Doing the Boom-Bust Boogie

Author: Heidi Mules | Physiotherapist & Injury Management Consultant

We have all done it before. With all good intentions, we have fallen off the exercise wagon, then to make up for lost time, have pushed through any discomfort to put in 150% effort when we finally take the step to start exercising again. We wake up the next day or the day after with a bad case of the DOMs and take several days of rest to recover, before starting the cycle all over again. 

For those people without persistent pain issues, this “boom-bust” cycle, whilst unhelpful, is not detrimental. For those who are in a persistent pain state it is different story. Once the pain is flared up it can take days or even weeks to recover enough so they feel they can exercise or do any activity again. This boom-bust cycle is a slippery slope to functional decline and worsening of the condition. And the bigger issue is that we can be in this boom-bust cycle without even realising it, across many aspects of life– formalised exercise and movement, activities of daily living, and even our working life. 

So how do we get out of this cycle? 

Seeking guidance within a multidisciplinary approach is helpful. Movement and exercise can be an integral part of recovery if delivered in a safe and appropriate way. I recently encountered a patient who was inadvertently using the boom-bust strategy and was therefore experiencing a delayed recovery. But when similar exercises and movement were delivered via a graded exposure approach, the outcome was much more positive. 

The situation 

John*, a 35-year-old police officer, presented with a two-year history of intermittent low back pain. The pain would worsen in times of intense physical activity and mental stress, but he would keep pushing through the symptoms, working his physically demanding job until the point that he had to have time off to recover. He was ultimately referred a specialist physician who recommended a microdiscectomy. While waiting for surgery he stopped doing any physical activity for fear of making his back worse. After waiting several months, the surgery went ahead followed by 6 weeks rest before commencing rehabilitation. He knew that he was deconditioned from his time off work and regular exercise, but he felt he had to make up for lost time now that his back was “fixed”. He had previously been very active in the gym and was confident he knew how to go about an exercise program. Once given the clearance he started back at the gym and pushed himself as much as he could, which lead to a significant flare up, to the point that he believed he needed more surgery. 

At this point, his return-to-work provider recommended he attend the Axis multidisciplinary pain management program to help guide his physical and mental wellbeing and assist him in coming up with a better exercise strategy and graded exercise plan. 

John was provided education about his condition, and his beliefs surrounding the causes of his pain were challenged. Despite being previously extremely fit, months of inactivity and years of using the boom-bust cycle to maintain his fitness had contributed to his deconditioning and functional decline. We were able to establish a baseline level of activity he was able to perform without causing a flare up and developed a firm plan on how to gradually build up these activities.  

The result 

On entering the Axis program, the patient had fallen into a boom-bust cycle and was convinced that he would require more surgery to recover. Following a six-week program, he demonstrated a significant reduction in outcome measures for self-reported back disability. The ultimate goal was to be able to return to his role as a police officer in the field, which he was able to do by the end of the program. 

If you would like to find out more about strategies to break the Boom-Bust cycle or the Axis Multidisciplinary Pain Program, please contact Axis directly. 


*Names were changed for the purposes of this article.