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Low back pain is one of the most dreaded injuries. It is also a common worldwide phenomenon. And often unfairly linked to CrossFit. In this article we present the facts about low back pain; the difference between men and women; and low back pain in athletes and specifically in CrossFit. We describe the value of MRI for diagnose; the evidence of several treatment options and the role of health psychology, and we discuss effective lifestyle changes. We conclude with advice for self- care.
What is low back pain?
There is no standardized definition of low back pain, and no agreement among researchers regarding the definition of low back pain. That has several implications and complications, for one for conducting research on the subject, as well as for formulating standardized treatment guidelines. Research methods and data show great heterogeneity and many limitations and caveats regarding research results must be made.[1]
Acute and chronic
The World Health Organization describes low back pain as: A dull ache or sharp pain between the lower edge of the ribs and the buttock. It can also cause pain to radiate into other areas of the body, especially the legs. Low back pain can be acute (lasting under 6 weeks), sub-acute (6–12 weeks) or chronic (over 12 weeks). In most cases of acute low back pain, symptoms go away on their own. In some cases, the symptoms turn into chronic pain. According to McGill, leading expert in spinal health, recovery from back pain can take as long as ten years. [2]
Specific and non- specific
In 90% of all cases, low back pain is non- specific. It is not possible to identify a specific disease or structural reason to explain the pain. In only 10% of the cases the low back pain is specific, caused by an underlying disease, tissue or organ damage or a structural problem in the spine. Although, according to McGill all back pain can be tracked back to a cause or certain pain trigger.[3]
Main causes
There are many personal and environmental risk factors for low back pain. Personal factors include metabolism, biochemistry, body composition (overweight/ obesity), anatomic structures (having a long back or a thicker spine), depressive tendencies and mental health issues, low educational level, and lifestyle factors such as low physical activity, alcohol, smoking and an unhealthy diet. Environmental factors include high physical stress at work such as repetitive, fast movements, handling heavy loads, long period of standing, sitting, and forward bending, and low levels of support at work.[6]
Worldwide prevalence
Low back pain is the single leading cause of disability globally. In the year 2020 over 600 million people suffered from low back pain. This number is expected to increase to over 800 million in the year 2050, mostly because of ageing of the worldwide population. About 50% to 80% of all adults experience low back pain at some point in their life, mostly at the age of 50-55 years. Recurrency of low back pain is also common, especially with ageing. It is estimated at one-year range from 24% to 80% of all cases.[4]
Healthcare workers, especially those with direct patient contact are amongst professions with the highest rate of work-related musculoskeletal disorders, physical therapists being one of them. Skills and knowledge as to correct body mechanics do not prevent these injuries.[5]
Societal and economic impact
Low back pain can be classified as a global epidemic with a huge societal and economic impact. Nearly 10% of the world’s population suffers from low back pain and this number is expected to grow. It is the main chronic health condition that drives people out of their workplace. It leads to loss of productivity and contributes to early retirement. It increases the need for medical care and medication. Low back pain affects all aspects of life such as work, school, hobbies, relationships, mental health (it is associated with increased depression, and depression is linked to worsening recovery), and overall wellbeing and the quality of life.[7]
To give an indication: In the United Kingdom low back pain costs the National Health Service nearly five billion pounds annually, in the United States this is 134 billion dollars per year. In Brazil, low back pain accounted for hundred days of absenteeism from work per person per year.[8]
Men versus women
According to the World Health Organization low back pain is more prevalent in women than in men. Women are more susceptible to develop low back pain, and it is estimated that women are two times more likely to develop chronic low back pain.[9]
Overall prevalence of low back pain seems to be 39% in men and almost 61% in women. Smoking, fewer year of education and hypertension are associated factors in men. Occupational activities such as heavy lifting, standing, a sitting posture leaning forward, and sitting at the computer three or more days per week are associated factors in women.[10]
Female sex hormones
Female sex hormones play an important role in the higher prevalence in women. Estrogen decline and deficiency, as part of ageing, accelerates disc degeneration.[11] The higher prevalence is also related to complex biopsychosocial mechanisms among which less efficient pain coping, genetic sensitivity, and the higher presents of concomitant chronic diseases such as osteoporosis, which is known to be risk factor for developing chronic low back pain.
