Pool Spine Workout

By Amy Price PhD

Chronic pain and balance can be improved with water exercise. Exercise releases feel good chemicals in the brain that are powerful mood booster and pain fighters. These neurochemicals help balance mood swings and the other benefits are looking better and having a body that burns fat more effectively. Many spinal patients can’t get the exercise they need because they find exercise painful torture so they lied down on the couch with a snack until feelings (mostly guilt) about exercise go away. This perpetuates the cycle as muscles and joint get stiff and lose flexibility, loss of muscle means less fat is burned and guilt and low energy levels steal that feel good feeling.  

Water provides a safe medium for joints and working in water improves balance. Be sure to choose a warm place for your water workout to avoid muscle spasms.  Afterwards a hot bath with a couple of cups of epsom salts included can provides an inexpensive muscle soothing experience. The NCPAD  has some great information on how to get started and exercise in water safely. Here are more aquatic exercises   . If you are a swimmer add some power to your water workout with swim fins for the feet and  hands.  

The buoyancy of water reduces the “weight” of a person by about 90%, (at least while in the water!) which means that the stress on weight bearing joints, bones and muscles is lessened. That’s why aqua exercies are good for people with arthritis or back problems. You still get a great work out, it just doesn’t hurt! Water exercise can encompass all of the components of fitness: cardiovascular fitness, muscular strength and endurance, and flexibility. And, when done regularly, water exercise can help reduce body fat 

Need some help with diet too? Check out this information on diet for pain relief and clear thinking here 

Psoas Muscle Location

By Amy Price PhD

 

Stretching Psoas can alleviate back and hip pain

                                       

The psoas muscle starts in the lower back at which point the paired psoas muscles act as anchors on either side of  the spine. These muscles wrap around the pelvic area attaching at the knobby part of the hip with several strong tendons. The psoas muscles are considered to be crucial among the hip flexor muscles. Hip flexors allow people to bend their bodies into their hips and to pull their hips into their bodies. Low back or hip pain can come from  contracted psoas muscles which fail to provide  support. They can gently stretch to elongate their muscles and make them more flexible, as well as seeking medical attention if the pain continues, grows worse, or changes. Engaging in a regular physical fitness routine which includes stretching such as Pilates or Yoga will help to keep the psoas muscle aligned, strong, and flexible, along with other vital muscles of the body.

  A gentle psoas stretch, involves lying on your back on the floor. Make sure that your pelvic position is neutral, your shoulder blades are flush with the floor, with your spine and head aligned, forming a straight, smooth line. Gently bring one knee up to your chest while extending the other leg along the floor, breathing deeply and evenly. Hold the position for 10 breaths before switching sides, and repeat 3 times. You should feel a gentle stretching action but not pain

 For a deeper psoas stretch, adopt a lunging position with one knee forward, forming a 90 degree angle, if possible, between the hip and the calf. Extend the other leg behind you, kneeling slightly, and lower yourself slowly into the stretch, which you will feel in the front of the hip. Make sure you don’t increase the curve in your back as you come forward (the Psoas connects the back with the front of the hip).  Sometimes it helps to tighten the stomach muscles as you come

Please Consult Your medical professional before stretching the psoas, In some cases psoas stretches can be counterproductive

Richard Don Tigney  referenced below states,  “Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas.

Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus m will tend to separate from a small slip on the sacrum.(1)

Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2)Murakami

Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected.”

References:

 1.   DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278

2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007

3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

Detailed Treatment Strategies for the Prevention
and Treatment of Piriformis Syndrome

If you suffer from piriformis syndrome or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, making stretching a part of your fitness regime will have a significant impact.

What is the Piriformis?
The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.

Piriformis

As you can see from the diagram to the right, there are many muscles and tendons that make up the hip and buttocks region. The diagram shows the posterior (rear) view of the buttock. The piriformis is the horizontal muscle in the center of the picture running over the top of the sciatic nerve.

What Causes Piriformis Syndrome?
Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly;
• Exercising in worn out or ill fitting shoes; and
• Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

• Poor running or walking mechanics;
• Tight, stiff muscles in the lower back, hips and buttocks;
• Running or walking with your toes pointed out.

Symptoms
Pain (or a dull ache) is the most common and obvious symptom associated with piriformis syndrome. This is most often experienced deep within the hip and buttocks region, but can also be experienced anywhere from the lower back to the lower leg.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of piriformis syndrome. Even tingling and numbness in the legs can be experienced.

Treatment
Piriformis syndrome is a soft tissue injury of the piriformis muscle and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

Prevention
Prevention is the key when it comes to piriformis syndrome. The more you can do to prevent it, the better off you’ll be. There are a number of preventative techniques that will help to prevent piriformis syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are four preventative measures that I feel are far more important and effective.

First, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.

Second, rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.

Third, strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent piriformis syndrome.

Fourth, (and most importantly) flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. I’ve included two effective piriformis stretches below.

