Pain That Keeps Coming Back
You hurt your back. You rest for a few days, maybe get a massage, stretch, take an anti-inflammatory, or see a therapist. The pain improves. Then a few weeks later, you bend over, play golf, work in the yard, go back to the gym and the pain comes right back. You think to yourself that something must still be “out of place,” damaged, or not fully healed.
Relief and resilience are two different animals. What we typically see is people “rest” it, and sometimes that’s enough to let the irritation go down. But why did it get irritated in the first place? Generally, you’re doing more than the tissue in question can tolerate. Most chronic musculoskeletal issues are overuse. It’s just that a weaker muscle gets overused faster.
There is nothing wrong with treatments designed to reduce pain. We use lots of passive techniques like scraping, cupping, and massage. That just desensitizes the area, and gives us an opportunity to get you to move better so we can work on strength and range of motion. However, it’s temporary. That’s why massage feels good, but the pain comes back if you don’t change something.
So you have two options; you can reduce or stop the activity that caused it in the first place. Or, you can improve the capacity of the tissue to be able to tolerate what you are doing. You almost have to over compensate with strength.
Let’s take a golfer who normally plays 3 days a week without pain. At the beginning of one week, he has a buddy ask him to help him move a couch, which he does because he’s a good friend. Then he continues on and plays normal 3 days a golf. Now he is in pain. What’s happened here? His tissue capacity was just good enough to tolerate the normal 3 days of golf. Moving the couch was the straw that broke the camel's back, even if it was earlier in the week. So the strategy should be to let the tissue calm down, and then when it does, get the back stronger so he can tolerate more.
One useful way to think about recurring pain is to compare two things:
Demand: What are you asking your body to do?
Capacity: How much of that demand can your body currently tolerate?
Demand can come from obvious physical activities:
Running
Lifting weights
Gardening
Golf
Pickleball
Repetitive work
Carrying children
Sitting for long periods
Walking or standing all day
But your capacity isn't determined by strength alone. Sleep, stress, nutrition, recent activity, illness, previous injuries, training history, and recovery can all influence how much stress your body can tolerate at a particular moment.
Problems often appear when:
Demand > Current Capacity
That doesn't necessarily mean something has been damaged. It may simply mean the stress placed on the system exceeded what it was prepared to handle.
The other part of all this (and often overlooked) is recovery. Training creates stress, recovery allows adaptation. If someone continuously adds physical stress without adequate recovery, their capacity may gradually decrease rather than increase.
This is why recurrent pain sometimes appears during periods of poor sleep, high psychological stress, rapid increases in exercise, long work weeks, travel, illness, or major changes in routine.
So back to your 2 options. Option 1 is to stop doing what you love. That will probably eliminate the pain, but that brings me to my favorite quote:
“A ship in harbor is safe, but that’s not what ships are for.”
If you go through life eliminating activities, eventually you’ll have nothing left you can do besides sit on the couch. Then when you have to travel and lift luggage overhead, back pain returns. This is not the right way in my opinion. If you don’t want to have your life slowly stripped away, you have to work at it. You have to keep building your strength and stay resilient, or as we like to say; anti-fragile.
