Motion is Lotion....Lets Move!!!!!!

We are going to start an Arthritis Foundation Exercise Program on February 23 at 11:15 AM, it will run for four weeks twice a week. The classes will be free. Please forward this information if you know anyone with arthrits that can benefit from the classes. They need to call 941-228-1632 to register as space is limited. They can also find valuable information at www.arthritis.org

Ramachandran on your Mind

VS Ramachandran on your mind | Video on TED.com

(Post # 121) What is Juvenile Arthritis?

Juvenile arthritis is a general term for all types of arthritis and related conditions that occur in children. An estimated 300,000 children under age 17 are affected by juvenile arthritis.

Arthritis affects girls twice as often as boys. Juvenile arthritis can occur anytime from birth until the age of 16 years. Early diagnosis and compliance with the medical treatment plan gives the child the best opportunity for a positive disease outcome. Some children's symptoms of juvenile arthritis go into remission -- and others will be affected to some degree throughout their lifetime.

What You Can Do?

Parents and teachers can take steps to build a student’s self-esteem:

1. Listen and observe the student.
2. Most do not complain and may even hide symptoms of the disease to appear like their peers.
3. Watch for body language (such as facial expressions or rubbing joints) that may indicate the child is in pain or experiencing fatigue.
4. Encourage students to look at strengths rather than limitations.
5. Include the student in planning classroom modifications.
6. Encourage decision making and acceptance of responsibility.
7. Help the student to participate in social interactions with peers and extracurricular activities whenever possible.
8. Encourage acceptance of diversity and individual differences in your classroom.

Exercise

Regular exercise in an important part of a juvenile arthritis treatment plan.

Exercise is important to:

1. Keep joints mobile;
2. Keep muscles strong, regain lost motion or strength;
3. Make everyday activities like walking, dressing or eating easier;
4. Improve general fitness and endurance.

If you want to help, visit the Arthritis Foundation site for more information.

(Post # 120) Dosage!!!... Dosage!!!... Dosage!!!

YOU CAN HAVE:

The right exercise...

With the right tool...

With the right technique...

For the right reason...

For the right body part...

At the right time...

At the right angle...

BUT IF YOU HAVE THE WRONG DOSAGE YOU ARE GOING TO MAKE A MISTAKE.

REMEMBER... NOT ENOUGH LOAD AND THE TISSUE WILL BECOME WEAK... TOO MUCH LOAD AND THE TISSUE WILL BREAK DOWN...SO WE NEED TO FIND THE RIGHT AMOUNT AND QUANTIFY IT.

(Post # 119) qUESTIONS tO tHINK aBOUT

WHEN SHOULD WE USE FUNCTIONAL TRAINING (Movement Training)?

Functional Training is best used when we want to:

1. Rehabilitate non-surgical orthopedic, neuromuscular and sports injuries.

2. Prevent injury and dysfunction.

3. Improve movement and sports performance.


WHEN SHOULD WE USE STRUCTURAL TRAINING (Muscle Training)?

Structural training is best utilized on the following situations:

1. First stages of rehabilitation after surgery.

2. When we don't have the muscle strength to start a functional movement.

3. If we are dealing with a condition or disease that does not allow us to train functionally.


(There is much more to functional training and structural training than the basic description given above)

(Post # 118) Any Clown can Push, Push, Push

Some of this clowns have the heart in the right place, but their knowledge is very limited.
Their concept is to push, push, push at all cost, as long as 10% to 20% of their athletes survive the poorly designed overtraining and win competitions, the other 80% that get permanent injuries and dysfunctions get overlooked or just dismissed as "collateral damage".

This sad story goes some thing like this..

Clown: "Go faster".

Athlete: "I am trying".

Clown: "Try harder"

Athlete: "I am in pain".

Clown: "You are not trying hard enough, just put some ice and take some ibuprofen".

Athlete: "I have been putting ice and taking ibuprofen everyday for while, but the pain does not stop and is getting worse".

Clown: "Just go and see a doctor".

Athlete: "Doctor say I need rehabilitation".

Therapist: "You need to take time off so we can rehabilitate your body properly".

Athlete: "I am not sure I can, my coach wont be happy and I don't think he would let me slow down".

Therapist : "If we don't do rehab right, therapy at best will only delay surgery".

So in another words the story goes something like this...

Ice + Advil ... and when that does not work...

Advil + Pain killers... and when that does not work...

Steroids shots ... and when that does not work...

Surgery ... and when that does not work...

More aggressive surgery... and when that does not work...

More surgeries and more pills...

The athlete is finished!

(Post # 117) Can Pills, Shots and Surgery be the Solution for Back Pain and Dysfunction?

Here is the problem...

1. There is an average of 60 % more pressure on the spinal discs when we are sitting than when we are standing.

2. Most people sit between 6 to 8 hours per day (driving, watching TV, using the computer, eating, reading,etc.)

3. Most people sit with poor posture.

4. Most people do not move often enough.

5. Most people lift with their backs and not with their hips and legs.

6. Most people exercise the trunk muscles "core" by doing some type of sit-ups and "supermans", which puts between 1000 to 1200 pounds of pressure to the spinal discs (Stuart McGill PhD 2006).

7. Most people exercise with machines, isolating muscles and blocking their proprioceptors and most of their stabilizers.

And then, after all this, when people develop spinal problems, such as, bulging disc, herniated disc, spinal stenosis, spondylolisthesis, etc., a common approach is to go from ibuprofen to pain killers and when that doesn't work, to go from steroids to epidural injection and when that doesn't work, to go from laminectomy (surgery) to spinal fusion (surgery) and when all that doesn't work, they are told to get more surgeries and more addictive pills.


Here is a better approach to prevent this from happening:

1. Walk with arm swing at least 20 to 30 minutes everyday (dog walking is OK but it does not count as therapeutic walking).

2. Sit with your spine in neutral (not too slouched nor too arched) and change you posture within a neutral zone every 30 minutes.

3. When lifting, keep your spine in neutral, use your legs (bend your hips, knees and ankles joints) and keep the object close to your center of gravity, in other words your belly button.

4. Floss your sciatic nerves 10 reps 2-4 times per day every day (See post 60).

5. Build neuromuscular endurance by speed walking, opposites (bird dog) exercises, planks (don' arch your back...keep it in neutral), squats, lunges and balance reach.

6. Avoid exercises that are harmful to the spinal discs such as: sit ups, prone leg raises, superman exercise (lying flat face down and raising both legs and arms up), knee to chest stretches, toe touch stretches and spine twisting stretches and don't put your self in danger with dumb exercises such as standing on a exercise ball.

7. Eat often and eat a balance diet of protein, complex carbohydrates, vegetables, fruits and clean water.

8. Rest, restore and recover through good night sleep, active rest and therapeutic massage.

9. Be patient. Although you may progressively feel better, it may take six to twelve months before you see results and get better.

(Post # 115) Keeping a Journal

Keeping a journal is one of the most important keys in getting better.

Here are the five thing you need to write:

1. Date.
2. Time.
3. Activity performed.
4. Length of time that activity was performed.
5. Location of symptoms and intensity before, during and after.

This information, integrated with the traffic light guide, can help you discover which activities and at which intensity they can be incorporated in you life.

Here is the traffic light guide:

Better after activity? -- Green light -- Go on !!!

Pain during activity, but no worst after it? -- yellow light -- Proceed with caution !!!!!

Worse after activity? -- Red Light -- Back off, by reducing the intensity, resistance, speed, repetitions, but don't stop !!!!!!!!!!

So, keep journaling and keep moving.

(Post #114) A Quick View Into Nerve Mobilization and "Nerve Flossing".

(Post #113) Red Flags

One red flag by itself is not enough to get concerned, but three or more and you need to DEMAND a thorough examination with a CT scan or MRI as they may indicate serious disease or pathology.

Here are some of the most common red flags:

1. Unexplained weight lost.

2. Night pain with or without night sweets.

3. Pain that does NOT respond to movement.

4. Family history of cancer or suspected disease.

(Post 112) Think Before You Lift

Lifting incorrectly is one of the most common causes of lower back pain and disc dysfunction.

Before you lift, stop and ask yourself:

1. Did I get my spine in neutral (mid point between flexed and extended lower back)?

2. Did I brace by tensing all trunk muscles between 30% to 80% (abdominal, back and side muscles)?

3. Did I squat or lunge before lifting, so that I used my hips, knees and ankles and not the lower back?

4. Did I bring the object close to my trunk?

(Post 111) Don't Kill the Grass

Lets say that every day, you get the mail out side your home, and that to get there you need to walk over the grass, and that every day you walk in a straight line over the same path, what happens to that grass? It won't have enough time to recover and it will die.

Now lets say that everyday you take a different path... well then, the grass will have enough time to recover and regenerate, the same goes with joints, ligaments, tendons and muscles.

So, my suggestion to you is:

1. Modify your exercises as much as possible.

2. Change the body positions within a neutral zone as often as possible.

3. Tweak the range of motion, distance, depth, ground level, environmental stability, quantity, frequency, direction, level of difficulty, resistance and speed.

Read post # 22 for more on progressions, modifications and tweaks.

(Post 110) The Symphony of Human Movement

When human movement is in balance, it is like a beautiful symphony, where the brain, cortex, spinal cord, nerve roots, propioceptors, stabilizers muscles, mobilizer muscles, joints and ligaments work in synchronicity creating effective, efficient, protective and healthy motion.