	Sit with one leg straight out in front. Hold onto the ankle of your other leg and pull it directly towards your chest.
	Lie face down and bend one leg under your stomach, then lean towards the ground.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don’t make the mistake of thinking that something as simple as stretching won’t be effective

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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
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Ligament injury refers pain see chart

 By Amy Price PhD

The ligaments act like duct tape to hold our bones and joints together.  When ligaments lose their elasticity the bones and joints move too much and irritate the structures around them. Ligaments provide boundaries for movement.  For example when we bend our fingers backwards the ligaments will stop us from pushing them too far back and breaking the bones. It is this way with most of the joints in our bodies. The ligaments cause them to work within a safe range of motion. When one of the ligaments is torn or stretched, the excess movement will cause pain and swelling. In an injured joint and you may notice more popping, cracking or even a grinding feeling.  The joint may have become unstable.

 In the neck and spine, ligaments are crucial for holding vertebrae together. Spinal ligaments are especially vulnerable to overstretching or tears in a car wreck.  If you experience these symptoms after a wreck you may want to be examined for a ligament injury:

•             popping, cracking, or grinding in the neck with movement

•             pain or spasms that get much worse with activity

•             Numbness or tingling into the hand(s) or feet that gets worse with activity or accompanied by popping, cracking, or grinding.

 Flexion-extension x-rays, or digital motion x-rays can be a good way to help diagnose ligament instability.  A good physician will want to test the spine segment by segment to test for stability and this is  an essential step for enabling accurate treatment. The diagram above shows some of the ways ligament pain is referred in the neck area. For referred pain in other body areas look at our dermatome pages

Treatment usually proceeds as follows:

•             Specially trained medical practitioners such as Chiropractors or Osteopaths can mobilize any stiff segments that may be overloading the unstable segment

•             Posture Training can improve stability, injury can increase tightening of muscle structures which can cause guarding of the painful area. This throws posture off balance and  can aggravate instability.

•             Strengthen any weak, deep supporting muscles (like multifidus) that may be allowing too much movement. Core strength exercise like modified Pilates with the guidance of a trained physiotherapist can be helpful

•             Don’t be talked into mobilizing or manipulating an unstable segment as this can bring a temporary improvement but over time can make things worse. Sometimes bracing is used and while this may seem like a good solution to reduce pain initially prolonged bracing can cause further weakening of the surrounding muscles and later slow recovery.

•             Prolotherapy may prove helpful, adult stem cell therapy using your own cells has been reasonably successful in initial trials.

•             Surgical stabilization is sometimes used when no other treatment brings improvement.

So you’ve pulled a muscle? Over-stretched it, torn it, strained it, sprained it. Call it what you want. From an injury point of view, the initial healing process is all the same.

Sprains (ligament) and strains (muscle or tendon) are the most common type of soft tissue sports injury and are often caused by activities that require the muscles to stretch and contract at the same time. A lack of conditioning, flexibility and warm up can also contribute.

While most people are well aware of the importance of applying the R.I.C.E. regime to a sprain or strain in the first 48 to 72 hours, it’s after this that most people get stuck. Let’s start by having a look at what happens during those first 72 hours and then move onto what’s needed for a full recovery.

The First 72 Hours
Without a doubt, the most effective, initial treatment for soft tissue injury is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment.

Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury.

The diagram below is a comparison of the same injury treated with the R.I.C.E.R. regime and without. The top row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is not used. While the bottom row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is used.

The first diagram in the series shows a rupture in the soft tissue immediately following an injury. 24 hours later, when R.I.C.E.R. has not been used, there is a large amount of uncontrolled bleeding and swelling. However, in the bottom diagram, the application of rest, ice, compression and elevation has significantly reduced the amount of bleeding and swelling.

The Problem with Scar Tissue

When a muscle is torn, you would expect that the body would repair that tear with new muscle. In reality, this doesn’t happen. The tear, or rupture, is repaired with scar tissue. As you can see with the final diagram on the right hand side, when the R.I.C.E.R. regime is used, this limits the formation of scar tissue.

Now this might not sound like a big deal, but if you have ever suffered a soft tissue injury, you’ll know how annoying it is to keep re-injuring that same old injury, over and over again. Untreated scar tissue is the major cause of re-injury, usually months after you thought that injury had fully healed.

Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it’s even possible to see and feel this bulky mass under the skin.

When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.

So what does this mean for the athlete? Firstly, it means a shortening of the soft tissues which results in a loss of flexibility. Secondly, it means a weak spot has formed within the soft tissues, which could easily result in further damage.

Lastly, the formation of scar tissue will result in a loss of strength and power. For a muscle to attain full power it must be fully stretched before contraction. Both the shortening effect and weakening of the tissues means that a full stretch and optimum contraction is not possible.

Getting rid of the Scar Tissue
To remove the unwanted scar tissue it is vital that you start a course of deep tissue sports massage. While ultrasound and heat will help the injured area, they will not remove the scar tissue. Only massage will do that.

Either find someone who can massage the effected area for you, or if the injury is accessible, massage the damaged tissues yourself. Doing this yourself has the advantage of knowing just how hard and deep you need to massage.

