Fix Back Pain

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Fix Back Pain by loosening tight muscles, strengthening weak

muscles and getting your body back into alignment

John Miller

4/20

Fix Back Pain

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Fix Back Pain

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Hi, I’m John Miller. Thanks for downloading the Fix Back Pain ebook.

Fix Back Pain is a musculo-skeletal health management program designed to help you

▪ maintain good musculo-skeletal function, and/or

▪ restore poor function to good.

If you can get your body back into alignment there’s a good chance your pain will go away. The causes What I’m about to give you is firstly information about the likely causes of back pain. There is definitely more than one cause. If you don’t know the cause, it’s pot luck whether any treatment will work.

The exercises Secondly, I’ll show you some of the key exercises you need to do to get you get your body back into better alignment, strong enough to do every day tasks in comfort - and pain free.

Then you’ll be pain free.

Fix Back Pain also contains

▪ an outline of some of the most common causes of musculo-skeletal dysfunction

▪ some of the basic principles that underpin good function

▪ an assessment section where you can gauge your risk of musculo-skeletal dysfunction

▪ descriptions of some of the key exercises you need to do to get your body back into better alignment. This book goes beyond the tablet, crême, rub down, ray lamp, crunch, hot pad, ice, the vibrator, hanging-up-side-down, electric muscle twitching and the scalpel.

*Crook Back There will be times in this book where you’ll come across the term ‘crook back’.

In Australia the word ‘crook’ is described by the dictionary as ‘sick; disabled; bad; inferior; unpleasant.’

A ‘crook back’ is Aussie-speak for lower back dysfunction, of which pain is the symptom. If you’ve got a crook back you’re experiencing lower back pain. Your lower back is not in good shape. The pain is telling you to do something to get your body back into better alignment.

Fix Back Pain © John Miller, BA, Dip PhysEd, Dip Teaching, RFP July 2012: April 2020 Published Global Back Care.com, a division of Miller Health Pty Ltd john.miller@millerhealth.com.au 7 Salvado Place Stirling (Canberra) ACT, Australia 2611 (612) 6288 7703 www.fitandhealthyonline.com www.globalbackcare.com www.johnmiller.com.au www.hourglassdiet.com

DEDICATION This book is dedicated to my mother, Doreen who gave me the freedom to pursue a wonderful, physically active life as a child and who a few years ago asked me if I knew any exercises that would be good for her back. Doreen passed away in April 2009 at the age of 92.

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ALL RIGHTS RESERVED Fix Back Pain has been written and published by John Miller. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, scanned, or otherwise, except as permitted under Australian copyright law, without the prior written permission of the author.

NOTES TO THE READER

While the author and publisher of this book have made reasonable efforts to ensure the accuracy and timeliness of the information

contained herein, the author and publisher assume no liability with respect to losses or damages caused, or alleged to be caused, by

any reliance on any information contained herein and disclaim any and all warranties, expressed or implied, as to the accuracy or

reliability of said information.

The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of

this work and specifically disclaim all warranties.

The words contained in this text which are believed to be trademarked, service marked, or to otherwise hold proprietary rights have

been designated as such by the use of italics or specific reference. Inclusion, exclusion, or definition of a word or term is not

intended to affect, or to express judgment upon the validity of legal status of any proprietary right which may be claimed for a specific

word or term.

The fact that an organization or website is referred to in this work as a citation and/or potential source of further information does not

mean that the author or publisher endorses the information the organization or website may provide or the recommendations it may

make.

Readers should be aware that the websites listed in this work may have changed or disappeared between when this work was

written and when it is read.

A NOTE OF CAUTION

The advice and strategies contained herein may not be suitable for every situation.

Individual results may vary.

It is the complete responsibility of the reader to ensure that they work within their known limits and take care not to injure or harm

themselves while performing the assessments and exercises contained wherein.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered.

It is sold with the understanding that neither the author nor the publisher is engaged in rendering professional services. If medical,

allied health, psychological, or any other expert assistance is required, the services of a competent professional should be sought.

