There is a lot to be said for losing weight!

The body mass index is a little clunky as a measure, but for those with knee and back problem, it should  be your 1st port of call.  Do you have  a healthy Body mass index?

click here and check

If not and you are  active, think on this. “Active” normally means 10,000 steps a day. If you are 10kg over weight  thats  10 x10,0000 that 100,000 kilos extra than your body  expected  . Weightlifters brace and prepare!

If you are inactive and slumping in your chair thats a lot of deadweight pressing on knackered  back and bum muscles.

“Dude, loose some weight!”

If you  have an ok weight, well thats ok. Go you. Thats not the problem!

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Spinal surgery and complications……..

Im not a spinal surgery fan but it was comforting to read

 Anterior Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Associated Complications

According to the report “complication rates with anterior lumbar spine surgery are relatively low, with the most common complications occurring at a rate of 1-3%. Complication rates are related to surgical technique, approach, and implant characteristics. Further randomized controlled trails are needed to validate the use of preventative measures including CTA and the use of an access surgeon”

Still tough on the 1-3% though!

Always remember you are “just” a fitness Instructor or a “mere” therapists

I treat a lot of backs with a mixture of appropriate mobility, core strengthening, Back hygiene emphasis, improving the aerobic capacity of Backs, breathing, positive thinking, pain control…. blah blah

I have a lot of clients and suggest methods to fellow trainers. I am however not a doctor. I  do talk to a lot of spinal surgeons, back researchers, GP’s and others with interests in “LBP”.

I frequently argue points with them. I don’t, however, ignore them. I do not believe myself to be superior to them. I do often see that we frame our thought processes: we automatically put  limitations to our evaluation  of the client. Evaluating the client is key.

You must listen to them, and watch how they move. If someone ends up in a surgeon’s office, they should do the same. Is there a saying along the lines that, if all you have is a hammer, every problem presents itself as a nail.

So 2 points,

1) if you are a one trick pony (” “stretching is the answer,” “cutting you open is the answer”) do  try and consider other options (if you cannot  nail some metal to  someones spine  in less than 8 weeks, why not  suggest  a therapy in the meantime. It could work!

2) As a fitness Instructor or “PT”  remember your place: every back client should   seen their doctor 1st. You  and they need to screen for “red flags” . Also, ask questions.  If  for example, someone comes in with a weaker leg maybe its something more serious.
A  report that appeared in the Spine  “Primary extraosseous Ewing’s sarcoma of the lumbar spine presenting with left leg weakness” is an interesting point according to this report

“A 7-year-old boy presented to the neurosurgery clinic with left leg weakness. Enhanced multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) were performed. MDCT images revealed a mass with minimal contrast enhancement that extended into the left L3-4 foramen and psoas muscle (figure 1). MRI images revealed a mass that was isointense on T1 weighted (T1W) images and hyperintense on T2- weighted (T2W) images compared with muscle (figure 2,3), with homogenous enhancement after contrast administration (figure 2,3), consistent with a nerve sheath tumors

In short, work with doctors, suggest and help BUT don’t tell clients to avoid them ( don’t make the pester them either)

Sit on your Ischial Tuberosities

When sitting, you can sit on your  Coccyx, or your Ischial Tuberosities. After all, it’s your ass!

sit on you ischial tuberosities

BUT…..sitting on your coccyx  ( right picture above: Boo. Bad) is the same as bending over badly and slumping (bad): the abdomen protrudes (bad) , the chest sinks ( bad), and breathing is inhibited. (cannot be good) It also indicates  fatigue (yawn) , and lack of support (Boo). In this position you can  try and make the client  (or yourself) sit up, but it will only last a short time before slumping back (sob) into your Backaholic patterns

Sitting on your Ischial Tuberosities ( a good place to sit, on the left above) , causes a more upright position (good), which elongates the spine (good)  and reduces excessive curvature (good; high five) .  Maintaining  this natural spine is easier as it is seen as a natural position (good. Fist bump). Each minute of wrong sitting can be compared to doing  the wrong exercise. if you sit poorly for 8 hours a day, thats a lot of bad exercise.  you are not a runner or a body builder or a crossfitter, you are a “bad back maker”

Of course, you should never sit  for that long, but if you must sit, sit on your Ischial Tuberosities!!

To get into correct “sit”, once you have sat down, lean to one side (imagine you are  trying to break wind!)  and gently lift your “lifted” buttock up with your hand,  scoop it back then sit down, then do the other side.

