Yes, definitely.  If you have lower back pain and/or sciatica you should do exercises, and perhaps more importantly, you should move.  What’s the difference?   Movement is unstructured exercise; exercise is a more formal way of moving.

The Number One Rule

Remember that the biological purpose of pain is a warning system – it’s your body’s way of telling you that if you keep doing that you’re likely to do yourself more damage.  So don’t do things that hurt.  On the other hand, movement is absolutely vital to health, and particularly when you are healing.  Lying still is a guaranteed way to speed up death – to put it bluntly!  So, your number one rule – should you choose to adopt it – should be “Use it or lose it, but don’t abuse it (UIOLIBDAI)“.  That means, if you don’t move you’ll seize up and/or become weaker, but don’t do things that hurt because two things are likely to happen if you do.

Why “Don’t Abuse it”?

As noted above, the purpose of pain is an alarm system.  So the first reason “Don’t abuse it” always holds true is that if you keep doing a movement or activity that hurts, you are likely to do yourself more harm – so why would you ignore it or mask it with painkillers and then keep doing things that would otherwise be sore?

The second reason “Don’t abuse it” is always good advice is that you don’t want to convert a short-term problem that can be fixed relatively easily into a long-term problem that’s much harder to deal with.  Your nervous system can effectively learn pain – think of it like memory.  If you want to learn French (or anything) you repeat it to yourself over and over again, thereby reinforcing connections between nerve cells in your brain.  The pain signal occurs due to very similar nerves firing together – the more often they fire together the more embedded that pathway becomes. The saying in neurology is “nerves that fire together, wire together“.  So, don’t, don’t, don’t, do things that make your back pain / sciatica fire more – that’s like pouring petrol/gas on the fire.

Why “Use it or Lose it”?

If you don’t use a physical or mental capacity you will lose it – that’s a physiological fact. So, if you want to retain or regain the ability to do something, you should keep doing it. This applies to big picture stuff, and very small details. If you want to be able to walk to the shops you should keep walking as much as your pain (“don’t abuse it”) allows.  We know from functional MRI scans that if you move less, the collections of nerves in your brain that control those movements soon start to lose connections with their neighbours – these neural networks start to break down, leading to less controlled movements, and weakness.  This is where the “weak core” begins (abdominal muscles are often referred to as your core muscles). Contrary to what many fitness professionals believe, it isn’t a weak core that causes back pain; it’s back pain that leads to lack of movement that then leads to a weak core, that then increases the likelihood of hurting your back again.

The other reason movement is so very important is that your circulation relies on movement for it to function fully.  If you don’t move, your circulation slows down and so does your rate of healing. Inflammation builds up when you stay still, which is an important reason many people have more pain first thing in the morning. Movement helps to wash away inflammation and bring in fresh blood, increasing the rate of healing and lessening pain at the same time.

“Use it or Lose it, but Don’t Abuse it” – in practice

How do you apply this rule?  Exactly as it says.  The more movement that you can do that doesn’t hurt during or after (see below), the better. If it hurts, back off, try and do it differently such that it doesn’t hurt.  People often say to me “Any movement triggers my back to spasm”.  To which I frequently answer “if you’re lying down and you pull your big toe up towards you, does your back spasm? No, right, let’s start there.”  Explore your body and the movements your back pain / sciatica will allow.  Do as many as you can that don’t hurt.  If you want to go to the gym or to yoga or pilates or zumba, then go – just don’t do movements that hurt.  If you find that cuts out most of the class, you might feel that you’ve been wasting your time, but on the other hand, perhaps you should think “Well at least I managed to do something, and something is better than nothing” (because it is).

Delayed pain and “Don’t Abuse it”

Sometimes an activity doesn’t hurt at the time but you feel worse afterwards, whether immediately or the following morning. Unfortunately this counts as abuse. It is often because the tissue became inflamed due to the activity but that inflammation builds up over hours (it can take as long as 36 hours to peak, particularly with disc problems), meaning you don’t feel the pain until the following day.  Why didn’t it hurt at the time?  Often, particularly when we’re enjoying an activity, our brain is pumping out endorphins which are natural, very strong, opiates.  When these are washing around your body you won’t feel pain, but when they wear off – if you’ve done something to aggravate your problem – you’ll feel more pain later.

Take note of pain that seems to come from nowhere – this may be due to the mechanism described.  Avoid it in future!

In summary, use the UIOLIBDAI rule as a screen when you’re not sure whether to do something or not – you won’t go wrong.