Monday, September 21, 2009
Back Ailments, Part Two - Lloyd Garner
Treating Weak Back Muscles
by Lloyd Garner
In my first article I attempted to outline the common causes and effects of back ailments. I emphasized that most back troubles today are the result of too much sitting, bad posture and improper living habits. In short, weakness.
All are products, to some extent, or our modern way of life. We try to do as little standing and walking as possible. We’d rather sit.
There’s no need, we figure, to throw our shoulders back and sit and walk erect. Carelessness in posture, we assume, is only something our teachers harped about way back in our early school days. It couldn’t possibly hurt us, we think.
And our living habits – plenty of good food, rest and fresh air – well, that’s for the birds. Well, in my first article, I attempted to show – and I’m willing to argue the point with anyone – that these things aren’t for the birds. They are all necessary ingredients in a healthy body. And they are so important in helping to ward off back problems.
As I stressed in my first article, all three things – too much sitting, bad posture and improper living habits – lead to weakness in the back. And it’s weakness in the muscles and in blood circulation that cause ailments in this part of the body.
When the back is not strong enough, it cannot stand the many strains and stresses to which it is subject many times during normal life. You say, probably, that you don’t put it to this type of test since you don’t do manual labor. Yes, that may be true, You lead a quiet life, not too strenuous, and avoid heavy work. But tomorrow, if there’s a heavy snowfall, you’ll trot out with you snow shovel and start to clear your sidewalk and driveway.
Much of the strain in show shoveling is on the back. And if it’s not used to this type of labor, you could find yourself with a back ailment before the job is done.
Of course, you may be in a part of the country where snow is seldom, or never, seen. True, but you will get some cool weather which is often just as tough on a weak back as physical labor.
How, you say, can cold cause back ailments? Well, a person in poor physical condition and with a weak back has more toxic materials in his bloodstream. When he comes in contact with cold, his blood is unable to fight it and he falls victim to it. And cold will often attack the weakest part of the body, which in many cases, is a person’s back.
As in the case of an injury, cold working on these toxic materials in the blood causes congestion. And where there is congestion there is pain, because the oversupply of blood now in the affected area is unable to remove waste products. In addition, the blood cannot properly nourish this section.
Well, you probably say, this is only a localized injury which can be cured with a bit of treatment. That, too, may be true, but unless something is done fast other parts of the body can also be affected as a result of this so-called minor injury.
When this small ailment is near a main nerve, this nerve often becomes irritated because, as I mentioned, the blood is not able to supply the entire area with sufficient nourishment. And before long, because of the improper functioning of this main nerve, a larger area is affected, e.g., sciatica, lumbago, etc.
Then, as it generally happens in such cases of back injury, the person tenses, especially when moving around. His body becomes unbalanced.
Other muscles are strained because they act as a sort of splint to assist the injured member and compensate for its restricted action. Before long, these muscles, which also aren’t in top physical condition, give way and join the injured list.
As I noted earlier, congestion causes pain. Remove the congestion and the pain is on its way out, too. So the first step I always take in my clinic is to attack the congestion.
This I do first with a steam bath which removes toxic materials from the blood through the veins, lymphatic glands and the millions of pores in the skin. Just note, if you take a steam bath, how the skin on the entire body is “flushed.”
In addition to removing toxins which cause congestion and inflammation, steam baths increase circulation throughout the whole body, thereby helping to heal the injured part. You will find that TREATMENT OF THE WHOLE BODY OR A LARGE SECTION ASSISTS A SMALL INJURED PART.
But maybe you haven’t a steam bath available. In that case, a hard, hot shower can help. And I don mean “hard and hot.” Turn of the force of the water as far as you can comfortably stand it. Then let the shower play on that particular area for about 10 minutes.
A third choice in treatment is a heat lamp or even hot compresses.
Heat, preferably in a steam bath, relaxes the injured area and prepares it for the next step, the massage table, where the patient can further relax and undergo passive exercises. On the table we begin with effleurage, a flowing massage motion, from the gluteals (buttocks) to the neck several times.
In back injuries, you will often find thickness and tenderness on the affected side of the gluteals and a similar condition halfway up the back on both sides of the spine, but usually on the sore side only. These thick areas can be softened by using frictions and kneading (a deep rotary motion).
