La diferencia entre que el dolor de espalda se sienta mejor y mejore

What if the things that make your back feel better don’t always actually make your pain get better? And what if the things that help you actually get better don’t always make you feel better, especially right away? 

Confused? Let me explain.

At Hinge Health, a digital clinic for joint and muscle care, we frequently talk about this distinction with members. Our healthcare system and wellness industry is full of treatments and techniques that can help people with back pain and other musculoskeletal pain feel better — prescription and over-the-counter medications, massage guns, acupressure mats, and traction tables, to name just a few. 

But there can be a not-so-hidden cost to spending your money, time, and energy only on feel-better stuff. When you focus too much on feel-better remedies, you might spend less time on get-better stuff — like exercise and movement.

Medically Reviewed By:

Jonathan Lee, MD, MBA

Dr. Lee is a board-certified orthopedic surgeon with subspecialty training in hip and knee replacement, as well as advanced clinical expertise in spine care. Dr. Lee oversees the Expert Medical Opinion program at Hinge Health.

When getting better doesn’t ‘feel good’

Truth time: Sometimes exercise and movement can make you feel achy, tired, sore, or spent. This is true whether you have an acute injury, chronic pain, or are completely healthy. Do any of these sentiments ring true for you?

• After a weekend of yard work: I was so sore the next day, it was hard to sit and stand from my desk chair.

• After a new exercise class with friends: My back, hips, and butt were so achy, it felt like I found muscles I’d never used before.

• After a long day of sightseeing on vacation: My calves and feet throbbed for days.

But despite these negative associations, we know from studies that getting regular physical activity is one of the best things you can do for your health. 

This is especially true for people with chronic pain. According to the International Association for the Study of Pain (IASP), “exercise is a key component of effective chronic low back pain management,” with reams of data showing that it helps improve “physical function, mood, sleep, stress tolerance, and cognitive function, as well as decrease the risk of secondary health problems including cancer, cardiovascular, metabolic, bone, and neurodegenerative disorders.” What’s more, the IASP says there’s a “substantial and growing body of evidence that long-term exercise therapy can provide pain relief across many different chronic pain conditions, including chronic low back pain.”

But pain and flare-ups after exercising can be very common, and it can make people stop and question: Is exercise actually good for my back? Is this really helping me or is it making things worse? Am I doing more damage?

These are all perfectly valid concerns. But in my experience as a physical therapist, for most people with chronic back pain the answer is a resounding no. 

How we feel vs. how we heal

Let’s say you’ve had on-and-off back pain for a few years. Maybe it’s related to a herniated disc, arthritis, or muscle strain. The exact cause doesn’t matter. Your back generally feels okay-but-not-great most of the time. But every now and then a painful flare strikes, causing you to wake up in agony and feel much more restricted in your daily activities. 

This is exactly when most people swap out exercising (the get-better approach) for other types of treatments like massage or over-the-counter pain medication (the feel-better approach). You might limit how much you move when exercise makes you feel worse for a short time.

But research has clearly demonstrated that moving and exercising is one of the most powerful things you can do both for your pain and injuries, even if it sometimes makes you feel a little worse short term. 

Your body on exercise

It can be hard to reconcile moving while you’re in pain, which is why it helps to understand what happens when you move your body.  

Every time you go for a walk around the block, your heart pumps and gets stronger. Blood circulates to your back, and your bones stay healthy. The synovial fluid that cushions your joints replenishes. Every time you lift weights, use resistance bands, or do some core exercises, your muscles contract to get stronger. Every time you get up during the day for a quick stretching break, you relax tight muscles and pump blood through your body. Every time you go up a flight of stairs, your brain gets oxygen and blood to help you think better and learn more.

Even knowing this, if you wake up and your back pain feels worse than usual or it hurts to bend down to put your socks on, you may be worried that exercise will only make things worse. Rather than avoiding movement altogether, this is a good opportunity to find a happy medium. Maybe it’s not the day to do a 30-minute advanced arm and shoulder workout with heavy weights or go for a five-mile run. But gentle exercise — a walk outside or on your treadmill, your Hinge Health stretches, a water aerobics class — will help your painful areas from the inside out, boosting the flow of healthy nutrients to your muscles and joints and helping to relieve inflammation. Over time, this is what causes your back to stay healthy and strong, and prevent pain flares in the future. 

When to use feel-better stuff

So should you stop using feel-better techniques for your back pain? Nope, not at all. Just don’t let it distract you from also using get-better treatments. Here’s what I always tell patients: Use feel-better methods to help you be able to do get-better stuff, like moving more, exercising, and getting a better night's sleep. 

• If you are struggling with high levels of pain, it might make sense to focus more on feel-better activities. But don’t get distracted from your get-better routine for too long. 

• Don’t confuse feel-better stuff with get-better stuff. Many feel-better devices or techniques say they are helping you get better. Be skeptical of these claims. For example, a massage gun is not going to make your back muscles stronger. It makes you feel better without doing much to help you get better. If the feel-better stuff is distracting you from moving more and exercising, that’s a bad sign and it may be creating an obstacle to your recovery.

How to stay consistent

This is what I wish I could tell every Hinge Health member, or anyone struggling with pain:

• Stay confident. It’s normal to feel down or anxious if your back pain is stopping you from doing what you love, but know that it's temporary. Our backs are strong, adaptable, and designed for movement, even when they are injured or show damage on scans. Just focus on taking small steps forward and keep doing what you can to heal and get better. 

• Play the long game. Exercise may contribute to upticks in pain at some point in your recovery. This can make anyone feel cautious and frustrated. Try to ground yourself in the fact that exercise is safe and recommended for pain and injuries, and it will help you get better, even when it causes some short-term pain.

• Find your movement sweet spot. This is the right type and amount of movement for you that challenges your body and pain system, and also strengthens your muscles and reduces your pain. If movement and exercise is causing unacceptable levels of pain or consistent flares, change how often or how much you are doing. You don’t want to ignore pain and just push through it, but you also don’t want you to stop exercising altogether when you experience a pain uptick. 

• See a physical therapist if needed. Working with a professional can help you know when to push through some pain, and when to adjust how much you are doing. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Posadzki, P., Pieper, D., Bajpai, R. et al. (2020). Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 20, 1724. doi:10.1186/s12889-020-09855-3

2. Benefits of Physical Activity. (2022, June 16). Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

3. Exercise and Chronic Low Back Pain. (2021, July 9). International Association for the Study of Pain. https://www.iasp-pain.org/resources/fact-sheets/exercise-and-chronic-low-back-pain/ 

4. O'Sullivan, P. B., Caneiro, J., O'Sullivan, K., et al. (2020). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54, 698-699.

5. Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., & Maher, C. G. (2018). Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 391(10137), 2368-2383. doi: 10.1016/S0140-6736(18)30489-6

6. O’Keeffe, M., & O’Sullivan, K. (2019, April 9). All you ever wanted to know about back pain. RTE. https://www.rte.ie/brainstorm/2018/0203/937071-all-you-ever-wanted-to-know-about-back-pain/