oleksiy kononov

Low back pain.
What to do?

A 7-minute article that will help you manage low back pain and return to an active life.
Hi, Kononov is in touch.

This 7-minute article will provide you with the findings of the scientific research + my experience that will help you recover from an exacerbation of low back pain.
❕The article is aimed at those who take responsibility ON THEMSELVES for THEIR OWN health.
❕The article is also useful for coaches and thinking athletes.
❕The article reveals my experience of dealing with lower back pain.
❕The article is based on the modern scientific research.
The back pain is now believed to be a symptom, not a disease [1; 2].
It resolves quickly on its own for the majority [3], like a headache or minor cold.
For a small percentage of people, it drags on, becomes chronic (when it lasts more than 6 months), greatly reducing the quality of life [4].
#️⃣ Operation VS Rehabilitation
A very few people have a specific pathological cause, such as a vertebral fracture, tumors, infections, as it is marked by Jan Hartvigsen and other authors of the review “What low back pain is and why we need to pay attention” [1]. It is rather difficult to determine the specific reason in most cases, as well as with headaches.

Real serious causes of low back pain – compression of the spinal roots, infections, tumors or diseases of the internal organs – are extremely rare [5].
The doctor identifies their presence or absence, deeply examining the patient during the medical check with the help of physical tests, focusing on the so-called ‘red markers’, and if it is really necessary, by prescribing the MRI or X-ray in some cases.
The ‘red markers’ of the situation include: the pain persists at night and lasts more than 4 – 6 weeks in complete repose, there is a significant unintentional weight loss, visible injuries, paralysis of legs, urinary incontinence, a blood infection is detected [6].
Looking for a problem vigorously, you will 100% find it.
As a rule, X-ray, CT or MRI are not required under the absence of such symptoms or visible physical damage.
At any rate, this idea is indicated in the modern clinical studies, such as Clinical Practice Guidelines (CPGs) [7] or in the updated recommendations of the National Institute for Health and Care Excellence (NICE) for the treatment of low back pain [8].
Why ❓
The fact is that unnecessary visualization of a symptom causes serious negative impact on you [9; 10].
Radiologists often misinterpret results, leading to useless prescriptions, unnecessary follow-up tests, or even surgery.

Searching for a problem vigorously, you will 100% spot it.
It goes without saying, patients also misinterpret the findings, this results in uncontrollable fear, movement avoidance, impairing recovery.
#️⃣ My experience in it
Once upon a time I got a knee injury, while the show was going on. The case did not seem to be urgent, and the MRI was arranged in my free time. In 5 days.

The inflammation began to lessen during these 5 days, and the pain decreased. I started walking. I did rehabilitation activities.
The mood was competitive. I was 99% sure of suffering a minor injury.
However, the MRI showed a torn ligament. That news knocked me down.
To clarify: in the morning I felt like a completely healthy person who stepped on the path of recovery, and in the afternoon, when the results showed up, I felt like a sick broken disabled man. Amazingly, nothing has changed in my body within these several hours. The information has just popped into my head. You can read more about this case HERE
#️⃣ Moving forward
Yes, indeed, the MRI can show protrusions, hernias. However, first, they are NOT the direct cause of pain in many cases, and second, visualization does not usually affect the treatment plan.

You will have to do recovery exercises anyway. If you want to live, you need to move.

Moreover, even if disc herniation is regarded as a problem, there has already been evidence to prove disc’s ability of “healing” on its own without surgery:
the body perceives this ‘booger’ as an extrinsic object and starts cleaving it.
#️⃣ Data
The article [11] collects data on the natural ‘resorption’ of a sequestered hernia by the body (the case when the hernia tore off from the disc and went into free floating). This is the most severe form.

▶️ In short, an improvement in well-being was reported after 1.5 months.
▶️ These improvements appeared after 9 –13 months on the X-ray image.
▶️ In general, “the probability of recovery stood at:
96% for disc sequestrations,
70% for extrusion,
41% for protrusion,
13% for disc bulges” [12].

It is stated in the article [13] that the overall frequency of size reduction or complete disappearance of disc herniation without surgical intervention makes up 66.66%.
#️⃣ My thoughts
What I realized in the study of this topic during pain exacerbation in the low back:

  • The gelatinous nucleus, which is located in the disc center (and allegedly flows out), is in the liquid form until the age of 21 – 25 years. What happens then? It “thickens” later, and the disk becomes an integral structure, a cartilage.

