This episode, Michael Dermansky is joined by Nick Adkins, an exercise physiologist at MD Health, to discuss the impact of back pain on exercise, wellness and mental health.

With 80% of people experiencing back pain in their lives, it’s a widespread problem that can strike any age group or fitness level. The good news is there are ways to manage and even overcome back pain so you can continue to exercise and improve your overall wellbeing.

Michael and Nick discuss the causes of back pain, what you should (and shouldn’t) do in terms of activity, and how a goal-oriented treatment plan can get you back (no pun intended) doing the things you love.

CLICK HERE to read the full transcript from episode 11 of The Confident Body Show

Topics discussed in this episode:

  • The main causes of back pain, and whether any age group or type of person is more prone to it.
  • Does feeling pain mean you’re doing damage? 
  • The activities patients with back pain should (or shouldn’t) do.
  • The role that mindset plays in managing and overcoming back pain.

Key takeaways:

  • Back pain is a widespread problem, with around 80% of the population experiencing back pain at some stage in their life. It’s easy to accept back pain as normal background noise. (1:45)
  • Back pain is not the same for everyone and a thorough assessment and plan is the best approach for most people. (5:00)
  • Your mindset, and your exposure to chronic pain, can change your brain structure, making you more (or less) sensitive to pain. (11:20)
  • It’s not just about the injury itself, but your anxiety about the pain. Fear about the injury increases your cortisol levels which amplifies your pain. (11:45)
  • Feeling pain doesn’t necessarily correlate to causing damage. You can still do activity that causes pain and not cause long term damage. Your feeling of pain can be heightened by how long you’ve been dealing with it, and how chronic it is. (13:00)
  • Restarting doing the things that you love is a very important part of the healing process, which releases endorphins that dampen down the perception of pain.
  • The rehabilitation process usually has a number of steps, including exercise to reduce the sensation of pain, core stability training for control and strength training for power. (15:00)
  • Exercise can be started from day 1 as a tool to reduce pain, not just after the pain has gone away. (19:40)


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Click on the Dash icon below to see the entire show transcript

Episode 11: Full Transcript

Voiceover (00:02):

Welcome to the Confident Body, where experienced health professionals discuss how to get the most out of your body for the lifestyle you choose. We believe everyone can exercise and get the most out of life, regardless of your injuries or health issues. Now here’s your host, senior physiotherapist, Michael Dermansky.

Michael Dermansky (00:23):

Hi everyone, and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. I’m Michael Dermansky, senior physiotherapist at MD Health, and I’ve got a special guest again today, Nick Adkins, who is our senior exercise physiologist at our Templestowe branch. And it’s the second time on the show, and he’s going to be talking about a special topic.

Michael Dermansky (00:43):

So for this month of October we’re going to be talking about back pain, and this is the first of those podcasts, specifically about back pain, in particular, is back pain stopping you getting the best out of your life? So welcome aboard, Nick.

Nick Adkins (00:57):

Thank you.

Michael Dermansky (00:57):

And welcome to the show. This is the topic you have been passionate about, and you’ve seen a lot of over the last, what, 10, 15 years now?

Nick Adkins (01:05):

Eight years I’ve been working, yeah.

Michael Dermansky (01:05):

Eight years.

Nick Adkins (01:05):

Close enough.

Michael Dermansky (01:07):

Close enough. So firstly, let’s start off with, what kind people do you see with lower back pain?

Nick Adkins (01:11):

That’s a very, very broad question.

Michael Dermansky (01:13):

A very broad question.

Nick Adkins (01:15):

Just about everyone, really. I mean a common statistic that’s brought out is about 80% of people experience back pain at some time in their life, and it is the number one burden disease in most countries.

Michael Dermansky (01:28):


Nick Adkins (01:29):

And quite a lot of time off work, a lot of money spent treating it. So, yeah, there’s a lot of people who we see with lower back pain. Through the time I’ve worked with MD Health it’s mostly been middle aged people who want to be active, ranging up to older people who want to be more active in their retirement. A high number of people, we’re more recently seeing more athletic populations, especially weightlifters or power lifters with back pain.