To start with, the area will be quite tender. Start with a light stroke and gradually increase the pressure until you’re able to use deep, firm strokes. The more you massage the effected area the harder and deeper you will be able to push. See a video demonstration and more tips here

Use deep, firm strokes, moving in the direction of the muscle fibers. Concentrate your effort at the direct point of injury, and use your thumbs to get in as deep as possible to break down the scar tissue.

A few final points before finishing up. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body.

Also, I recommend you purchase a special ointment to use for your massage called “Arnica”. This special ointment is extremely effective in treating soft tissue injuries, like sprains, strains and tears. You can purchase this ointment at most health food shops and pharmacies.

To Stretch or not to Stretch
During this phase of the rehabilitation process NO STRETCHING should be used at all! This is not the time to start stretching. Concentrate on the R.I.C.E.R. regime and avoid all stretching or any activity that puts stress on the injured area. Stretching during this early stage of the rehabilitation process will only cause more damage to the injured tissues. Avoid stretching during the first 72 hours. Click here for a more detailed article on how to use stretching for injury rehabilitation.

———————————————————–
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
———————————————————–

 
Without a doubt, the most effective, initial treatment for soft tissue injury is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment.

stretching pose (ehow.com)

The First 72 Hours 

Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury.

However, during this phase of the rehabilitation process NO STRETCHING should be used at all! This is not the time to start stretching. Concentrate on the R.I.C.E.R. regime and avoid all stretching or any activity that puts stress on the injured area. Stretching during this early stage of the rehabilitation process will only cause more damage to the injured tissues. Avoid stretching during the first 72 hours.

The Next 10 to 14 Days
After the first 72 hours most of the initial swelling will have subsided and you can start with some gentle active rehabilitation techniques.

The most effective treatment at this stage is the use of heat and massage, but including light, gentle static and passive stretching exercises after your heat and massage treatment will help to dramatically speed up the recovery process. So what is static and passive stretching?

• Static stretching is performed by placing the body into a position whereby the muscle (or group of muscles) to be stretched is under tension. Both the opposing muscle group and the muscles to be stretched are relaxed. Then slowly and cautiously the body is moved to increase the tension of the stretched muscle group. At this point the position is held or maintained to allow the muscles to lengthen.
• Passive stretching is very similar to static stretching; however another person or apparatus is used to help further stretch the muscles. Due to the greater force applied to the muscles, this form of stretching is slightly more hazardous. Therefore it is very important that any apparatus used is both solid and stable. When using a partner it is imperative that no jerky or bouncing force is applied to the stretched muscle. So, choose your partner carefully, they must be responsible for your safety while stretching.

The important point to remember during this phase of the rehabilitation process is light, gentle stretching. Never, never, never do any activity that hurts the injured area. Of course you may feel some discomfort, but never push yourself to the point where you’re feeling pain. Be very careful with any activity you do. Pain is the warning sign; don’t ignore it.

The Next 2 to 5 Weeks
The aim of this phase of your rehabilitation is to regain all the fitness components that were lost as a result of the injury. Regaining your flexibility, strength, power, muscular endurance, balance and co-ordination will be the primary focus.

Without this phase of the rehabilitation, there is no hope of completely and permanently making a full recovery from your injury. A quote from a great book called “Sporting injuries” by Peter Dornan & Richard Dunn will help to reinforce the value of this phase of the rehabilitation process.

“The injury symptoms will permanently disappear only after the patient has undergone a very specific exercise program, deliberately designed to stretch and strengthen and regain all parameters of fitness of the damaged structure or structures. Further, it is suggested that when a specific stretching program is followed, thus more permanently reorganizing the scar fibers and allowing the circulation to become normal, the painful symptoms will disappear permanently.“

So what type of stretching is best to use during this phase? Stick with the static and passive stretching exercises described above, but also include PNF Stretching.

• PNF stretching, or Proprioceptive Neuromuscular Facilitation, is a more advanced form of flexibility training that involves both the stretching and contraction of the muscle group being targeted. PNF stretching was originally developed as a form of rehabilitation, and for this purpose it is very effective. It is also excellent for targeting specific muscle groups, and as well as increasing flexibility, (and range of movement) it also improves muscular strength.

Looking Long Term
Once you’re over your injury and have started to regain the fitness components that were lost during the injury process, it’s time to focus on making the injured area stronger and more flexible that it was before the injury occurred. To do this, the best types of stretches to use are dynamic and active stretching exercises.

• Dynamic stretching uses a controlled, soft bounce or swinging motion to move a particular body part to the limit of its range of movement. The force of the bounce or swing is gradually increased but should never become radical or uncontrolled.
• Active stretching is performed without any aid or assistance from an external force. This form of stretching involves using only the strength of your opposing muscles to generate a stretch within the targeted muscle group. The contraction of the opposing muscles helps to relax the stretched muscles. A classic example of an active stretch is one where an individual raises one leg straight out in front as high as possible and then maintains that position with out any assistance from a partner or object.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don’t make the mistake of thinking that something as simple as stretching won’t be effective.

———————————————————–
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
———————————————————–