Saturday, August 31, 2013

Back Pain Research

A lot of back pain research is selective-evidence-based because of its focus on and around the spot where it hurts, rather than taking a global, system-wide approach to its causes and treatment.
Most people with low back pain have a pelvis that's out of alignment due to tight muscles attached to it, front, back and sides - but usually tight hamstring and buttock muscles - and maybe hip flexors.

There are a genre of people who are exceptionally aerobically fit and strong who succumb to back pain. Usually they're very inflexible. Bones in the back will usually already be out of alignment. You can test how far out of alignment but using this diagnostic procedure.

When the pelvis is out of alignment the bones above it move out of alignment. When the vertebrae move out of alignment ligaments, tendons and muscles attached to those bones are stretched beyond their pain threshold. The nucleus of one of more discs starts to get squeezed out. Then along comes an incident - often trivial - that 'tips the person over the edge' and the disc herniates.

The 'straw that breaks the camels back' usually gets the blame, whether it's bending down to pick up a leaf, swivelling round to pick up a phone book, cleaning your desk or lifting a bag of groceries into the car. It can happen to the best of us.

The bag of groceries is not the underlying cause of the problem, just one of the many straws that lob on the lower back. The groceries (the leaf, the phone book, the desk) get the blame.

This is an example of the post hoc ergo propter hoc fallacy. (If A occurs before B then A must have caused B.)

Academic bio mechanics and physiotherapists want to scare us with selective-evidence-based science. For instance, Canadian bio mechanic, Stuart McGill warns against doing situps because they place HUGE forces at the spot where discs herniate.

 However, a healthy musclo-skeletal system is designed to cope with the HUGE forces he rails against.

Blaming a sit up for herniating a disc is indeed a selective piece of evidence. How far the bones of the spinal column are already out of alignment, how inflexible some of the muscles attached to it are and how weak the muscles attached to the pelvis and spine are more important factors.

The body needs persistent flexibility exercises done in sufficient dosage to keep the pelvis and spinal column in good alignment. It needs persistent strength exercises to support the bones in good alignment. (The point I suspect McGill misses is the fact that a good strength training program will also support bones in misalignment.)

But just focusing on the strength of muscles attached to the spine 'somewhere' in the vicinity of the pain misses the point. The cause of the pain is rarely at the site of the pain

The fact that the medical and therapeutic industries are fixated on the site of the pain, has perverted the course of lower back pain research. It's a system problem, that manifests itself in the lower back, not a lower back problem per se.

This means a lot of the evidence as to the cause of lower back pain is selective and if the evidence is selective then we need to be careful not to rely on it too heavily.

As for yoga, if the Chinese have been doing it for 2,000 years, I'd bet on it. I wouldn't change it. It's a musculo-skeletal health program that focuses on the musculo-skeletal system as a whole and not just on one small segment of it. I wouldn't be scared off from doing some of the poses on the say-so of latter day bio mechanics and physiotherapists.

We're dealing with a system that goes from the bottom of the feet right up to the top of the head and just about all the muscles in this chain work together to keep the bones in correct alignment - including the bones in the lower spine.

Focus on the system, not just spot where it hurts. Keep the system strong and flexible and the chances of coming down with a crook back are quite remote.

If you're searching for back pain bogy men, you've got to look further than leaves, desks, bags of groceries and situps.

In the meantime stay tuned, highly tuned and diminish your risk of joint and muscle pain by keeping yourself strong and flexible.

John Miller

Friday, August 30, 2013

Core Strength Exercises

There's a lot of debate about which muscles are 'core' muscles and which exercises you need to do to improve core strength.

Most people think that core muscles are those 'somewhere behind your belly button'.  Physiotherapists get people to lie on their back and suck their guts in to strengthen those muscles.

Not many people became stronger by sucking their guts in.

My definition of core muscles is any muscle attached to the pelvis or the spine.

Withjout complicating the sipple you ought to be able to look after your core strength by regularly doing these four exercises:

1. Situps of any type.

2. Pressups definitely. Pressups are plank in motion - the best predictor of risk of lower back pain.

3. Squats - don't forget that core muscles are any muscles attached to the pelvis or spine. Just get a piece of wood an inch or so thick, place it under your heels and start squatting. Make sure your backside goes below your knees.

4. Superman - don't forget the muscles on the 'back side' of the body.

If everyone could do 40 situps, 40 pressups and 40 squats doctors, physios and chiros would be sitting around twiddling their thumbs.

