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Monthly Archives

August 2017

Blog 8: Gradual exposure and Pacing

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Last blog I talked about returning to activities which currently result in a flare up and how finding a baseline is good starting point, but what’s next?

Today is all about the next phase and the pathway back to movement. Every heard of the saying fail to prepare, prepare to fail. This saying can be applied to so many aspects in life but today I want to use it to explore return to movement.

Pacing is making a plan, to gradually increase one variable of an activity at a time. This variable might be time, repetitions, load, range of movement or any aspect of the activity as long as the change is moving forwards. That means, a plan is in place in order to achieve an end goal and the practice and implementation of the plan is not dependent on how your body is feeling on the day. I know I found this the most difficult part when I had a plan to complete body weight squats without increasing my back pain.

I thought I was doing this pacing thing right. I had made a plan to complete squats in my gym program as all the reading I was doing said movement and lower limb strength will only help back pain. However the where I went wrong was I always carried the mentality of ‘I’ll see how I’m feeling at the time’. When the time came for body weight squats my back would miraculously always feel more restricted with increased pain and thus these squats didn’t happen- this is known as fear avoidance. This continued on for months before I realised 5 months had past and I still hadn’t done any squats. The minute I change my mindset of I am doing 5 squats today not matter how my back is feeling is the moment I starting moving forwards. Yes I felt extremely anxious when doing my 5 body weight squats and yes I was worried I would re injury my back, however this never happened. If an effective baseline is chosen for a particular activity, then applying a gradual pacing strategy despite how your body is feeling is the way to move forwards.

I have created a few key points to remember when using pacing strategies to return to an activity which currently result in a flare up.

  • Physically rite down a pacing plan.
  • Find your baseline- (see my last blog!)
  • Only alter one variable at a time.
  • Alter this variable by 10% per week.
  • Stick to the plan despite having a good or bad day.

This are the rules I stuck to when returning to squatting and now I can do a squat while carrying 50 kgs. I’ve said it before but I’ll say it again. Slow and steady wins the race.

In my next blog I talk about manual therapies and where services like massage play a role in ongoing back pain.

As always, I love hearing form you. Email me at claire@tailoredhealth.com.au


Blog 7: Boom and Bust

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I get excited by being active. I have always loved netball, running around and pretending like I can do gymnastics, basketball, ballet, parkour, rock climbing or anything involving movement. Experiencing ongoing back pain has resulted in me learning how to pull back from and breakdown movements. I have used a number of different strategies to increase my fitness after stopping all sport however, I often found myself entering a cycle called the boom and bust cycle.

It is very common for anyone who experiences ongoing pain to do more on days when they feel good and less on days when feeling sore and stiff.  I know I do. Waking up feeling fantastic and pain free makes you want to get moving and do all of those activities and jobs you haven’t been doing due to pain. I’ll give you an example. One day I felt really good and completed a fun workout in a park including jumping over equipment, hanging from bars and finishing with all out sprints- the sort of stuff that I get really excited by. I did this kind of workout for 30 mins and felt good. I had one rest day with the normal soreness you would feel after exercise and decided to do it again the day after. When I woke up the next morning I could hardly get out of bed as my back has stiffened up so much that moving was the last thing I wanted to do. After this I was inactive for the next week doing only a few stretches in attempt to loosen my back. This is known as the boom (the exercise) and bust (the flare up). For my body the load of two high impact training sessions over 3 days was too much, resulting in a flare up.

A flare up, is a sudden onset of increased pain and stiffness, commonly occurring from exceeding your body’s load tolerance. This load or baseline which your body can tolerate is built up over time and also decreases during periods of rest. Periods of inactivity result in a reduced load tolerance, from decreased strength and fitness, therefore flare ups occur more easily.  These ‘bust’ periods then occur more frequently and the boom gets smaller and the bust gets bigger.  It’s like taking 2 steps forward and three steps backwards. However we know movement is good for ongoing pain so how do we avoid the boom and bust cycle?

Starting any kind of physical activity whether it be purposeful exercise or doing chores around the house needs to be built up gradually, especially after periods of rest. But where to begin? Start with finding your baseline. This could be as simple as doing a particular chore for 1 minute or for me it was adding one set of jumping exercise to my normal gym routine. The baseline activity can seem really easy on good days, but the most important part in determining the baseline is being able to complete it on bad days. From the baseline the gradual exposure journey begins, however I will go into this further in my next blog.

Remember, slow and steady wins the race every time!

Any questions or comments? Hit me up!


Blog 6: Just Move

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An all too frequent situation when someone talks about their back pain is to focus on what movements they can’t do. This leads to FEAR AVOIDANCE. Fear avoidance is the devil! The fear of re injury, turns into a fear of movement and this is what stops individuals participating in activities and movements. It makes sense how fear avoidance happens. Back pain is flared up with certain movements or activities so this becomes the point of focus when you think of your back. The problem is, these movements become part of your back injury, so that means you have a sore back and you have a sore squat movement and a sore bending to pick up something from the floor movement. It sounds a little silly when you say it like that but that’s how your brain views it.

A popular approach to rehabilitating lower back pain is to focus on activating and strengthening individual muscles ie. the glutes or more specifically the glut med. Activating and strengthening your gluteus medius will assist in improving overall glute activation and stability when standing on one leg, however this alone will not fix back pain. The main focus should be on training the movement. Functional body movements completed in a stress free, relaxed way is the key. Once you can train your body to move freely, you start unlocking the fear avoidance behaviors development and the sensitivity to certain situations. It’s almost like meditation for your back.

I have a proposition…What would happen if everyone with back pain changed their focus away from what they can’t do and use it as an opportunity to find cool new movements they can do? There are so many cool things we can do with our bodies, all you need to do is find one movement which can be completed stress and anxiety free. Be creative! Today I re-visited my ballet days from 20 years ago as a way to explore new movements. If you feel stuck and need suggestions I am more than happy to help you find new cool movements that don’t flare up your back.

Building up a base of movements will give you a safe zone and creates a conditioning experience for your body. Once this is achieved the next goal is training movements which are currently being avoided through gradual exposure. However, this is something I will break down more in my next blog.

Keep moving, your body will love you for it 🙂

I would love to hear about any cool movements you can come up with.

Send through any comments or questions to claire@tailoredhealth.com.au