John Miller Ps, I’m always open to questions, queries, comments, compliments and complaints. If you can help me make this a better book I’d

be much obliged. You can email them to me at:

john.miller@millerhealth.com.au

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CONTENTS All rights reserved 4

Foreword 6

A word of advice 7

1. Are you ready for a breakthrough? 8

2. The inspiration 10

3. The motion starvation conspiracy 12

4. The spectrum of perception 14

5. The knowledge gap 15

6. The quest for the pain free life 16

BACK PAIN PRINCIPLES 17

7. The cardinal rules of joint and muscle pain 18

8. The body as an ecosystem 21

9. The musculo-skeletal firewall 22

10. A word of warning 23

11. The research 25

12. The mechanics of joint and muscle pain 27

13. Causes of lower back pain 30

14. The wisdom of the ancients 41

15. The law of too much 42

16. The law of too little 44

17. The esoteric interpretation of back pain 45

18. The complementary role of manipulative therapy 46

19. The twin pillars of rehabilitation theory 47

20. Formula 1 rehab 48

ASSESSMENTS 49

21. Health climate survey 50

22. Musculo-skeletal risk factor assessment 51

23. Clinical diagnostic assessment 53

24 Subjective rating of the condition of your musculo-skeletal system 59

25. Good ergonomics 60

KEY EXERCISES TO RELIEVE BACK PAIN 63

26. A word about sciatica 64

27. Back pain flexibility training program 65

28. Relaxation exercises 66

29. Flexibility exercises 68

30. General strength training program 74

31. General strength training program at home 75

32. General strength training program in the gym 79

33. Pain relief and therapeutic modalities 82

34. The back pain prescription 85

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FOREWORD The secret to fixing musculo-skeletal pain is getting your body back in alignment. One of the best kept secrets is how to do this; the secret being, strengthening weak muscles and loosening tight muscles. In some ways it’s a bit like fixing up a tent after the ropes have slackened off. This book is designed to provide you with: -

1. clues, insight, awareness and understanding as to what may be causing your musculo-skeletal pain

2. a musculo-skeletal risk factor assessment which will provide you with information about your musculo-skeletal health and your risk of dysfunction

3. detailed descriptions of the key strength and flexibility exercises that hundreds of people have used to get themselves back into better alignment and pain free.

Millions of people the world over are experiencing musculo-skeletal pain, much of it personally generated. In a sense this is good news because if you’ve caused the pain yourself, there’s a better than even chance you can get rid of the pain yourself.

From my surveys of corporate groups, over 50% of people are experiencing constant pain. Most have resigned themselves to putting up with this pain for the rest of their life. The treatment they’ve undergone has not restored poor function to good. In the main that’s because the treatments have not addressed the cause of the pain, plus their therapists have not encouraged them to embark on a regular and systematic strength and flexibility training program.

With over 40 years experience in the PhysEd and fitness industries I firmly believe that for 80% of these people there is an 80% chance they can get their musculo-skeletal system back to 80% of good function, if they are diligent.

Imagine if you could reduce your back pain by 80%? Well, based on my experience you can, not in all cases, but in a significant proportion.

If you do the right strength and flexibility exercises for your condition, there is a good chance your body will get back into better alignment and your pain will disappear or be significantly reduced. Additional therapy, particularly intensive therapy using a range of modalities, as outlined in the Formula 1 Rehab section of the book, will speed up the rehab process.

My back got better when I started to do a selection of the exercises I recommend every night in front of TV for a couple of hours, and at the gym during every fitness class I supervised.

I will always remain indebted to the woman who pointed me in the direction of Pete Egoscue. Until I became acquainted with his work, through his book ‘Pain Free’ and my visit to his clinic in San Diego, I didn't have a real appreciation of the causes and treatment of musculo-skeletal dysfunction.

It was from Pete Egoscue that I learnt the two basic principles of musculo-skeletal dysfunction upon which this book is based:

▪ bones do what muscles tell them to do, and

▪ the cause of the pain is rarely at the site of the pain - trauma excepted.

Three key principles of my own are

▪ in our culture it’s a big ask expecting to stay healthy without keeping yourself fit

▪ it’s a big ask expecting to get better by having someone do something to you; sooner or later you have to do something for yourself

▪ musculo-skeletal dysfunction is a fitness problem. The chances of fixing a fitness problem with a medical solution are quite remote.