But when this symphony is out of tune and out of synchronicity, we then have:

1. Propioceptors that don't get properly stimulated and can't communicate.
2. Stabilizers that don't hold joints in their neutral position while mobilizers create movement.
3. Muscles that don't fire on time, therefore can't protect the body nor create efficient movements.
4. Joints, nerves, tendons and muscles take the uneven, unhealthy and damaging loads.

So to to keep your symphony in balance, you need to train...

1. Mobility
2. Stability
3. Endurance
4. Strength
5. Power
6. Agility
7. Speed

By using ...

1. The three-dimensions.
2. The ten directions.
3. Gravity.
4. Ground forces.
5. Progressive resistance.
6. The right tools for your body, your goals and your sports.
7. Different environments.

(Post 109) "Sticky Nerves"

What are "Sticky Nerves" or in some medical terms "Adherent Nerve Roots?

1. Nerve roots, spinal cord and sometimes brain tissue that is adhered to other tissue such as bones, spinal discs, muscles and fascia.
2. Nerve tissue that is entrapped by other structures like spinal disc, calcium deposit and sometime muscles.

What are the symptoms?

1. Pain, burning and restriction that is often confused with by muscle pain and tightness.
2. Burning sensation on legs when speed walking and running.
3. Wrist and arm pain often misdiagnosed as carpal tunnel.

What causes it?

1. Inflammation from misuse and overuse.
2. Injury or trauma.
3. Poor training methods.

What can you do about it?

1. Learn to mobilize or "floss" your nervous system (see post 60 for sciatic flossing).
2. Walk 20-30 minutes everyday.
3. Swim 20-30 minutes.

(Post 108) Joint and Spine Instability

What is it?

Inability to keep the joints and spine in neutral position due to:

1. Poor propioception.
2. Lack of endurance and strength in the stabilizer muscles.
3. Loose joint capsules and ligaments.

What are the symptoms?

1. Pain that may move around.
2. Pain that is inconsistent.
3. Pain that comes and goes.
4. Pain that is resistant to traditional treatments.
5. Pain that persist for many years.
6. Disc and joint dysfunctions.
7. Clunking, clicking, popping and grinding sounds coming from spine and/or joints.
8. It may affect one or more areas of the body.

What causes joint and spine instability?

Instability may be caused by:

1. Injury and/or trauma.
2. Degenerative joint and spinal changes.
3. Born with loose ligaments and joint capsule.
4. Poor sitting, standing and moving posture.
5. Poor training methods.
6. Poor stretching methods.

What can you do to improve your joint and spine instability?

DO...
1. Practice therapeutic walking (walking with swinging arms, free hands and at a good pace)for at least 20 minutes every day.
2. Keep a good sitting, standing and moving posture.
3. Balance in a wobble board for the count of 20 breaths 10 times.
4. Practice balance reaches on a stability pad, 20 per side.
5. Do trunk exercises, such as planks, opposites, lunges and balance reaches 10-20 reps / 2-4 sets per day.

DON'T DO...
1. Sit ups.
2. Stretch.
3. Twisting exercises.

(Post 107) Propioception

What is it?

My definition of propioception is, the conscious and unconscious awareness and perception of our body, position, movement and environment through our neuro-musculo-skeletal system.

What are the symptoms of poor propioception?

When our propioceptors are not working properly and are not in balance...

1. Muscles can't protect the spine and joints.
2. Muscles can't stabilize the body and its parts.
3. Muscles can't react fast enough to protect us from a fall, accident and/or a sports injury.
4. Muscles can't help us keep a good posture when sitting, standing or moving.
5. Muscles can't react fast enough to change direction or position in sports.

What causes poor propioception?

1. Injury.
2. Pain.
3. Physical dysfunctions.
4. Inactivity.
5. Poor training methods.
6. Some neurological disorders.
7. Walkers for babies and kids inhibits propioception development.

What can you do to improve your propioception?

1. Practice therapeutic walking (walking with swinging arms, free hands and at a good pace)for at least 20 minutes every day.
2. Keep a good sitting, standing and moving posture.
3. Balance in a wobble board for the count of 20 breaths 10 times.
4. Practice balance reaches on a stability pad, 20 per side.

(Pain 106) Phantom Pain

"Phantom pain feels like it's coming from a body part that's no longer there. For decades, doctors believed this post-amputation phenomenon was a psychological problem, but experts now recognize a physical cause for this pain — and that it actually originates in the brain.

Most people who've had a limb removed report that it sometimes feels as if their amputated limb is still there. This painless phenomenon, known as phantom limb sensation, can also occur in people who were born without limbs. Phantom limb sensations may include feelings of cold, warmth, itchiness or tingling — but should not be confused with phantom pain. Similarly, pain from the remaining stump of an amputated limb is not the same as phantom pain.

For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies."

--Mayo Clinic

(Post 105) Pregnancy and Low Back Pain

According to Obstetrics, Normal and Problem Pregnancies by Steven Gabbe, Fourth Edition, the most widely read textbook on Obstetric Medicine...

Back pain in pregnant women can be prevented to a large degree by:

1. Avoidance of excessive weight gain.
2. Exercise to strengthen back muscles.
3. Good sitting and sleeping posture.
4. Sensible shoes, not high heels, should be worn.

(Post 104) Tennis Elbow

What is it?

It is an inflammatory or degenerative dysfunction of the common extensor tendon of the elbow.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor shoulder, elbow, wrist and hand mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.
9. Trauma.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over the elbow with referred pain down the forearm to the base of the hand.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to play, type or work as long or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at the site. This may indicate bursitis.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive isometric, eccentric and concentric strengthening exercises.
Step 4. Continue walking and cycling as much as the pain will allow.
Step 5. Progressively start exercising 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Exercise with mild resistance (squeeze rubber ball, open hand against elastic resistance) 10 to 20 minutes
Step 8. Star playing tennis or your sports, beginning slowly for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 103) Rotator Cuff Tendenitis and Tendonosis

What is it?

It is an inflammatory or degenerative dysfunction of the rotator cuff tendons, which are four tendons of the shoulder.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor shoulder mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.
9. Trauma.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over the shoulder with referred pain down the arm to the base of the thumb.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to play or work as long or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at the site. This may indicate bursitis.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive isometric, eccentric and concentric strengthening exercises.
Step 4. Continue walking and cycling as much as the pain will allow.
Step 5. Progressively start exercising 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Exercise with mild resistance (push, pull and lift) 10 to 20 minutes
Step 8. Swim, beginning slowly for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 102) Achilles Tendinitis and Tendonosis

What is it?

It is an inflammatory or degenerative dysfunction of the achilles tendon, which is one of the strongest and largest tendons of the body, it attaches the calf muscles to the heel bone.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor feet mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over a 2-3cm area of the tendon between the calf muscles and the heel bone.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to run as far or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at 0.5cm in size. This may indicate a small tear.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive eccentric and concentric strengthening exercises (calf raises and depressions on a step). Start with both legs together, and build up progressively until you can manage 3 sets of 15 single leg calf raises twice a day (90 calf raises a day). Do these on a staircase or a stable aerobic step.
Step 4. Continue swimming and cycling as much as the pain will allow.
Step 5. Progressively start walking 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Jog 10 to 20 minutes
Step 8. Run, beginning slowly on grass and at the beach for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 101) On Asking The Right Questions

When we don't ask the right questions we end up asking....

Why is it that every time...

I try to swim longer distance, my shoulders (rotators cuff) and back hurts?

I try to run faster, my knees (meniscus), ankles (Achilles tendon) and feet (plantar fascia) hurts?

I try to lift heavier weights, my back (spinal discs) and neck (nerve that goes to and under the shoulder blade) hurts?

I try to exercise, my sciatic nerve and back hurts?

I try to golf better, my neck, shoulders and elbow (golfer's elbow) hurts?

I try to play tennis better, my feet, ankle, knees and my elbow (tennis' elbow)hurts?

So lets start asking the right questions such as...

What is the right type of...

Exercise: The type of exercise we need to use might be isometric(muscle contraction but no joint movement) or dynamic(muscle and joint movement).

Position: The position that we need to put our body or body parts may be neutral, mid-range or, end of the rage.

Quantity: We can always change the quantity depending on our physical response, adaptation, energy level and our rehab and training goals.

Frequency: We need to find the right amount of resting time between rehab and training sessions so we can properly rebuild, restore and recover.

Level of difficulty : Avoid making the exercise more difficult without a good reason, meaningful plan and a purpose.

Direction: The more directions an exercise is performed the better results we will have.

Range of motion(R.O.M.): Just like quantity and frequency, range of motion can be modified to fulfill the goal in mind.

Ground levels: We can modify the height we are standing on or stepping into by using different level steps, so the body can gain dynamic strength when performing activities at different surface levels, which require changing our body position in relation to the ground, such as going up and down stairs, hiking, climbing, running in uneven surface, etc.

Environmental stability: When we introduce external or environmental instability to our rehab and training program, such as a balance board or stability ball, we stimulate our body's neuromuscular system and gain physical stability.

Resistance: Weight and/or resistance should only be applied when we have complete control of our body weight in motion.

Speed: Speed should be the last progression unless we have very good reason to do otherwise.

(Post 100) Back in Motion...

