For the last 3 weeks, we’ve been talking about new habits, how to choose new habits, and how to practice those new habits. I want to tell you a story about a patient who I saw earlier last year.  She had been in an exceptional amount of back pain that interfered with her ability to work, relax, and enjoy time with her children. 


SMART Goals for Pain

One of the most important things in a patient’s initial visit is to figure out what their main goal is. If we don’t know what the patient wants, it’s hard for us to help them. We seek to make it a SMART Goal, because it also helps us understand a patient’s expected timeline. This keeps us accountable, and make sure that the goal we are trying to achieve is within a reasonable time line. 


Back to the story. 


As we discussed the things that she wanted and needed, it became clear that the pain was interfering with her ability to work. And by the end of the day, she had no mental energy to do this at home with her kids and around the house. We decided to focus on getting her back happy during the workday. She works a typical 9-5 hospital administration job. So her goal was to be able to work for 8 hours without back pain.  She wanted to be able to do this over the next 4 weeks. 


The Pareto Principle

We had to find the thing to practice that would give her the most relief. We had to take a look at her day-to-day activities. This will help us find the one activity that will give her the most relief. As we talked, we found that she sits for 80% of the day. So we looked at what we needed to figure out to give her the most relief possible. She talked about she has been working hard to sit with good posture, because she had been told that it would fix her back pain. She discovered the opposite. It only made her back pain worse. 


So we played around with her seated posture. We found that her pain would completely disappear when she relaxed into her chair instead of sitting up right. When she had started the visit she rated her pain a 8/10. When we practiced this relaxed sitting, she rated her back pain a 2/10. These were her cues. I had her sit all the way into the back of her chair. I told her to take a really big breath in, then sigh as she released that breath.  This was the one action that she could start doing that would make a massive change in her symptoms and quality of life. I also told her to grab a couple reams of paper from the supply closet. She was on the shorter side and had to sit more forward so that she could keep her feet on the ground. By placing something under her feet, she could feel more comfortable in her chair without feeling like a child swinging her feet. 


8 Hours vs 8 Reps

So how do you practice a different seated posture? This is a harder thing to practice. You can’t just do it 8 times throughout the day. You need to do this as often as you can in short windows so that you can maximize your new habit. With this patient, I recommended that she do her best to relax into the chair while working. I did know that she was going to end up in the old posture, so I wanted her to find times to take a “movement break”. We discussed that she did have some idle time between tasks when she was waiting on emails or meetings. So we decided that would be the time to practice this exercise. That way she is taking these 5 second “movement breaks” to make sure her low back and neck were not overworking for the entire workday.  This allowed her to be more relaxed at the office, as well as be in less pain. 


If you need help finding the one thing that will start you on the road to recovery or to maximize your time at the gym… Give us a call so that we can point you in the right direction!


Byron  Lam

Byron Lam

Chiropractor, CCSP®, FR® Spine

Contact Me