Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain.
Welcome to part 2 of finding freedom from back pain.
In my previous article, I described 7 strategies which included pain education and lifestyle factors. Lifestyle factors are equally as important as tissue healing when it comes to healing and recovery. Everything is connected! Wouldn’t you like to know how you can help your body promote healing, reduce inflammation, decrease pain, and calm the nervous system? This is incredibly important for people who have been dealing with any level of persistent, chronic pain or dysfunction. Below I am listing the 6 main pillars of health and giving you tools to begin your journey on each one.
Focused diaphragmatic breathing reduces your heart rate and blood pressure, stimulates the vagus nerve, and brings focus and connection to your body. It can be the key tool for reducing your stress response and reducing your pain level. Reducing pain is part of the featured content in my online course, The Connected Breath.
Lie down in a comfortable position- this could be on your back or on your side. Make sure you neck and head are supported by a pillow. Bend the knees and hips.
Inhale through the nose and create expansion through the lower part of your rib cage.
Inhale for a count of 4 seconds.
Hold for a count of 4 seconds.
Exhale through the mouth for a count of 8 seconds. ( an exhale twice as long as the inhale allows for better vagus nerve stimulation and calms the nervous system)
Repeat for 5 minutes.
We can’t remove all stressors from our lives but we can improve our self awareness, learn better stress responses, and have tools to calm our nervous system.
- Self awareness
Im an enneagram 9. I’m a peacemaker, but under stress I head toward 6 which responds in fear. Under stress I shut down, internalize, and avoid. If you’ve studied the enneagram you know there are 9 types and each of those types has its own blind spots and also its own unique way to respond under stress. Self awareness is huge. It’s greater than self help in my opinion because it opens your eyes to the why behind your actions. Understanding why you act under stress can help you navigate better ways to respond and as opposed to react.
- Stress response
Some people may be highly reactive toward stressful situations and some may be more withdrawn. Therefore your stress responses could look different but both be equally healthy. A healthy stress response means you are connected with yourself enough to know how you normally react and give yourself better options to respond appropriately. A healthy stress response also means having safeguards in place to not have cortisol running on autopilot (I.e. what happens when social media and screen time keep you continually wired.
- Calm your nerves
This is where the vagus nerve become more important than your sciatic nerve.
Your vagus nerve activates the rest and digest system. This list of actions will help to stimulate the vagus nerve and call your nervous system by implementing the rest and digest part (parasympathetic). This system should be our default mode, but in this high tech and high stress day and age, most people are living off their fight or flight mode (sympathetic) and ready to react at a moments notice which eventually leads to extreme exhaustion. The following list are ways you can calm your nerves:
7. Sun exposure – get outside
Don’t these tools bring a smile to your face? They help us decompress and down regulate which is incredibly important for us all.
Sleep and pain have a reciprocal relationship.
What is interesting however is the studies on sleep science say that existing pain is not a strong indicator of someone developing insomnia. Rather “sleep disturbance is a stronger predictor of future pain than pain of sleep disturbance.”
Disturbed sleep significantly affects pain catastrophizing and one’s inability to function due to pain. From a clinical standpoint, I can’t stress enough the importance of sleep education and sleep hygiene for patients with persistent pain. They need to know the above correlation and be given helpful strategies and/or be referred for further help in this regard. As physical therapists we need to pay attention just as much to the biopsychosocial matter as we do the biomechanial ones. When you suffer from chronic pain, it could be easy to think that good sleep is unattainable and that pain is to blame. How much more valuable for some in persistent pain to be empowered toward knowing they can change their pain response through focusing on their sleep.
Here are 3 sleep tips for you:
- Practice expressivewriting before bed. It is a journal of sorts to get your thoughts out of mind and on to paper. These can be both negative or positive thoughts. Write it all out then tear up the paper. This helps to calm the nervous system and decrease the mental fixation on your negative thoughts.
- Avoid screen time ideally 2 hours before bedtime to allow for melatonin to rise and cortisol to lower naturally.
- Practice deep exhales to stimulate the vagus nerve to enhance the rest or digest system and reduce the fight or flight system. See above technique.
Movement directly affects your energy, flexibility, strength, mindset, nutritional choices, brain health, gut health, and even your sugar cravings.
