The question that comes up more than any other, on consultations, on check-ins, on calls every single week, is some version of the same thing. Why do I get a flare-up when it feels like I barely pushed myself?
I was on a call with a client yesterday who put it perfectly. During the session, he said, it felt fine. It actually even felt good. It didn’t even feel like he was pushing that hard. And then later that same day, a nasty flare-up showed up. It felt like it came out of nowhere.
It doesn’t come from nowhere. It usually comes down to this. You still feel like the same person you were before the injury, so you don’t realize how much your margin for error has actually shrunk. The point where something tips into a flare-up is much lower than you think it is, because you’re still calibrated to how your body used to work, not how it works today.
That’s exactly the gap I want to help you close. A few weeks ago I recorded a podcast with a physical therapist based in Pennsylvania called Julian Burd. He uses a framework with his own clients to catch exactly this gap. He calls it the four D’s.
The four D’s
During. Did you actually feel any symptoms while you were doing the movement? Not discomfort in general, the exact thing you’re trying to resolve.
Duration. If it did show up, how long did it take to settle back to your normal baseline? A few minutes? A few hours?
Dusk. Was it still bothering you in the evening, before bed?
Dawn. The next morning, when you get up and move around, is it worse than the day before?
Most people only ever check the first D. If nothing hurt while they were doing the movement, they assume it was fine. But the actual cost can show up later that night, or the next morning, well after they’ve stopped thinking about what they did. If you only check during, you’re working with a quarter of the information your body is actually giving you.
In my experience, a lot of clients are pretty disconnected from their bodies. Before you get injured, that doesn’t really matter, there are no consequences to it. After an injury, your margin for error gets much smaller, so you actually have to build real self-awareness, how you’re feeling during a movement, how you’re feeling after it, even the stuff you do around the house that you’d never normally think twice about.
I find the four D’s is a great tool for building exactly that kind of awareness with certain clients.
But what if I get a flare-up? What then?
I’ve been dealing with a long term cartilage issue in my ankle, and last week I overdid the volume a bit on my rehab. The next day, my ankle was quite sore, that dull bony ache you get with cartilage issues.
In the past, particularly when I had my L5-S1 disc bulge, a flare-up like that would send me into a downward anxiety spiral. The pain would drag up all these fears. Is my back damaged? Is this getting worse?
These days, from the education and research I’ve picked up over the last four or five years, I understand that a flare-up is much closer to sunburn than to a significant, damaging injury. That reframe alone settled a huge amount of my actual fear and worry. I was able to just acknowledge that my ankle had flared up, notice that I’d actually been walking barefoot on my walking pad, which was almost certainly the cause, learn from it, and move on. My ankle was fine the next day.
One honest caveat
This isn’t the right tool for everyone. If you’re naturally analytical and like structure, it’ll probably suit you well. But if tracking during, duration, dusk and dawn starts making you more hyper aware of your back, checking in constantly, more anxious rather than less, this isn’t the right tool for you right now. For some people, more monitoring helps. For others, it just gives them more to worry about.
Takeaway
Low back pain is one of the most confusing, challenging injuries you can go through. The skills and self-awareness you build during your recovery are tools that will help you maintain a strong, resilient body for the rest of your life. It’s something you’ll look back on with gratitude once you’re out the other side.
One question for you
Did any of this resonate with you? If so, hit reply and let me know what part.
Conor
P.S. If you want help with your low back recovery, you can book in a call with me here.