Hi guys! In this video, I'm going to discuss the four steps you've got to take if you want to get
back to running after you've had back pain. My name is Maryke. I'm one of the physios from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
injuries. So, have a look at the description of this video if you want to have a link to the
website. Now, the four steps you've got to take if you've got back pain: Step Number 1 is, you've got
to find out what the cause is, because if you know the cause, you'll know what exercises or treatment
to do, and you'll also have a very good idea of how long you can expect your recovery time to be.
Some back injuries need a little bit more caution before you go back to running, whilst others are
quite robust and don't really need that much caution. You do not need a scan to know what's
causing your back pain; a physiotherapist can help you with that. So, they can assess you through
making you do movements, listening to what your symptoms are, how were you injured, your injury,
all of those things; if you put them together, it gives you a very good idea of what injury a
patient has. So, that's something that a physio can help you with. Then, Step 2 is, you have to do
the right treatment for it. Now, you don't need hands-on treatment necessarily. It's usually a
combination through moving, mobility, and strength work. And I should have put moving at the top,
to be honest. We used to ... well, long before my time, early 90s and 80s ... they used to put
you on bed rest if you had back pain, and we now know that that's probably the worst thing you can
do. If you just rest an injury, you may get that the pain settles a bit, but if it was back pain,
to be honest, it doesn't even work that well. But then, everything stiffens up and it doesn't really
become any stronger or healthier again. You've got to move to get the tissue to be healthy. Now,
movement will mean something very different for different people with back pain. It will on your
severity of your injury. So, somebody with quite acute, painful back, movement may just mean that
they're moving around the house every so often, you know, keep it moving or go for small walks;
where somebody with a rather settled back pain or not as acutely painful could go for walks,
they could cycle, they could swim. It all depends on what's going on with their back.
But the more active you can be within your limits of pain, the better for your back, because it'll
increase your blood flow, it'll help your joints to be lubricated, and it will just create more
healthy tissue. But it's important that it's not moving through pain and causing more pain;
it's all within the limits of your specific injury. Then, the second thing is mobility. So,
yes, you want to do mobility exercises, which can include stretches. But not all back injuries
do well with strong stretching. Disc injuries, for instance, really don't like to be stretched at the
beginning, whereas an overuse type injury, that's stiff back from sitting for long periods of time,
usually do really well with mobility exercises and stronger stretches. So, again, your choice
of exercise or stretch or mobility exercise will depend on the type of injury you've got,
and also the severity it. Strength training: I've not met anybody with back pain who couldn't
benefit from strength training, and it's actually for two reasons: The most obvious one is that it
strengthens the muscles, stabilises the spine; and the stronger the muscles are, the less force
goes through the joints, the ligaments, and the discs and stuff. But the second reason is,
strength training is a brilliant way of increasing circulation into the lower back, and if you can
improve the circulation, you get more blood flow, more oxygen, more nutrients, and you just get
healthier tissue and it's easier for the body to replace those injured cells, okay. So, those
are the three main components that a treatment programme for back pain should include: moving
around as much as you can within your limits of pain is the most important, and then a combination
of mobility and strengthening exercises. Now, the third step is that you have to allow enough time
to pass, because the body can't just … it's not like a switch, that you can just pop something
back in, and then you're fixed. I despair when people injure their backs and the first immediate
thing they say is, oh, they need to go see a chiropractor or physio or somebody to manipulate
their back to get it back into place. Actually, you know what? If things are popping out of place,
that's quite dangerous, that's subluxing, that's dislocating, and that doesn't happen often at all.
