The Number 1 Myth About Reducing Pain

The most common advice I see being given to reduce pain is that you need to make your core stronger.

That pain is somehow related to having a weak core, and to make the pain go away your core has to be stronger, which invariably leads to you bracing your core.

It's well known that stiffness leads to loss of function, less activity and more pain. Bracing your core makes your body stiffer (that's kind of the point of bracing!)... So how's bracing your core more going to reduce your pain?!? 

Pain and injury are often associated with loss of control and instability, BUT that's not the same as having a 'weak' core or that you need to strengthen your core.

So what to do instead?

Firstly, let's look at what muscles form the core....

Anatomy of the Core

Here are the muscles that we refer to as the core:

As you can see these are deep lying muscles, and not ones that we have a great deal of conscious awareness of.

Try sneezing on command! That would be a conscious, voluntary contraction of the diaphragm. Not easy is it?

Therefore, when you're told that your core is 'weak' or that you need to brace your core, a typical response would be to tense ALL the muscles around your midsection.

Yes, this will increase stiffness of the spine, but is that actually a good thing, especially if you have chronic pain?

There's plenty of research literature showing that atrophy and reduced contraction of multifidus and transverse abdominus is associated with low back pain. There's other studies showing either no or weak association between the thickness and power of these 2 muscles and back pain. 

What nearly all of these studies measure is these muscles in isolation. The muscle is stimulated by an electrical impulse and the contraction measured by ultrasound. Then how the muscle performs is related back to the study participant's medical history - do they have chronic back pair or not?

Current clinical treatment programmes for back pain are based on the results of these studies. Can you see the major, stand out flaw?

If you said that this is a very artificial set up, and that muscles don't naturally work in isolation from other muscles.....GOLD STAR!!!!! 

Already we've hit a big stumbling block in the clinical reasoning for needing to brace the core or make the core stronger to relieve pain.

I did say above that pain and injury are often associated with instability and loss of control. So doesn't that mean that you should strengthen the core for more stability and control?

NOOOOO!!!!!!!!

Here's the thing, if you lack control of your body, and try to do strengthening exercises with that lack of control in order to get more control, how is that going to work? Make it make sense please!

The first step isn't even to regain control.

The first step is awareness.

• HOW is your body moving?
• What are your patterns of muscle tension and muscle relaxation?
• What muscles do you feel tensing when you do a movement?
• Is that helpful tension or not so helpful?
• How can you do that movement more easily?

Here's the mindset that I bring when considering movement and pain......

Rather than try to increase stiffness in order to stop a body part (eg. the spine or pelvis) from moving around and feeling unstable, I prefer to explore WHY that unwanted movement or instability is happening. What else can you feel happening in your body?

Let's look at an example.....

A common core strengthening exercise is Leg Extensions: 

• Lie supine on your back with your knees over your hips in a tabletop position
• Extend 1 leg out, keeping lower back towards the floor

If you notice that your lower back lifts away from the floor, or that your pelvis tilts when you straighten your leg, you might assume that your core is too weak and it needs to be stronger to do the exercise successfully.

But if you ditch this assumption and pay attention to what's happening in your body as you execute the movement you could notice that...

• the pelvis is pulling on the front and/or the back of your body, leading to increased muscle tension in the spinal / abdominal muscles
• the hip flexor isn't releasing at the appropriate time to allow the hip and leg to extend independently of the pelvis
• the waist muscles aren't working as designed, creating loss of control of the pelvis / spine / ribs

There are many other scenarios that may be happening, and it's very likely that each person will have something different going on with their body.

So, advising that everyone with back pain needs to strengthen their core or learn to brace to reduce their pain is what I call "tick box treatment".

This advice doesn't take into account that:

• everyone's drivers or triggers of pain will be different as we're all individuals with unique life experiences
• most core strengthening exercises encourage bracing or muscular contraction (tension)
• bracing increases stiffness, and stiffness leads to less activity, loss of function and more pain
• bracing is a natural stress response - you brace when you're frightened, think you might get hurt (eg. if you fall you brace for impact) or to immobilise an injury. When your brain senses that you're bracing, it puts the nervous system on alert for danger or potential harm, increasing tension and stress in the body.
• bracing to prevent movement as a remedy for instability or lack of control means that you don't feel unstable but the root cause of the instability hasn't been addressed. This increases the risk of further pain or injury recurring later.

Takeaway

Move away from generic advice and tick box protocols that treat everyone's pain in the same way.

There are many drivers of chronic pain, and a 'weak core' is way down the list.

Simply strengthening or bracing the core is unlikely to resolve instability and loss of control - this requires restoration of sensory-motor awareness between brain, nervous system and muscles.

NEXT STEPS

Would you be interested in a small group movement class specifically designed for pain relief? You won't have to fit in with a general class of healthy people, feeling like the only person in the room who can't do all the exercises or who needs to modify. You'll be part of a supportive community of people who are in the same boat as you.

If this type of class is of interest, please contact me on one of the channels below and register your interest. I'll then keep you posted on updates.

Other ways you can find help with managing chronic pain or an injury are:

• Get my expert insights on a specific injury or pain problem that you're struggling with in a 15 mins clarity call. This will help you move forwards in finding solutions to your pain. Complete the interest form HERE and I'll send you a link to book your call with me.
• Book into a Stretch or Pilates class with me - these are a good introduction to The Befriend Your Body (BYB) Method (mindful movement) for pain relief.
• Come to a pop-up class - a different theme each month, open to everyone, run at a peaceful retreat venue, small group. See the class schedule HERE
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

You can connect with me through any of these channels:

• Email at norma@unicornhealthandfitness.com
• DM me on Facebook Messenger https://www.facebook.com/norma.pearsonfitness
• WhatsApp message to 07801 867361.