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Posts Tagged ‘lower back pain’

“So What If I Die Out of Shape?”

Friday, August 27th, 2010 by Karena

This quote-of-the-day comes from a  long-time patient and retired doctor who calls

Our 'Five-Toe' is even Cuter than this Sloth!

Our 'Five-Toe' is even Cuter than this Sloth!

himself ‘The Five-Toed Sloth”.  He retired from doctoring due to back/hip pain and we’ve been working together for about 5 years.  He is definitely a believer in the ability of movement to heal pain and is hugely grateful for that pain relief.

So ‘Five-Toe’ (what we call him for short) came in discouraged and out blurted a variation on the ‘death statement’. You’ve probably heard something along the lines of: “It doesn’t matter what I do; we are all going to die anyway”. Yes, but wouldn’t it be great if we could all live while we are still breathing?

Do you know anyone who has spent years of their lives hindered because of disease or pain? How much of this is preventable? Almost all heart disease, all Type II diabetes and approximately 50% of all cancers are preventable with healthier diet decisions. Colon cancer risk is reduced 30% with daily exercise, depression is reduced, energy is increased, pain is reduced… In fact, I’ve never seen a single study that said: “Just eat Twinkies and for heaven’s sake STOP exercising!”

But let’s get back to good ol’ “Five-Toe”.  I don’t put him through a series of therapeutic exercises twice weekly in order to keep people from sadly shaking their heads at his funeral: “Too bad he died so out-of-shape.”  No, we work together so he can live while he is still breathing.  So that when he does pass away no one will say: “What a relief; he suffered for so long.” No, they’ll remember him for doing just what he wanted and just what he loved every day that he lived.

New Favorite Exercise for Stabilization

Monday, May 10th, 2010 by Karena

Hey, Everyone! Just a quickie today and I don’t even have a pic so we’ll all have to tune into the same Pilates Psychic channel so you can ’see’ what I’m talking about here.  I have been using this exercise for the last three weeks for:

  1. Hip Extensor Strength
  2. Quadricep eccentric contraction
  3. Glut med, min, endurance
  4. Soleus and tibialis anterior endurance
  5. Spine stability
  6. Pelvic stability

Here’s how it goes:

  1. Stand on the side of the reformer facing the footbar with the right leg next to the reformer. The heel of the right foot is about 4″ forward of the shoulder rest (4″ towards the footbar but on the floor).
  2. The left foot goes on the shoulder rest with the toes in extension and the ball and heel of the foot on the actual shoulder pad.
  3. With, of course, perfect alignment, press the left hip into extension.
  4. I give my client a six foot dowel to hold for balance. Watch for hyper-extension of the right knee and accommodations in the low back

Notes: Upon extension, if your client has little hip extension or tight hip flexors the left knee may meet the line of the right knee but may not extend beyond that point.  As the left hip extends be sure that your client is not ‘dumping’ into the low back.

I’ve been giving this exercise to my low back pain clients for increasing pelvic and spine stability. I’ve also used it for a client with a hip replacement to really zero in on the hip extension process without a whole lot of extraneous ’stuff’ going on.  And most recently I’ve used the exercise with a knee pathology.

If you have a variation on this that you love, let me know! I’m always looking for new things.  K

Understanding Pain

Sunday, May 9th, 2010 by Karena
Dysfunction can create increased nociceptors and therefore increased pain

I took a great class from Eric Cobb of Z-Health at the Pilates conference about a month ago about understanding the neuroscience behind pain.  It was a great class and I find myself referring to one point over and over again with my clients and my staff so I thought you might be interested too. So here it is.

When there is an injury, let’s use an injured back as an example, the brain starts to create change to several systems in your body to react to that injury.  Let’s focus on just the nervous system, and then just one small part of the nervous system.

There are many different types of nerve receptors but let’s talk about these two:

  1. Mechanoreceptors: in charge of mechanics. It is because of mechanoreceptors that that we are able to receive movement information.
  2. Nociceptors: in charge of sensing pain. Sensing pain is of utmost importance to survival. Nociceptors can be triggered by any stimulus that your body/brain finds noxious.
  3. In a normal, pain-free muscle there is a balance between mechanoreceptors and nociceptors. When pain exists, an unbalance is created.The unbalance is created because of a tendency to brace or not use an area that is painful.  You tend to stop moving, and in our example the backs become stiff.

The brain senses a threat (because not moving well is a dysfunction) by erring on the side of caution, not on the side of performance, by reducing mechanoreceptors and increasing nociceptors.  With more nociceptors there is more pain. So your clients that are in pain are going to generally be ‘really good’ at being in pain because there are more nociceptors.  The more nociceptors, the less movement (because of increased pain).  The less movement, the more the brain senses a dysfunction and creates more nociceptors.  Classic vicious cycle.

So how do we stop the cycle? We have to move.  If we begin moving, the brain senses the need for mechanoreceptors. If the brain is sensing more movement then that signals an end to dysfunction.  And what happens with an end to dysfunction? Less nociceptors.  No more pain.