This said, you still  have  to fight your slumping habit. You must learn to sit tall and relaxed, but with an appropriate amount of abdominal tone. Say No to being a Backaholic!!

The shoulder bridge: gluteal engagement

Lie on the floor with your knees flexed (feet on the floor) and stick your fingers into the meat of your ass.

Squeeze your ass cheeks together as your method of engaging them  and not by trying to over extend your hips or play with your pelvis; keep that neutral.

Once that is mastered,  bridge the torso off the floor. At this stage, you , a friend or your trainer needs to feel your hamstrings. People who are “hamstring dominant and gluteal deficient will engage the hamstrings prior to moving” (McGill: page 195 Ultimate back Fitness).

This is the wrong pattern. The glutes should drive this action. To help  we can put our foot against your toes, and whilst asking you to squeeze your ass, we  can help your quads engage by lightly cueing from the knees ( so either a finger hook under the knee to gently pull them up, or if you know each other, a quad stroke ( to encourage the hamstrings to switch off) ).

Once you get  your  ass  engaging, “Boom” your back gets  a bit more resilient  and your squat gets better!

shoulder bridge

Help your back find its way: tape it up!

If you struggle to maintain  a neutral spine when deadlifting or squatting, or sitting for that matter, a “bit of gaffer tape” either side of your lumbar spine can give some very useful feedback. Set your neutral back, and get someone to stick tape either side of your spine ( the boney bit in the middle): when you stoop it pulls, and reminds you to maintain a better back position (  but don’t tape into a hyper- lordotic position!!)

backtape1

Obvious point, but make sure you are not allergic to the tape you are going to use! This can really help you save your back and cut down your  pack pain. Essentially it tells the body where your back is. Often back pain sufferer’s have no idea what their back is doing.

3 interesting exercises for Scheuermann’s

I came across these interesting, non lethal looking exercises , allegedly for Scheuermann’s . I have a couple of occasional clients with this condition, so I’ve sent it over to  test!

I’ll report back.

From  a risk assessment point of view, lying on a swiss ball for 3 minutes, shouldn’t kill you. Nor should leaning against a door, or snoozing on  a towel.

Evaluating the Schroth Method

Once you start looking at the whole area of scoliosis and  conditions like Scheuermann’s disease you inevitably end up  reviewing the work of  Christa Lehnert-schroth and her  “Three-dimensional Treatment for Scoliosis”

Over the next few months we will evaluate and practice some of the aspects of this  method and look at the 3 segment concept , scoliotic breathing patterns. We might as well throw in sun and air now!

Exercise out doors whenever possible. “Many people need clean living air, more than nutrition.  Next to natural nutrition, air, light and sun are the best physiological means to stimulate  and increase the  body’s defences” (Bottomberg).  As someone who trains in a railway arch in East London I would endorse fresh air wouldn’t I!

Handstands for scoliosis and back pain

I have a belief that handstands have a  role is developing the Core and aiding spinal mechanics. However, Im sure this has not been studied in any depth. The aim of this review is simply to collect enough evidence from easily accessible sources  to justify experimenting with my clients.

Whilst Im not sure about many of her recommendations, it was interesting to note that Sarah Key recommends the handstand for her scoliosis patients.

“the best specific strengthening exercise is handstands….. being upside down it literally tricks both sides of the para-spinal muscles into working equally hard in keeping you upright and balanced”

According to site that sells inversion tables, “In mild cases of Scoliosis, research and clinical studies have shown that inversion tables and regular exercise can have a positive effect on treating the physical defect. Unfortunately, inversion therapy has not been shown to effectively treat Scoliosis in severe cases”

BTW, I’m not validating passively hanging upside down. The benefit of  a handstand is that your body needs to be the tightest its ever been.

The “Mindbodygreen” blog by Heidi Kristoffer discusses that handstands can heal, but to avoid headstands! I must admit, I’ve never been a headstand fan!

Whilst this is far from anything resembling science, hanging people upside down , making them handstand, seems  not to kill people, so it may be worth experimenting with,  as long as  a proper posture ( neutral spine) is maintained. .

I’m assuming that I’ll develop the handstand from a good plank position, then walk it slowly up the wall!

I should say, I think that handstands will help IF people have adequate shoulder flexibility: hanging in an awful arch could do harm