Diagnosing and Rehab of Back Pain -
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Display Name Post: Diagnosing and Rehab of Back Pain
A 04-09-06 04:31 PM - Post#199294    

Laree, that post is very dense with information! I think I have been covering much of the same ground in parallel these past few years.

More and more I see the process as an incremental progression. For everything you want to do, there are prerequisites. For example you start out with back pain. Maybe it's severe and until you can get ahead of the pain you aren't going to get anywhere. For someone in this position of acute injury prescription drugs, muscle relaxers and pain killers, may be the only option.

Next you have to heal your spine's basic integrity. You can't do much with the muscles until the joints are at least somewhat sound. SO you wind up doing inversion, or on a traction table, doing Mackenzie exercises, etc. In the vast majority of cases, even according to orthopedic surgeons themselves, problems will resolve to a reasonable degree without surgery.

Once that's done, you can work on strengthening what's weak and stretching what's tight. This process can be sped up dramatically with some soft tissue therapy, whether it be the heavy artillery - active release therapy (ART) or the Graston technique, myofascial release or other deep tissue massage, or rolling around on a foam roller or a ball.

Knowing what's tight and what's weak can be pretty complicated. This is where the Escogue method left me high and dry. The book describes certain general postural conditions that cause problems for people. I am thinking I have a fair number of the problems of each, but don't fit any of Escogue's categories very well.

For an awful lot of people, a blind stab in the dark might not be a bad way to go. Stretch you hamstrings, calves, hip flexors, pectorals, lats, upper traps, and subscapularis. Strengthen your rhomboids, lower traps, external rotators, posterior chain (glutes especially), and your entire core.

There is a progression to stretching and strengthening too. The phenomenon of reciprocal inhibition is a huge factor; if you're tight on one side of the joint, you may get very little results trying to strengthen the opposite side. It seems to me that the first logical step is static stretching, then isolation exercises for remedial strengthening.

I think this is what was preventing me from getting the results I expected out of the prone "I" or "Y" exercise Laree describes. I was doing it and it was working a little at first but not much. When I stretched the antagonists - improved my pectoral flexibility - things really took off. For those of you who are bored to tears by this, my pathetic overhead strength is finally moving up as a result. :)

One thing I learned from this, close isn't good enough. I was stretching and strengthening ineffectively and getting little results. Start doing it effectively and bam, things really turned around.

The next step may be more complicated: taking basic strength and flexibility and turning it into useable strength and flexibility on the field and in daily life. There are special exercises that develop the neurological coordination that makes the stabilizers and the prime movers function together effectively - this is the basis of functional training. There are dynamic stretches, or should I call them mobility exercises, that develop strength and flexibility over a full range of motion.

(Some of these "special" exercises might not seem so special. The traditional straight legged situp, long reviled as unsafe and undesirable, can actually be a good exercise for training the deep abdominal muscles to stabilize the spine during hip flexion.)

At that point I think we've covered athletic performance but maybe not daily life. I am beginning to think it is easier to learn to overhead squat than to correct bad posture! I think it is Paul Chek that noted that dynamic mobility comes easier than static stability. I have been trying to learn more about the Alexander Technique, which I gather is basically a method of learning good posture and method for making it a habit. Here is an odd but interesting link on the Alexander Technique with some very good illustrations:

http://www.horseshoes.com/advice/prentice/cntwywr.htm

A lot of these things will overlap and intertwine but I think understanding the progressive nature is the key.

I have certainly blathered on here but this stuff is really important. Thanks for posting this Laree and I hope more will chime in. (Deston? Laird?) We have a lot of discussions about the best way to do preacher curls or what's a good superset for arms, which we all enjoy. But I think this type of information returns so much more because ultimately it isn't how you do your preacher curls, it's staying in the game that matters.
The most important test a lifter has to pass
is the test of time.
-Jon Cole
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