“I’ve tried everything, Doc,” the patient said. “Yoga, Pilates, lifting weights, walking. Nothing seems to help. And it seems sometimes exercise even makes it worse. I guess the arthritis is just too bad in my back.”
I hear this a lot from my patients. They assume that most back pain comes from muscles that are too tight or weak, so the answer must be to exercise them, strengthen the core, stretch the tight hamstrings, etc. When that doesn’t work, well, the problem must be structural — arthritis, ruptured disk, torn tendons.
I recommend, even insist, that my patients exercise. But that does not mean exercise is always a good thing. In fact, I tell many patients to avoid most exercises in the beginning of care, even stretches. It’s not because exercise is bad for arthritic joints — it’s not. But exercise can be bad for a joint that is out of alignment.
For years, chiropractors have compared joint alignment with car tire alignment. The comparison is certainly oversimplified, but can be used for our purposes. If your tires are out of alignment, it only makes sense that the harder and faster you drive the car, the more stress there will be on the tires and all their supporting structures.
The same is true for our bodies. If a joint is not working properly and you increase the demand on it — exercise — the result is more inflammation and pain, not only in the joint but also the nearby structures. Conditions such as tendonitis, bursitis, and even arthritis — the “itis” at the end of the word means inflammation — are often caused by secondary stress from a joint that is dysfunctional.
However, once joint alignment is restored, exercise is vital to maintaining it. When treating a patient with chronic problems, we were trained to start them on gentle stretches, progress to more aggressive ones as the patient improves, and only when they are doing well do we introduce core training or other strengthening exercises.
“Deconditioning” is a common problem with patients who have chronic pain. This is the result of the downward spiral these people are caught up in. They have chronic pain that is worse with activity, so naturally they start to limit what they do. That helps in the short run, but in the long run it only allows the problem to worsen, until even minor activities cause pain, because the underlying joint issue is not being addressed. Unfortunately, many of these people are given the well-meaning advice to “work through the pain.” While it does work for some people, I have seen too many cases where it makes things worse.
How do you break this vicious cycle? Start by fixing the joint alignment. Faulty joints are the underlying cause for much chronic inflammation and pain. These mechanical problems cannot be “worked out” by exercise; they respond best to manipulation — a quick, shallow thrust into the joint. So if your pain and inflammation don’t respond to exercise, the problem probably isn’t in the muscles. Once the joint is moving well again, then exercise becomes a necessity.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.