  • What if the fibrous ring ruptures, and the gelatinous nucleus leaks out? It solidifies like lava. It turns into a kind of a small snot, sorry, a ‘booger’ :).

  • The body perceives this ‘booger’ as an extrinsic object and starts splitting, cleaving it. There appears an inflammation. In fact, a painful process as always when the body is in the state of struggle.
The task doesn’t focus on ‘treating’ the disease, but reducing pain and improving motor function.
#️⃣ Doctor Vs Auto Mechanic
The authors of the review “What low back pain is and why we need to pay attention” [1] also made the point that due to the difficulty of identifying the exact cause, the source of pain in the low spine, the aim is not to “cure” the disease, but to reduce pain and improve motor skills, functions.

In general, the view on pain in the low back is changing according to a new research. Many doctors preferred to look at the problem “technically”, like car mechanics, and this approach has been prevailing up to now.

Low back pain ➡️ MRI ➡️ I see hernia ➡️ I remove hernia ▶️ I remove pain.

According to Dr. Hamilton Hall, a world-renowned surgeon and founder of the Canadian Spine Institute, 92% of people with the spine surgery never get rid of their pain.

That is, interested in performing operations to remove a hernia from the spine, a specialist warns of a small percentage of successful cases.
Instead of the BioMedical (technical) model of problem consideration, the BioPsychoSocial (BPS) model is becoming popular currently. Excuse me for the complicated phrase :)
This model states that pain comes from a complex interaction between:

• BODY (tissue processes),
• BRAIN (thoughts and beliefs),
• ENVIRONMENT (social and cultural influence).

For example: if you have plucked a callus during a training session at the Canadian Cirque du Soleil, this is almost an emergency. The training will be stopped. Physiotherapists will get down to business: they will stop the blood, clean, disinfect, tape. This is regarded as the standard of behavior.

If you have plucked a callus in the Ukrainian gymnastics hall, it is considered usual to spit on your hand, heap up more magnesia, rub hands and continue the training.
92% of those who have undergone the spinal surgery never get rid of their pain.
According to a researcher and clinician Lorimer Moseley, the BPS model adds several key points to our approach to studying low back pain:

1️⃣ Pain does NOT give an accurate assessment of the tissue conditions.
2️⃣ Pain is formed by the above mentioned components: Body, Brain, Environment.
The relationship between pain and tissue conditions becomes less predictable since pain may persist after tissue repairing.
4️⃣ Pain may correlate with the perception of danger / threat [14].
The complete disappearance of disc herniation without surgical intervention made up at 66.66%.
The most relevant conclusion this model allows us to draw is that the experience of pain is purely individual, it depends on many factors, and not on one tissue source – ‘technical breakdown’. It is a limited viewpoint to try to isolate any single component.
#️⃣ Personal experience in it:
Suffering from the lower back pain, I went to the doctor in the hospital. The examination took 5 minutes, 5 questions were asked, a regular X-ray was conducted, and the word “operation” was mentioned.
I felt absolutely devastated and sick after that visit. I thought if I went to the MRI, the psychological trap would close. I had been over that before :)

Having received guidelines for anti-inflammatory injections, I never returned to the clinic. I did not do the MRI.

The injections helped relieve inflammation and acute pain. I got my sleep back and a better recovery with it.
I kept on doing morning exercises. Those were the simplest exercises, what I exactly did HERE
Such simple exercises gave hope and actual confirmation for me being alive.
The experience of pain is purely individual.
I got a bit stronger after 3 months. I did exercises more confidently, slept well, could work while sitting, however, I could not go longer than 10 minutes. Buttocks and legs began to go numb. It still scared the hell out of me.

Going on my recovery journey, I decided to try the shock wave therapy. This procedure is possible only after examination by a physiotherapist. Therefore, I got to a top-notch specialist.

The physiotherapist examined me thoroughly with questions, found out what I had been doing in the professional sport and in Cirque du Soleil. The expert figured out how my lifestyle had changed after performing on stage, did fitness testing, fingered me.
#️⃣ The shocking news
There are no visible injuries. All functions are within normal limits. There’s a muscle imbalance, overall you’re in good shape, man. You don’t need the shock wave therapy at all.

Although I can’t walk or even step...

I got an important insight at that moment: if the pain continued more than 6 – 8 weeks, psychological consequences could appear. The brain remembers which movement has brought pain and continues to ‘whip up’ an unpleasant signal, although the tissues have already recovered. A kind of a phantom pain.