Getting Back in Motion is a process...There are stages, steps, strategies, hurdles and many physical and emotional ups and downs.
At the beginning of this process, you enter the first stage which we will call "feeling better". At this stage, you temporarily feel less pain, you have good and bad days, you move a bit better, and feel a bit uplifted, but then a flare up or a set back shows up, and you feel temporarily discouraged, but if you keep up the hard work you enter the second stage which we will call "getting better". At this stage, you feel less pain, move better and start to have good days more often, but a few more set backs and flare ups show up and you feel briefly frustrated and discouraged, but with hard work and patience you enter the final stage which we will call "staying better". At this stage you no longer feel pain, you can move and perform better and the risk of relapse is eliminated.

Is this process worth it?

Can you enjoy your life, family, friend and activities when you are in pain?

How will you be physically and emotionally in five, ten or fifteen years from now if you don't take care of your body and mind now?

...You now have 100 posts that can guide you and hopefully encourage you to MOVE beyond pain and dysfunction so you can enjoy a more comfortable and complete life...Good Luck.

(Post 99) What You Can Do About that Painful Ending

If you have back pain with or without sciatica and you are willing to do the work necessary to get better, here is what I recommend you do...

1. Walk with arm swing at least 20 to 30 minutes everyday (dog walking is OK but it does not count as therapeutic walking).

2. Sit with your spine in neutral (not too slouched nor too arched) and change you posture within a neutral zone every 30 minutes.

3. When lifting, keep your spine in neutral, use your legs (bend your hips, knees and ankles joints) and keep the object close to your center of gravity, in other words your belly button.

4. Floss your sciatic nerves 10 reps 2-4 times per day every day (See post 60).

5. Build neuromuscular endurance by speed walking, opposites (bird dog) exercises, planks (don' arch your back...keep it in neutral), squats, lunges and balance reach.

6. Avoid exercises that are harmful to the spinal discs such as: sit ups, prone leg raises, superman exercise (lying flat face down and raising both legs and arms up), knee to chest stretches, toe touch stretches and spine twisting stretches and don't put your self in danger with dumb exercises such as standing on a exercise ball.

7. Eat often and eat a balance diet of protein, complex carbohydrates, vegetables, fruits and clean water.

8. Rest, restore and recover through good night sleep, active rest and therapeutic massage.

9. Be patient. Although you may progressively feel better, it may take six to twelve months before you see results and get better.

(Post 98) A Painful Movie to Watch

First Episode:
Symptom location -- Back pain that last between 5 days to 2 weeks.
Common treatment given -- Advil + Time

...and the pain comes back...

Second Episode:
Symptom location: Severe back pain that radiates to the hip that last from 2 weeks to 2 months.
Common treatment: Advil + Pain Medication + Electric stimulation + Ultrasound.

...and the pain comes back...

Third Episode:
Symptom location: Severe back pain that radiates down to the knee that last 8 weeks or more.
Common treatment: Systematic steroids + Pain medication + Some knee to chest stretches + Sit ups.

...and the pain comes back...

Fourth Episode:
Symptom location: Extreme back pain that radiates all the way to the foot that last 6 months or more.
Common treatment: Epidural injection with steroids plus anesthetic + Pain killers.

...and the pain comes back...

Fifth Episode:
Symptom location: Extreme back pain that radiates all the way to the foot with foot numbness that last 1 years or more.
Common treatment: Laminectomy (Surgery)+ More pain pills.

...and the pain does not go away...

Sixth Episode:
Symptom location: Extreme back pain that radiates all the way to the foot with foot numbness and or leg weakness that last 2 years or more.
Common treatment: Spinal fusion (Surgery)+ More pain pills.


So in another words the movie goes something like this...

Advil ... and when that does not work...

Advil + Pain killers... and when that does not work...

Steroids ... and when that does not work...

Laminectomy (Surgery) ... and when that does not work...

Fusion (Surgery)... and when that does not work...

More surgeries and more pills...

Sad, very sad ending...But it does not have to end like this...Take charge!!!!...Read the next post...

(Post 97) Break the Bounds of Traditionalism...

Remove the source ... not just the symptoms.

Treat the whole body ... not just the pain.

Think of your environment ... not just your body.

Train movements... not just muscles.

Learn meaningful exercises ... not just exercises.

Practice therapeutic walking ... not just walking.

Think of dynamic posture... not just static posture.

Train the neuro-musculo-skeletal system ... not just the muscular system.

Train stability ... not just balance.

Train endurance ... not just strength.

Train mobility ... not just flexibility.

Train power ... not just speed.

Tweak the frequency, quantity, depth, length, environmental stability and speed ... not just the resistance.

Work on active rest, recovery and restoration ... not just on training.

Expand your strengths ... don't just work on your weakness.

Question everything ... don't just follow.

(Post 96) Mobile, Stable, Strong, Explosive and Super Stiff...Usain Bolt Fastest Man in the World!

Can you see how the trunk is in neutral, stable and super stiff? and not in a shortened sit up like position?

Can you see how the shoulders, arms, hips and legs are mobile, stable and super stiff?

Can you see a modified lunge? and not an artificial leg press like position?

Can you see how a flexibility program must be done with active stretches and done in positions that are at least similar to running? and not with artificial and passive, toe touch, lying on your back type of stretches?

(Post 95) Vacuuming it's a Pain !!!

It is very common for some people to feel back pain during/or after vacuuming. Very often these people have unstable spines and dysfunctional spinal discs, which causes recurrent back pain and dysfunction.

Why do they feel pain?

Most people tend to vacuum pushing and pulling the vacuum with one hand on one side of their body, rotating and twisting the spine, and causing high amounts of torque on the spinal discs where muscles can take the load but not the unstable spine.


What can be done?

If you are one of this people, when vacuuming you should:

1. Keep your spine in neutral (not bent or twisted).

2. Keep the vacuum in front of your body.

3. Push and pull the vacuum with both hands as much as possible, this will eliminate the spinal torque which is one of the reasons for spinal disc damage, back pain and dysfunction.

4. Try to vacuum after you have been moving around, one to two hours after rising from bed as our spinal discs have more water in them and are more prone to damage.

(Post 94) On Massage Therapy

American and Russian research (Siff MC & Yessis M 1992, Dubrovsky 1982 and others) has consistently shown that massage therapy when integrated with movement therapy is an effective tool in orthopedic, neuromuscular and sports restoration and rehabilitation by:

1. Increasing blood supply and speeding up venous flow.

2. Increasing lymphatic flow therefore helping the tissue to get rid of waste and toxins.

3. Increasing oxygen in arterial blood (Dubrovsky, 1982).

4. Helping to break adhesions and scar tissue, therefore improving muscle function by letting muscle fibers glide, contract and relax more efficiently.

In sports preparation, its main roles, as described by many Russian experts are:

1. Pre-starting neuromuscular relaxation.

2. Pre-starting neuromuscular stimulation.

3. Warming, loosening and mobilizing tissue.

4. Restoration during and after workouts or competitions.

Now, if you are a therapist and believe massage is time consuming think about this ... If you spend 20 minutes on electric stimulation plus 10 minutes on micro-current and 7 minutes on ultrasound, you have 37 MINUTES OF FLASHY PLACEBOS that at best would entertain the patient, but if you spend only 20 minutes on massage therapy, you would be far more successful in restoring and rehabilitating the neuromuscular system in almost half of the time.

References cited in this post and many further details of restorative procedures may be found in Siff MC & Yessis M book "Sport Restoration and Massage" 1992.

(Post 93) More Myths and the Problems they Cause

Myth #4: When performing a lunge, the knee must never cross the foot and the knee must always be in the direction of the middle toe.

This myth can causes many problems, but before we go any further lets ask the following:

What happens when you are playing a sports or when you have to move your body in an unexpected way that requires that your knee does go beyond the foot and where your knee is not aligned with the foot (which is very common!) and you have not trained your neuromuscular system to control these movements, ranges of motion and positions?

You are taking a huge risk of injuring or rupturing your ligaments, meniscus, tendons and other structures, and this is not taking in consideration that depending on the severity, you may also compromise you hip and ankle which are both functionally linked to the knee.

(Post 92) Question Everything!

Don't follow blindly...Question everything!

Laws, facts, theories, hypothesis, assumptions and opinions.

Here are some points from Dr Siff that can help when questioning...

A rule is not a law

A theory is not a law

A judicial law is not a scientific law

A position statement is not a law

Scientific laws can not be broken; judicial laws can

An hypothesis is not a law; an hypothesis is a theory

A theory has to be proved repeatedly to become a law

Most rules and laws are relative to some point of reference

Beware of absolutes; almost everything is relative

Rules change; scientific laws do not; judicial laws do

Rules can be and usually are broken

Some rules should be broken

Look for undiscovered laws

Think before you rule

Question all rules.

(Post 91) Newton's Law and Kids

Newton's First law

"Any body will remain at rest or in its state of constant motion unless acted on by an outside force".

So turn off the TV and get those kids moving!!!

Here are some ideas:

1. Speed walk with them...is good for them, for your back and for your neck.

2. Jump rope..and see how many jumps per minute they can do and then have them compete against themselves.

3. Invest in a Wii video game... boxing or tennis will get you both moving!!!.

(Post 90 ) The Silent Part of Rehabilitation, Training and Athletic Development

Rest, recovery and restoration are the most commonly ignored and misunderstood parts of rehabilitation, training and athletic development. This is due to the mislead notion that the gains of training such as stability, endurance, strength, speed and power are only attained while the work is being done, when in reality according to most experienced sports scientists and exercise physiologists the benefits and improvements can only be gain when the body has enough time to rest, recover, regenerate and adapt.
Ignoring this will only create tissue damage, dysfunction and pain.