Nick Adkins (01:56):

But, yeah, it’s not exclusive to any age group, or any particular profession, or type of activity. Most people experience back pain. I’ve met more people in my life who have back pain than those who don’t have back pain.

Michael Dermansky (02:10):

Right, fair enough.

Nick Adkins (02:11):

It is a very, very common issue that a lot of people have. As I said, it’s not exclusive to any age, gender, race or anything. It’s just so broad.

Michael Dermansky (02:23):

And when you think about someone with back pain, you usually think of someone bent over because they’ve just hurt themselves.

Nick Adkins (02:27):

Generally. Yeah.

Michael Dermansky (02:28):

But is it just like that? Because I know in my practice as well, you see a lot of… It’s background, or you accept it as a degree of normal in the background, where often it’s not, it’s not the way it should be. And it’s not just someone just walked in because they hurt themselves yesterday. A lot of times most people have had it for a while, and that’s when we see us.

Nick Adkins (02:48):

Yeah. We rarely see people in that acute stage, unless they’re already seeing us and it’s just a flare up. But yeah, we very rarely see people on the acute stage of when their back pain occurred. It’s usually, something they’ve, essentially learned to live with because, in my opinion, they just haven’t been treated properly throughout the time. Yeah.

Michael Dermansky (03:11):

So what are the main causes of lower back pain that you are aware of, or that you see of?

Nick Adkins (03:17)

Again, it’s another broad question.

Michael Dermansky (03:18):

It’s a very broad question.

Nick Adkins (03:20):

And especially, probably over the last five years, the notion has of been challenging industry around being very biomedical and mechanical focused on the diagnosis, which is still important but there are a lot of other factors they contribute to people’s back pain. But in saying that, they’re usually, if you dig deep enough into the patient’s story, you can usually find when it first occurred, and it usually is after a particular event or something happened. And then it’s usually a cascade from there.

Nick Adkins (03:54):

So it’s continuously irritated, there’s a change in mechanics in the spine which then causes other areas to become overloaded, then they become irritable. But, yeah, it’s usually a cascade that happens over a number of months, or even a number of years that can lead to their pain. But to really answer the question, in my opinion, the most common cause of back pain is a disc injury. And that can happen through very many different forms. The most common one is bending down and injuring a disc in that particular way.

Nick Adkins (04:25):

Now there is evidence to suggest that it doesn’t always happen that way, but there’s a lot of evidence to show that it is, like flexion is a aggravator for disc injury. That’s the most common one, but it’s not the only one.

Michael Dermansky (04:37):


Nick Adkins (04:38):

And the one thing we need to be aware of is that someone might have a disc injury previously, but that’s actually resolved and now is another area that’s become the issue because of that initial injury.

Michael Dermansky (04:49):


Nick Adkins (04:49):

And that’s where, in my opinion, the assessment is really important. That’s one of the things we do a lot here at MD Health, is we spend a lot of time assessing the patient to get their full story, to get their full history to find exactly what was the initial cause, and then how has that tracked on over time to where they’re now?

Michael Dermansky (05:07):

Yeah, it’s interesting because I see that as well, where the people have come in and said, “Oh I’ve got a disc bulge.” And then you’re doing the assessment and it’s got nothing to do with their current symptoms.

Nick Adkins (05:16):

Exactly. Yeah.

Michael Dermansky (05:17):

It may have happened five years ago, and that’s pretty much resolved. Or even if it’s on their scans, it’s really not the symptomatic side.

Nick Adkins (05:24):

Yeah, exactly. It doesn’t show in their actual physical testing, and when we assess them, assess their movement, we can see that’s actually not affecting them.

Michael Dermansky (05:33):

Yeah. So with that, we said disc bulge, any other major causes as well? I know there’s many ones, but any other major causes that you’re aware of as well?

