The Context of “Exercise” – The Recovery Phase

First there was when to stop.

Then Relief Care context.

Then Rehab, the transition.

Then “core” stabilization or strengthening.

I kind of backed into this series of Posts inadvertently. Initially, I wanted to address some of the issues that could come up in the consideration of why or why not to do an exercise – when to stop doing it.

But, years ago, I did want to do a series on this cycle (injury-relief-rehab-recovery-reinjury). I began with the story about my own back injury and how I progressed to full recovery. (It took 15 years and had almost nothing to do with any of the health care professionals I came in contact with – the rehab and recovery phases didn’t that is.)

So why is it necessary to talk about recovery at all: you are ‘recovered’ after all. Well, in a word: relapse. In the tissues of a significant injury, aging is going to take place faster than in the surrounding, uninjured tissues. That injured spot is a weak link. Now might be the time to take a more global look. To find out if there are other weaknesses that need to be balanced out. Finally, the phrase, “I just want to ‘get in shape'” makes sense. This part is about your longer term future. The point I would make here is the same one I have made all along: what you do should be guided by why you are doing it. Elsewhere (all over) this Blog I have written about setting goals, assessing where you are now, “progressing” in steps to where you want to be. That is all covered. Use the search box on this Blog, using whatever key words seem appropriate, to find a list of Posts. (Start with “progressions” to get started.) Here, too, there are all kinds of ‘normals’ that can guide you into exercises that will give you meaningful benefits safely. And normal is a worthy goal: most people are far from it. It will keep you healthy. How you get there is a journey. And you know about journeys… they all start with a single step:-)

If you need help, let me know.

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The Context of “Exercise” – Rehab Phase “Core Strengthening”

First there was when to stop.

Then Relief Care context.

Then Rehab, the transition.

Now, finally, strengthening the ‘core’ muscles. To begin, there are the following four assumptions: (1) you are pretty much out of pain, (2) you are in adjustment, pretty much, (3) there is little to no pain with palpation during visits to the office, and (4) you do know how to move properly and can demonstrate that.

You can argue whether stretching hamstrings belongs in the Rehab or the Relief phase, but when it comes to core strengthening exercises, failing to factor in the above assumptions can come at a cost.

All of these ‘phases’ overlap in real life. That is where it becomes and ‘Art’.

If you are following the research, then strengthening the core begins with “The Big 3”. These are tried and true exercises that work. They have been studied enough to know that as a way of strengthening, they will work. The Big 3 amounts to abdominal strengthening (ala Stuart McGill if you are absolutely on the straight and narrow). (Personally, this is where I make sure that the Reverse Back Crunch is in place, effective and not painful, then I move patients into the McGill stomach exercise. Second, is the Bird Dog – on the hand and knees, then one arm and the other leg extended. (Like everything else here, we could spend all day talking about the Bird Dog – technique is everything!) Third is the Side Plank: a tough exercise, one which I always give last and bite into carefully. Here too, bracing (but this time the shoulder as well as the trunk) is critical to correctly doing the exercise. Don’t use anything that I have put in a Blog Post as instructions on how to do an exercise: get professional instruction from someone who knows what they are doing.

Strengthening can then proceed, typically, to the repetitive squat, lunge, one-legged standing, and eventually, the gym ball exercises that involve back muscle endurance.

One nice thing about many of these exercises is that they double as balance tests, or tests of what a normal. So if you fail the test, you know that you need to do the exercise – and you have not fully rehabilitated your back.

A reasonable time doing all of these exercises (at least to test), without pain, is the evidence that you have rehabilitated a back pain episode to the point where you can think about “going to the gym to get in shape”.

The Context of “Exercise” – Rehab Phase of Chiropractic Care

First I talked about when to stop an exercise…

Then the context of exercises given during the Relief Phase of care…

And then there is Rehab. I have been Blogging for 14 years – there are more than 2,000 Posts here. Given that it would probably be safe to say that half have to do with Tai chi, all toll I would guess 75% of all Posts on this Blog could, in some way, shape, or form, being incorporated into a discussion of rehab. The scope of this Post is typical patients, typical exercises, and the typical thought process.

Transitioning from Relief to Rehab is a step into the grey zone. As a chiropractor, I keep track of where, how many, and how often various levels of the spine (or extremities) need to be adjusted. Whether the patient is still in pain or not. And whether there is pain when I touch the injured area with a little bit of pressure. A chiropractor’s first priority is the subluxation. When a person returns for several visits and the same parts of the spine continue to need to be adjusted, that is the time to consider giving the patient a way to keep the joints moving, themselves, in between visits. These exercises are designed to articulate the joints, primarily. They also restore reflex patterns to normal, and retrain muscles and movement patterns. In addition, there may be stretching, and finally – only after all of the rest has been done, strengthening.

