understand that the more severe dysfunction was likely a work in progress all along.
What to Do
1. Recognize that it is not what you do for an hour but what you do minute by minute that matters most
2. Take time to slow down and listen to your body. can you detect how your body feels different left to right? For example, if you walk slowly can you feel your glutes work the same on each side?
3. Consider reaching out to a clinician that will help you to redefine a solid motor plan to get your body back "online."
4. If tackling an exercise program or yoga feels scary or threatening, recognize that you will likely not find success. working with someone to find a safe space to nurture movement is key. Your body will not move well when your nervous system is on high alert!
Is a mom of two, life long exercise enthusiast and women's health coach & physical therapist.