Babying Your Back Makes It Worse?

There is a revolution afoot. If you're more than 20 years old, you likely remember a time when you or a schoolmate broke a limb and were in a cast the whole summer or practically the whole school year. If you've been paying any attention, you'll have noticed no one does that anymore. The science of healing has changed a lot. Official guidelines for post-surgical patients went from weeks or months of inactivity to "get up and move ASAP". Movement IS the cure. In fact, we're having to question a lot of previous recommendations about rest as a treatment due to more and more findings pointing to the fact that some of the hormones and enzymes involved in healing will not be produced during inactivity. This Harvard paper explores the concept even with regard to back pain: https://www.health.harvard.edu/pain/babying-your-back-may-delay-healing?fbclid=IwAR0hMkGyMV7R2bqQ4YHySgRR6aSd_qgqgvB-v6MlGg-41s6V2cdDuRm_qPE

It should've always been evident that there is such a thing as too much rest. But the propensity toward torpor bled out into all kinds of areas of medicine. Think about directives to have pregnant women or people with cardiovascular disadvantage "not push themselves." In the first case, we were telling someone who is going to engage in the most physically demanding activity of her life to prepare by doing nothing. In the second case, we were telling someone whose only hope comes from physical improvement to avoid the very stimulus that provides improvement.

It's no surprise then that even certain aggravation, certain pain, is not really going to improve by avoidance strategy. The average American loses one pound of skeleton, tendon, muscle, ligament, cartilage per year and gains one pound of fat per year every year after age 25 or so. Our problem is not that we need more rest from movement. Our problem is that we are getting the exact health and body we deserve from our ever-increasing rest. 

I have had the great fortune of being able to observe tens of thousands of members and clients. I have never seen a longterm successful outcome from avoiding intense lifting and heavy weight training. Every single pretext for rest ends up amplified by rest. Even when people discover a short-term reduction in pain symptoms or irritation from discontinuing intensity, 100% of the time their overall status is worsened in the mid-term to longterm. A single week break from physical activity can lead someone to lose a substantial amount of endurance and stamina. A two-to-four week break loses both the skill of strength and the deep anti-inflammatory benefits from contracting skeletal muscle. I've known people who had great reductions in their need for surgical intervention while they trained hard three days per week, and in some cases these same people had a linear increase in surgical need correlating to their reduction in lifting intensity and frequency. One client in particular forestalled all cortisone injections, surgeries, and pain medications at the peak of her hard training. In the wake of increased work demands, she started to experience a tiny uptick in her pain, ironically interpreted that as a reason to reduce her training, but at EACH step of frequency and intensity decrease she had a measurable linear increase in her need for pain meds and cortisone injections. She thought she was trading the acute irritation of lifting weights for improvement. But she was trading short-lived pain for longterm deterioration. Getting weaker and weaker, her path was predictable, but unavoidable with the increases in rest.

On rare occasion I've encountered some laggard clinicians who err on the side of gratuitous rest periods for their patients. I don't know if they don't read their own journals or if they skipped the continuing education workshops. But this is not evidence-based any more. This is ignorance-based. As such, every single time it worsened the situation. I have a client whose neurologist recommended 4 week rest periods after a 3-part procedure. That added up to 12 weeks of low to no physical stress. Mind you, this client is a person with a movement disorder wherein we KNOW that inactivity aggressively progresses the disease. The outcome was tragic. The client lost coordination, all conditioning, and well over 25% of his strength. The procedure, which should've improved the situation starkly, appears to have done absolutely nothing. In fact, even a year later, it's evident that the 12 week rest period made a permanent negative impact. It was completely out of step with the neurologist's own official guidelines. Brain surgery patients should get up and moving as soon as humanly possible for very good reason. The motor cortex informs the rest of the brain's health. So, technically, you can't even heal properly UNTIL you incorporate exercise. That's not even mentioning risks of clotting and stroke. It's just basic sensibility: we don't get better by removing the stimulus to get better.

Orthopedic pain is a tricky item. There are so many emotions wrapped up in it that 9 out of 10 times people's intuition leads them to reduce the physical activity such that pain really doesn't go away AND the genuine orthopedic pathology worsens at an accelerating rate. Consequently, at long last we can see this changing in the medical and physical therapy guidelines. And we have proof positive in astronaut studies. Weightlessness doesn't make anything better. We require a certain amount of physical stress to just hold this thing together. Babying the body seems prudent from a certain point-of-view during aches and pain. But that babying is causal in the worsening of your condition.