More times, or more often, it's that you've strained a muscle, you've strained a disc,
you've injured a joint, you've sprained something. Think of it in line with the ankle joint. The same
way that you can sprain an ankle joint, pull a muscle in your ankle joint, pull a ligament, you
can do the same things to your back. Because you remember, you've got joints, you've got ligaments,
you've got discs, you've got nerves. It's not that you need something to go “crack” to go
back in place. And these structures, once you've injured them, if you've given them a sprain or a
strain or a tear or something like that, the body needs a certain amount of time to replace those
damaged cells with new ones and strong ones, and that takes time. So, for a mild sprain, it usually
takes about four weeks to be about 90, 95 percent better. For a more severe sprain, it can take six
weeks, three months, even a bit longer, depending on how bad it is. Disc injuries: in my experience,
if it's a mild disc injury, about six to eight weeks; if it's a more severe disc injury,
three months or longer; and if it's a really severe one, it can take up to two years to get
to full strength. That doesn't mean two years of you being in pain, but just two years of you being
in a situation where it's easy to flare it up. And again, it doesn't mean two years with no running,
it just means that you're likely going to have to be a little bit more careful or take longer before
you can introduce the running. Then, let me think what else. Oh yes! If there's nerve involvement,
so, something's irritating a nerve as well from the back, that can add more time on to it,
because nerves take a lot longer to recover, and they are a lot more sensitive for large
forces like you get with running. Now, if it's a mild nerve irritation, like numbness,
or pins and needles, that just comes and goes and it's just not very intense, it can take as
little as four to six weeks to get better. But if it's a proper flare-up like sciatica something,
strong pain down the leg, that can take three months or longer to settle down. So, it all
depends on your specific case. So, you've got to allow enough time. Now ... And again,
you'll know how much time you need if you get some guidance from a physio. So, I could usually … It's
difficult to tell immediately how long an injury will take to get better, because the interesting
thing is, the amount of pain you're in does not equate to the amount of damage you've got. So,
somebody can be in severe severe pain from just a mild sprain, it just depends on how sensitive
their alarm system is at creating pain. Then, somebody else can have quite a severe injury
but rate it as only mild discomfort. So, those two things don't align well. And what I find is,
I can usually tell within two weeks of somebody following a rehab program how long the recovery
process will likely take. That first week or two is all about just calming the pain signals
down and getting them settled into their rehab. And it depends on how quickly they react during
that period, that can usually give me a bigger or a more clear indication of how long their
recovery will take. Then, the last important point is: You're now done all your exercises, you're
feeling great, you think you're ready to start a run. Don't just do a continuous run; start with a
run-walk programme, and quite a mild run-walk programme; something like one minute run, one
minute walk, for 10 minutes, with a warm-up walk at the beginning and the end. And the reason for
that is that walking creates a totally different new force through the whole of the body … running,
sorry! … and it actually acts as a strength stimulus then for your back if you do the walk-run
sessions. So, during that one-minute run, you've got enough time to really think about your form,
concentrate on it all, but not get that tired that you lose your form or things get too tired and you
reinjure yourself. Also, what I find is, if that session does stir a bit of pain up in the back,
it's usually just a mild discomfort that settles quite quickly, whereas if you go for a continuous
run, by the time that you realise there’s trouble, your back may be so flared up later on that it
then takes days and days to settle back down. So, I definitely can recommend a run-walk programme,
where you just start with one minute running, one minute walking, for about 10 minutes, the first
session. And you also don't do it every day; you do it alternative days so that you give it enough
time to recover between walk-run sessions. And then you just slowly increase the time you do.
I usually get my patients to get to a total of 20 minutes walk-run, and then I get them to make the
run sections longer. So for instance, if they were doing one minute run, one minute walk,
I'll get them to then do two minutes run, one minute walk; three minutes run, one walk;
until they get to 20 minutes continuous running. That process, if we've done the rehab properly
and their back's happy with it, takes about two-and-a-half weeks to get them to 20 minutes
continues running. But the difference is, I know it sounds quite a long period of time to get back
into it, but it usually means that they don't have to take a step back, that at that point,
the back is quite happy with running, and they can just continue to build on that. Okay, so
let me know if you've got any questions about any of this. If you need more help with any injuries,
have a look at our website; you're welcome to consult myself or one of my colleagues via video
call. We can help you with assessing your injuries as well as a treatment program. Take care!