Nick Adkins (05:43):

Probably, I guess we would just go down the list. Then your next one after that would be either osteoarthritis of the facet joints, which we see a lot more in older people.

Michael Dermansky (05:50):


Nick Adkins (05:50):

But, younger people can get damage in the face joints as well, or not so much damage but irritation of them. But again, that’s generally secondary to the initial disc injury. And like I said, there’s so many different things that can cause back pain. There’s the structural, the passive tissues of the spine, such as the disc, such as the facet joint, such as the vertebrae, but then you have muscle irritation, muscle spasms around the spine as well, which is again usually secondary. Then you have nerve implications as well. Again, generally because the nerve root’s been impacted by the disc injury. And that will cause the pain down the legs, or the classic, what people call sciatica.

Michael Dermansky (06:31):


Nick Adkins (06:31):

Yeah. But there’s many, many different things. And then you have the medical side things that can affect back pain, where you can have viruses and those sort of things that can aggravate people’s back pain. I’ve seen a couple of people who have had an onset of back pain after catching COVID, which is quite interesting.

Michael Dermansky (06:48):

Right, okay. I haven’t seen it myself, but do they have a mechanical injury like a disc bulge, or was it actually from the virus?

Nick Adkins (06:53):

It seems to be more viral, like a chemical change.

Michael Dermansky (06:57):

Right. I see. Interesting, you said about disc bulge as well. So, is it really important… We do a lot of assessment here, is it really important to the assessment? What does doing the assessment, how does it make a difference to what you do?

Nick Adkins (07:12):

Well it basically tells us what movement is beneficial or relieving for the patient, which then helps us detail our treatment plan and what we’re going to do with them, the plan we’re going to create for this person. And how we’re going to treat them over, not just the session that we see them, but over the next however many weeks it’s going to be, whether it’s three weeks, seven weeks, three months.

Nick Adkins (07:37):

Yeah, it really just guides what we do with the patient, and how we’re going to progress them over time back to whatever they want to get back to. So it’s always goal orientated in terms of what the patient’s goals are, whatever they want to get back to. Whether that’s their sport, or just their general activity, or their work, whatever it is. Our treatment plan and our assessment is always verging towards achieving those goals.

Michael Dermansky (08:02):

Right. So basically the two things you’re getting out of the assessment is that, what is the restrictions for this person? They’ve got this issue, so this will work better for them, and this will work bit worse. So you’re being guided, and then where they want get to, how we’re going to get from A to B to that person?

Nick Adkins (08:16):

Yeah. And that gives the client a lot of clarity as well in terms of, we’re not just treating this issue to get to reduce their pain, we’re also working towards their goal, or whatever they want to be able to achieve.

Michael Dermansky (08:29):

So, getting rid of the pain in the short term may not mean that someone can go skiing, or they might not be able to go lifting, or they might not be able to go running on the weekends as well.

Nick Adkins (08:40):

To the best of their ability.

Michael Dermansky (08:42):

Yeah. So we need to build up towards that?

Nick Adkins (08:44):

Yeah, and that then builds their confidence in their body as well.

Michael Dermansky (08:48):

So going in that direction as well, where does mindset come into this? Because that’s a really important part, you and I know about the biosocial model, but it’s not obvious to everyone else what that means. How does it mindset come into the picture?

Nick Adkins (09:05):

Well mindset, not just on the topic of back pain or pain in general, but we know mindset affects everything. In your work, in your personal life, in your own financial goals or personal goals, mindset has a very big impact on that. So we know if your mindset isn’t set towards your goal or achieving something, you’re not really going to achieve it. And on the topic of back pain, something we see a lot is, like you said before, someone coming in saying they’ve got a disc bulge. They become quite attached to that diagnosis, and they think that because they’ve got this disc bulge it’s never going to change. And so they’re always going to be in pain, and that’s their mindset.