Approximately 25% of all postmenopausal women suffer from vertebral compression fracture and the prevalence of this condition increases with age. Although patients with this type of fracture experience more disability compared to patients with non-specific low back pain, only 30% is diagnosed correctly. The reasons being many of them falsely think joint pain is their faith and just a part of getting older.[12]
Women-specific conditions
Several conditions related to low back pain seem to be more common in women than in men, some obvious:
Pregnancy
The increase in body weight, the changes in the center of gravity and hormones relaxing muscles and ligaments, can cause lo back pain especially in the second and third trimester of pregnancy.
Menstruation
Severe menstrual cramps may be accompanied by lower back pain.
Menopause
Estrogen decline and deficiency can lead to musculoskeletal problems such as low back pain. A majority of peri-menopausal women experience these symptoms.
Endometriosis
Endometriosisis a gynecological disorder, causing tissue of the uterus to grow outside the womb. It results in abnormal and painful menstrual cycles, frequent urination and sharp pain in the pelvic area and abdominal area, often radiating into the lower right back. The pelvic and low back pain can become chronic.
Sacroiliac Joint Dysfunction
The sacroiliac joint (SI joint) connects the bottom of the spine to the pelvis. It is the main source of pain in 13% to 30% of patients with low back pain. Under normal circumstances, the movement of the SI joint is limited to a maximum of 2 to 3 degrees and 2mm. Women have different anatomical structures than men. They have a smaller SI joint surface, and the sacrum is wider, more uneven and tilted backwards more.[13] Research has shown that a female model of the SI joint has significant higher mobility compared to a male model. This can lead to higher stress across the joint, especially on the sacrum, and can increase the risk of problems such as low back pain, pain over the buttocks or down the thigh, especially when sitting, lying on the affected side, or climbing stairs.
Piriformis Syndrome
The piriformis muscle is located deep in the buttocks. Due to hormones and pregnancy related changes in the pelvis, women can become more susceptible to piriformis spasms, irritating, and compressing the sciatic nerve. This can cause chronic pain in the buttocks and hip area, and radiating pain in the thigh, leg, and foot, when getting out of bed, sitting for a long time, or during exercise such as walking or running.
Tailbone pain
Tailbone pain is pain at the end of the spine (the coccyx). This is mostly due to trauma, such as child birth or a fall. It is more common in women due to the differences in the shape and angle of the pelvis and from injury during childbirth. It causes pain when sitting down or when standing up from a seated position. [14]
Spinal osteoarthritis
Spinal osteoarthritis, also known as degenerative arthritis, is a breakdown of the cartilage of the (facet) joints and discs in the neck and lower back. The cartilage that cushions the tops of bones degenerates or wears down. This causes swelling, pain in lower back, groin, buttocks and thighs, morning stiffness, and sometimes bone spurs. This is more common in women than in men, after the age of 45.
Degenerative spondylolisthesis
Degenerative spondylolisthesis is the slip of one spinal vertebra over the other. Low levels of estrogen in (post)menopausal women cause degradation of vertebral discs and loosening of ligaments that hold the vertebrae together. This causes spinal instability and a higher risk of slipping vertebrae, resulting in low back pain radiating to the legs and pain when bending forward. [15]
Spinal osteoporosis fractures
Osteoporosis is a condition of decrease of bone mass and bone density. Bones become weak and brittle. This increases the risk of fractures, especially in hips and spine. Post- menopausal women are four times more likely to develop osteoporosis than men, mostly due to a deficiency in estrogen. Fractures of hips and spine can result in acute back pain and spinal compression because of osteoporosis, and can cause pain in the mid and low back, sometimes confused with heart and lung problems.[16]
Low back pain among athletes
Low back pain is common among athletes, although statements cannot be made with certainty considering the high heterogeneity of research methods and data. The estimated life-time prevalence of low back pain in athletes varies from 1% to 94%, some studies show this to be 33% to 84%, others say 1% to 30% depending on the type of sports.[17] The highest prevalence seems to be among skiers, floorball players and rowers.[18]
Risk factors
Some studies show that playing sports can be a risk factor for developing non-specific low back pain, especially activities with high or repeated loading of the spine.[19] Risk factors with relative strong evidence of a positive association with low back pain are decreased lumbar flexion and extension, hip flexor tightness and high body weight.[20] Risk factors with less strong evidence are the volume and intensity of the sport, concurrent lower extremity pain, older age, female sex and family history of low back pain.[21]
Acute and chronic
Most cases of acute low back pain among athletes are due to sprains or strains. Chronic low back pain in athletes is often associated with degenerative lumbar disc disease and spondylolysis.[22] The prevalence of spondylolysis is not higher in athletes than in non- athletes, although participation in sports involving repetitive hyperextension maneuvers, such as gymnastics appears to be associated with disproportionately higher rates of spondylolysis.[23]
Appraisal of pain
The appraisal of low back pain by athletes differs from non- athletes. Athletes perceive less impairment of low back pain compared to non- athletes. They report lower frequencies of behavioral avoidance than non- athletes. They report a less severe impact on every day functioning and make less changes in adapting their training or lowering their training volume.[24]
Importants of exercise
It cannot be said that athletes have a greater risk of low back pain than non-athletes, and that exercise must be avoided if low back pain is to be avoided. The contribution of sport in non-specific low back pain remains unknown, due to a large heterogeneity in the methods applied in research.[25]
There is extensive and convincing evidence that an active lifestyle and exercise can prevent the risk of many chronic diseases and disabilities, and contribute to good physical, mental and emotional health, and the quality of life.[26] The prevalence and intensity of low back pain increased during the COVID-19 pandemic, partly due to increased inactivity and worsened ergonomics of working from home.[27]
Low back pain in CrossFit
There is a hint of suspicion that CrossFit results in lower back pain. Statements must be made with great caution considering the heterogeneity of research data and methods, and little available (strong) evidence.
Prevalence and incidence
The injury incidence in CrossFit seems to range from 12,8% to 73,5%,depending on training frequency, duration of CrossFit experience and level of the athlete. A short duration of participation in CrossFit (less than 6 months) is significantly associated with an increased risk for injury. The probability of injury seems five times higher among competitive-level athletes than tha tamong less-experienced athletes. The injury incidence for Dutch athletes participating in CrossFit is 56.1%. The majority of injuries are caused by overuse (58.7%).
The incidence of injuries in CrossFit seems to be similar to that in other recreational sports such as Olympic weightlifting, power lifting, basic weight lifting, and artistic gymnastics.[28] Some Crossfit movements and participant characteristics may lead to higher incidences of specific injuries and injuries overall.[29]
Types of injury
The most common injuries in CrossFit are shoulder, spine and knee-related, in almost half of the cases related to the lower extremities.[30] The lumbar spine is the most common location of spinal injuries (83.1%), Female athletes suffer more frequently from lower extremity injuries, male athletes from shoulder injuries.[31] Average symptom duration in CrossFitters with spine injuries is 6,4 months, and 32% had positive findings on neurologic examination.[32]
Risk factors
Some studies identify risk factors associated with injuries in CrossFit such as older age, male sex, a greater body mass index, the existence of previous injuries, the lack of coach supervision, the experience level of the athlete, and participation in competitions.[33] Other studies show that specifically training load (increasing load) and level of experience (being new to CrossFit) are potentially important risk factors. Close supervision of a coach as well as avoiding progressive scaling are relevant in those cases.[34]
Herniated disc and MRI
The exact cause of low back pain often remains unknown. In only 50% of cases the precise cause can be determined with an MRI or CT. Sometimes, and often feared, a herniated disc causes low back pain. A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people at the age of 30-50, mostly male. In people aged 25-55 years, about 95% of herniated discs occur at the lower lumbar spine.[35] In 85% of cases with symptoms associated with an acute herniated disc, the disc herniation heals within 8 to 12 weeks without specific treatment.
Accidental reveal
Many cases of disc herniation are a- symptomatic (patients do not experience symptoms or pain) and found accidently on an MRI or CT. There is not necessarily a relationship between the severity of the injury as seen on an MRI or CT, and the intensity of the pain experienced. An MRI can show degenerative changes in the spinal discs without any pain or symptoms being experienced, and conversely, people can experience pain without any significant spinal changes visible on an MRI.[36]
The potential impact of changes seen on an MRI can be significant. It can lead to stress, worrying and inactivity. A higher utilization of MRI and CT in health care is not associated with improvements in patient outcome, although it is advice to use an MRI for diagnosis and treatment, in cases of chronic pain and symptoms.[37]
Treatment
According to the World Health Organization low back pain is the condition for which the greatest number of people may benefit from rehabilitation.[38] Rehabilitation should focus on the biological as well as the psychological and social components of pain. Treatment includes health psychology, non-surgical and surgical options. Physical therapy seems vital in all cases. [39]
Health psychology
According to the biopsychosocial model of health cognitive, emotional, psychological, behavioral, physical and social factors affect (low back) pain and a health psychological approach should be taken into account in treatment.