As these thickenings are broken down, they are directed to the nearest set of lymph glands situated in the groin. From there they are eliminated. But, I must emphasize, they must be eliminated. If they are only broken down, they will form again.
From here we turn to two sets of exercises – passive, performed by the operator and not by the patient, and active, in which the patient plays the leading role. The former, carried out first, are designed to break down adhesive materials and assist the patient to regain his full functions, whereas the latter strengthen the injured part and help to prevent future ailments.
Passive exercises I strongly recommend are:
1.) With the patient on his abdomen and fully relaxed (Fig. 1), the operator places both his hands on the sides of the spine opposite to the side of the body on which he is standing. Working from the gluteals to the neck region, he uses a pushing motion, stretching the muscles on this part of the body. Then he repeats this treatment, working from the opposite side. All these movements must be painless.
2.) The operator then places his left hand under the patient’s far hip and pulls toward himself (Fig. 2). With the right hand, he pushes on the back, starting at the neck and continuing down the spine to the hips. The left hand is in the same position all the time – on the hip. Only the right hand moves, as it travels back and forth down the back to meet the left. Then, as in the first exercise, the operator repeats this movement on the other side of the body. Above all, this must not be a jerky or strong, vigorous movement, which could cause pain. It should be smooth and painless.
3.) The patient is then placed on his side with the painful side up (Fig. 3). The operator, facing the patient, flexes the knee back toward the patient’s chest in a backward and forward motion, gradually bending it a little farther all the time. (Fig. 3-B). The shoulder is pushed away from the operator and the hip is pulled toward him. This is done several times in a stretching motion, not a jerking motion which can result in pain. Then the process is repeated on the other side.
4.) With the patient on his back (Fig. 4-A), the operator flexes one leg at a time toward the chest and then both legs at the same time (Fig. 4-B). People with lower back troubles find this position, with both legs up to the chest, often alleviates pain when all other things fail, but not always.
5.) In this exercise the patient sits and the operator stands in front of him, with one hand placed on the front of the patient’s shoulder and the other behind the opposite shoulder (Fig. 5-A). To prevent rotation of his hips, the patient places his knees between the operator’s knees. The latter rotates the patient’s trunk by pushing away with the hand on the front of the shoulder and pulling with the other hand. As the operator feels the muscles’ resistance lessening, he gradually slides the back hand from the rear of the shoulder down to the small of the back and then slowly up again to the starting position (Fig 5-B). He keeps the other hand at the front of the shoulder at all times. The process is repeated on the opposite side by changing the position of the hands.
6.) Here the patient sits and the operator stands behind him (Fig. 6). The patient clasps his hands behind the neck with the fingers interlaced. The operator grasps the patient’s wrists as in the illustration and lifts him with no assistance from the patient. The weight of the latter’s body gives a stretching effect to the spine and muscles of the spine.
Next we turn to ACTIVE EXERCISES WHICH MAY BE PERFORMED ONLY WHEN THERE IS NO PAIN FROM THE PASSIVE MOVEMENTS. And they must never be overdone. THE BACK MUST BE ALLOWED TO HEAL, NOT FORCED TO HEAL.
I generally suggest a series of 10 active exercises which, as I said before, are performed only by the patient:
1.) The patient lies on his abdomen and links his hands behind the small of his back (Fig. A-1). He then raises his head and shoulders slightly, gradually increasing the height as the muscles strengthen. When 20 repetitions can be performed, he clasps his hands behind the neck with the elbows held back as far as possible (Fig. A-2). The head is then raised as high as possible, held for two seconds and lowered to the table. The feet can be held down. The process is repeated.
2.) Lying on his abdomen, the patient raises one leg with the knee straight as high as he comfortably can from the hip (Fig B). Hold for two seconds and return it to the table. Repeat six times. Repeat with the other leg the same number of times. Repeat in sets of six by alternating the legs as often as it is possible without any discomfort. In this way the patient does not tire the one side excessively and each side gets equal exercise.
I must inject a word of warning in this exercise. Both legs should never be raised at once unless the back is completely cured. If one leg isn’t stabilized on the table, the hips will be tilted forward and a lordosed condition, or exaggerated lumbar concavity, will result. Also, the lumbar muscles may become cramped and go into spasm.