Eric Cobb, made an important point about increasing movement.  The activity must be active not passive.  Passive movement is not something that normally happens in a Pilates environment but I thought I should throw that in there.  The number of nociceptors will not change if your client is not moving her body by herself.  Do not, in other words, move your clients body for her.  Yes, I know, not really going to happen in Pilates unless you are working in the physical therapy sector. When your client is moving the joint, find every possible pain-free range of motion. It is not possible, in most cases, to decrease pain by increasing pain; it messes up the nociceptor balance.

Good luck and let me know how it goes!

Getting Fit or Healing Back Pain: It’s HARD work

Wednesday, January 20th, 2010 by Karena

Picture 26I don’t usually blog about my radio show. But today is different. It touched a nerve. I had marathon runner, Suman, on the air and she was saying things I should have been saying to my patients and clients for years: It’s really hard work to get fit so just do it or don’t and stop telling me why you can’t. I don’t want to hear about how your day somehow whisks by faster than mine or that you are somehow busier than I am or that I am fit because I own a Pilates studio or genetics or whatever. Enough. If you want to feel great you will. If you don’t want to feel great you won’t.

I’ve been working with patients with chronic back pain for 10 years. I can count on one hand the number of people who have done their prescriptive exercise program at home every day, just like they were instructed. WHY??!! Pain is addictive? No one wants to work that hard? Not enough time in the day? What? I do not understand. And yes, I know what it is like to have horrible back pain. I’ve had it most of my life and finally had surgery two years ago. I also kayaked the Channel Islands on my 40th birthday and I am the celebrity dancer in our local version of ‘Dancing with the Stars’. All to tell say that it is possible to have back pain and to work hard to be extremely functional and able to do what you love to do.

But yes, it IS really hard work to be fit. And it’s even harder to stop being in so much pain. You are going to have to spend an hour a day to change the way you have been living. If you don’t have an hour then you will be old before your time and exhausted all the way there. Not being fit will make you tired, but being in pain is completely exhausting. You enjoy that? I mean, c’mon, really? You’d rather be slugging your butt around because you are out of shape? Immobile because you are in pain? Need to scare yourself straight? Go visit a nursing home. Scary stuff that. Fifty percent of the problems at a nursing home are out of our control but the other 50% would have been solved with lifelong good health habits (and probably more than 50%).

I attended a 9am meeting yesterday. I already had the dogs out for a 2 mile walk and I did my 30 minutes of exercise for keeping my own back pain in check. At the meeting, I would say half of the attendees had had similar mornings. The other half ‘didn’t have time’ in the morning and won’t have time later, either. Really? How is it that so many people are capable of fitting it all in but then there is the flip side of that: so many people can’t. You have no choice but to get your act together if you want to feel better. I really believe that feeling good is a habit you need to hone if feeling good is really what you want.

Is it worth it? That’s your call. I, and a thousand other fitness/health experts, can give you the tools but the hard, hard work is all your.

Wishing for a Bootie-Bra?

Tuesday, January 12th, 2010 by Karena

Picture 25There’s quite a few of us out there that would love someone to invent a bra that does the same thing for the backside that a regular bra does for the front side. Why do our booties sag? Is it an inevitable part of aging? Let’s talk about the ‘why’ question first.

Why our Booties Sag…

The obvious answer is that your bootie is sagging because you aren’t using it. But it’s not just a matter of doing an hour long butt-busting workout to make that muscle (gluteus maximus) more toned. I watch clients everyday perform so-called gluteal exercises without using their gluteals. That’s bad news. If the gluteals aren’t working then the low back and the hamstrings are working overtime. The result? Tight spine extensors and hamstrings. This pattern is actually very common with anyone who has ever experienced a bout of back pain. No one really knows why, but those gluteals stop working when the back starts hurting. And when the back pain goes away those gluteals still don’t want to work. Without intense focus those gluteals won’t begin to fire again.

Is a Sagging Bootie an Inevitable Part of Aging?

Yes and no. Yes, because 80% of will experience a serious bout of back pain at some time in our lives. So those 80% will need to really focus on getting those gluteals to fire again if they are to avoid the Bootie-Bra. No, because anyone can learn to reactivate those gluteals again but the more back pain you’ve had the more you will have to work on getting those gluteals to come to back to the party.

Here’s what to look for when you are trying to fire up those gluteals.

  • Are your pants puckering? If there is no change in the crease of your pants when you are performing a butt exercise then your butt is definitely not working.
  • Is there an indent in the side of your hips? There should be a dent. The size of half a tennis ball.
  • Poke your fingers into the sides of your butt muscles. You will feel them tighten if they are working.
  • And most obvious of all, you should feel them working. When you are doing a butt exercise you should feel the butt muscles. No? Then you are doing it wrong. Try again. You can do it.

Here a link to a great exercise to get you started: http://bit.ly/625QTL

Good luck and let me know if you have any questions. Karena