Nick Adkins (09:48):

I’ve got this disc bulge, that’s not going to change, I’m always going to be in pain. Or, that disc is always going to be weak, or going to be injured in some way. Whereas part of our treatment is basically changing their beliefs and changing their mindset, that, yes, that disc bulge might be a problem, but it’s not going to stop you from achieving your goals. And two, it can change. We know it can change.

Michael Dermansky (10:13):

It can heal too.

Nick Adkins (10:14):

Exactly. So, yeah, mindset plays a big role in that, that not only you need to believe that you’re going get better, and you need to change your mindset from, this pain’s always going to stop me, that I can overcome this pain, or this pain will improve. A very common thing in mental health is mindset.

Michael Dermansky (10:34):

There’s a chemical reason for this too.

Nick Adkins (10:36):


Michael Dermansky (10:36):

It’s not just, I should believe this way.

Nick Adkins (10:39):

Yes, but that creates changes in the nervous system, it changes the way your brain works. And that’s the powerful thing around mindset is it does change how your brain works, which then in turn changes how your nervous system works, which then in turn changes how you feel pain. Because you can’t feel pain with how your nervous system. And one of the things that’s been shown, especially in people with chronic pains, who have had… Back pain’s a very common one, for chronic pain, back pain for 20, 30 years, there is actual literal changes to their brain.

Michael Dermansky (11:09):

What do you mean? What kind of changes to your brain? Does that mean I’m making it up? It’s in my head?

Nick Adkins (11:15):


Michael Dermansky (11:15):

What does that mean?

Nick Adkins (11:15):

No, there’s literally chemical changes and neurological changes to their brain.

Michael Dermansky (11:20):


Nick Adkins (11:21):

And that can increase the sensitivity of the nervous system. They’re taking more information, so they’re essentially more sensitive to changes in their back. And whether that’s change in their back position, change in their load or change on what they’re doing, they’re a lot more vigilant and sensitive to those changes.

Michael Dermansky (11:36):

Right. I know, basically, over time your cortisol levels increase.

Nick Adkins (11:43):


Michael Dermansky (11:44):

Where you’ve got this over time. And so what cortisol does, it’s a natural hormone that’s released at times of pain, and particularly anxiety. And your body can’t tell a difference between anxiety and a real threat, so it raises the cortisol levels, and that hyper sensitizes the whole system. So what would be considered a normal sensation is really amplified.

Nick Adkins (12:03):

Correct. Yeah.

Michael Dermansky (12:04):

And that has a massive effect.

Nick Adkins (12:06):

Yeah. And that goes on for years and years and years. Imagine just being in that fight or flight response all the time.

Michael Dermansky (12:14):

All the time.

Nick Adkins (12:15):

You’re pumped with cortisol and adrenaline, and you’re just always waiting for something to happen.

Michael Dermansky (12:20):

So, there’s a big one there that you talked about, so in that case the anxiety about pain, that, “Oh, I’m going to do this and I’m going to be in pain and further injure myself.” It’s not an absolute correlation, is it? I hurt, therefore I’m doing more damage. Tell us about that, because it’s not the same, just because it hurts at the time doesn’t mean I’m doing any more damage.

Nick Adkins (12:42):

Oh, definitely. And again, that’s something that’s been shown time and time and again. Not recently, this is research that’s existed for decades.

Michael Dermansky (12:50):


Nick Adkins (12:52):

Is it pain that you feel just not correlate to damage. And as medical imaging has got better, so like MRIs and CT scans for example has got better, that’s just more solidified that thinking that pain doesn’t equal damage. Because someone can be in a lot of pain and then the imaging is completely and utterly fine. There’s nothing abnormal detected on their scans.

Nick Adkins (13:11):

Now, granted that is in a static position, but, yeah, someone could be excruciating pain but there’s absolutely nothing on their scan. And then vice versa, someone could have a lot going on their scans and no pain whatsoever. So pain doesn’t correlate to damage at all.