What keeps you from moving well?
Besides illness or injury, the main factors that reduce our capacity to move are fatigue, stress, pain, and fear. Let’s discuss these last 4.
Fatigue can be derived emotionally, hormonally, and physically. You may need to seek targeted treatment for these 3 areas. But the amazing thing is even if you need further treatment, choosing to move can still play a huge role in balancing hormonal, emotional, and physical health. Movement improves the health of your G.I. system, your muscles, joints, bones and your brain. Plus when you move well you sleep well (vice versa) so that’s an extra help with fatigue.
Choosing movement when you’re in pain can be a daunting task when you are unsure of the right ways to move. No one wants to further injure or re-injure themselves. Fear of movement however worsens the pain cycle. Basically pain leads to fear avoidance which leads to more pain which leads to even less movement which leads to disuse, disability and depression. Seek out help from me or a qualified physical therapist to learn how it’s ok to be sore but safe. Once certain movement dysfunctions have been checked out by your PT, you can move forward with confidence!
When you fear less you move more!
If you are stuck with persistent pain, get an assessment with a PT who can teach you healthy forms of movement for your body. Finding the movement you enjoy and feel safe with can calm your fear and nervous system and decrease pain.
It’s no shocker that exercise is a powerful stress reliever. Certain seasons of you life you may crave slower forms of movement like yoga and other season you may find you crave a HIIT workout. When your stress levels are high, movement must be a priority to reverse the constant state of fight or flight. Any type of exercise you do make sure you learn to incorporate breathwork which will also play an active role in reducing stress.
Four years ago I became certified as a health coach to help my patients understand the link between their gut health and their body’s health. Last year I wrote my book, How To Tame Your Sweet Tooth, to help people quit sugar and balance their diet. Proper nutrition is so much more than just changing which foods you consume. Movement, stress, sleep and mindset are all discussed in my book because they are integral parts of nourishing yourself. Each of these pillars makes up an integrated cycle, creating both positive or negative affects on the other. Good quality sleep gives you more energy to move well throughout the day. Exercise is shown to improve your nutritional habits and decrease sugar cravings. The foods you eat directly affect your mindset. Dr. Eva Selhub explains how, “Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibit pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions.”
In, Finding freedom from back pain: Part One, I discussed how pain is derived in the brain. It’s fascinating to realize that you can nourish your brain through food, sleep, movement etc and create positive and lasting changes on your health, stress, pain, and mindset.
It has been shown that people with chronic low back pain have ineffective coping strategies which can lead to more depression, and more pain related anxiety. Chronic pain is all encompassing and most people don’t know where to start so they stay overwhelmed and stuck. People with chronic low back pain have been shown to have ” poorer back pain beliefs and increased fear avoidance behaviors relating to physical activity.” I explained in my previous post on how fear avoidance leads to more pain. Positive and effective health behaviors could break the cycle of chronic pain and emotional distress because it will empower the individual.
Therefore if food affects your mindset, then choosing to eat a well balanced diet rich in antioxidants, vitamins, nutrients, good bacteria, and healthy fat is a great first step to take.
Moving well and more often helps you fear less, which can free up your mindset toward hope.
Expressive writing can improve your sleep and give you more of a growth mindset as you work replacing the negative emotions and thoughts with more positive ones.
Breathing will calm your mind and allow you to prepare for your next right step.
When you are dealing with persistent pain it’s invaluable to be given education and empowerment on every factor that can create a more positive loop in the pain cycle. Its incredibly important for me to teach my patient how to be in control of your pain and movement and not always have to run to someone to “fix them”. Unfortunately in the medical field we have allowed or even coerced people to rely too heavily on medication or on ourselves. (Both external factors that don’t allow patient to have any control). Yes I know how to help you, but more importantly I want to teach you how to help yourself. Breathing, stress relief, movement, nutrition, and sleep make up a powerfully healing cycle to get you started on the right path to restoration.
Self care tips for chronic pain:
- Learn to breathe deeply to reduce stress
- Get enough sleep
- Find movement you enjoy and be consistent with it
- Eat a diet of real food to promote gut health and good bacteria. Ditch the sugar!
- Don’t lose hope