Coming soon... more Myths and the Problems they cause.

(Post 89) Listening to the Body...But not too Close and Not too Far Away.

When rehabilitating and training your body, it is essential that you listen to it.

But the question is, how close do we listen to it?

The answer is ambiguously clear...

Too close? and we get lost as we change direction too frequently.

Too far? and we keep the same strategy for too long and then we break down.

So here is where the traffic light can guide us.

Better after exercise? -- Green light -- Go on !!!

No change after exercise? -- yellow light -- Proceed with caution !!!!!

Worse after exercise? -- Red Light -- Back off, by reducing the intensity, resistance, speed, repetitions, but don't stop !!!!!!!!!!

(Post 88) In my last day in Barcelona....

Being in Barcelona for the second time has been a great experience.

Listening to so many musicians in the streets reminds me that just like the strings of a guitar can not be too tight or too lose to sound right, the body is not different. When the body is too tight it becomes restricted and when it is too lose it becomes unstable and dysfunctional.
And when playing, there is always a silence between those notes, otherwise there would only be noise...
Well in training we also need that rest in between training sessions, otherwise we would only produce neuro-musculo-skeletal chaos, pain and dysfunction.

(Post 87) Remember!!!

Remember...Not enough load and the tissue will become weak...Too much load and the tissue will break down...So we need to find the right amount, quantify it and then gradually modify it.

(Post 86) Therapeutic Exercise # 1

Training to lift properly with squats is the first strategy to strengthen the leg muscles and to increase range of motion at the ankles, knees and hips so we can protect our spinal discs from getting damaged.

Points to remember:

1. Keep your spine in neutral.

2. Sit back and do not bend your lower back.

3. Use your hips, knees and ankles to get you there.

(Post 85) Common Mistake # 7

We all know lifting with our back instead of lifting with our legs hurts the lower back, but do you know why?

Here are some of the reasons:

1. Bending the lower back creates massive compressive forces to the spinal discs from the contraction of the back muscles.

2. Flexing the lower back forwards pushes the nucleus of the spinal discs backwards into the spinal cord and nerve roots.

3. Whatever you are lifting, multiply the load by 15, that is the amount of pressure that will compress your spinal discs, and that is not taking in consideration your upper body weight which adds to the compression.

I will be in Spain...I will be back soon!!!

(Post 84) Common Mistake # 6

After treating and training people with neuromuscular pain and dysfunction for over 12 years, I can honestly say that if some one does not stop sleeping on their stomach, treatments and training will be at best a waste of time... So if you sleep on your stomach, you need to re-train and remind yourself to sleep on your back and sides so you do not develop neck pain and dysfunction.

(Post # 83) Common Mistake # 5

This exercise is often done incorrectly, but when done properly with...

1. Back in neutral.

2. Without arching.

3. With pelvis even.

4. Without hiking or drooping a hip

...Is a very useful exercise when treating pain and dysfunction.

(Post # 82) Common Mistake # 4

While this exercise may give short term relief for back pain, it is at the expense of the stability and integrity of the spine and spinal discs.

(Post # 81) Common Mistake # 3

Although this exercise may strengthen core muscles, it does it at a very high cost to the spinal discs, even more so than sit ups.

(Post # 80) Common Mistake # 2

This is a very popular exercise that is often recommended for people with back pain. What most people do not know is that there is plenty of evidence against it. It makes backs more unstable by stretching the spinal ligaments and disc displacements protrude farther into the spinal canal by squeezing the front of the disc therefore pushing the nucleus backward where the spinal cord and nerve roots are.

(Post # 79) Common Mistake # 1

According to the studies on spinal disc pressure by Dr. Nachemson, there is 210% of your body weight of pressure into the spinal disc with sit ups, and 180% of your body weight of pressure with back extension.

For example: If your weight is 150 pounds and you do a sit-up, you are putting 330 pounds of pressure on your spinal discs per repetition, in other words, this is a very effective exercise to rupture a disc.

(Post # 78) Elbow Pain & Dysfunction

Tennis elbow and golfers elbow are terms used to describe inflammation or degeneration of the tendons of muscles that go from the elbow into the fingers.

Most of the time these tendons get injured or irritated by using the wrong tennis racquet, by typing without enough rest in between or by misuse through poor training. An example may be going from little use to excessive use, such as in a heavy tennis match or golf game.

So what do we do?

1. Train all the muscles of the upper body including the fingers with stability, mobility, strength and endurance exercises.

2. Mobilize all the joints of the body specially the ones of the shoulders, arms, hands and fingers.

3. Warm up before every training, game or activity.

4. Cool down after every exercises or training sessions.

5. Take frequent rest between typing, training or game sessions.

(Post # 77) On Healing

Problems cannot be solved by the level of awareness that created them.

--Albert Enstein

(Post # 76) The Mind- Body-Environment Connection

Not long ago when some of us talked about the mind - body connection we were not only looked as very creative but also very confused.
Today with the advances of neuro-science and functional MRI the evidence for this connection is clear, but I believe we need to take this concept a step further and realize that the environment is our extended body, and that there is not separation between our mind, body and the environment.

When we can understand that our thoughts are recycled information, and that our bodies are recycled environment (water, food and air), and that our environment is recycled universe, we can then see how when we contaminate our environment we contaminate our food, and when we contaminate our food we contaminate our body, and when we contaminate our body we contaminate our mind, and when we contaminate our mind we pollute everything.

When we can see that our personal wellbeing depends on the wellbeing of our mind, body and environment, we will then have a more holistic view and take care of all three.

To see a great video on a similar subject click http://www.ted.com/talks/view/id/229

(Post # 75) Complex Simplicity

I believe this chart shows very important interconnected factors that have the potential to influence our body. Unfortunately they are often ignored but are essential when treating and training our pain and dysfunction.

(Post # 74 ) A Must Read for Anyone in Chronic Pain

This is one of my favorite book on self pain management by David Butler and Dr. Lorimer Moseley, written in a very simple and comprehensive way for anyone in pain.
To order go to www.noigroup.com or www.optp.com

(Post # 73) According to Some of the Greatest Scientists, Here is What Works and What Doesn't for Back and Neck Pain.

According to Dr. Nachemson M.D., P.H.D. and his group of scientist (orthopedic- and neuro- surgeons, medical doctors, biomechanists, physical therapists, sociologists, psychologist, epidemiologists and economists) here is what their studies found:

NOT EFFECTIVE

1. There is no acceptable evidence on the efficacy of any form of fusion for back pain or instability.

2. There is no acceptable evidence on the efficacy of any form of decompression for degenerative lumbar disc disease or spinal stenosis.

3. There is no evidence on whether any form of surgery for degenerative lumbar disc disease is effective in returning patients to work.

4. There is strong evidence that bed rest is not effective for treating acute lower back pain.

5. There is no evidence on the effectiveness of ultrasound, heat, ice or short-wave diathermy for treating acute lower back pain.

EFFECTIVE

1. There is consistent evidence that exercise is effective in treating and preventing back and neck pain and dysfunction.

2. There is consistent evidence that advice on staying active is effective in treating and preventing back and neck pain.

3. There is evidence on anti-inflammatory medication for helping inflammation.

For doctors and therapists who want to read more on the subject read Neck and Back Pain, The Scientific Evidence of Causes, Diagnosis, and Treatment by Alf L. Nachemson and Egon Jonsson

(Post # 72) Are Smokers Smoking Their Spines?

Yes, smoking does create more than heart disease, lungs disease and cancer, it creates spinal pain and dysfunction as well.

Here is how smoking creates spinal problems:

1. It increases degenerative changes in the body.

2. It changes the pH of the spinal discs, thus deteriorating them from within.

3. It decreases blood flow and nutrition to the spine.

4. Decreases mineral content, therefore decreasing bone density in the vertebrae.

(Post # 71) Strong Life

Finish this sentence as many time as you need to and be as specific as you can...

I feel strong when I...

I feel weak when I...

Stop doing what weakens you and do more of what strengthens you; It does not matter if it is thinking, feeling or doing.

(Post # 70) Pain Cycle

Although this is a great pain cycle chart, it does not show the most common causes of pain and dysfunction which are:

1. Inactivity

2. Misuse

3. Over training

4. Poor training method

5. Poor posture

6. Poor diet

7. Stress

(Post # 69) On Breast Pain

Breast pain can be due to many possible causes such as:

1. Hormonal fluctuations from menstruation, pregnancy, puberty, menopause, and breastfeeding.

2. Fibrocystic breast disease, but pain is a very unusual symptom of breast cancer.

3. Cervical spine (neck)dysfunction.

4. Thoracic spine (rib cage) dysfunction.

...So what can you do?

1. Drink plenty of water and avoid sodas especially Coke and Pepsi.

2. Exercise everyday for 20 minutes, swimming is one of the best exercise for this condition, it helps to stimulate lymphatic drainage and blood flow.

3. Eat plenty of raw food such as fruits and vegetables.

4. Gently massage your breasts toward the armpits or get Lymphatic Massage Therapy.

(Post # 68) The Right Therapeutic Dosage

By far the most important strategy in getting better is learning how to identify and apply the right therapeutic dosage.

