Thursday, June 24, 2010

Treating Disc Injuries With Manual Therapy and Exercise – Part 3

Prescribing the right type of exercises for a disc problem is essential. The first thing when it comes to exercising with a disc injury is to avoid exercises that cause more injury. It may sound strange but most disc patients, back patients are prescribed exercises that perpetuate their conditions.

If we consider the mechanism of how disc injuries occur we can obtain considerable insight into what exercises to perform and which to avoid. Considering that cumulative motions with your spine in a flexed position commonly lead to disc tears, exercises such as bent-knee sit-ups should definitely be avoided.

One of our main objectives in prescribing exercises to disc patients should be to increase neuromuscular control and muscular endurance. Just focusing on increasing strength and flexibility often leads to poor results.

On a general note, the spinal exercises (other than a Cat Camel stretch) should not be performed first thing in the morning. You need to give your body time to warm up; the discs and surrounding soft-tissue structures of your spine are very stiff. This is partially due to an increase of viscosity in the disc. When you lie down at night your discs rehydrate all the fluid that was pushed out with the compressive force of gravity – you standing.

This increased viscosity in your discs can create increased internal friction which can have a very damaging affect on disc problems. That is why we recommend Cat Camel stretches first thing in the morning. This exercise pumps fluid out of the disc, reducing the chance of injury first thing in the morning.

Important Principles:
No Pain All Gain
  • Exercising in a manner that causes pain develops abnormal neuromuscular patterns that may lead to further injury. Conventional rehabilitation strategies commonly do not succeed because they do not address the underlying neuromuscular problems. They are often designed to make you work through your pain (as in work- hardening programs). This only causes you to create or reinforce the abnormal motor responses which in turn continues to keep you in pain.
  • In addition, if you work through pain caused by tissue damage you run the risk of central sensitization. This is a nervous system process which causes you to become more sensitive to pain. The only way to break this pattern is to perform your exercises in a pain-free zone.
  • We commonly have patients come to our clinic who have exercised through their pain for years! They are always amazed at how, by exercising within a pain-free zone, we were able to help them break their pain- cycle in just a few short weeks.
Cardiovascular exercise is important

  • Besides stretching and strengthening exercises rehabilitative care of any injury requires you to build a good aerobic base. Your cardiovascular system is responsible for transporting oxygen and nutrients to all your cells, and for carrying away toxins and waste products.
  • Building up your aerobic base makes you heal faster by increasing the density of capillaries in your muscles, and by increasing the mitochondrial function of your cells

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