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Plan Activity and Recovery!

With the new year we all make resolutions but how many keep them?
The truth is very few. If you have chronic pain, such as lower back pain, then giving up on a rehabilitation program is not an option.

Professor Dominic Hegarty, (Clinical Director, Pain Relief Ireland) explains that most individuals have very limited insight into what fitness means.

“I am regularly asked about what the best exercise is and what to do?”

Obviously, everyone is different, but it reflects the poor insight we have as a nation about the benefit of regular exercise. Then when we develop a chronic pain, such as lower back pain we commonly head to our physiotherapist and promise ourselves to do the exercises. While they can often help in the short term what is needed is a long-term plan to commit to better behaviour.  

Naturally, once we get over the “flare up” we go back to our old ways paying very little attention to taking care of ourselves until the next time. The issue is the next time might be too late!

At Pain Relief Ireland we regularly treat individuals with a chronic lower back pain generated by an injury to the facet joint. This is referred to as Lumbar Facets Syndrome can respond very well to target injections in the lower back. Quite often the muscles in the area, the paraspinal muscles, are in spasm and we typically encourage walking, stretching, and introducing some level of regular activity to assist relaxing and rebuilding their strength.

While there is no perfect formula, Prof. Hegarty suggests a few pointers to help.

1. Make a plan to get Active!

Start somewhere. For example, walking on a smooth flat surface is a great starting point. Treadmills offer an advantage because you can control many variables. Jogging and running will come later. You can increase the pace and the terrain once it feels comfortable. The best place to start with is one where you are just out of breath. Stopping to take a break is okay and not a negative sign.

2. Aim for Time, not Distance!

Everyone wants to reach 10,000 steps or do 5km now! The first goal should be to set time limits, not distance. You are less likely to fall into the trap of pushing outside your comfort zone if you fix the time. Going beyond this boundary and you run the risk of paying the price with poor recovery. Start with a reasonable time such as 10-15 minutes and build it up.

3. Monitor your Recovery time.

Allowing recovery time is an important part of rehabilitation. Walking through the pain barrier is old school. If you do this then you will very quickly loose interest and will be back on the sofa before you know it. Don’t over commit and force yourself to overdo it.

4. “Pick” a friend/buddy

It is good to have a partner to exercise with. It makes it more socially interesting but ensure you both have similar goals you can become each other’s point of reference. Just make sure you do not compete with others. This is not a race.  Avoid checking your GPS, exercise tracker or social media. It is your pace and rehabilitation that is relevant. Setting realistic goals, you can achieve is important.  

5. Zone 2 Pace target

For those of you who want to push on one way of working out an appropriate pace is to use the Heart Rate Zone 2 as a guide.

Zone 2 training is a level where physiological stress is relatively low (Biggs et al). This is approximately 60% of your maximum heart rate (MHR).
Some fitness trackers will tell you this, but you can estimate by calculating your maximum heart rate MHR as 220-your age.

MHR = 220-age in years

For example a 50 year old would have theoretical MHR of 170 ( i.e 220-50) and 60% means you need to have a HR of 106 beats per minute.


Slow steady progress is key. Sometimes measuring your progress can help motivate you. Some individuals can work with a personal trainer in the gym or there are many different programs is the community to help individuals with similar limits progress. Join up and make it happen.

Every step counts!


See also:

Don't let pain stop a golf career!

Take control of lower back pain today!

Dr Hegarty discusses neck pain with Maura & Daithi on RTE Today

New technology to treat chronic lower back pain