Recommendation: keep on doing exercises and pay attention to the psychological rehabilitation.

I accepted. I was inspired. I went on doing exercises and paid more attention to outdoor activities: strolling, swimming, sauna, massage, favorite music, watching sports competitions, etc.

The brain remembers which movement has brought pain and continues to ‘whip up’ the tension.

Today I can walk again as long as I want, I returned to gymnastics, I can keep the backbend. Here is my brief conclusion from this story:
#️⃣ My conclusion
1️⃣ Look at the functions, not a diagnosis. Use motor tests and common sense.

2️⃣ Look at the problem in a complex way, taking into consideration the Body, Brain, Environment.
3️⃣ Remember, you will have to do exercises to restore functions anyway (with or without surgery), though it’s better without.

4️⃣ Look for a sports specialist / physiotherapist who understands that movement is life.

5️⃣ Search for facts and successful stories that encourage recovery.

6️⃣ Eliminate factors that cause fear of movement (such as: X-rays, CT or MRI) if there are neither red markers, nor emergency. Avoid toxic doctors, physical therapists, coaches who fanatically seek a problem, not a solution; who hang labels right at the entrance, causing a feeling of ‘things get hard, it’s not ok at all’; who kill the incentive for recovery training and an active life in general.

7️⃣ No matter how awesome and painful it is, remember: our body has a huge potential for self-healing. Keep moving step by step, but every single day.
Well, I would like to sum it up with a quote of my favorite Ukrainian singer Monatik:

“Run away not from problems, run to Dreams...

Remember, you can always do more."

  • Oleksiy Kononov
    Artist Cirque Du Soleil | Professional Athlete
    Let's be friends on Instagram or Facebook Got a question? Write it. 'm here!
    Set Crazy Goals, Practice Smart. Turn yourself into a Superman.

    I believe in you and I know you can do more.
    With all my respect,
    Oleksiy Kononov
List of articles with research results:

1. Jan Hartvigsen et al. What low back pain is and why we need to pay attention/ Lancet 2018 Jun 9;391(10137):2356-2367

2. Pengel LH, Herbert RD, Maher CG, et al. Acute low back pain: systematic review of its prognosis. BMJ 2003;327:323.

3. Carey TS, Evans AT, Hadler NM, et al. Acute severe low back pain. A population-based study of prevalence and care-seeking. Spine 1996;21:339–44.

4. Von Korff M, Saunders K. The course of back pain in primary care. Spine 1996; 21:2833–7 [discussion: 2838–9].

5. Bart Koes, Maurits Van Tulder. Acute Low Back Pain. Am Fam Physician. 2006 Sep 1;74(5):803-805.

6. Nathan Patrick. Acute and chronic low back pain/ Med Clin North Am. 2014 Jul;98(4):777-89, xii.

7. Clinical Practice Guidelines https://www.nccih.nih.gov/health/providers/clinicalpractice

8. Low back pain and sciatica in over 16s: assessment and management https://www.nice.org.uk/guidance/ng59

9. Darlow B, Forster BB, O'Sullivan K, O'Sullivan P. It is time to stop causing harm with inappropriate imaging for low back pain. British journal of sports medicine. 2017; 51(5):414-415.

10. Steffens D, Hancock MJ, Maher CG, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. European journal of pain (London, England). 2014; 18(6):755-65.

11. Macki M, Hernandez-Hermann M, Bydon M, Gokaslan A, McGovern K, Bydon A. Spontaneous regression of sequestrated lumbar disc herniations: Literature review Clinical Neurology and Neurosurgery. 2014; 120:136-141.

12. Chiu C, Chuang T, Chang K, Wu C, Lin P, Hsu W. The probability of spontaneous regression of lumbar herniated disc: a systematic review Clin Rehabil. 2014; 29(2):184-195.

13. Zhong M, Liu JT, Jiang H, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain physician. ; 20(1):E45-E52.

14. Moseley GL. Reconceptualising pain according to modern pain science Physical Therapy Reviews. 2013; 12(3):169-178.

15. Linda S Pescatello, Ross Arena, Deborah Riebe, Paul D Thompson. ACSM’s Guidelines for Exercise Testing and Prescription. 9th Ed. 2014 J Can Chiropr Assoc. 2014 Sep; 58(3): 328.

16 Walter Bouwmeester. Quality of low back pain guidelines improved. Spine (Phila Pa 1976). 2009 Nov 1;34(23):2562-7.