This episode is entitled “Going to the gym with low back pain / sciatica?” You will learn:

  • Pain and rehabilitation
  • Which exercises to avoid and which to focus on
  • The application of “Use it but don’t abuse it” principle in the gym

Pain and rehabilitation

If you have lower back pain / sciatica and you’re not a regular gym attender, you shouldn’t go. There are other ways of rehabilitating your lower back / sciatica without going to a gym. However, if you are a gym attender and you want to get back into the gym, then yes, you should go. You don’t want to associate the gym with further risk of pain, because that will increase the likelihood of having pain in the future. Lifting something heavy, for example, can be a powerful neurotag, which is when a collection of neurons all fire at the same time in order to reproduce pain. If you lift something heavy, you associate that with the pain neurotag. Maybe lifting hurts not because you’ve strained your back at a physical level, but because the same collection of neurons were triggered to fire by that lift.

For many people, pain is caused by non-damaging activities, which could be any emotional trigger. These systems are all interconnected. If a neuron fires in one system, it increases the likelihood that the pain neurotag fires too. If going to the gym is a normal activity for you and you want to keep it that way, you should get back into the gym in a way that doesn’t increase your pain or the healing time. Do whatever physical activity you can that doesn’t increase your pain and avoid things that do, or do them in a different way, with a lighter load. If your trigger in the past has been deadlifts, do them just with a bar. Go through the motions. You should be doing whatever movement you can in the gym without increasing your pain.

Which exercises to avoid and which to focus on

You shouldn’t avoid any of them. There are no exercises that are fundamentally bad for you. What’s sensible is that you do a range of diverse range of exercise, rather than just doing the same thing all the time. However, if you do the same thing all the time, you’ll be more likely to get very good at it and build up resilience in that movement. Do them in such a way that they don’t hurt.

Focus on exercises and movements that don’t hurt. Try and find a way of doing an exercise that hurts, in such a way that it doesn’t. We don’t want that exercise to be something that you are fearful of doing in the long run, otherwise it will become a trigger for you.

The application of use it, but don’t abuse it

Get back to doing the things you’re used to doing, but in a way they don’t hurt. That’s the best way to reduce your risk of future lower back pain / sciatica problems. You may have to modify how you do them in the short term so that they’re not painful and then, very gradually, return to full physical activity in all of its diversity. Don’t cut things out other than in the very short term, while tissues are knitting back together again. Use it, but don’t abuse it. The key thing is to always focus on what it is that you are keen to be able to do again and train for that activity. If you just want to be able to get back into the garden and do weeding for an hour at a time without getting a sore back, that’s what you should train for.

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