1. Quantity: We can always change the quantity depending on our physical response, adaptation, energy level and our rehab and/or training goals.
2. Frequency: We need to find the right amount of resting time between rehab and training sessions so we can properly rebuild, restore and recover.
3. Resistance: Weight and/or resistance should only be applied when we have complete control of our body weight in motion.
4. Level of difficulty : Avoid making the exercise more difficult without a good reason, meaningful plan and a purpose.
5. Environmental stability: When we introduce external or environmental instability to our rehab and training program, such as a balance board or stability ball, we stimulate our body's neuromuscular system and gain physical stability.
6. Speed: Speed should be the last progression unless we have very good reason to do otherwise.

Remember...Not enough load and the tissue will become weak...Too much load and the tissue will break down...So we need to find the right amount and quantify it.

(Post #67) On Headaches

Headaches can be triggered by:

1. Mechanical causes-- neck or jaw dysfunctions(TMJ).

2. Emotional causes--stress, toxic relationship, unsatisfied lifestyle, job, etc.

3. Chemical causes--poor nutrition, smoking, alcohol, etc.

4. Hormonal causes-- hormonal dis-balance.

So what can you do?

Ask yourself:

1. Am I getting enough aerobic exercise at least 5 days per week?... remember 220 minus your age x .8 for example: for me is 220 - 35 x .8 = 148 beats per minute or 24 beats per 10 seconds.

2. Am I eating enough proteins (fish, chicken and beans with rice), vegetables, fruits and clean water?

3. Am I sleeping and resting enough?

4. Am I keeping a good posture most of the time?

5. Am I interrupting the sitting I do, every 30 minutes?

6. Am I doing something about stress such as finding the activities or people that weaken me and getting rid of them?

If your answer is no to any of the questions above, then get started!!!.

If your answer is yes to all of these questions and you still have headaches...it is time to see a doctor.

(Post # 66) On Running

Running is a great way to:

1. Get cardiovascular exercise.

2. Get good brain chemicals.

3. Get rid of stress.

4. Get rid of pent-up energy so you can sleep better.

But it can be hard on our joints if you don't know how to run correctly...so how can we get all of these benefits and minimize the impact and micro trauma?

1. Train your body with multi-directional lunges.

2. Train your glutes and leg muscles with squats.

3. Train your trunk muscles "core" with planks.

4. Floss your sciatic nerves.

5. Warm up with a speed walk right before your run.

6. When running visualize yourself running in the sand trying not to leave deep marks on the sand, in other words learn to decelerate your body when your foot enters the ground.

7. Find a safe place and run backwards and side to side as a cool down

8. And finally stretch all your muscles, but do it in a functional way.

(Post # 65) What Is Sitting Doing To Us?

What is sitting doing to us?

1. It turns off most of the abdominal muscles.

2. It over works the back muscles (when posture is controlled otherwise it just stresses the spine).

3. It over stretches the spinal ligaments.

4. It stresses the back portion of the spinal discs.

5. It shortens the very popular Psoas muscle.

6. It shortens the hamstring muscles.

7. It shortens the calf muscles.

8. It reduces blood circulation by restricting the vessels in the groin area.

9. It slows down lymph flow by restricting lymph nodes and vessels in the groin area.

10. It stresses the neck by making it more difficult to keep our neck in neutral.

etc...etc...etc...etc...etc...etc...

So what do we do?

1. Interrupt sitting as much as possible, at least every 30 minutes by stretching or walking for a few seconds.

2. Work standing up as much as possible. If you think this is unrealistic think of the cashiers at Publix or nurses, who are on their feet all day.

3. Change posture as often as possible or at least every 30 minutes.

4. Walk every day for at least 20 minutes.

5. Try sitting on a ball... is great for posture, but remember your hips must be higher than your knees, so get the right size ball (I like gimmic plus, which you can order from www.optp.com).

(Post # 64) Great Times Are Coming !!!

Science, economics, good physicians, therapist and trainers combined with an huge numbers of suffering patients are helping to move physical rehabilitation, medicine and health forward into a system where:

1. Entertaining the patient while nature takes its course is not acceptable.

2. Where machines that plug into the wall acting as flashy placebos will not longer be the treatment of choice but will be replaced by active treatment such as therapeutic exercises, aerobic exercise combined with healthier eating habits.

3. Where treatment begins with education and is followed by encouragement.

I hope that the closing of so many rehabilitation practice around the country in the last few months will encourage practitioners to move away from endless passive treatments to an active, education, encouragement based practice where everyone benefits.

(Post # 63) The 8 Rs of Healing

In order to be successful in rehabilitating and training our bodies, we need to follow a simple but often ignored approach which consist of the 8Rs:

1.Recognize the source.
2.Remove the cause.
3.Repair the tissue.
4.Restore the function.
5.Re-educate the neuromuscular system.
6.Rebuild the whole body.
7.Re-train for specific sports, task or goal(s).
8.Rest the body and tissues through active rest such as walking, biking or swimming.

(Post # 62) The Role of Aerobic Exercise in Back Rehabilitation

It is well known that aerobic exercise is great for our cardiovascular system, but there is also a great amount of evidence supporting the role of aerobic exercise in rehabilitation of back pain and dysfunction(Juker at al., 1998).

Most of the studies done by Nutter 1988, McGill 1998, Suni 1998 and others show that:

1. Fast walking with arm swing is one of the best strategies to create endurance for the back muscles and therefore a great tool for rehabilitation and prevention of back pain and dysfunction.

2. Slow walk without arm swing tends to aggravate back pain and dysfunction.

(Post # 61) Strength Training vs. Endurance Training for Back Pain and Dysfunction

Although increasing back muscle strength is a popular objective of low back rehabilitation, studies have not been able to support this concept.

Studies of Leino (1987), Biering-Sorensen (1984), Holmstrom and Moritz (1992) and others demonstrate that:

1. No type of back muscles strength training can be preventative or curative for lower back injuries.

2. Most people have back muscle strength but hip and leg muscles weakness, this is why most people lift with their back muscles thus damaging their spinal discs.

3. Creating back endurance is the only training that when combined with hip strength, power and flexibility plus good posture and right lifting mechanics, is effective in treating and preventing back pain and dysfunction.

(Post # 60) Two Ways To Floss The Sciatic Nerve

(Post # 58) How Many Muscles and Joints are Being Activated and/or Mobilized?

(Post # 57) Knowledge vs Wisdom

What is the difference between knowledge and wisdom?

Knowledge is information which can be relatively correct or incorrect.

Wisdom in the other hand is the integration of information, experience and logic.

(Post # 55) Knee vs Ankle Dysfunctions

See if you can answer these questions...

Why is it that knee surgeries are so much more common than ankle surgeries?

Doesn't the ankle hold more body weight than the knee?

Isn't the ankle joint smaller than the knee joint?

Isn't the ankle one of the first joints to get the stress that comes from gravity and ground forces?

How often have you heard people getting ankle replacements?


I need everyone to participate and send me your answers at backtofunction@gmail.com

(Post # 54) Back Pain

Guidelines for treating your back pain:

1. Exercise daily.
2. Exercise should not increase back pain.
3. Walk every day for at least 20 minutes.
4. Reduce the amount of sitting a much as possible.
5. When sitting change posture every 20 minutes.
6. Avoid full spine bending for the first hour after rising from bed.
7. More repetition of less demanding exercises will enhance endurance and strength.
8. No method of exercises fits all individuals.
9. Be patient and stick with the program.
10. Remember to lift properly, by bending hips and knee and not the back.

(Post # 51) On Your Bones... Ready?... Go!

Traditionalists will tell you to:

• Take Calcium, Tums will do.
• Do exercise, any will do.
• Take hormones. Horse urine? or wild yam? any will do.
• When all fails take Fosamax.

...and you may ask...

What about tums and indigestion?

What about hormones and cancer and heart disease?

What about Fosamax and osteonecrosis (bones that are dying and rotting) ?

...and they say...

• only a small percent get those side effects.
• if they happen we will deal with that later.

So I am going to ask you...

1. Are you walking at least 20 minutes every day?
2. Are you doing three dimensional, multi-directional, against gravity, free from any artificial stability exercises?
3. Are you eating a balanced diet of healthy proteins, whole grains, organic vegetables and fruits?
4. Are you avoiding refined foods, sugars and sodas?

If yes, great!

If not, let's get started!!!!

(Post # 50) The Last Straw That Broke His Back

(Post # 49) Protect Your Discs

(Post # 48) Just a Thought

It is Important to know what you are doing

but it is more important to do what you know.

(Post # 47) Pelvic Floor Dysfunction

Pelvic floor dysfunction is a very common problem affecting 1 in 4 women.

Between pregnancy, childbirth, hormones, inactivity, and too much uninterrupted sitting (at the desk, computer, driving, reading, etc.) I predict this already high percentage of women getting the dysfunction is going to get much higher in the coming years.

Symptoms vary but the most common are:

• Bladder incontinence
• Bowel incontinence
• Sexual dysfunction (lack of feeling or sensation)
• Pelvic floor pain

The traditional way tells us to Squeeze!...Squeeze!...Squeeze!

I believe this approach is very limited at best.

What can you do to treat or prevent this problem?