Michael Dermansky (13:26):

So, what I’m hearing as well is that when you’re doing assessment, there’s actually probably three things you need to know about one. Number one, what structure do you believe are causing the major issues at that time?

Nick Adkins (13:37):


Michael Dermansky (13:40):

Number two, what the person’s goal is. Number three, how is that feeling of pain affecting that person’s life? Which is not always correlated to the degree of damage that’s under the surface.

Nick Adkins (13:52):

Correct. Yeah. So there may be a mechanical, or a biomechanical issue is there that needs to be addressed, but at the same time, this person’s intensity of pain can be altered by what they’ve gone through in their life, or how long they’ve been dealing with this pain for. Because generally as it gets more chronic, it becomes worse.

Michael Dermansky (14:15):

So tell me about how then lifestyle comes into this too? Because what people’s life outside of the clinical room looks like, and how that affects their back pain as well.

Nick Adkins (14:26):

So, if someone’s got pain they generally tend to withdraw from doing things that they enjoyed previously doing. So that might be withdrawing from the sport they used to enjoy doing, or playing with their kids or grandkids. And if you’re withdrawing from something, you’re not enjoying something you used to do, that, again affects your mental health, which then affects your mindset. So, yeah, people’s back pain definitely affects their lifestyle. And again, that’s why we always have our goal orientated treatment plans, is to get them back to the lifestyle they enjoy doing.

Michael Dermansky (15:02):

And that’s a chemically mediated thing too. When you don’t do the things you like, your anxiety is higher, your cortisol levels rise. When you start doing the things you do like to do, or you continue on, that releases endorphins, that releases serotonin-

Nick Adkins (15:18):

Yeah, exactly.

Michael Dermansky (15:18):

All those things dampen down the feeling of pain.

Nick Adkins (15:21):

Exactly right. So it’s not only addressing the issue that’s contributing to pain, but then, yeah, it’s also affecting the chemical mediated side of it.

Michael Dermansky (15:30):

What about the other side of lifestyle? Because we usually see people, “Well, I wasn’t doing anything. I sit at my desk at work, I don’t do anything, and suddenly I get up and there’s back pain.” Where’s the problem there?

Nick Adkins (15:43):

I would say the problem would be they’re sitting down for too long. So there may a particular structure that’s being stressed in that position. So we’ve got to find a different position for them to be in. And that’s a very common one. Office workers, they sit down all day, that can easily be alleviated by simply getting up and moving around throughout the day. That’s how you can range something like that.

Nick Adkins (16:06):

That means that there’s a particular issue there that’s being stressed. But then in saying that, there can be outside stress as well that can contribute to increase anxiety or stress. So if the work’s really stressful, if they’ve got a deadline to meet, or their boss is being really mean to them, that all will increase their cortisol levels, which then can potentially exacerbate their pain.

Michael Dermansky (16:33):

I mean the other classic thing I tend to find as well is that a lot of people, when they have their injury they’re surprised about it, but when you test for them, there’s no surprise there, because you can see all these weaknesses there too.

Nick Adkins (16:44):

Yeah. That’s the cascade I talked about earlier. Generally, there’s an onset, and then over time they stop doing whatever they were doing, or whatever treatment they’ve had done hasn’t been targeted enough, they start to develop some sort of weaknesses because of this pain. And then that translates in other parts of their life or other parts of their body.

Michael Dermansky (17:05):

Yeah. And what I also often see as well is the people, the weekend worries in terms of, “Oh, I bike ride three hours on a weekend, I’m fit and strong.” But when we test them, they’re very, very weak in their back muscles, and they’re bottom muscles, and all the things that support them staying up straight, that would allow them to lift and sit up for a long time, and they’re just not strong enough when they do strength work. “Oh, but I go riding every weekend.” “But you’re not strong enough.” “What do you mean, I’m not strong enough, I ride every weekend?”

Nick Adkins (17:32):

Yeah, well it is a different type of exercise, and I guess on that topic of cycling, you’re in a static position for however long you’re cycling for, your back and your hip muscles aren’t doing all that much when you’re cycling.

