PAIN MANAGEMENT

                                       PART OF A CONTINUING SERIES



In this section, I want to take a moment and talk a little about why therapeutic exercise is therapeutic.  First of all, of course, if an exercise or set of exercises addresses the pathology, then the exercise will be beneficial.  For example, if one's low back pain is caused by spasm of the quadratus lumborum , than we might expect that treating the QL would assist in stabilizing the lower back and reducing pain.  On the other hand, if the lower back pain is caused by, for example, spinal stenosis (a dessication of one or more vertebral discs), than we wouldn't expect treatment of the QL to be significant as a primary factor.

So, when the cause of pain is rooted in the soft tissue--that is, the muscles, fascia, tendons, and ligaments--what characteristics do exercises share that are of therapeutic value?  We can actually make a list.

  1. Exercises tend to decompress.  That is, move the joints slightly apart.  When you decompress the spine, you separate the vertabrae.

  2. Exercises tend towards extension rather than flexion.  Extension is what happens when you stretch your back or reach your arm out in front of you.  With extension, you are making the angle of the joints wider. Flexion closes the angle of the joints.  You can see that as you extend a part of your body, you also decompress the joints.

  3. Exercises, to greater or lesser degree depending on severity of the complaint, encourage joint mobility.

  4. Exercises tend to stretch and loosen muscle fiber.  However, it certainly can be the case that a muscles require tonification, or an increase in muscle tone, or tension among the fibers.

  5. To some degree, exercises break up adhesions, though here massage therapy or physical therapy may produce faster results. Adhesions are areas where the muscle fiber has torn and then stuck together in the healing process.

  6. Therapeutic exercises also promote blood and lymph circulation from which the next characteristic follows:

  7. Oxygenated muscle tissue actively discharging waste via lymph.

It is also true that therapeutic exercises tend to promote relaxation, strength, and functional use of the muscle or muscle group.  However, I think the seven above cover the most important commonalities.  I personally see therapeutic exercise as bringing a client up to the point where he or she may begin to work on strength.


I want to add a few more comments to the above.  Therapeutic exercise is usually gentle.  This is very important.  In fact, unless you have been specifically instructed and advised by an M.D. or physical therapist, always do therapeutic exercise gently.  Remember, the point is to reach a level where you can resume normal function and build from there.  I personally know people, some of them my clients, who--with the help of a bit of shiatsu-- have reduced their back pain to zero through the diligent application of specific, gentle exercise.   I'm talking about people whose pain had them in tears and whose mobility was severely compromised.  Just because exercise is gentle doesn't mean it isn't powerful. 

(If you would like to read an earlier post which suggests an inexpensive, easily found book--easily found in a public library, too--you can find that here.


I have said elsewhere what may be obvious to you, that not all back pain has the same source.  I say this again because back pain is often represented as having a single cause.  Responsible practitioners are quick to point this out.  When someone tells you without examination that all back pain is a problem of the psoas, that is irresponsible.  However, it is true that there are common causes of back pain.  One of the major factors involved in many  cases in posture.  Posture is sort of the sleeping tiger of back pain.  That is, it goes unnoticed until one day you start hurting, and you don't understand why.  Well, the tiger woke up.  Even when posture isn't the primary cause of pain, as in cases of arthritis, spinal stenosis, or scoliosis, it can be a major complicating factor.  It is very easy to overlook or discount because it is part of us from the moment we are born and gradually becomes invisible to us.  There is a sort of formula for pain complicated by posture:


In other words, repetition of minor (or maybe not so minor) postural deviations over a period of time lead to pain.  Let me say this again.  Repetition of postural deviation leads to pain.  In fact, repetition of almost any action that puts the body out of alignment and forces the muscles to compensate will lead to pain.  Thus, you may gradually find that you have chronic, lower back pain without ever having "done anything" to your back and wonder why.  Never underestimate the power of the repetition of seemingly harmless movements.  