3.) Lie on the back, the patient’s legs straight as in the illustration (Fig. C). Consciously force the lower back against the table by contracting the abdominal muscles. Relax and repeat. Hold for 5 seconds and repeat.
4.) Again lying on his back, the patient bends one leg and extends the other straight horizontally without touching the table (Fig. D-1). Pull the extended leg back as closely to the chest as possible (Fig. D-1). Repeat the exercise six times. Repeat with the other leg, at the same time holding the inactive leg in a bent position. This can be performed in sets of six repetitions. The patient should not, however, do all he can with one leg before carrying out the exercise with the other. This will make the movement unbalanced. Alternate six reps at a time as in Ex. 2.
5.) In this action, the single leg raise, the patient is again on his back with one leg bent (Fig. D-1). Straighten the other leg and raise it as high as possible (Fig. E). Lower it almost to the table, hold for two seconds, and repeat it six times. Then do the same movement with the other leg, always keeping the non-exercising leg bent. Repeat in series of six as with previous exercises.
6.) The patient is on his back, both knees bent and feet on the table, in this exercise, known as the hips thrust. Lift the hips slowly until the abdomen is in a straight line with the shoulders and knees (Fig. F). Hold this position for two seconds, lower them to the table and repeat. The patient should note by feeling with his hands, when he is in the higher position, how the lumbar muscles contract. This movement exercises the abdomen and the lower back.
7.) On his back, the patient flexes his knees, lifts his head and shoulders until a strong contraction is felt in the abdominal muscles (Fig. G). Hold for two seconds, lower them and repeat. This stretches the lower back and strengthens the abdominal region.
8.) Here the patient lies on his back straight out on the table. Keeping the legs stiff from the hips, alternately stretch each leg from the hip (Fig. H). The legs must not be bent at any time during this drill. All the movement is at the sacroiliac joints. This movement should be done fairly fast but always controlled.
9.) The patient now moves to a sitting position on a chair with his legs apart. Reach between the legs and touch the floor with both hands (Fig. I-1). Holding the arms straight, raise them to arms length over the head (Fig. I-2), then lower them and repeat. The sitting position is suggested because it stabilized the hips, thereby preventing any possible lordosed condition.
10.) In the final exercise the patient lies on his back and draws his knees up near his chest with his hands (Fig. J). Alternately pull them up to the chest and relax them a few inches. Repeat several times.
Again I must stress the importance of performing these active exercises only when all pain is gone or at least when they can be carried out without any pain or discomfort. Two further tips I could offer: always rub a painful area wit a good liniment so that it is well heated, and wear a good covering, possible a sweat suit, to guard against drafts and cold coming in contact with the muscles. A warm muscle is seldom injured.
No standing exercises, double leg raises, situps with legs straight of double leg thrusts should even be attempted unless the back is healed and strong again.
Some articles on back injuries suggest stiff-legged deadlifts and side bends. I am strongly opposed to these. Besides being nearly impossible for a person with back trouble, these exercises increase the pressure on the intra-vertebral discs. And if a nerve is pinched, the pressure and pain will increase. Even if there were no pain, an injured back leans to one side, making it impossible to exercise both sides of the body evenly.
As you may have noticed, at least one knee is bent in many of these movements. This keeps he pelvis tilted backwards, eliminating the strain on the injured part and keeping the lower back muscles relaxed.
I CANNOT OVEREMPHASIZE THE IMPORTANCE OF PERFORMING THESE EXERCISES IN THE ORDER GIVEN, ending with a movement which stretches the lumbar spine and muscles. Since, as I have so often stated, there is always pain in a congested and shortened muscle, stretching motions in the muscles will cut the congestion and with it the pain.
You may notice that these exercises affect the abdominal region strongly. As I said earlier, it is impossible to strengthen the back without also improving the abdomen.
In closing this article, I would like to stress that I do not want to work against any advice your medical doctor may have given you. These exercises are not meant to cure serious spine injuries, which are handled by a medical practitioner. In my clinic I work with doctors, not against them. And I have always found that our cooperation – their medical work coupled with my practice – has always worked to the best advantage of all – the MDs, myself and our patients.
In my next article, the final in this three-part series, I propose to deal with treatment for weightlifters and trainees who have injured their backs through improper training.
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