Back Pain Web Reference
Reconditioning Your Back - A New Type of Exercise For Lower Back Pain
There are more-effective and less-effective systems of exercise for the relief of back pain. Advocates of strengthening and stretching exercises point to yoga, Pilates, therapy ball exercises, and various programs of stretches. These exercises have a degree of efficacy with mild to moderate back pain; with more severe cases, however, a specific kind of exercise is needed for fast and definitive improvement (days or weeks, rather than months or years).
To understand the process of reconditioning your back, beyond the idea that certain exercises promise to do that, you need a bit of technical understanding of what's behind most back pain and what back exercises must do to alleviate it.
First, a brief overview of back pain:
Most back pain is of neuromuscular origin -- meaning that it comes from muscles triggered to stay tight by brain-level conditioning. "Conditioning" means "learned or acquired habit patterns".
According to a writer at WebMD.com, on the topic, "Low Back Pain - Cause"...
Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine.
Muscle strain generally means, "musclebound" muscles; musclebound muscles generate pain through muscle fatigue and soreness.
If muscles are tight, it's because the brain is triggering them into a state of tightness. The technical term would be, "conditioned postural reflex". "Reflex" means "on automatic". So, most back pain comes from acquired habit patterns that keep muscles tight on automatic. Pain follows.
Tight back muscles pull vertebrae (back bones) tight and close together, causing friction between neighboring vertebrae (facet joints), leading to facet joint irritation (facet joint syndrome). At the same time, they cause spinal misalignment ("subluxation"), compress discs, leading to disc breakdown ("degenerative disc disease"), disc bulges (herniation), nerve root entrapment (e.g., sciatica), eventual disc rupture, extrusion of disc material (nucleus pulposus) and pressure on nerve roots, and eventual disc fusion. That about covers the range conditions associated with back pain -- and, except for violent accidents, they all trace back to neuromuscular conditioning.
How Does Neuromuscular Conditioning Develop?
Another name for neuromuscular conditioning is habits of posture and movement. Most movements, you may notice, occur on automatic once set into motion. That's because you've learned them previously and now only need to intend them for them to occur and to make minor adjustments of movement to meet the need of your activity.
In other words, you've learned habits of movement.
That's how excessive back muscle tension and back pain form: the formation of a back-muscle tension habit, through any of these three routes: repetitive motion, violent accident, or emotional stress. All make their impression on "movement memory" ("muscle memory"); all lead to and underlie most back pain.
That simplifies matters: When we think of learning, we think of memories formed by repetition, drill, and an experience of some intensity. In other words, repetitive motions and accidents produce enough of an impression on the brain to create a memory of "how movement should be" to create a tension habit and habits of movement.
The Way Out
Most articles on back pain revolve around a few common approaches:
- warming up before activity
- good posture
- good structural support
All of these approaches are ways of coping with a poorly conditioned back. However, they don't go deeply enough to change that conditioning to the point of a definitive end to back trouble.
Let's hear from some of these writers, just to be able to make my point in relation to something specific.
With regard to dynamic lumbar stabilization exercises, writer Nishanth Reddy has this to say in his article, "Physical Therapy for the Lower Back: How to Prevent and Treat Lower Back Pain":
... the first thing that a physical therapist does is to look for the patient's "neutral" spine; [a]fterwards, when the patient is in that position, the back muscles are then exercised in order to "teach" the spine how to stay in this position.
The basic error in this kind of thinking is of "teaching the spine how to stay in this position." You can't bend over, you can't twist, you can scarcely move while keeping your spine in a neutral position. So, regardless of whether it is the standard of treatment for back pain, it is limiting and impractical and we can scarcely consider it a definitive cure for back pain -- and I think you will find that therapists agree with me.
Dr. Graeme Teague, an accepted expert in the structural field, advocates releasing tension in the hip flexors and improving the strength of the abdominals. While releasing tension in the hip flexors allows for a more erect carriage of posture, improving the strength of the abdominals does not change the conditioning of the back muscles, but only brings temporary relief as long as the person keeps their abdominal muscles tight -- not needed by someone with a normal or healthy back.
On the website for The National Institute of Neurologic Disorders and Stroke, on the topic, "How is back pain treated?" the writer states:
Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.
Since the brain controls the tension and strength of muscles, and through that, muscle tension, length and posture, the brain's control of muscular action is a major key to ending back pain.
In other words, the effect of strengthening and stretching exercises comes almost entirely from learning better control of back muscle action. It's not "added strength" or "added stretch", but added control, which regulates muscle strength and length (degree of "stretch" and tendency to spasm), posture, and degree of muscle fatigue (soreness).
Since our brain has learned its way into your back pain, we must teach it the way out. That's the key to effective back exercises.
That point understood, we understand that the most direct route back to comfort is learning better regulation of muscle tension and movement, which leads to better posture and movement and which leads out of strain to ease. That kind of learning works in reverse to the other kind of conditioning that creates back pain to create a new, automatic, healthier pattern of back muscle conditioning. That kind of learning makes efforts at "maintaining good posture", "maintaining neutral spine position", or "holding adjustments" unnecessary -- unnecessary because your good condition is now automatic, your new baseline or habit of natural movement -- like anyone else with a good back.
As with all methods and techniques for accomplishing anything, there exist more effective ways and less effective ways. First, a description of a less effective way: A quote from writer, Dave Powell, in his article, "Ouch! Prevent Lower Back Pain!", makes my point.
First, notice the regimen he recommends, then notice, in his own words, the expected outcome:
First of all..., [w]hen you stand up, stand tall, tuck in your chin and then tuck your tail in.
This recommendation amounts to holding a certain posture and alignment. While there's a measure of truth in his recommendation (e.g., good ergonomics in your work situation), his recommendation instills additional patterns of muscular holding (tension) to counter the habitual ones.
... lower back pain prevention means you must think and plan before you carry out a tough task. This will minimise the stress you put upon your back and very much reduce the risk of episodes of lower back pain.
In other words, he implies that you can't be care-free about your movements and expect to be free of back pain.
I differ from these writers. I say (based on my experience and that of my colleagues in the field of clinical somatic education, who have worked with thousands of clients over the years). If you recondition your back muscle control, rather than merely strengthen or stretch muscles -- or limit your posture and movement -- you can have healthy back without concern for maintaining posture and alignment, without concern for pain or for a "bad back" -- because your habits of movement are already automatically healthy.
Even if you may be skeptical -- and I can understand why you would be -- do you like that idea? What I say is doable and my words are testable. See the links at the end of this article for free instructional video that teaches somatic exercises for back pain.
Learning to Control Your Back Muscles
If you have back trouble, almost certainly your back muscles are musclebound and out of your control, held tight by brain-level conditioning that keeps them tight, out of reach of strengthening, stretching, or efforts at good posture or correct movement.
To recondition your back muscles better is to free yourself from painful conditioning that keeps them tight, and so to establish a new, healthier, automatic (second-nature) pattern of movement. The result is freedom from back pain as a person with a healthy back.
Moreover, it doesn't matter, in most cases, how long you have been in your condition; you can correct it fairly quickly using an approach that treats the underlying cause.
That's it, in principle.
An Entirely New Form of Therapeutic Exercise
Somatic exercises free you from habituated back muscle tension and establish a healthier pattern by dissolving the grip of the old habit pattern and imprinting a new sense of movement and control into your memory. In other words, they teach your brain a new pattern of muscular control.
The way they dissolve the grip of the old habit pattern is by triggering, in the problem areas, a neuromuscular response similar to yawning. That action, called "pandiculation", involves your deliberately contracting the musclebound muscles in specific positions and then slowly releasing the contraction; it refreshes voluntary control of movement sufficiently to shift control from conditioned reflexes, to your voluntary control. The immediate result is a relaxation of habitual tension patterns. The way they teach your brain a new pattern of control is the same way as you learn any other pattern of control: by practicing the new pattern until it is as familiar to you as the old pattern. At that point, you're set free; you don't have to hold on to the new pattern because it's a pattern of freedom.
You can see such exercises in the links, below, to free instructional videos of somatic exercises for back pain.
Because somatic exercises are designed specifically for learning muscular control ("muscle memory" or "movement memory"), they target the central process of effective back exercises for lower back pain (and other locations of pain, as well) and accomplish what is ordinarily sought through strengthening, stretching, efforts at good posture or good body mechanics.
Here are the elements of somatic exercises.
Somatic exercises are...
- patterned movements
that, by establishing new memories of how movement feels...
- relieve pain
- free the muscles
- develop new, low-strain patterns of movement
- coordinate movement better
- improve strength
... all of which result in natural, easy movement in comfort.
What I've done in this article is highlight standard ways of treating back pain to illuminate their underlying principles and their degree of efficacy, then present and explain an alternative that accomplishes all they seek to accomplish.
The proof of the pudding is in the eating.
ARTICLE and VIDEO: Somatic Back Exercises for Lower Back Pain
To PREVIEW the program, "Free Yourself from Back Pain -- 9 Movements for a Back You Can Trust All the Time", send blank email to firstname.lastname@example.org
An Entirely New Class of Therapeutic Exercises
Lawrence Gold is a long-time practicing clinical somatic educator certified in The Rolf Method of Structural Integration and in Hanna Somatic Education, with two years' hospital rehab center experience (Watsonville Community Hospital Wellness and Rehabilitation Center: 1997-1999) and articles published in The American Journal of Pain Management (Pain Relief through Movement Education: January, 1996, Vol. 6, no. 1, pg. 30) and in The Townsend Letter for Doctors and Patients (A Functional Look at Back Pain and Treatment Methods: November, 1994, #136, pg. 1186 ).
Back pain - Wikipedia, the free encyclopedia
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