While at the American College of Sports Medicine Summit for 2015, I had the pleasure of listening to Captain Steve Blivin, Orthopedic Doctor and Executive Officer at the Naval Health Clinic in Corpus Christi. He spoke about usual pain syndromes and shared his expertise on treating them with simple exercise programs. He estimates that greater than 80 % of all people get better with these recommendations. He is a big proponent for keeping exercise recommendations simple and easy. His catch phrase during the conference was a fun and smart recommendation for implementing exercise compliance. “The exercise that is best, is the one you will do.” Dr. Blivin chose these exercises to recommend because they do not require any equipment or money and they are easy to teach. They also have low risks of injury due to being completely self-regulated and static (meaning less movement involved). These self-regulated stretches and body weight exercises are suitable for a wide range of people with different training levels and exercise backgrounds. He talked about 5 different regional pain syndromes and their quick fixes. We will break this down into 5 different segments to cover each region. Check the blog for these other segments:

  • Segment 1 “Back” Pain (AKA SI Joint Pain)

  • Segment 2 Anterior Knee Pain

  • Segment 3 Anterior Hip Pain

  • Segment 4 Anterior Shoulder Pain

  • Segment 5 Plantar Fascia Pain

Before starting any exercise programming, it is very important to rule out any major or life threatening issues. This is especially important with back pain and even more important to stress on a blog where I cannot see you. You are doing a self assessment to see if exercise is suitable for you, I am trusting you to make a sound decision in your best interest. If you have any questions or concerns, contact a doctor. If not, use these red flags to help guide your decision to engage in exercise. American College of Sports Medicine defines a red flag as something that needs immediate attention from a doctor and should precede exercise programming. If you answer yes to any of the following questions, consult a doctor before starting an exercise program.

  1. Is your pain the result of an accident or major trauma?

  2. Have you had a persistent fever that won’t go away?

  3. Do you have a history of cancer that is not being controlled by a doctor?

  4. Do you have any metabolic disorders not being controlled by a doctor?

  5. Do you have any unusual muscle weakness?

  6. Do you have difficulty controlling your bladder or bowels?

  7. Do you have significant night pain?

If you answered no to ALL of the above questions, please feel free to continue to the next section.

Is It Back Pain or SI Joint Pain?

The simple way to tell between back pain and Sacroiliac Joint pain is to assess the location. True back pain is centralized over the spine and may produce symptoms to the touch. Sacroiliac (SI) Joint pain is across the low back on either or both sides of the spine. Both can cause numbness, tingling, decrease in muscle action and muscle spasms. The above picture illustrates the location of the SI Joint, circling in red where the back of the hip (Ilium) and the bottom portion of the spine (Sacrum) connect. Back pain with any of those above red flags warrants a doctor visit before any home remedies are tried. SI Joint pain without the presence of red flags can be treated with simple muscle balancing techniques that we will discuss in the next paragraph.

Why do I have pain?

Pain results when an area is too weak and too tight to do the things that it is doing. This is a general term that includes all training levels and is specific to each person. Casual walkers and endurance runners can have the same symptoms and movement patters, even if their exercise intensity is different. We are addressing the stability and function of the affected area relative to what specific activities each person does. If you are too weak and tight it will cause bone alignment and exercise form to suffer, which may cause rubbing and inflammation. In instances of “back” pain, this means your core and hip complex is likely too week while your hamstrings are too tight. To address this, we strengthen the weak things and stretch the tight things.

“Back” Pain Exercise Protocol: 

Do the following exercises in 3 sets, 2-3 x a day for 6 weeks

  • Core Strengthening: Bicycle kicks until you feel the burn in your abs, keeping your lower back flat to the floor

  • Hip Strengthening: Hip hikes until you feel the burn in your outer hip

  • Hamstring Stretching: Your favorite hamstring stretch, hold 30-60 seconds

  • Bicycle Kicks: Alternating opposite arm to opposite knee

  • Hip Hikes: Standing on a step, keep both legs straight and “hike” up the floating leg so that hip is higher than the fixated leg’s hip

  • Hamstring Stretch: Do both sides. Hold for 60 seconds or a combined amount of 60 seconds (4 x 15 seconds)

How long does it take for these exercises to work?

As with any exercise or healing process, the body takes about 6-8 weeks to change. At about 3-4 weeks you should feel better, allow 6-8 weeks to feel “fixed”.

What if I don’t feel better?

New studies are showing links between chronic pain syndromes and untreated depression. Between 30-80 % of people who do not get better within 6 weeks using these simple yet effective exercise programs have depression as an underlying cause. Treating the depression with the injury has proven very effective for that population. There is more information on depression now than ever before. I suggest using the tool below to do a quick self assessment.

PHQ2 Test

  • How often in the last two weeks have you felt down, depressed or hopeless

  • How often in the last two weeks have you felt little interest or pleasure in doing things that you normally like to do?

If you answer more than 2 days for either of those questions, you might want to talk to your doctor about depression to get more information.

How do I prevent this from happening again?

  • Continue with cross training exercises to promote body and muscle balance (wall sits, core strengthening, hip hikes, scapular retractions)

  • “Don’t over water” – Don’t do too much too quickly too often. Only increase exercise by 10% each week, any more and you will increase risk of injury

  • Warm up pre-exercise using foam rollers and joint motion, cool down post exercise effectively using stretching and ice. Read more on foam rolling HERE

  • Ice after exericse to decrease infllimation; Icing protocol is 20 minutes on/2 hours off

  • Try some higher level core and abdominal exercises on the blog post “Kick start Your Core”