Exercises to Articulate Joints

That is a little oversimplification, but it will do. And it is not a category of exercises usually discussed. But, to the chiropractor, it is a very important consideration: it will help patients hold adjustments – and that is how they get the results that they do. Some of the exercises that we recommend you can find on the internet: Brugger’s comes to mind (although when I looked for a video that I could put on my Blog, I was not happy with any of the videos that I saw). It is usually better to discuss, demonstrate, and have the patient perform it in the office. They will do it correctly that way; and I will know that they know how to to it correctly before they are off on their own. Brugger’s Maneuver is the exercise that counteracts many of the ill effects of a sitting desk job, crouched over a computer. It stretches everything on the front side of the body, while it strengthens everything on the back side: and it moves joints at the same time.

We have a neck exercise with the same primary objective: to move the joints and keep them moving while retraining normal reflex and muscle patterns. We call it the Figure Eight exercise. I learned it from a patient, who learned it from a book by an eye doctor, who credited his Tai chi teacher with teaching it to him. (Imagine that!)

Finally, for the pelvis (sacroiliac joints) there is an exercise that I got from a Yoga Therapist (I did not even know that there was such a thing until I met.) She didn’t have a name for it, so I made one up: you won’t find it on the internet.

The point here is, if you were subluxated, and that caused you to have symptoms, and getting adjusted relieved your symptoms, and there was an exercise that you could do to hold your adjustments longer, when do you think is a good time to stop doing that exercise?

Rehab (especially in the context of back pain) usually, or often at least, also involves the need to stretch the hamstring muscles. As a chiropractor concerned with joints articulating properly, I recommend stretches that also involve making sure that the hip socket moves properly. Here we discuss passive stretching and active stretching (again, it is already part of the Brugger’s conversation).

This Post is already over 600 words so I will take up Spinal Stabilization strengthening in a separate Post.

The Context of “Exercise” – Relief Phase of Chiropractic Care

The other day I wrote about when, and why to stop doing an exercise.

There I mentioned the Relief-Rehab-Recovery-Reinjury cycle. What I really wanted to talk about was the context of any given exercise, within each of the phases of care in the cycle. (It should go without saying that as a chiropractor, I offer a chiropractic perspective. A good reason for me to write it and a good reason, maybe, for you to read it: you might not get it anywhere else.)

That said, it also needs to be said that the chiropractic overall goal of care is to promote health (toward normal – a measurable normal). It bears reminding that we are the ones who have been talking about addressing the cause and not just the symptoms – for 124 years! Yes, patients are focused on the feeling. And, yes, we need to honor and respect that. And we need to deal with the pain (usually it is pain). But in keeping with our primary focus (health promotion), we also attempt to educate and increase awareness of function. Enough about all of that for now.

Speaking of symptoms, the Relief Phase of care is all about relieving them. That is where ice is recommended. We chiropractors find the joints that don’t move (subluxations) and we move them (adjustments). But that is not all we do. To the extent that pain allows, we begin the process of restoring function beyond just moving joints that were not previously moving (or not properly moving).

Keeping in mind that everything we recommend is a test: and the feedback from the patient after trying it is measure: Did they do it (a measure of compliance)? Did it increase, decrease, or have no effect on the symptoms, and what does that mean in terms of continuing, discontinuing, or modifying it.

In the Relief Phase, exercises such as bracing are described and discussed. Coughing engages those muscles and a patient can try that to find out how it feels. They also become aware of which muscles are involved, and begin to get acquainted with those muscles. This stiffening of the spine is an important feature of many important motions a patient is expected to do, usually, in there work. Bracing is also enhanced, and much else is learned, by an exercise called the Reverse Back Crunch (see Pain Free, by Peter Egosque, 1997 – a good book, a great exercise). While they are still in pain, this may be relieving. They can do it while they are on ice. It trains the abdominal muscles. All the while it is also increasing awareness and the patient is gaining control.

This has turned into 400 plus words already so I will do Rehab Phase and Recovery Phase exercises in additional Posts, but here, in the Relief Phase, proper moving technique (biomechanics) are also discussed. How to bend and lift, get up off the ground, and sometimes how to push and/or pull, are important movements patients often have to do all day every day at work. If they are doing them poorly, then relief and recovery are much harder to accomplish. If they begin to do them well, it is another opportunity for epiphanies as a patient becomes aware and gains control. They feel stronger and more stable, and they are less likely to get hurt again.

That is a start on the exercises in the Relief Phase of care. Does knowing the context help? It does help patients.

When can I stop doing this exercise?

A question almost no patient ever asked. (They just stop. They have lots of reasons to stop; and not enough reasons not to.) There are times to stop an exercise (progressions or a relapse comes to mind). But a better question to ask first is: “Why am I doing this exercise?”

If you think of each exercise as a solution to a problem, or answer to a question, that will help. Reasons for doing an exercise differ whether in Relief Care, Rehabilitation, or in Recovery. As the reasons for doing an exercise go away, so can the exercise. If the reason remains, so should the exercise.