In order to stimulate, strengthen and give endurance to the pelvic floor muscles you need to:

1. Lunge in every direction (front, back, sideways, front diagonal and back diagonal) x 20 every day
   
2. Squat with different foot position (feet together, feet 1 foot apart, 2 feet apart) x 20 every day
   
3. Walk 20 minutes every day
   
4. Only then will Kegel exercises (contract the pelvic floor muscles and hold 4 seconds x 20) will be effective.

(Post # 46) More on Exercise and Breast Health

Physiological Effects of Exercise on Breast Cancer Risk

• Decreased Lifetime Exposure to Endogenous Estrogen
• Decreased Number of Menstruations/Ovulations
• Decreased Level of Ovarian Estrogen Production
• Decreased Levels of Endogenous Estrogen in Blood
• Less Conversion of Androgen to Estrogen in Fat Cells
• Decreased Breast Density
• Risk Four Times Lower with Less Breast Density
• Increased Immune Function
• Increased Natural Killer Cells Fight Tumor Initiation

--American College of Sports Medicine

(Post # 45) Alcohol and Breast Health

Breast Cancer Risk
(1 drink = 5 oz. wine, 1.5 oz. hard liquor, 12 oz. beer)
• 1 drink per day = 11 percent increased risk
• 2 drinks per day = 24 percent increased risk
• 3 drinks per day = 40 percent increased risk

Effect of Alcohol on Breast Cancer Risk
• Increases blood triglyceride levels
• Increases estrogen levels in blood circulation
• Increases liver detoxification of toxins in alcohol
• Decreases liver’s processing of excess estrogen in blood
• Causes long-term liver damage Prevents liver from
removing excess estrogen from blood
• Decreases immune function
• Increases blood levels of carcinogen acetaldehyde
• Decreases absorption of cancer-fighting nutrients
• Decreases antioxidant activity in the blood
• Can increase weight gain through excess calories
• Higher body fat increases breast cancer risk

--American College of Sports Medicine, Certify News

(Post # 43) Just a Thought

Don't ever let a miserable moment go to waste!

We can always learn from it.

(Post # 42) Myths and the Problems they Cause # 3

Myth #3: Stretching before exercising will prevent sports injuries.

After studying the work of Dr Siff and Dr McGill, both professors of biomechanics , I realized I was not alone in believing how wrong this common misconception is.

If you were a sculptor trying to give shape to a piece of clay, metal or glass, you would first warm it up or melt it, otherwise it could crack and brake when you tried to bend it. Well, the body is no different.

These are steps I recommend for a safe and effective work out:

1. Before playing sports or doing exercises, you need to warm up for 5 minutes with any of the following: Gentle progressive fast walks, mini squats, short lunge matrix or any exercises that would increase you heart rate and circulation.
2. After the warm-up you are now ready to do your sport or exercise routine.
3. After you finish, you need to slow down with a gentle 5 minutes walk, run, or lunge matrix.
4. Only after you have finish your slow down, should you stretch or mobilize your body as a cool down.

(Post # 41) 13,000 Yoga Related Injuries

According to the Consumer Product Safety Commission there were over 13,000 Americans treated in an emergency room or doctor's office for yoga-related injuries in the last three years.

All these injuries are thought to be caused by specific yoga poses, lack of preparation, age, and/or unqualified instructors.

I believe that some of these factors may contribute to these injuries, but I also believe that the problem is caused by not asking the right questions:

Why am I stretching?

How do I know I need flexibility rather than stability?

If I have loose or unstable joints, would yoga help me or hurt me?

Can too much yoga create so much flexibility that it becomes instability?

I am posing these questions because I believe yoga can be very beneficial for the right person, for the right reason, when combined with the right amount of stability training and with the right the instructor.

(Post # 40) Wisdom from Pooh Bear

Pooh: Oh bother! Why am I sitting on this tree stump trying to make my leg go straight with Piglet hanging onto my ankle?

Owl: So Rabbit and I can calculate how strong your leg is.

Rabbit: Extending a Piglet twenty times means you have a strong leg for a bear.

Piglet: It is hard to hang on. I hope I don't fall off when you make your leg go fast.

Eeyore: This all looks very boring to me.

Pooh: But this is not what the leg of a Pooh Bear does.

Owl: And what, may I ask, do you mean by that?

Pooh: Well, the leg of a Pooh Bear likes to balance while reaching for a jar of honey, likes to squat down to play sticks with Piglet, likes to lunge back during tug-a-war with Eeyore, likes to climb the three steps to visit with Owl, likes to jump over logs in the forest with Tigger and likes to play hop games with Rabbit.

Tigger: Oh, thank you, Pooh. I like jumping with you, too...that's what Tiggers do best, you know.

Owl: May be if Piglet lets go of your ankle and you get up off the slump we can see what the leg of a Pooh Bear can do.

Rabbit: But there will be nothing to calculate, nothing to count, nothing to time, nothing to measure.

Pooh: It seems if you let my leg do what it likes, you could measure it while it likes what it does.

Tigger: You mean like jumping with me, hopping with Rabbit, tugging on Eeyore and squatting with Piglet?

Eeyore: Everyone is always tugging on my tail.

Pooh: and specially balancing while reaching for a jar of honey...just the thought of all this makes me very hungry, indeed.

Owl: Maybe there is a way to measure all the things your leg likes to do. I really enjoy it when you climb up the steps into the tree to visit me...maybe next time we can count the steps.

Rabbit: I would like to see how far and how fast we can jump together...that's what we do best, you know.

Eeyore: I'll bet you will want to lunge as far as you can to see how far back you can pull me by my tail.

Pooh: I wonder how long I can balance and how far I can reach for a jar of honey?

Rabbit: It seems like there is going to be a lot of things to measure if we are going to measure all the things the leg of a Pooh Bear likes to do.

Piglet: But what am I going to do now that I am not hanging onto the ankle of a Pooh Bear?

Pooh: Oh, Piglet, now you can hang onto the hand of a Pooh Bear and the rest of your friends and join in on all the fun.

--Gary Gray.

(Post # 39) Understanding The Mechanics of Pain

There are four ways that pain can be activated:

• Normal stress on abnormal tissue: Example: Walking (normal stress) with a degenerated knee (abnormal tissue).
• Abnormal stress on normal tissue: Example: Healthy person (normal tissue) who sits with a slouched posture (abnormal stress).
• Abnormal stress on abnormal tissue: Example: Sleeping on stomach (abnormal stress) with a pinched nerve in the neck (abnormal tissue).
• Chemical stress: Inflammation, infection or trauma.

(Post # 38) Are You In Balance?

Are you flexible?

Are you stable?

Are you strong?

Are you fast?

Do you have endurance?


I am not talking physically... I am talking emotionally.

(Post # 37) Some Times Provoking Transformation Is The Best Help We Can Give

A man found a butterfly cocoon. One day a small opening appeared and the man watched the butterfly as it struggled to force its body through the small hole. It appeared that it had gotten as far as it could and could go no farther. The man decided to help the butterfly, so he got a pair of scissors and snipped off the remanding bit of the cocoon.The butterfly then emerged easily, but with a swollen body and tiny, shriveled wings. The man continued to watch the butterfly, expecting that at any moment the wings would enlarge and expand to be able to support the body, which would contract in time.

Neither happened. In fact, the butterfly spent the rest of its life crawling around with a swollen body and shivered wings, never able to fly.

What the man had not understood was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature's way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved freedom from the cocoon.

Some struggles are exactly what we need in our life. If nature allowed us to go through life without any obstacles, it would cripple us. We would not be as strong as we might otherwise be.

And we could never fly...

-Author unknown

(Post # 36) Simple

"Any intelligent fool can make things bigger and more complex.
It takes a touch of genius...to move in the opposite direction."
-Albert Einstein

I would like to suggest an alternative to those who are suffering with simple back pain (pain that is less than 8 weeks):

• Walk every day for at least 20 minutes.


• Move around and gently stretch 1 minute for every 30 minutes of sitting.


• Change posture within a neutral position.


• When working, try changing position as often as possible.

• When lifting, get your pelvis close to the object first and then lift.

• If the above is not enough, find a good therapist or trainer who would teach you the right type of exercises.

(Post # 35) Myths and the Problems they Cause

There are two main exercises that are often prescribed for lower back pain and dysfunctions: sit ups and back extensions. They're both recommended on the assumption that back pain is caused by weak muscles.

Although weak trunk muscles are part of the problem and sit ups and back extension exercises do strengthens some of the trunk muscles, they're also the most destructive exercises for the spinal disc.

Just look at this chart to see how much excessive load there is on the spinal disc.

According to the studies on spinal disc pressure by Dr. Nachemson, there is 210% of your body weight of pressure into the spinal disc with sit ups and 180% of your body weight of pressure with back extension.


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(Post # 34 ) On Walking

Walking is the most underrated treatment for lower back pain and its dysfunctions. With every step we take, the lower spine goes from a neutral position into a mild extension movement. This causes the spinal disc to be mobilized into its natural position, where it gets hydrated with water and nutrients and where the spinal load gets evenly distributed.

(Post # 33) Exercise & Breast Health

I believe that walking must be a part of every treatment for neuromuscular pain and dysfunction. There is now evidence that brisk walking can reduce the risk of breast cancer by 20 percent. For those who already have the disease, walking three to five hours a week may reduce the chance of dying from it by as much as 50 percent.

For more on this see February issue of Medicine & Science in Sports & Exercise (official journal of the American College of Sports Medicine).

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(Post # 32) The Silent Lymphatic System

The lymphatic system is part of our immune system. It is composed of lymph vessels, nodes, glands and lymph fluid. It is always working in silence removing toxins, carcinogens, bacterias, viruses, pesticides that we get from foods, etc. It's one of our best tools against cancer and disease, but it needs to circulate, move and drain to work properly, and since it does not have a pump like the cardiovascular system, it relies on muscle contractions, body movements and breathing.

So how can we help our lymphatic system to work at its best?.