In the meantime stay tuned, highly tuned, keep strengthening your core muscles and visit for a complete musculo-skeletal health training program.

John Miller

Wednesday, August 28, 2013

Accupuncture and Back Pain

I'd bet on anything the Chinese have been doing to 2000 years, BUT, that wouldn't stop me from doing the strength and flexibility exercises that need to be done to get the pelvis and the bones above it back in alignment.

Most people go for a particular therapy and then forget that the most effective therapy is the one that they can do themselves - for free - at home - a targeted strength and flexibility training program.

There is no way you can keep yourself in good musculo-skeletal health without such a program.

The corollary is that if you have low back pain, start doing the exercises needed to get the pelvis and the bones above itback into better alignment, for a sufficient period of time each day for them to take effect. No rubbing, no crunching, no heating, no vibrating, no doping, no surgery.

Norman Marcus, Director, Norman Marcus Pain Institute, Associate Professor, NYU/Langone School of Medicine writes, 'non specific or idiopathic low back pain which refers to sprains and strains of soft tissue accounts for 70 to 80% of patients presenting with pain in the low back ('

The Australian National Health and Medical Research Council puts the idiopathic figure at 95%.

Believing that 70% - 95% of low back pain doesn't have a cause pretty much rules out the medical industry as being the experts in this field.

If you don't know the cause how can you possible direct a treatment at fixing it?

Motor mechanics would go out of business if they adopted these principles.

You could pretty much count on the causes of those 70%-95% being generated by a lack of strength and flexibility - causing bones to move out of alignment.

In the first instance treat low back pain as a personally-generated fitness problem - and understand that the chances of solving a personally-generated fitness problem with a medical/pharmaceutical/surgical solution is very remote.

Just about everything the medical industry writes about low back pain and just about every things it recommends to relieve the pain provides evidence that it is out of its depth.

Complicating the simple and making the cheap expensive definitely doesn't mean you're going to solve the problem.

In the meantime stay tuned, highly tuned, loosen the tight muscles and strengthen the weak muscles.

John Miller

Saturday, August 24, 2013

Stretching Before Exercise

I've read one of the research reports (Herbert et al. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. British Medical Journal. 2002). All Herbert and his mate, Gabriel did was look at the results of other studies - without saying just how bad they were.

'The first study investigated effects of supervised stretching of calf muscles before exercising (two stretches of soleus and gastrocnemius muscles for 20 seconds on each limb, total stretch time 160 seconds).'

If the feet are out of alignment, if the upper and lower leg bones are out of alignment, if the pelvis is out of alignment, 20 seconds of calf stretching to avoid soreness is about as useful as a hip pocket on a singlet.

'The second study investigated effects of supervised stretching of six muscle groups in the lower limbs before exercising (one 20 second stretch to each muscle group on each limb, total stretch time 240 seconds.)'

At least more muscles were being stretched but the time was grossly inadequate to have much of an effect. No wonder this regime didn't work.

'Total stretch time per session varied from 300 seconds to 600 seconds, with the exception of one study in which total stretch time was only 80 seconds.'

'This systematic review finds clear evidence from five studies of nominally moderate quality that stretching before or after exercising has no effect on delayed onset muscle soreness.'

Well at least Herbert and Gabriel had the decency to say the studies were of 'nominally moderate quality.' What he should have said was they were of dreadful quality.

'Conclusions: Stretching before or after exercising does not confer protection from muscle soreness. Stretching before exercising does not seem to confer a practically useful reduction in the risk of injury, but the generality of this finding needs testing. Insufficient research has been done with which to determine the effects of stretching on sporting performance.'

Read it again. The 'generality of this finding needs testing.' The last sentence says it all. 'Insufficient research has been done ...' Add to that 'insufficient quality research has been done.'

Can you believe that the sporting world is now running around using this evidence as gospel?

Herbert and Gabriel have produced a very tawdry report. Basing the findings on the effectiveness of stretching as a method of reducing injury or muscles soreness on a stretching regime that takes 20 seconds if definitely baloney.

Anyone who knows anything about stretching (loosening) knows that 20 seconds is useless. In that time the muscles doesn't even get the message that it's safe to loosen off.

The other flaw in the report is that it takes no consideration of the effect of constant, daily, extended loosening off of ALL the major muscles of the body associated with keeping the skeleton in good alignment and facilitating propulsion and locomotion.

If I were running an elite athlete program I'd make the athletes do at least an hour of yoga a day and probably have them working at the barre for the same amount of time.

