The Importance of Pacing During Back Pain Rehabilitation

One of the most important functions healthcare providers serve in working with patients with recurrent back pain is helping these individuals get back to activities they find meaningful. In some cases, this might be return to work, in others, competing in an upcoming pickleball tournament. In all events, these are the things that patients believe make life worth living. While much has been said about catastrophizing among back pain patients, that is relatively rare compared to frustration over activity limitations, which can lead to enduring stress, anxiety and depression.

In this context, the importance of pacing and rest breaks cannot be overstated. Elite athletes apply similar principles to training, mixing up very hard workouts with easy days or days of complete rest. Rest allows the athlete to work hard during the workout without increasing the risk of injury. Everyone has a breaking point, even an Olympic level athlete.

In a Canadian study, researchers investigated the role of frequent rest breaks in seated office work (Sheahan et al., 2015). Researchers compared four groups in a bout of extended sitting. Groups that took routine standing breaks not only experienced some relief from the back pain; the groups with more frequent breaks also had less mental fatigue.

In a study on interdisciplinary rehabilitation for improving function in people with chronic pain, occupational therapists taught patients modification of daily activities, as well as relaxation techniques including diaphragmatic breathing and progressive muscle relaxation, as a way of balancing the stresses of daily activity. This concept of pacing as part of rehabilitation enables patients to get back into the world, while at the same time allowing adequate recovery time for muscles that may be weak from disuse.

Finally, a meta-analysis of research on short rest breaks as a method of improving task performance found beneficial effects through strain related cognitive, emotional and motivational mechanisms (Wendsche et al., 2016). While rest breaks may reduce time on task, employee performance rises, compensating for time lost. Most of who work 40-hour (or more) work weeks experience times of day when we feel fatigued and burnt out, and find it more difficult to focus on tasks requiring more mental effort. Short rest breaks reduce the burden of long workdays, allowing physical and mental breaks, as well as the opportunity to briefly socialize with co-workers.

Recurrence is perhaps the most stressful aspect of living with back pain. For most individuals, back pain isn’t intractable, but rather comes and goes (Waddell, 2004). While there is no guarantee against pain recurrence, pacing can certainly slant the odds in the patient’s favor. When rehabbing from one of these episodes, consider the following:

* Schedule physically demanding tasks on different days throughout the week if at all possible.

* Break these tasks up into smaller bits. A five-minute sitting break during cooking or laundry folding can make a big difference in pain level, without using up much extra time.

* Keep track of sitting time at the office, and schedule a brief walking break at least once per hour. It may help to set a reminder alarm on the phone. Consider more frequent five-minute breaks in place of traditional fifteen-minute breaks in the morning and afternoon. Spend part of the lunch break taking a brief walk as well.

* If returning to a sport such as pickleball or golf, ask a physical therapist for some warm-up exercises. Muscles recovering from injury and/or disuse need to warm up before vigorous activity. A five-minute period of stretching and flexibility exercises can make the difference between success and relapse.

For back patients whose pain is not due to structural damage, recovery may depend more on pacing strategy than interventions such as injections or prescription analgesics. The human body is remarkably resilient, given the chance to recover.


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