Here are some suggestions:

• Exercise for at least 20 minutes a day or 10 minutes twice a day every day (walking, biking, swimming, working out or whichever activity you enjoy).
• Drink plenty of clean water.
• Get plenty of rest.
• Eat healthy proteins, organic vegetable and fruits.
• Reduce stress by practicing silence.
• Get massage therapy.

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(Post # 31) Posture It's a Pain!

Can poor posture cause pressure and stress on the kidneys, liver, stomach, lungs, pancreas and the many other organs, vessels and arteries? I am not sure. But I do believe that poor posture creates pain and dysfunctions, such as bulging disc, herniated disc, degenerative disc disorders, spinal arthritis, and nerve compressions among many others.
For more on this read post # 7.

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(Post # 30) The Emotional Nervous System

Both physical pain and emotional distress are felt through the nervous system. When you feel dissatisfaction with your lifestyle, your job, or are involved in a toxic relationship, or are experiencing any type of emotional stress, your nervous system gets affected. When physical pain is experienced in addition to emotional pain, it adds up to an already overloaded nervous system and the pain feels stronger than if emotional issues were absent.
There may be occasions when a person, consciously or subconsciously, uses physical pain to distract the mind from emotional pain. Pain threshold is lowered by emotional pain and focus is on the physical pain to avoid dealing with emotional issues.

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(Post # 29) What is the Difference Between Mobility and Flexibility?

Mobility is how effectively and efficiently our body moves throughout the range of motion. Flexibility is how much range of motion our body has.

Mobility and stability training are an essential part of any rehabilitation and training program.
Flexibility on the other hand, is something that may or may not be needed depending on your body, rehab and training goals.

Remember: Too much flexibility will cause instability.

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(Post # 26) What is the Difference Between Rehabilitation and Training?

I believe that rehabilitation is the removal of the cause of pain and dysfunction, restoration of function and rebuilding of the body. Training is the creation of specific mobility, stability, endurance, strength, flexibility, power and speed based on our physical needs and goals.



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(Post # 25 ) On Training

"Efficiency is doing things right; effectiveness is doing the right things."--Peter Drucker


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(Post # 24) What is Chain Reaction

A series of events or actions in which each event or action is the result of the one preceding and the cause of the one following.
It is important to keep this definition in mind when training because if we train our body by artificially stabilizing or restricting body parts or movement patterns, we may disturb the chain reaction that needs to happen before and after that action.

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(Post # 23) In Motion

"Move to the dance of life--As our dance partner, life insist that we put ourselves in motion, that we learn to live with instability, chaos, change, and surprise. We can continue to stand immobilized on the shoreline, trying to protect ourselves from life's insistent storms, or we can begin moving. We can watch our plans be washed away, or we can discover something new." -Margaret Wheatley



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(Post # 22) Rehabilitation and Training Progressions

Rehabilitation and training progression does not always mean pushing forward, sometimes the right thing to do is to back off or to progress on some aspects and regress in others. Sometimes we need to start in a non-functional way, then move into a pre-functional system and only then to a functional method of treatment and/or training.

Here are some of the treatment and training progressions:

Exercise: The type of exercise we need to use might be isometric(muscle contraction but no joint movement) or dynamic(muscle and joint movement).

Position: The position that we need to put our body or body parts may be neutral, mid-range or, end of the rage.

Quantity: We can always change the quantity depending on our physical response, adaptation, energy level and our rehab and training goals.

Frequency: We need to find the right amount of resting time between rehab and training sessions so we can properly rebuild, restore and recover.

Level of difficulty : Avoid making the exercise more difficult without a good reason, meaningful plan and a purpose.

Direction: The more directions an exercise is performed the better results we will have.

Range of motion(R.O.M.): Just like quantity and frequency, range of motion can be modified to fulfill the goal in mind.

Ground levels: We can modify the height we are standing on or stepping into by using different level steps, so the body can gain dynamic strength when performing activities at different surface levels, which require changing our body position in relation to the ground, such as going up and down stairs, hiking, climbing, running in uneven surface, etc.

Environmental stability: When we introduce external or environmental instability to our rehab and training program, such as a balance board or stability ball, we stimulate our body's neuromuscular system and gain physical stability.

Resistance: Weight and/or resistance should only be applied when we have complete control of our body weight in motion.

Speed: Speed should be the last progression unless we have very good reason to do otherwise.

I want to thank all of you that wrote e-mails and comments. I will be back soon.

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(Post # 21) Rehabilitation and Training a Continuum

I believe that in rehabilitation and training there is a continuum from non-functional to more functional. For practical reasons I also believe that is helpful to separate them into three main types of treatments and training: Non-functional, Pre-functional and Functional.

Non-functional: Requires no action; such as passive movements, rest, ice, compress, elevate, massage etc.

Pre-functional: Semi-active treatments and training that are composed of stabilized movement such as floor exercises, gym machines, stationary bike, etc.

Functional: Active treatments and training that use three dimensional and multi-directional movements, have no artificial stability and work against gravity and ground forces.

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(Post # 20) Nerve Mobility and Sports Injuries

Can some our sports injuries be associated with the ability of the nervous system to move properly?

Can achilles tendonitis or a hamstring tear be caused by the inability of the sciatic nerve to move and glide freely?

Think for a moment how our brain is connected to the spinal cord and how the spinal cord is connected to the lumbar nerve roots; such as the sciatic nerve.
The sciatic nerve travels near the hamstring, behind the knee, all the way to the toes innervating all of these muscles. To test the sciatic nerve to see if a spinal disc is compressing it and not letting it glide, a clinician would perform a test which would put our leg in a position very similar to many sports moves therefore put our nerve roots under tension.
If there are restrictions in the lower spine the nerve roots may give the wrong information to those muscles not to relax on time, or not to relax at all.

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(Post # 19) What is the Difference Between Balance and Stability?

What is the difference between balance and stability?

Balance is how well you are able to control your body without movement against gravity.

Stability is how well you are able to control your body during movement.

So one is static and the other is dynamic.

They are both important, but if you are going to fall, think which one will protect you more?

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(Post # 18) What is the Most Vulnerable Part of Healing

What is the most vulnerable part of healing?

The most vulnerable part of healing is when we feel better and we forget about lifting properly, keeping a good posture, changing postures every 20-30 minutes of sitting, walking as a therapy for 20-30 minutes, and doing the work that got us better and we fall in the trap of I am too busy, I don't have enough time, etc.

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(Post #17) Uncertainty

Uncertainty is uncomfortable,

Certainty is ridiculous.

(Post # 16) Challenging Traditional Physical Rehabilitation and Training

Physical Rehabilitation and Training:

Lets keep it Functional-- multi-directional, three dimentional, against gravity, free from any artificial stability.

Lets keep it Simple-- no fancy exercises, try to train as close to real life and/or sports requirements as you can.

Lets keep it Effective-- train to fulfill a need and train with a purpose.

Lets keep it Efficient-- engage most amount of movement patterns and body parts with each repetition.


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(Post # 15) Factors that can Influence Pain and Dysfunction

Physical activity

• Misuse--often mistaken for overuse. All tissues respond to load; not only will they get damaged if the load is too much or weakened if the load is too small, but become dysfunctional if there is not enough rest in between engagements.
• Disuse or lack of use will atrophy most tissues in the body including bones, cartilage, ligaments, muscles and tendons.

Emotional

• Dissatisfaction with job and/or lifestyle.
• Patient consciously or subconsciously uses physical pain to distract his/her mind from emotional pain
• Patient involved in toxic relationship

Nutritional

• Poor diet or nutritional deficient. The lack of needed nutrients, vitamins, minerals and enzymes in the body can contribute to conditions such as weak bones (osteoporosis), weak cartilage, weak ligaments, weak tendons, etc.
• Lack of adequate nourishment inhibits the body's natural healing response.

Hormonal

• Hormonal imbalance may weaken bones, cartilage, ligaments and tendons.
• Hormonal imbalance can cause conditions such as systematic joint instability by making ligaments too lose.
• Diabetes by itself, may cause conditions like tendonitis and bursitis.

Genetic

• Genetic predisposition can be the cause for diseases like rheumatoid arthritis, degenerative osteoarthritis, osteoporosis, scoliosis, etc.

(some of this factors can be backed up with science but others are just my clinical observations)

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(Post # 14) Referred Pain

What is referred pain?

Pain that is felt in an area other than the lesion.

Why is this important?

A patient is treated for thigh pain, and receives treatment for the quadriceps muscle. The reason? Pain is felt there. After endless treatments of stretching, strengthening, ultrasound, electric stimulation, etc,...etc...etc..., she gets to the right clinician who performs a functional assessment. It becomes clear that resisted knee extension (which is one of the test that test the quadriceps' contractile ability) shows negative proving that the function of the quadriceps muscle is not disturbed. Further examination, this time of the lumbar spine, shows that the patient is not able to perform lumbar extension (backward bending) without pain, and that repeated lumbar flexion (forth ward bending) increases the pain, which is referred into the thigh (L-2 dermatome). We can conclude, that the lesion lies in the lumbar spine, most likely nerve root L-2, and not in the quadriceps muscle.
Although this is just one piece of the puzzle, we can now create a plan to figure out the best treatment approach for the lower back and for the entire kinetic chain. Here is a list of some but not all of the treatment option we can explore:

1. Trunk stability exercises.
2. Nerve mobilisation exercises (nerve flossing).
3. Walking 20-30 minutes.
4. Sitting habits (finding a new neutral zone for the spine every 20-30 minutes).
5. Lifting habits (training the legs by doing squats).

