Diagnosing and Rehab of Back Pain -
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Display Name Post: Diagnosing and Rehab of Back Pain
A 04-09-06 03:00 PM - Post#199289    

25 years of aggressive and consistent weight training is not enough to compensate for a lifetime of bad posture. You see, my back muscles are as strong as I need, stronger even, yet my back's aching all the time. We're not talking about lack of strength in carrying or pulling, and we're not talking about injury; we're talking about imbalance, lack of flexibility and a weakness in the supportive muscles that hold the body -- the spine and head -- upright.

Don't assume this is a case of exercising wrong, bad form or whatnot. It's more of a case of workload imbalance, heavy deadlifts, say, but offset by only bodyweight hyperextensions, for instance� and these would be hypers with less-than-stellar range of motion, having bought into the "don't extend your back farther than parallel" school of thought. Wrong school, I now believe.

Those who've been around for a few years may remember earlier posts as I discovered Active Release Therapy (ART) to release adhesions in my shoulder, gave in to massage to loosen spasming mid-back muscles, sought out chiropractic to ease a pinched nerve in my neck that caused migraines, and learned upper back isolation exercises to cure an impossibly aching neck.

I had an aching neck and traps for close to 20 years, which worsened the past few as I began spending most of each day in front of the computer. Turns out the rhomboid muscles below the traps were weak, so all the effort of holding up my head went to the neck area. When weakened, my neck locked up completely, causing headaches. A most-excellent chiropractor did aggressive massage on the rhomboids, hooked me up to a Stim machine for a couple sessions and gave me specific, targeted, light-weight, goofy-looking exercises that I did for a month to completely clear up this 20-year problem. Embarrassing, really, to have not known this before.

Here's the post that documented the goofy exercise that began to cure my neck in less than a week.

I wrote in a post a year ago that I grew up kinda stubborn: work hard, ignore pain; see a doc only when bleeding or broken; vitamins are a stupid waste of money. I confused strength with health, and it got me in trouble over the past 10 years. Bigtime. Some of the items on my list were purely physical, like muscles in spasm, adhesions and imbalance that were causing me grief; the others were hormonal deficiencies and imbalances. All are intertwined, and all pain and hormonal problems contribute to a catabolic state (when muscles and body tissue is broken down), as opposed to an anabolic state (when the tissue repair process is healthy). Catabolism and cortisol make you feel awful, worse in the big picture than losing a few pounds, but the combination will surely keep us fatter than we want to be, so perhaps a thought here will help with those last few stubborn pounds, too.

Now, a few months ago I went off on another track. A guy from San Diego, Pete Egoscue, has built a practice around a method of stretching that begins by flattening the lower back to the floor. My thinking at the moment is this was the opposite of what I personally needed, and contributed to making things worse. Or perhaps I was just doing the work wrong.

Here's an excerpt of Pete's book, available at this link on Amazon.com:

This stretching started me on a quest for increased flexibility, so I added more stretching exercises to mix, including stuff like toe-touches, which thrilled me because I went from a lifetime of hitting about mid-shin on my way to my toes, to a solid three fingers on the floor. Bad juju, unfortunately.

To correct this, I read the book, The Stark Reality, by Dr. Steven Stark,> as recommended by both Jim Bryan and Fred Fornicola in Static Stretching here in the forum recently, and discovered pretty much all of my stretching exercises are wrong. Stuff I picked up back in the late '70s from the early Jim Fixx and Runner's World crowd didn't hold up through the year 2006. These stretches didn't bother me those decades ago, but the aging tendons and ligaments didn't stand the excess strain so well this time around.

The basics of Stark's work is to stretch the muscle, not the connective tissue, by isolating the muscle, finding the point of no tension and then moving gently into the first point of tension. Hold there until the tension diminishes, release and repeat. My mistakes were in not isolating the muscle, and in overstretching -- yanking on the tendons instead of gently easing the muscle into its full length. The book explains how the muscles, tendons and ligaments work in a way I'd never seen or known (and will have to review again).

Couple the incorrect stretching with my re-energized cardio work that you may remember (Dave's wrong, right?), which I started doing aggressively on my spin bike. This is done bent over in a bike racer's position, in case you've never seen a spin bike. Upon finishing the biking, I'd get on the floor and to the incorrect stretching, in particular, lots of back flexion stretching� basically, bend over the bike handles, then get on the floor and bend over some more.

This felt good to me, because, as it turns out, that's my strong position. It's the back extension that needs work, so what happened over the past couple of months is my back got worse and worse until eventually -- recently -- I could barely face coming up to sit at my desk. Anything but that! Only� if I don't sit here, nothing gets done.

I did some research, checking out things like herniated discs, arthritis and osteoporsis, and in the midst of it, bumped into the "The McKenzie Method,"basically a combination of back extension exercises that offset weak posture muscles and help to elongate the spine. The example of slouching posture fit me to a T, and it's a posture I've held since I was around twelve -- hopefully all this time invested in perfecting it will be forgotten quickly as I practice Robin's exercises....Robin McKenzie's 7 Steps to a Pain-Free Life, got it for $10.40 at Amazon.

Part of McKenzie's philosophy is that problems arise when we bend forward while lifting or working, etc., and I take issue with that (not that I'm in any position to). Instead, *I* think it's more a matter of building up opposing muscle strength. If this new regime works to any extent, and I'm still able to do my normal lifting of cases of books, lugging them up and down the hill and all, I'll stand by this position, but of course, following up the forward bending with an equal amount of back extension work.

I also got a new backless computer chair ($49 at OfficeMax) that's sort of forcing the issue.

The dense foam roller I picked up a few months ago is getting double use (Dave rolls around on it, too), and the myofascial release ball hurts like the dickens� several times a day.

Clair Davies' Trigger Point Therapy Workbook (picked that one up when Dan Cenidoza posted how valuable it's been to him) is as yet unopened. Haven't tried hanging upside down yet, but I have it on good authority that Dick Tyler, D.C. (Dave's golden era pal who wrote both West Coast Bodybuilding Scene and the text Alternative Chiropractic) inverts himself twice a day to hold together his weak back.

Some of you guys will think I'm nuts right about now. But I got to the point where it was either fix it for real, or back off and accept a future of back pain and I wasn't ready to go that route.

As things progress over the next couple of weeks, I'll add any discoveries. One of the points to note is what a long process this can be, one fix leads to another, or perhaps even causes something adverse. But you have to keep at it. It's either that, or plan on spending the rest of your life on the couch.

Meanwhile, here are links in the wiki that all this back pain research dredged up.

**And later... here's the rehab followup post.
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