This is a research report that never should have been given the light of day, let alone be used to bag the benefits of a regular, systematic and extended muscle loosening program.

20 seconds, bah humbug.

Wednesday, August 21, 2013

Stretching Research

Reports are coming out saying that the latest stretching research is telling people that stretching is useless.

It's baloney.

In the sit down culture it's imperative that you stretch in order to prevent tight muscles from taking your skeleton out of alignment.

If your stretches are not making your muscles looser, chances are you're not doing them for long enough - or often enough.

The western world is experiencing a musculo-skeletal pain catastrophe/calamity/epidemic, caused mainly by tight muscles taking bones out of alignment. Weak muscles exacerbates the problem.

I don't know where this research comes from - probably Pfizzer, Smerk, Roach or the American College of Surgeons!

If every one did half and hour's yoga every day, doctors, physiotherapists, chiropractors and chemists would be sitting around twiddling their thumbs and playing golf most afternoons.

In the meantime stay tuned, highly tuned and keep loosening off tight muscles and strengthening weak muscles.

Monday, August 19, 2013

How Long do you Need to Stretch For?

I think the duration of the 'stretch' is very important. Keep in mind that what we're talking about is giving muscles 'confidence' that it is safe to loosen off. It's not stretching per se, but creating the conditions for the muscle to loosen off that we need to focus on.

I'd say it takes at least a minute for a muscle to get the message it is safe to loosen up, maybe even longer. With lower back pain, you'd want to allocate 20 minutes for each of static back, supine groin stretch and hip crossover. Most people only stretch for 20 seconds and wonder why they never get better.

If you're planning on loosening a muscle, take10 or 20 long, slow breaths and with every breath you breathe out increase the 'stretch', even by the smallest amount.

For instance, with a conventional hamstring 'stretch' with one leg on a bar, with every breath you breathe out, take your navel a little closer to your thigh. With 20 deep breaths you'll make a lot of progress. Tust give the muscle time and respect.

I haven't expressed this in scientific terms but you'll get the message.

Ozone Therapy for Herniated Disc

It's doubtful that any treatment for low back pain comes close to the effectiveness of a set of strength and flexibility exercises, specifically designed to get the pelvis and the bones above it back into better alignment.

This is the gold standard treatment, simple and cost effective.

Research studies on the effectiveness of other treatments that don't compare the effectiveness of those treatments against the effectiveness of a regular, systematic and sustained set of exercises is poor research that leads to poor clinical practice.

Keep in mind too that the exercises most physicians prescribe to their customers, fail to target the cause of the misalignment and lack the frequency, intensity and duration needed to bring about this re-alignment of the skeleton!

For a high proportion of people, low back pain comes not only with a pelvis and spinal column that are out of alignment but a body that is in poor general physical condition.

If your customer can't do a sit up, can't hardly do any press-ups, situps, or squats, can't touch their toes or sit up straight with their legs crossed, is more than 20Kg over weight and doesn't have a regular and systematic strength and flexibility training program, it's highly unlikely that their herniated disc is due to a lack of oxygen therapy.

When it comes to the medical treatment of lower back pain, the medical industry has complicated the simple and made the cheap expensive.

When the Australian National Health and Medical Research Council  (NHMRC) (and other medical institutes around the world) can get away with describing 95% of lower back pain as being idiopathic, you'll know that a high proportion of physicians are poorly trained to know where to look for the underlying cause of the pain, let alone prescribe the simple strength an flexibility exercises designed to restore poor function to good.

These physicians are prime targets for surgeons and drug companies.

Saturday, August 3, 2013

The Fitness Frontline

It's time for the fitness industry to elbow its way into the front line of primary health care for the personally-generated metabolic, musculo-skeletal and psychological dysfunctions.

The disease/medical model of treating these dysfunctions isn't working. The community is being short-changed by the practice of junk medicine, where drugs are used to mask symptoms, rather than restore poor function to good.

It's the wrong prescription. You can't solve fitness problems with medical solutions. It's a swifty, a legerdemain, a fraud.

The fitness industry and all of us as practitioners stand to make a real impact on the 80% of people who never pass through our doors, believing that traipsing through the waiting rooms of doctors is the pathway to good health.

It's time for governments to wind back protection of the medical and pharmaceutical industries in favour of the fitness industry.

In the meantime stay tuned, highly tuned and if your in the fitness industry sharpen you elbows.

Regards and best wishes

John Miller