Which back exercise program do you recommend for my back pain?
The back exercise question above is something I get asked everyday by
patients, physicians and other professional colleagues who suffer from back pain.
I usually say: "Let me tell you what worked for me"... and then I describe
a little bit about what I did to "cure" my back pain.
My
motivation for finding a cure. The search for the best exercises for the back has
been especially important to me. Of course I wanted to help my patients as
a physical therapist... But an even more obvious reward for me was to cure
my own back problems. I had experienced chronic back pain since I was 14
years old that resulted from a football injury.
You may have heard the saying: "Physician heal thyself." Well,
I've tried to do the same (with a slight modification): "Physical therapist heal
thyself."
My first introduction to transversus and
multifidus. During my last year of physical therapy school (in 1997) I was
working at a clinic in Scottsdale, AZ. This is where I was first
introduced to "specific exercises" for relieving back pain that focus on retraining
transversus abdominis and lumbar multifidus.
Unfortunately the
information was coming third or fourth-hand from a physical therapist assistant student
during her internship presentation. I came away from that presentation
thinking:
"All this stuff about retraining tiny muscles
in the back and abs
to relieve back pain is bogus!"
Afterwards, I talked to my clinical supervisor
(who also attended the presentation) and he quickly corrected my thought
process. He told me to check it out, read the research, and report back to
him on my
findings. This was his first exposure to the information, but it
sounded legit to him.
His advice started me on a long path of learning...
It was my aspiration to learn the most effective treatments for my patients and at the same time help
relieve
my own back pain.
First, I read every research article and book I could find on the
subject. And I tried to teach the specific exercises to my patients while
I attempted to perform them myself.
Eventually I found a few workshops to attend that were taught by an Australian expert
(Paul Hodges)
who helped do much of the research on the inner core muscles. Shortly after attending
his courses I even purchased an
 ultrasound imaging machine to use in my clinic.
Later, I traveled to Canada for a week-long residency on
ultrasound imaging for lumbopelvic dysfunction.
Finally, I traveled to Australia for 2.5 weeks to
study with multiply experts who use ultrasound imaging to retrain the inner core
muscles (transversus abdominis, lumbar multifidus and
pelvic floor).
And, after all of this... I still didn't "get
it!"
Yes, some of my patients did have success, but
after 8 years of clinical practice my back pain was actually worse than ever. And
if it wasn't working for me how could I continue to recommend these exercises to
my patients?
What was the key to finding a cure? I was half-way there, but
my back exercise program was definitely missing something.
What was it? Well, "it" is now what I describe to my patients
(at Back Trainer Institute) as Stage Ia of
the program of
motor control exercises (click image below to see larger image).
Without the back exercises that are performed
during Stage Ia I never was able to get to Stage II and therefore, my back pain
continued.
If you look at the larger view of the image above,
you will see that the subtitle of Stage Ia is "Relax/Release Outer Core
Muscles." This was the most important part of the "equation" for me and it
allows me to train most patients to get the right response during Stage Ib
exercises within minutes. My patients of course have to practice,
practice, practice before they can progress to Stage II.
I've learned the specifics of Stage II from
Felicity Kermode when I visited Perth, Australia. Stage II is a
major update from the program developed by Queensland University (I have not
seen anyone else using it). In this stage we continue to use real-time
ultrasound imaging during specific movement patterns that are progressive (as
seen in the larger view of the image above).
In the outer circle of the poster above, the top
half shows some of the "Graded Exercises" and the lower half shows some
"Intensive Strengthening" exercises that are popular. One of the more
popular back exercises at the gym is hyperextensions on a roman chair (read a
review on different varieties of roman chair exercise
equipment or go to the number one site on the internet to buy
a roman chair).
|