Interpretation of physical signs
The interpretation of physical signs of low back pain by the patient plays an important role in the healing process. Physical signs should be distinguished from symptoms of disease. Physical signs are objectively observable, symptoms are interpretations of the patient. For example: a physical sign is a herniated disc shown on an MRI, a symptom is pain in the knee that the patient assigns to the herniated disc but may also be due to osteoarthritis. Research on the prevalence of symptoms shows that the three most common symptoms are back pain, joint pain and fatigue.
Some physical signs increase the likelihood of symptom perception by the patient. Painful, new, persistent, and chronic symptoms are more likely to be noticed. Previous experiences with pain or disease and understanding of medical knowledge play a role in how physical signs are experienced and perceived. Therefore, it is important that patients receive evidence-based information on their expected rehabilitation course and about effective self- care options and ways to remain active. Treatment with pain education can contribute to improvements in low back pain and disability.[40]
Physical signals are less likely to be noticed when the patient is distracted, while high attention to the signal leads to an increase in sensitivity. This high attention could be the patient's own attention to the physical signal but could also be, for example, media attention to certain diseases.
Mindset and emotions
Mindset and emotions strongly affect symptom perception and the course of the recovery proces. Positive personality traits and positive ratings influence disease outcomes. Patients with a positive attitude rate themselves healthier and report fewer symptoms. An optimistic outlook has a favorable influence on illness. For example, research has shown that in cancer patients it leads to less severe pain and fatigue.
Positive emotions promote psychological resilience and effective problem solving; they dispel negative emotions and encourage an upward spiral of more positive feelings. Research shows that elderly hip fracture patients who have a positive mindset have better functional recovery than those with a more negative mindset.
Patients with a negative attitude are more pessimistic about the extent to which they believe they can do something about their symptoms themselves. Negative emotions may increase symptom perception. Attention to signs increases and new signs are more likely to be perceived as symptoms. Anxiety and neuroticism can on the one hand lead to increased alertness to symptoms and exaggerating the significance and consequences of symptoms, but on the other hand can also lead to ignoring relevant signs and avoiding help.
Dysfunctional cognitions can hinder treatment. Catastrophic thoughts often lead to avoidance of those activities and movements that may still be painful during and after injury, but actually contribute to treatment and recovery. Avoidance often leads to inactivity, which hinders the recovery process.
Research has shown that especially in patients with low back pain, an opposite pattern can also occur. Patients then remain active until the pain becomes unbearable. Overactivity and underactivity alternate, which hinders the recovery process. Athletes with low back pain often do not fully recover from their episode and continue sports participation regardless of the pain. Psychological and social factors play an important role in this decision making by the athlete.
Only one-third of patients take action when observing symptoms. Several factors play a role in not seeking or delaying medical help such as expectations concerning the effectiveness of treatment; medical costs; not having time to take action; believes that symptoms are not serious enough; friends or family who say it will pass; non-medical ideas about the disease; or worries about treatments or prognosis. [41]
Treatment of specific low back pain
Treatment for specific low back pain should be focused on treating the underlying condition.
Treatment of herniated disc
In 90% of symptomatic cases of herniated discs, the injury resolves six weeks after the injury happened without any specific treatment. In most cases the first option for treatment after a few weeks is non- surgical such as over the counter NSAIDs and physiotherapy. The majority of cases respond well to conservative management. Epidural injections and nerve root blocks can be a second option, although there seems limited evidence of the efficacy of epidural injections beyond three months.