Here are two examples from the Relief phase of care: the Cat/Camel and Bracing. At some point the Cat/Camel will become unnecessary – a patient will move on to more demanding exercises that incorporate all the benefits of the Cat/Camel but also have additional benefits. Until there is a relapse or re-injury there is no serious need to continue doing it – no prohibition against it, just no real need.

Bracing is different. It is supposed to be a natural, unconscious, normal, part of movement – especially movement that involves exertion. For most it is a forgotten art. So, we use bracing to stabilize the lower back in the Relief phase (if bracing does not hurt). By consciously training bracing a person gets good at it. Eventually, if they first consciously practice, it will become the second nature part of movement that it was always suppose to be. You never stop doing it, you just stop having to think about it.

So before you stop doing an exercise, ask why you were doing it in the first place. And if you do not know, ask.

For Tai Chi Students: Fan Through The Back Application with Othmar

Blue Zones: The Benefits of Walking (Research)

https://www.bluezones.com/2018/07/research-says-walking-this-much-per-week-extends-your-life/?utm_source=BLUE+ZONES+Newsletter&utm_campaign=a462ca7a69-SPRING-FRESH-FRUIT-RECIPES_COPY_01&utm_medium=email&utm_term=0_9642311849-a462ca7a69-198896425&mc_cid=a462ca7a69&mc_eid=0d9ed4d239

People with Low Back Pain

Many people with low back pain, who receive chiropractic care to get relief, fail to understand a fundamental truth.

Because they have always responded well to adjustments, and rapidly, they believe that all they have to do is make it to the office and get up on the table and everything will be fine. It has always been the case for them. No matter how bad their pain has been: from the first visit to the last, over years, and even decades. When they get adjusted they feel a lot better. The back pain goes away. And they can return to thinking that they do not have a ‘problem’.

The truth that they fail to appreciate is that their pain is not their problem: their problem is that they have a spinal subluxation complex.

It is a progressive condition if not corrected. Which means that it gets worse over time, if not corrected. And however bad the symptoms, they can get a worse too. Possibly a lot worse.

The answer: everything this Blog is about. Prevention. Correction. And maintaining good healthy habits, breathing, bracing, bending and lifting. It also means not going 6 months (or several years) between visits to the chiropractor.

That is our message. But sometimes the aid car comes in handy; the surgeons gets to do their work; and the pharmaceutical companies get a little richer.

Excerpts from “The Diabetes Code” by Jason Fung, M.D.

page xvi

“When there’s too much glucose in the blood, insulin does not appear to be doing its usual job of moving the sugar into the cells. We then say that the body has become insulin resistant, but it’s not truly insulin’s fault. The primary problem is that the cells are overflowing with glucose. The high blood glucose is only part of the issue. Not only is there too much glucose in the blood, there is too much glucose in all of the cells. Type 2 diabetes is simply an overflow phenomenon that occurs where there is too much glucose in the entire body..”

“In response to excess glucose in the blood, the body secretes even more insulin to overcome this resistance. This forces more glucose into the overflowing cells to keep blood levels normal. This works, but the effect is only temporary because it has not addressed the problem of excess sugar; it has only moved the excess from the blood to the cells, making insulin resistance worse. At some point, even with more insulin, the body cannot force any more glucose into the cells.”

“What happens in the body if we do not remove the excess glucose? First, the body keeps increasing the amount of insulin it produces to try to force more glucose into the cells. But this only makes more insulin resistance, in what then becomes a vicious cycle. When the insulin levels can no longer keep pace with rising resistance, blood glucose spikes. That is when your doctor is likely to diagnose type 2 diabetes.”

For Tai Chi Students: Stephen Wooster

Running Thunder Hand

Vacuuming without Back Pain

Patients often show up in the office after vacuuming. Here is how to move, push and pull without undue stress to the back (here we won’t talk about all the other injuries that could happen, later if there is interest).

Vacuuming is no different than anything else; it is the basics that keep you safe: knee rule, neutral spine, pushing from the heel.

Use the stance to push: go from weight being on the back leg to weight being on the front leg: push with the heel of the back leg. Critical to back safety is the ‘line’ we always talk about in Tai Chi (this line is the signature characteristic of Wu style Tai Chi). DO NOT BEND AT THE WAIST! Reaching further than you can go by shifting your stance will require that you bend over at the waist. Instead, take a step.

Use the stance to pull: go from weight being on the front leg to weight being all on the back leg. In Tai Chi we call this the Back Stance. These stances: ‘back stance’ and ‘front stance’ are described in great detail with pictures elsewhere on this Blog (use the Search Box). Move your feet, generate the force from the heel, then leg, then waist.

Stiffen your spine with ‘bracing’ to add strength and increase safety. That just means to tighten the butt, gut, and pelvic floor muscles when you generate force. Bracing correctly is how the strong people squat, bench, and dead lift great weights – and you are welcome to make all of that noise that they make, too, no one will hear it over the vacuum cleaner.

Let me know if this helps.

For Tai Chi Students: Form (Cuong Sam)