This is perhaps one of the most important articles I’ve ever written because it gets to the root of how best to recover from lower back pain / sciatica. If someone asked you, “What’s the quickest way from Edinburgh to London?” you might reply “What modes of transport are you considering?” and “What’s your budget?” but beyond that there aren’t a lot of variables. The quickest way is to fly, but once you take into account the travel time to the airport, navigating security, waiting in the departure area, boarding, taxiing along the runway and similar when you arrive in the airport of your choice and then the journey into London, the difference between plane and train diminishes – and then there are the unexpected delays (setbacks in terms of rehabilitation). The point I’m making (pretty poorly) is that there are a lot of variables in most journeys, and these influence the time to destination – as well as how much you enjoy the journey.
A perhaps more appropriate comparison – because it relates to another health matter – is “what’s the quickest way to lose 10 kilos of body fat?” You can do this very quickly, by way of starvation, but that is likely to result in re-gaining the weight very quickly when you go back to eating, because your body is now in survival mode. Food has been extremely rare during your massive calorie cut-back, and so when your body does come across a reasonable supply of it again, your physiology – which is primed for survival – stores it as fat by slowing up your metabolic rate. Fixing your lower back isn’t exactly like this, but there are good, sustainable ways of improving your lower back pain /sciatica; and then there are quick fixes that are less sustainable. If you’re interested in long-term solutions, which also get you the fastest return to normality, this article is for you.
We all want pain-relief as soon as possible, but remember pain is there for a reason. There are points up for grabs here if you can recall from another of my articles/books/courses what the purpose of pain is… Got it? Give up? The purpose of pain is… it’s a biological alarm system. It’s there to warn you that something is wrong and you’d better do something about it, or else matters could get worse. This leads me to the first principle in rehabilitation (swiftly followed by the others below).
1. Don’t aggravate your pain
Pain is there to tell you that you’re in danger of harming yourself further, so don’t ignore it, don’t try to battle through it, don’t suppress it with painkillers and then carry on doing things that would otherwise be painful. If you want whatever tissue you’ve damaged to heal (muscle, ligament, bone, disc, tendon, whatever) then stop doing things that make it more painful! Now this rule is not so easy to follow if there’s a delay between the activity and the increase in pain that may follow. Inflammation can take from a few hours to two days to peak and so you may not realise that all the sitting you did over dinner with friends last night is the reason your back is so much worse this morning. But you must must must try to work out which activities are aggravating your pain, and eliminate them or do them in such a way that they don’t give you more pain AND impede your recovery. The best treatment in the world will not solve your back problem if you keep aggravating it.
Movement is absolutely essential to health. Without good regular movement your circulation slows up (prolonging healing time), inflammation builds up (when it’s present) and you will have more pain. Movement washes the inflammation away, and helps to restore muscle activity and joint range of motion. The more movement that you do that doesn’t hurt – even tiny little movements – the better. Often this needs to be little but very often in the early days of severe pain. Also, early movement decreases the risk that you will have a recurrence of lower back pain / sciatica. Remember that 60% of lower back pains recur within 12 months! Movement reassures your subconscious nervous system that everything is going to be OK; unaccustomed rest puts your system on alert, which contributes to sensitising your nervous system – which is another way of saying that you’re more likely to “learn pain”. One metaphor that springs to mind is “when you fall off a horse, get right back on it again”. In the clinical and research world it’s well-known that those who move less – often due to fear of making their problem worse – are more likely to develop long-term pain.
3. Eat and drink well
If you want the engine to run, you have to fuel it properly. Drink plenty of water, and eat lots of healthy foods, rather than pro-inflammatory ones.
4. Don’t smoke
Smoking slows up your rate of healing, and is a risk factor for long-term lower back pain – enough said.
5. Return to normal activities within the limits of pain
This is related to “Move”. It also reflects the importance of not turning a drama into a crisis, which is where number 6. comes in. Medicalising yourself and your back problem is not going to help in the long-run. Try to get on with life as normally as possible, while still adhering to principle number 1.
6. Don’t catastrophise
The people who have the worst long-term complications from lower back pain / sciatica tend to be those who have a history of depression and/or anxiety. Try to stay positive and don’t dwell on how bad it might be or might become.
7. Pro-active manual therapy
There is good evidence that manual therapy is effective at speeding up recovery from lower back pain and sciatica. However, it’s vitally important that it is undertaken in conjunction with advice on physical activity, rather than relied on entirely as a passive form of therapy.
Many of the above principles are incorporated in my Number One Rule, which is “Use it or Lose it, but Don’t Abuse it (UIOLIBDAI)” I’ve been trotting this out for over 20 years, since my first book on lower back pain was published in 1997. Basically, if you don’t keep moving and doing the things you want/need to do, you’ll seize up / get weaker. But if you do things that increase your pain (abuse it) then you will slow up your rate of recovery. One of the most common manifestations of this is the boom and bust cycle. You get a bit better, so you think “I’ll just wash the floors and do a bit of ironing / play a few more holes of golf”. The next day you feel as bad as ever and it takes several days to settle back down again. So, you yo-yo – I often say “The road to recovery is usually a bumpy ride, but you can ride the bumps if you at least stay on the road.”
IF you were a full-time athlete you would work full-time at following the above principles and this rule. In my experience many many people take weeks – sometimes months – longer to heal than they would if they threw everything at getting better. Either it’s because there are (usually) so many demands on you that you just can’t prioritise your health/back to the extent that you need to in order to make rapid progress, or you just haven’t taken on board how difficult healing can be for your body under the circumstances in which you’re running your life. If you really want to fix your lower back pain / sciatica as quickly as possible, stop making it worse, and try to devote as many of your resources as possible to getting better. In short, follow the principles here (summarised in UIOLIBDAI), and work with your clinician rather than against him/her.
If you’d like more personalised support in getting better, just arrange a consultation by emailing firstname.lastname@example.org
N.B. A last note for those of you who – like me – are in the second half of life. I’m sorry, it’s a fact – it takes longer to heal as we get older. It shouldn’t be impossible, but it is almost inevitable that for the same degree of tissue injury you will take considerably longer to heal at 50 than you did at 20, and a lot longer at 80!