Surgical treatment is considered the last option. The benefits are moderate and tend to decrease over time. Patients are often left with residual pain and neurological deficits, which are often worse after surgery. Although surgery may lead to fast recovery, the results are similar to conservative management at one year after surgery.[42]
Treatment of non- specific low back pain
The overuse of medication and surgery is a widespread problem in the treatment of non-specific low back pain. According to McGill, post- surgery recuperation is as effective in pain reduction as surgery itself, due to the recovery program.[43] According to the World Health Organization treatment for non- specific low back pain ideally includes a combination of physical therapy to increase muscle and core strength and improve mobility; psychological therapy to deal with the pain and consequences of the pain especially since chronic low back pain is associated with depression; medication to reduce symptoms and relief pain; education to teach patient to develop strategies for self-care; and lifestyle changes (as discussed later). This set of interventions aims to maintain independence in life and optimal participation in meaningful activities.[44]
The American College of Physicians and the American Pain Association recommend non- pharmacologic treatment with superficial heat, massage or spinal manipulation, and optional anti-inflammatory drugs or skeletal muscle relaxants, in cases of acute and subacute low pain.
In cases of chronic low back pain, the recommendation is non- pharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation. In cases with a ninadequate response to non- pharmacologic therapy, the recommendation is to consider pharmacologic treatment. [45]
Exercise
The outcomes of treatment depend on many factors, but regular exercise and maintain a healthy body weight have better results than a sedentary lifestyle.[46] The type of exercise seems to matter in relation to treatment of non-specific low back pain. Walking for 30 minutes per day and strength exercises for two or more days per week lowers the risk of low back pain after the age of 65 years.[47] Some studies show that exercise is probably effective for treatment of low back pain compared to no treatment, usual care or a placebo, although the evidence is limited.[48] It seems that exercise types like Pilates, McKenzie therapy and functional restoration are more effective than other types of exercise such as aerobics, to reduce pain intensity and functional limitations. Most exercise types are more effective than minimal or no treatment, especially if the exercise is done regularly and consistently.[49]
Treatment of women
Many cases of low back pain in women are related to a decline or deficiency in female sex hormones. Research has shown that endocrine hormones can promote nerve regeneration and functional recovery in patients with spinal cord injuries. Estrogen helps to keep the spinal cord healthy, decreases inflammation and aid in restoration of function. Progesterone plays an important role in the function of the nervous system.
A deficiency of estrogen can lead to osteoporosis, which increases the risk of spinal injuries and low back pain in women. A combination of Hormone Replacement Therapy, a healthy diet and weight- bearing exercise can help prevent bone loss. It can strengthen already weak bones and help to lower the risk of spinal fractures, chronic low back pain and complication.[50]
Treatment of athletes
In the treatment of athletes with low back pain, it is important to know the types of painful lumbar motion during sports in order to tackle the main cause or the triggering movements. In other words: is the pain triggered by bending forward, backward, sideways or rotation, and does this lead to an inflammatory reaction? Minimally invasive procedures, including bracing and intradiscalsteroid infiltration could be beneficial for athletes.[51]
The evidence for the effectiveness of interventions for low back pain among athletes is somewhat insufficient. Several treatment options seem to improve pain and function, regardless of whether the healing was shown on an MRI or not, but it remains unclear what the most effective treatments is and for whom. Exercise seems to reduce pain and improved function in athletes, but the value of manual therapy or biomechanical modifications is unclear. The evidence for the use of core stability exercises is low. [52] In cases of athletes with spondylolysis, nonsurgical treatment result in successful pain relief in approximately 80% of the cases, independent of radiographic evidence of defect healing.[53]
Some studies claim that athletes with chronic low back pain suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (a form of resistance training which strengthens the muscles that you use to breathe) seems to improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with chronic low back pain. According to McGill, developping endurance of core musculature as well as a proportional amount of strength of the global muscular system are key in injury prevention.[54]
Other studies claim that superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies for athletes. Non- steroidal anti-inflammatory medications and skeletal muscle relaxants seem to benefit in the initial management of low back pain, but also have considerable side effects.[55]
Lifestyle changes and self- care
Lifestyle factors play an important role in the treatment of low back pain. Sometimes, these factors are being overseen because people are not aware or underestimate the impact. Sometimes these factors are ignored because a lifestyle change implies a behavioral change. Changing daily habits can be difficult. Self-care comes down to self- reflection, will- power, and discipline.