Michael Dermansky (17:47):

No, it’s all quads.

Nick Adkins (17:49):

Mostly, yeah. Yeah.

Michael Dermansky (17:51):

So someone’s come in, they’ve had back pain, you’ve assessed them, you’ve figured out they’ve got a disc bulge, for example. What would you do next? What’s a rough idea of a typical program? It doesn’t have to be a perfect response, but what would a rough program for someone look like, if they did it themselves?

Nick Adkins (18:09):

Well again, no two people are the same.

Michael Dermansky (18:11):


Nick Adkins (18:12):

Yes they might have this particular pathology, but the way that it behaves, or the way that it affects them is quite unique to that person. And again, everything is sort of based on that individual person’s assessment. And again, we’re focusing towards their goals. So we’ve got to go, okay, where we are now, what we’ve assessed, how are we going to get towards that goal? What things do we need to work on? And then essentially start to work on that.

Nick Adkins (18:40):

So early stages, if they’re in pain, we try and reduce their pain as best we can. Now, that can be by various types of stretches or positions, or showing them different ways to move or to do activities or moves they have to commonly do throughout the day. Showing them different ways, or working on different ways and new ways to do those moves that doesn’t stress their pain as much, in an effort to desensitize it.

Nick Adkins (19:08):

And then we have to work on what muscle groups we’ve identified as, not necessarily weak, but aren’t working as best as they could be, which is going to, again affect their movement and the tasks they have to perform throughout the day. And again, we determine that from our assessment. So then we do whatever exercise we think is appropriate for that person, the dosage that we think is appropriate. So sets and reps and what weight, and then progress that appropriately as their symptoms improve. Again, the progression is working towards what their goal is.

Michael Dermansky (19:38):

And something I wouldn’t have known 20 years ago, but you know can reduce someone’s pain with exercise. You don’t have to put your hands on them to be able to reduce someone’s back pain at the very start. So, is it safe to exercise someone day one, after they hurt themselves?

Nick Adkins (19:55):

Oh, definitely. Yeah. It depends on the severity of their pain. If they are quite acute and quite severe, they may not tolerate a lot of exercise. But again, in my opinion, at that point the goal of the exercise isn’t necessarily to start improving their muscle strength, it’s really just to get some movement through the affected areas. Because we know movement is good, we know movement is alleviating.

Michael Dermansky (20:19):

So it’s alleviating, it reduces someone’s mindset that they can’t do it, it reduces their anxiety to reduce their cortisone levels.

Nick Adkins (20:25):


Michael Dermansky (20:26):

And increases their endorphin levels. So both of those aspects of being addressed when you’re doing that.

Nick Adkins (20:30):


Michael Dermansky (20:31):

And also it tells them, it’s okay to do it.

Nick Adkins (20:33):

Exactly. Yes. Yeah, there is that assumption that, yeah I’ve hurt myself, I have to get someone else to relieve my pain, when you can do it yourself, and that’s very powerful.

Michael Dermansky (20:44):

So there’s two other big things I talk about. Number one, “I’ve hurt my back, I’ve got back pain because I’ve got a weak core.” Is that true?

Nick Adkins (20:52):

I’ll then ask them, “What is a weak core, and how has that been tested?” Because a lot of people just make that assumption, that I’ve got a weak core, they haven’t had it really assessed. And then you jump into the other issue of how do you assess someone’s core? Because there’s so many different ways to do it.

Michael Dermansky (21:08):


Nick Adkins (21:09):

And again, what do they define as their core? Because a lot of people think core is just the abdominal wall. But when I think about core, I think of pretty much everything that attaches to the back. So that includes the upper back, the lats, the hips, the lags, everything affects it, in my opinion. To say it’s just from a weak core, I think is quite, almost reductionist. Someone’s pain is much more than that. It’s certainly a contributor, but, yeah, to say their pain is purely from a weak core is a bit ridiculous in my opinion.