Now, as pointed out, it is held in the therapeutic bodywork field that posture is a major factor in back pain.  The implication is that the entire body is fair game as a source, and in order to really handle posture we must look at the entire body.  In this post, we will not handle the entire body.  Here, we are assuming a spinal pain pattern that may include pain radiating out from the neck (if your problem is neck pain), or running through one or both of the buttocks and into the posterior thigh.

How do we know if posture is the problem?  I want to borrow a set of criteria that Robin McKenzie, a well-know physical therapist from New Zealand uses in his book, 7 Steps to a Pain-Free-Life.  To paraphrase:

1. Are there periods in the day when you have no pain?

2. Is the pain confined to areas above the knee?

3. Are you generally worse when sitting for prolonged periods, or when 
standing up from the sitting position?

4. Are you generally worse during or right after prolonged bending or
stooping, as when making a bed, vacuuming, ironing, gardening, or
laying concrete?

5. Are generally worse when getting up in the morning but improve
after about half an hour?

6. Are you generally better when walking?

7. Are you generally better when lying face down?

8. Have you had several episodes of lower back pain over the past
months or years?

If this list describes you, then there is a good chance your pain is related to posture and can be alleviated with diligent application of some pretty simple exercises.  I like the exercises McKenzie illustrates not just because they are simple, but they are stripped down to the essence of what makes so many exercises beneficial.  And that is decompression  and extension of the spinal vertabrae.  If you want to have a look at this book, you'll find it on Amazon here.   If you happen to be interested in hatha yoga, there is a superb book titled Anatomy of Hatha Yoga.  I don't recall off-hand who the author is, and as I happen to be writing this sitting on the floor next to my dog (talk about bad posture), I don't have it to hand.  What makes it a great book, in my opinion, is that it deals with the essence of what is happening when you do the exercises.  All right.  More later.


Well, talking about back pain . . . I have been in my clinic assembling bookshelves, so I'm having my own tete a tete with back pain.  So, I do exactly what I describe here, decompression and extension to make my back smile.  

Exercise works over the long term.  Think about how long it takes to arrive at a condition of chronic pain. Or consider the amount of sudden trauma required create severe acute pain and/or to lead to severe chronic pain.  It is amazing to me how easily some back pain resolves for the short term.  Yes, for the long term, regular attention over time is required.  I am constantly surprised that people--well, some people--expect to have pain handled in one session or, in the case of exercise, within a few days.  It takes time.  The right exercise will pay off, but it is an investment that must be made every day.  The more you put in, the more you get back.  Set pain management goals in units of 3 to 6 months, or even in 1 year units of time. 

All right. Back to bookcase assembly and back care.  Ouch!


All right.  Above, I have given a rough guideline for figuring out whether or not your pain is posture related.  And, as I have mentioned elsewhere, this is a list I am borrowing from the physical therapist, Robin McKenzie.  I'll go out on a limb and say that most back pain not complicated by arthritis, extreme congenital scoliosis, stenosis, spondylolisthesis, or other significant structural alteration due to birth or injury,  will be directly related to posture, and posture will be a significant player in most other back pain conditions.  Foturnately, posture is something that can be corrected either through diligent self study and application of therapeutic exercise, and/or with the help of properly trained massage therapists, and/or with techniques such as Tai Chi, yoga, Pilates,  Feldenkrais, and  Alexander Technique.  

It is important to pay a degree of attention to posture because once it goes "off," it does not get better by itself.  Posture, like all other things in the physical universe, follows the law of entropy and continues to worsen until at some point there is chronic pain.  

There is a formula that describes this:

             posture + gravity + time = pain

We can work against this somewhat through application of the principles of compression and decompression.  Decompression and extension in combination with joint mobility alleviate pain.  In general, strengthening exercises involve compression.  So, we keep ourselves healthy--generally speaking--through compression and decompression.  To some extent, then, we can counter entropy through deliberate application of compression and decompression.  






Best regards,

Evan Davis


If you have questions for me personally, you can write to:


WebMaster: ecdavis
Copyright ŠNovember 08, 2004 GainWithoutPain.Net. All rights reserved.
Revised: November 23, 2004






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