Four lifestyle factors contribute both independently and in conjunction to the global burden of low back pain: Obesity, smoking, physical inactivity and poor diet. Studies show a weight loss program targeting diet and physical activity significantly improves low back pain-related disability. Exercise successfully reduces disability compared to not exercising, and quit smoking can reduce low back pain with 30%. [56]
The risk of developing long duration troublesome low back pain among women with occasional low back pain decreases with increasing healthy lifestyle behavior (not smoking, no alcohol, physical activity and the consumption of fruit and vegetables). Research shows the risk of chronic low back pain among women can be reduced to 35% for one of four healthy lifestyle behaviors, to 52% with all four factors.[57] A healthy lifestyle can also be protective against the onset of chronic low back pain in men and chronic neck pain in women.[58] In both men and women, a clustering of unhealthy lifestyle factors (smoking, alcohol intake, exercise, physical activity, walking speed, weight control, eating habits, and sleep) is associated with increased risk of low back pain regardless of age and body mass index.[59]
According to the World Health Organization several lifestyle changes can reduce low back pain, additional to maintaining a healthy body weight and not smoking[60]:
Being physically active, inside and outside the gym
At the gym
Inside the gym, it is important to choose the appropriate type of exercise, in which the load of the exercise and the load capacity of the patient are in the right ratio. Exercise must be done regularly and consistently to be effective, at the right intensity, with the correct technique and good posture, and under the close supervision of a professional coach especially in CrossFit.
Timing of the exercise during the day is relevant. can also be for example not lifting heavy 30 minutes after waking up.
The focus of the exercise should be on increasing core endurance, strength, spinal stability and stiffness, and mobility. Mobility of the hips and shoulders, not of the spine (!) is important since a lack of mobility can lead to muscle cramps, the inability to strengthen muscles or improve posture, and a higher risk of injuries.
Spinal health
Outside the gym means being active at least five days per week for at least 30 minutes per day at moderate intensity, such as brisk walking to help deload the spine. It also means undertaking daily activities while maintaining a good posture (there is a direct relation between posture, position and pain). Avoid habits such as crashing on the couch, wearing high heels, driving a car a lot, and scrolling on the phone. Spinal health refers to taking care of your back every single day, with exercises and with improving poor habits or movements. This takes discipline and consistency.
Optimizing mental well-being
A positive mindset and stress management enhance the healing process of low back pain. Mindfulness, meditation and pain education can help to develop effective coping strategies.
Getting good sleep
Sleep is vital for overall health and well-being. Several dimensions of sleep are associated with chronic low back pain. Consistent evidence is found that chronic low back pain is associated with greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress.[61]
Making ergonomic adjustments in the workplace
Alternate sitting, standing and walking during the day seems best. A proper and adjustable desk and chair are advised. Sitting crossed legged, sitting on one butt cheek, driving a car, always leaning on the same leg while standing, are habits that can contribute to low back pain.
Having a healthy diet
A healthy diet ensures the spinal cord, muscles, ligaments, tendons and circulatory system are properly nourished to promote healing of the body, while reducing the chances of inflammation. A healthy anti- inflammatory diet, such as the Mediterranean diet, includes whole grains, fish, chicken, fruits and vegetables.[62] Additionally, protein and products or supplements with vitamin D and calcium seem to be important in relation to the treatment of low back pain and for bone health especially in women.
Unhealthy diets low in vitamins and minerals such as the Western diet, can lead to inflammation and worsening of low back pain. These diets include highly processed food, foods low in fiber, energy dense foods, fatty and red meat, sugar, salt, soft drinks and alcohol.
Advice
Our advice:
- Fix your lifestyle habits first. This matters greatly and is totally in your own hands. It takes discipline.
- Train smarter, not harder. Focus on the quality of movement and on good posture and spinal health. Seek professional coaching.
- Keep a positive mindset and focus on what you still can do instead of on limitations.
- Get treatment. Consult a physiotherapist specialized in low bac kissues and sports. If you’re a woman in your 40s, consult a gynecologist
- Educate yourself. Ask a professional for an analysis of your posture and movement pattern to get insight into aspects that contribute to the pain and how to fix this.
- Step away from YouTube self- help videos if you are not 100% sure what you are doing.
DO NOT:
- Ignore symptoms, be stubborn or avoid treatment and advice.
- Give up! Recovery takes time and is never linear. There will always be ups and down.
- Stop exercising, or blame exercise (especially if you spend 2 hours per week at the gym, and the other 166 hours mostly sitting or lying…)
Create your own health!©
References
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