Treating Disc Injuries With Manual Therapy and Exercise – Part 3

Exercises for disc injuries

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

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Treating Disc Injuries With Manual Therapy and Exercise – Part 2

Manual Therapy

Removing any type of mechanical restriction that causes stress on the disc will be of great benefit. The specific physical restrictions that need to be addressed with manual procedures (ART, Graston, Massage, Manipulation) in a disc injury will vary depending on the individual.

Determining which areas need to be addressed will depend on biomechanical analysis and palpation of the affected areas. A key point to remember is that there is no one group of structures that is the key to addressing all disc issues. Any injured muscle, joint capsule, ligament, tendon, or connective tissue restriction can cause changes in motor patterns (neuromuscular imbalances) that directly affect spinal stability.

Imbalances increase stress on the discs of your back which perpetuate or cause further injury. Fortunately, those spinal imbalances can be addressed with manuel procedures. When these procedures are combined with dynamic exercises to re-estabilsh normal motor control good results are often seen.

The following muscles are example of structures that can affect disc function. These are examples of structures that manual procedures can address can to manage or resolve a disc problem. Just remember these are only two examples in a very large list of structures.

Structure

• Multifidus Muscle (deep back extensors)

Relationship to disc injuries

• Research shows that during a disc injury neurological input to the multifidus muscle can be reduced. This leads to muscle wasting (type I and type II fibres). This deep spinal muscle functions as a spinal stabilizer. ART procedures can help in re-establishing normal multifidus function. Yoshihara at el. (2001). Spine, 26(6), 622-626

Structure

• Abdominal muscles and back extensor muscles

Relationship to disc injuries

• A balance between the abdominal muscle and back extensors affects muscle strength and lumbar lordosis (lumbar curve), sacral angle and spinal stability. Any imbalance in these antagonistic muscles can cause increased spinal tension, spinal instability, and stress on the disc. Manuel procedures are very effective at addressing this type of imbalance.

Bottom line when it comes to therapy, the successful resolution of a disc problem involves a complex understanding of kinetic chain relationships, and a functional understanding of how each body action is related to specific anatomical structures.

In part three of “Treating Disc injuries with Manual Therapy and Exercise” will cover Exercise for disc injuries.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Treating Disc Injuries With Manual Therapy and Exercise – Part 1

Resolving a disc injury is a combination of removing any type of mechanical restriction that is causing stress on the disc and avoiding all physical stresses that are perpetuating the disc problem.

Initially, disc injuries can be incredibly painful, it may seem that surgery will be the inevitable outcome. Fortunately the majority of disc injury patients do not require surgery, in fact less than 5% of patients do. This is a good thing to keep in mind as you are going through therapy. The length of time therapy takes too resolve a disc injury depends on several factors; the severity of the disc problem, the length of time you have had the problem, your age, and your physical condition to begin with.

For acute disc injuries, ice should be initially applied for the first 72 hours to reduce pain, inflammation, swelling, and muscle spasms. For the lumbar spine one of the most effective ways to ice the area is either ice massage or wet ice. Wet ice refers to putting crushed ice in a bag which is then covered by a wet towel. This will lower the temperature of the affected area very quickly to reduce pain and inflammation.

After 72 hours, heat can be applied to the affected area to increase blood flow and reduce muscle spasms; even the deeper structures such as facet joints can benefit from heat therapy.

In the acute stage of injury resting for a maximum of two days can be helpful. If you have ever had a disc injury, as I have had, just lying on the floor for a few days may be all you can do. On the other hand, the sooner the patient can return to normal activities the faster the recovery will be. Disc injuries are not a condition that you can wait for symptoms to resolve before returning to your activities.

Performing Activities of Daily Living

When you have a disc injury all your daily activities should be performed in a way that will not aggravate your condition. Essentially you must do everything you can to avoid performing tasks in a way that causes you pain or irritates the disc injury. This may require you to reduce your range-of-motion when performing a task, move more through your hips than your back and brace your core before moving or lifting any object.

Another essential action you have to perform is listening to your body. If your body tells you the way you are performing this action really hurts, listen to it. Basically, if you try to work through the pain you are experiencing you will only do more damage to your body turning an acute problem into a chronic one.

Activities that are especially damaging to the discs in your back are actions that involve any repetitive motions performed in a flexed spinal position. This is particularly true if you are lifting heavy loads in this position. Even lifting minimal loads can lead to considerable disc damage if the task is performed repetitively in a flexed position.

Static flexed positions are also very damaging to the discs in your back, such as sitting behind a desk without taking a break for a long period of time. Therefore avoid sitting for long periods of time, take frequent breaks, change your position often, and make sure you get up and out of your chair frequently.

Another motion that should be limited if you have a disc injury are twisting motions, especially if you are carrying even minimal loads. Torquing stresses can easily damage an already injured disc.

In general terms, doing any activity for too long of a time period, even tasks performed with perfect ergonomic conditions, can cause problems. If your task requires you to perform active tasks then take a rest break. Slow down and rest, give your body a break from whatever active tasks you have been performing. If your work or daily tasks are relatively static, such as sitting at a desk, then take active breaks. Get up and go for a walk, get your whole body moving; don’t just move from one static task to a static break.

In part two of “Treating Disc injuries with Manual Therapy and Exercise” we will cover manual therapy.

If you would like  more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)