And remember to listen to the body by asking: are you better? worse? or no change?

Thank you David for your comment.

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(Post # 13) The X-ray, a doubtful assistance?

Can an X-ray be a substitute for functional assessment?

No, a characteristic shared by the moving soft tissues is their radio-translucency (their ability not to be seen in a x-ray). The tissues that I am talking about are joint capsules, ligaments, fasciae, muscles, tenons, bursae, spinal discs, dura mater, dural sheaths, and nerve roots. Any of these structures can cause pain. None of them inflame or other wise, can be diagnose on the x-ray. If a soft tissue causes pain, the x-ray can show only one of two things. First, it may reveal the bones are normal; therefore it allows the patient to be open to a misplace diagnosis of neurosis or psychogenic pain (pain caused by the mind). On the other hand the x-ray may disclose some symptomless abnormalities or natural degenerative changes which is then incorrectly regarded as the source of the pain. In this case the x-ray is positively misleading.
So be skeptical of those clinicians that will give you a diagnosis, without giving you a thorough functional assessment first.

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(Post # 12) Dr Cyriax the Father of Orthopedic Medicine

My biggest hero Dr James Cyriax MD once said

"All pain has a source"

"All treatment must reach the source"

"All treatment must benefit the lesion"



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(Post # 11) To Treat or Not to Treat

Needless to say, there can be no justification for physical treatment unless that treatment is known to accelerate the natural history of the condition or to assist in the recovery of function. I believe that all patients are entitle to comprehensive guidance and education in the appropriate strategies to assist in the healing process and to regain normal painless function.


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(Post # 10) 11 Factors that can Inhibit Healing

Factors that can Inhibit Healing

1. Poor blood supply – especially tendon lesions where intrinsic blood supply may be poor.

2. Lack of initial protection and reduction of swelling (first few days).

3. Lack or not enough early mobilization – gentle natural mobilization encourages good quality repair (starting within the first week post-injury).

4. Prolonged inflammation: anything that prolongs or re-triggers this phase will cause poor healing – for instance infection, a hematoma, or excessive premature mobilization.

5. Inadequate use of steroid medication – decreases tensile strength of healing lesions, slows the rate of wound closure and vascularisation.

6. Nutrition – lack of nourishment inhibits the body’s response to injury and healing.

7. Diabetes – mechanical problems and metabolic defect impairs wound healing.

8. Increased or too much deposit of collagen or scar tissue.

9. The grade of mobilization or physical activity must be appropriated for the stage of healing. If too aggressive too early, or not enough stresses are applied to repair tissue, the end result can be the same – poor wound healing and function.

10. Inappropriate behavior in dealing with pain and its consequence--letting fear of pain paralyze your lifestyle, leading to fear-avoidance beliefs and behaviors such as: lack of movement, becoming inactive, low self-efficacy, low self-reliance, anxiety and depression.

11. Inappropriate behaviors on the part of the health care practitioner – encouraging patient to adopt sick-roles, obtain sick leave, and offering passive, clinician-led treatment strategies, which help to maintain low self-efficacy and clinician dependency.


I know I got a bit technical with this one, but for some of you it can be very useful.



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(Post # 9) Three Stages of Healing

From my perspective here is why its important to keep the nervous system moving, so it does not become adhered and dysfunctional when injury and healing goes through the three progressive phases:

Inflammatory phase....prepares tissue for repair....we need to protect tissue.

Repair phase....rebuilds the structure....we need to gently move tissue.

Remodeling phase....provides the final form for the structure....we need to move tissue to its end-range.


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(Post # 8 ) The Sensitive Nervous System

In my opinion, one of the most comprehensive textbooks on the assessment and treatment of pain and dysfunction is The Sensitive Nervous System by David Butler. One of the many great points I got from this book is the need to encourage those in pain to stay active and to keep the fear of pain from paralyzing their lives. To do this effectively, first establish a comfortable level of activity or a functional baseline. Then gradually increase the activity level whether it is five minutes walking, swimming, or riding a stationary bike, even if five minutes does not seem like much, it will keep the nervous system moving and healthy while the surrounding tissues repair and heal.

(Post # 7) Myth and the Problems they Cause

Myth #2: Posture must be completely straight all the time!!!

I am the first to admit that at the beginning of my career I also bought into this theory.
It was frustrating for me as a therapist but specially frustrating for my patients. They had the best intentions of maintaining a straight posture but would give in after just a few minutes because of lack of muscle endurance or because they would get distracted by the computer or book they were reading and would go right back to old habits.

So I asked myself...

Is a sustained straight posture good for the spinal disc?

Is asking patients to sustain a good posture on will alone a reasonable approach?

Is there a better approach?

I believe good posture is a combination of different postures within a neutral zone, where ears are on top of shoulders, and shoulders on top of hips, and the spine in neutral position.
We must find a different neutral position every twenty to thirty minutes for the pressure of the spinal discs to get redistributed and evenly loaded and unloaded.
We must build strength and endurance of all muscles, specially those of the trunk, so we do not rely on will alone but also in the strength and endurance of those muscles.


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(Post # 6) Myths and the Problems they Cause # 1

Myth #1: Sit ups for lower back pain.
Although this concept has been disproved many times before, it keeps being recommended by many therapist and trainers. It is based on the assumption that all lower back pain is caused by weak abdominal muscles when in reality every back pain is different, and every back pain responds to different treatments. Different pain responds to different approaches like: stability exercises, nerve mobilization exercises, end-range stretching, strengthening of the trunk muscles, static and dynamic posture correction, gate correction, lifting techniques, and some may need a combination of all or some of them.

(Post # 5) Help from Socrates

To help us answer the questions in the last post, I would like to follow Socrates, the father of Western philosophy, the one that taught Plato and Aristotle that through questions you have the potential to discover, learn, teach and get as close to the truth as possible, to ask the following questions:

How do you know you have pain?

How do you feel it?

How does pain travels to the brain?

Can we at least say that nerves are involved?

Which structures have the potential to compress them?

If you have pain in the shoulder and arm muscles, but can only induce the pain by moving the neck, where is the problem?

Can we say that the problem may be in the cervical spine (neck) and is only referred to the shoulder and arm?

How is it that someone who has lost an arm in an accident can still feel pain down an arm that is not longer there?

Is it possible that the cortex (sensory part of the brain) may be misinterpreting the location of the dysfunction?

Can the lack of functional understanding be the reason why most doctors, therapists, trainers and us may be confused by the cortex?

(Post # 4) Tissue Dysfunctions

About every other year there is a tissue that comes in style.

Whaaaat? you ask. And yes, you are told that: your pain is caused by a tight psoas, No!... by a tight piriformis, No!...by a weak core, No!... by a disc, No!..by a bone out of place, No!... by a psiatic nerve, No!... by facet joints, No!... by weak abs, etc,etc,etc.
Well, what are we suppose to do with all this confusion?

Here is a description of most common dysfunctions:

Spinal Dysfunction—usually caused by disc displacement or restrictions.

Joint Dysfunction--lack of range of motion, due to displacement, instability or restriction.

Nerve Dysfunction--Inability for the nervous system to move and glide freely with movement.

Neuromuscular Dysfunction-- caused by inactivity, misuse, or wrong method of training.

Tendon Dysfunction--usually caused by joint injury, instability or misuse.

Bursa Dysfunction--usually secondary to other dysfunction such as joint instability or neuromuscular dysfunction.

(Post # 3) Physical Dysfunctions

It is crucial to identify the different types of physical dysfunctions so we don't make common mistakes such as stretching an unstable joint when the right strategy is to stabilize, or strengthen a restricted part when the right strategy is to mobilize or stretch.

Here are the four main different types of physical dysfunctions:

Instability : The inability to control a neutral position of joints or body parts during movement, therefore causing pain and dysfunction.

Displacement: Joint, spinal disc and meniscus displacement can cause disturbances in normal resting position, obstruct movement in the direction of the displacement and cause pain by compressing and/or stressing nerve tissues.

Restriction: Lack of range of motion caused by dysfunctional joints, muscles and nerve tissue.

Weakness: Neuromuscular dysfunction that is caused by lack of use, inactivity or injury.

(Post # 2) Understanding Pain

To treat our pain safely and effectively, we must first identify the type of pain we are dealing with.

Here are the different types of pain:

Chemical Pain

• Pain is constant, regardlessof the position we adopt.


• It is caused by inflammation.


• Movement makes it worst.


• It may be helped by anti-inflammatory medication.


• We may need to use the RICES concept (Rest, Ice, Compress, Elevate and Stabilize).

Mechanical Pain

• Pain is intermittent, it comes and goes depending on the position we adopt.


• Pain will improve if we do the right type of movement or therapeutic exercise.


• It does not respond to medication.

(Post # 1) Back in Motion

The purpose of this training is to teach you how to identify, treat and prevent pain, injury and dysfunction so you can safely and effectively train your body perform better and get fit. In order to do that we need to understand the following:

1. Types of Pain
2. Mechanics of Pain
3. Factors that influence pain
4. Injury and healing Phases
5. Factors that influence injury and healing
6. Physical Dysfunctions
7. Tissue Dysfunctions
8. Rehabilitation and training Principles
9. Rehabilitation and training Stages
10. Rehabilitation and training Goals
11. Rehabilitation and training Strategies
12. Rehabilitation and training Guidelines
13. Rehabilitation and Training progressions and Modifications
14. Rehabilitation and Training exercises