(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.