Michael Dermansky (21:40):

Well I mean the biggest issue is that weak cores doesn’t cause back pain.

Nick Adkins (21:45):


Michael Dermansky (21:45):

It gives you the potential that you can’t protect your back. Your muscles aren’t strong enough to protect you back, so that you need to work on that, but it’s not the cause of the pain. It’s the bit that needs to be stronger to be able to protect it, and because it’s not strong enough then your other areas that are pain sensitive are more vulnerable.

Nick Adkins (21:58):

Correct. Yeah.

Michael Dermansky (22:04):

So, is just working the abdominal muscles enough? What do you need to work on then?

Nick Adkins (22:07):

As I just said before, your core stability is much more than just your abdominal muscles. Yes, they play a part of it, but you’ve got muscle around your back. Like there’s muscles that attach, run into your spine. They’re very important, there’s static stabilizers of the spine. You’ve got other muscles around the spine that control the movement of the spine, the position of the spine, they’re all really important and they need to be addressed. And then you’ve got your muscles and your hips, which play a very big role in just general movement. And if those muscles aren’t performing adequately to perform the tasks that you want, other things have to take up the slack.

Nick Adkins (22:42):

And generally it’s passive tissue, until that passive tissue [inaudible 00:22:45] and that’s when it gets painful. So, yeah, just working on abdominals is nowhere near enough. It’s just again, as part of the puzzle, as part of, it’s definitely not enough.

Michael Dermansky (22:56):

So adding that extra layer in afterwards. Okay, you worked in your core, these are the stabilizers, but you also need the power on top of that too, because those muscles aren’t strong enough to allow you to lift. It’s the muscles around your hips and pelvis, all those real big hip muscles that actually allow you to lift heavy weights, and do it safely, that you also need to build up. If you don’t work on those, it’s just not enough. You will repeat the same cycle.

Nick Adkins (23:19):

And then, on that, when you are building their strengths, you’re teaching healthy movement patterns as well.

Michael Dermansky (23:25):


Nick Adkins (23:25):

So again, I guess on the topic of lifting, when you’re learning to do those particular exercises, you’re doing them in the most optimal way for the muscles that you’re targeting to work, which is going to offload the passive tissue, so they don’t have too take much stress.

Michael Dermansky (23:40):


Nick Adkins (23:40):

Yeah, you can make muscles stronger, but you can still get hurt when you have strong muscles.

Michael Dermansky (23:44):

Explain that a bit, again one more time. So you can have strong muscles, but you can still get hurt.

Nick Adkins (23:47):

Yeah. Well, you can have strong muscles, but passive tissue can still be overloaded.

Michael Dermansky (23:53):


Nick Adkins (23:53):

If strong muscles stopped you from getting pain, then power lifters, strong men, elite athletes wouldn’t experience pain. But we know they’re a very common population that we see, that experience pain. So necessarily being strong, like you said, it does reduce the risk of it happening, but you still have to perform adequate movement to offload the passive structures, and to load those strong muscles optimally.

Michael Dermansky (24:18):

Right. So basically, you have to be strong enough for what you’re asking your body to do.

Nick Adkins (24:21):

Yes. And then do it properly.

Michael Dermansky (24:23):

And do it properly. Well, yeah. So, going with that too, this question is quite important. So okay, I lift something and it hurts. Does that mean I’m doing damage, and I should stop doing it?

Nick Adkins (24:33):

Not quite. I’d look at, okay, what movement am I doing? What am I working to achieve here? If it is painful, what can I modify to make it easier? Now, is it an exercise, or is it a particular task at work, or a sport or activity that they’re doing? But with that sort of thing, I like to use what’s called the traffic light system. So a red light would be to stop if the pain gets worse as you’re continuing to do the activity.

Michael Dermansky (25:01):


Nick Adkins (25:01):

And then a green light is, keep going if it starts to feel better as you do it. Because especially, and again this comes back to the desensitization of tissue, that when you first perform something you’re not used at doing, your body can be a little overprotective and say, essentially, “Be careful with this.” And increase the pain a bit.

Nick Adkins (25:24):

But then as you do it, your brain realizes, oh this movement is safe for me to do. And your pain levels, or the pain decreases as you do the movement. Because we see it all the time. We give someone an exercise, they’ll say, “Oh, that hurts.” And then do a few more reps. “Oh, it feels better.”

Michael Dermansky (25:36):

So it’s really about the selection of what’s appropriate from person to person?

Nick Adkins (25:39):

Yeah. If it’s hurt, or something’s hurting, you just don’t stop it right away. Let’s critically think about this. What can we modify, or what can we do to reduce this? Or, is it a fact of, okay, let’s just keep going and see how it feels. And most of the time, it gets better.

Michael Dermansky (25:56):

So one last question, over the last eight years, what have you seen that’s changed in the management in back problems since then? Is it still the same as when you started, or has the view on how to manage back problems challenged over the time?

Nick Adkins (26:10):

There’s not as much focus on just core stability.

Michael Dermansky (26:13):


Nick Adkins (26:14):

As we spoke about before, and again, not as much is focused on the abdominal wall, even though it is something that’s very common. Clients will still come in to stay that their abdominal wall, or the core is weak. That’s still something that exists, I guess in the general population. But in terms of in the rehabilitation industry, there’s not as much focus on that anymore.

Nick Adkins (26:32):

Again, it’s part of what needs to be addressed, but it’s addressing everything else around the spine, around the hips as well.

Michael Dermansky (26:37):


Nick Adkins (26:37):

And then there’s a lot more focus on the mindset, and on the social and behavioral factors as well. Which, again doesn’t necessarily cause their pain, but definitely contributes their pain. And that’s something that needs to be addressed.

Michael Dermansky (26:51):

So how much anxiety makes a difference, and how much stopping living your life makes a difference to a lot of back problems.

Nick Adkins (26:57):

Exactly right. Yeah. And I always find that the pendulum shifts in one direction, people are either really focused on the biomedical, biomechanical side of things, or they’re really focused on the sociological side of things. Where, in my opinion-

Michael Dermansky (27:10):

It’s about both.

Nick Adkins (27:14):

It’s about both. Yeah, like I said earlier, you can usually find a particular event when their pain started. Now that can be 10, 20 years ago, whenever it is. And that’s something that potentially needs still to be addressed. But then you have to address what behaviors have they then developed since then that’s now contributing to their pain?

Michael Dermansky (27:28):

Yeah. And one last thing, is there anything else you want to tell the listeners about lower back pain before we finish up today?

Nick Adkins (27:35):

The biggest thing is, it can change. It’s not for the rest of your life.

Michael Dermansky (27:39):


Nick Adkins (27:40):

You may have to change the way you do things, but you kind of have to do that throughout your life anyway.

Michael Dermansky (27:45):


Nick Adkins (27:45):

And may require a change in your lifestyle, or a change in the way you’re simply doing things in your life. But it’s certainly not something that lasts your entire life, and it is something that’s very, very, very manageable.

Michael Dermansky (27:58):

Fantastic. Excellent. Well thank you very much Nick, for talking to us about lower back pain. For the next episode, we’ve got an interesting episode two, we’re going to talk to one of our clients who’s had back surgery. And the big question we get asked is, “Do I have to have surgery, or do I have to treated without surgery? What’s the right answer?” And sometimes the answer is both, because it doesn’t necessarily mean, you have operation, that that’s the end of it. There’s often a large before, and a large after, and we’re going to talk about that journey, and what that looks like. Thank you very much again, Nick.

Nick Adkins (28:31):

That’s okay.

Michael Dermansky (28:31):

Thanks a lot. Bye.

Voiceover (28:34):

Thank you for listening to The Confident Body. For practical articles to help you build a confident body, go to mdhealth.com.au/articles.


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