J ohn Mi l l e rJ o h n Mi l l e rJ o h n Mi l l e rJ o h n Mi l l e r

April 2020

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A WORD OF ADVICE

FITNESS The Global Back Care Fix Back Pain Program is a fitness program designed to address the problem of skeletal misalignment by the prescription of a targeted set of flexibility and strength exercises. The book stands in the domain of the fitness industry – the strength and flexibility experts. I work on the premise that for a high percentage of people, joint and muscle pain is personally-generated. By this I mean that over the weeks, months, years and decades muscles attached to the skeleton have tightened up and gradually drawn it out of alignment. At the same time, weak muscles have failed to support the skeleton as it goes about every tasks like lifting, pushing, pulling, bending down … That’s the bad news. The good news is that if the pain has been personally generated there’s a good chance it can be personally un-generated. In the sit down, sedentary society, if you don’t have a regular and systematic flexibility and strength training program, joint and muscles pain is almost inevitable. In this case, pain is just the messenger, telling you to get your skeleton back into better alignment. It stands to reason then that once you embark on a specifically tailored flexibility training program, muscles will gradually loosen off and the skeleton will get back into better alignment. With stronger muscles the skeleton will be better supported. The pain will go away. Do it yourself Using the Fix Back Pain ebook you’ll be able to immediately make many of the diagnostic assessments yourself and start doing the flexibility and strength exercises I recommend. See a fitness practitioner who is experienced in diagnosing the likely cause of your joint and muscle pain and prescribing exercises likely to restore poor function to good. MEDICINE It may be advisable to seek medical attention for your joint and muscle pain, particularly if a small problem has turned into a big problem. You may be sent to a radiologist, after which you’ll receive a report which will tell you what’s happened. The report will let you know if discs have been herniated and highlight the tearing of ligaments, tendons and muscles. Medical support in one form or another may be prescribed. See a doctor who is experienced in the diagnosis and medical management of joint and muscle pain. PHYSIOTHERAPY A physiotherapist will have a detailed understanding of which muscles are likely to require therapeutic assistance of one form or another as well as providing you with exercises which will speed up the process of restoring poor function to good. See a physiotherapist, for therapeutic assistance particularly if you are unsure whether the Fix Back Pain program is the right one for you, if you’re struggling to fix the problem yourself or you want to speed up the rehab process. DEEP TISSUE MASSAGE The hands of a trained masseur may also speed up the rehab process by helping to release tight muscles. See a masseur. YOGA If everyone did yoga three times a week, doctors, physiotherapists, masseurs, radiologists, surgeons and chemists would be sitting around twiddling their thumbs. You can be pretty certain that the flexibility exercises anyone prescribes have their origin in the ancient science of yoga. Yet thee to a yoga teacher.

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1. ARE YOU READY FOR A BREAKTHROUGH – or more of the same? Fix Back Pain is a program designed to give you insight into what has caused your musculo-skeletal system to become dysfunctional and to provide you with some of the key exercises you need to do to restore good function. If you do the exercises outlined in this book on a regular and systematic basis, you can expect a dramatic improvement in your musculo-skeletal health. As your skeleton becomes better aligned, as the muscles designed to support it in better alignment become stronger, you can expect your pain to decrease.

IN THE BEGINNING A few years ago while I was working at the Australian Institute of Sport in Canberra I got a painfully sore back. It hurt when I got out of bed, it hurt when I sneezed and when I coughed. I could hardly bend over the basin to clean my teeth it hurt so much. I'm not sure what got the blame at the time, probably the rowing machine! I started doing more back strengthening and flexibility exercises and on a scale of 1 - 100, (1 being wretched and 100 being absolutely fantastic) it went from about 20 to 70, and there it stayed for about five years. I resigned myself to putting up with it forever: ‘John, you’re getting older, put up with it!’ When I look back on it now I realize that the exercises I was doing were necessary but not sufficient, and isn't it usually the case that if you keep doing what you’re doing, you’ll just end up getting more of the same? Then one Saturday morning in April 2000, I volunteered to take an early morning stretching class for the National Speakers Association Conference in Canberra. As I got out of bed at 5.30am my first thought was 'Why am I doing this? What's in it for me?’ My wife, Christine was more to the point. She said, ‘Are you getting paid for this?’ I said, ‘No, it’s a love job’ and slipped out the door. At the time I didn't realise the chain of events that this opportunity would lead to. It didn't take long to find out. One of the women in the class showed me a new exercise, the hip crossover and asked if I had a copy of Pete Egoscue's book, 'Pain Free'. I hadn't, but a couple of weeks later I bought a copy and started doing some of the exercises he recommended. My back got a bit better. But I still wasn't happy. