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| Waking Up the Bear: A Physical Therapist's Recommendation |
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by Matthew Goodemote MPT, Dip MDT - July 7, 2010
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I would like to share a recommendation that I offer my patients on a fairly regular basis. I call it “avoid waking up the bear.”
It started a few years ago when I had a patient with sciatica. At first, this patient responded very well to the exercises I offered and their sciatica went away completely. A week or so later, the patient came back with fear in their eyes. I told them “all is well” and proceeded to explain the “bear in the cave” example.
I said, “Sciatica is like a bear sleeping in its cave. If you let it sleep, it’s a happy camper. BUT…if you take a stick and poke it, it will wake up. And when it wakes up, it won’t be happy. Sciatica is like this. Once you put it to sleep, let it sleep. If you find a stick, don’t go poking it!”
What I mean by this is that if you are someone who “knows” that sitting for more than 10 minutes causes your pain/symptoms to come back, then don’t sit for more than 10 minutes. If you do sit for more than 10 minutes, it’s like taking a stick and poking a sleeping bear. It is just not the wisest decision you can make.
Sciatica is generally a completely fixable condition. In fact, the vast majority of people with true sciatica do get better. When I say the majority, I mean 90% or more. If you are someone with persistent sciatica, I can almost guarantee you are somehow “poking the bear” and waking up your sciatica.
I recently treated a patient who was the perfect example of this. She has been dealing with back issues for the last few years. Each time another episode of back pain comes around, she gets more and more discouraged and believes it is hopeless and she will never get better again.
Her return to the Wellness Center is the result of her “waking up” her sciatica by doing things she tells me she “knows will make her worse.” I realize as I write this that this is a common theme, “knowing what will make us worse” and doing it anyway. I have pointed it out in a few articles on different topics, and yet for some reason we believe that doing things that make us hurt is enjoyable.
Anyway, let me stay focused!
Back pain in particular is a relatively easy condition to fix. What is more difficult is keeping it away. Too often we have learned one of two behaviors that are not helpful:
1) We have learned to do things that hurt us, or 2) We have learned to avoid doing things that we think will hurt us.
The most helpful thing to do when it comes to back pain is to stay active. But if you insist on doing activities that will provoke your pain, you must learn preventative strategies and first aid strategies to resolve any flare-ups. To me, “staying active” means doing everything you want to do, but if you have an activity that you “know” will “wake up the bear” then you must know what to do to help it go back to sleep again, sort of a lullaby strategy. When you use a lullaby strategy, you must keep singing the lullaby to make sure that not only is the bear asleep, but it returns to deep hibernation mode- and stays there.
For example, my patient who keeps “poking her sleeping bear” named sciatica consistently responds to bending backwards and good postural habits. For her, these are the lullaby strategies that she needs to use. So to put the bear to sleep, she needs to work extra hard on her posture even when she is feeling good and perform her back bends daily. In fact, I recommended that she do this several times a day.
Patients are often surprised when I don’t tell them to stop a certain activity, but instead to try the activity…cautiously perhaps…but to keep living and moving as normally as possible. If there is a particular activity that you “know” will make you worse, then common sense would say that you should in fact avoid that activity, TEMPORARILY.
The sign of a truly healthy spine is a return to full function, including the movements and activities that have made your pain worse in the past. It is not by avoiding things that our back gets stronger, it is by learning how to do them properly and/or doing something to prevent or immediately treat ourselves if we are going to continue the offensive activity.
This may go against things you have been advised in the past, but as you know I am a big fan of what is happening now, not then or some time in the future. For example, I have patients who tell me that sitting for more than five minutes will cause them back pain, so they avoid sitting altogether. I ask them to sit a certain way and then I talk about the spine for more than five minutes and it turns out they CAN sit longer IF they sit with a different posture than they are used to. It is also sometimes because they are sitting in a different style of chair. So the sitting isn’t the problem, it is what they are sitting in or how they are sitting in it.
So when dealing with the “sleeping bear” of sciatica or other back pain, in addition to staying active, using lullaby strategies to keep the bear asleep, and knowing what to do if you see the bear’s eyes opening, you must get to know the warning signs. Know what clue your body offers you before you have pain. Maybe you get a stiff back before you get sciatica. Maybe you feel a little numbness in your toe before the pain starts. Whatever the clue is, learn to recognize it and pay attention to it.
If you love some activity that consistently provokes your pain, try learning the early signs so you can apply the first aid you know sooner and prevent the bear from waking up fully. Sing the bear your lullaby and let it rest soundly. If you know that a certain stick is particularly effective at waking up the bear, maybe you can choose something else, or perhaps choose it less frequently. Maybe what wakes up your bear is not getting poked once or twice, but over and over again for hours or days. Pay attention to what you are doing and how long you are doing it, and with some persistence you may find exactly what you need to know to resolve your condition once and for all.
 Matthew Goodemote is the founder and owner of Community Physical Therapy & Wellness in Gloversville, NY. He has degrees in Exercise Science, Health Science, Physical Therapy, and he is one of just over 250 in the world with a Diploma from the McKenzie International Spine Institute. Matthew is recognized as an expert in the fields of Physical Therapy, orthopedics, spinal disorders, sports medicine, and wellness. He is routinely called upon to offer tips and suggestions relating to health and wellness. His unique approach makes him a highly sought after expert at different ends of the media spectrum. He has received requests to participate in studies for scientific journals, and to write articles for trade magazines and popular press magazines such as Fitness to offer proven recommendations that stand the test of time. More of Matt’s blogs can be found at http://www.matthewgoodemote.com/blog/.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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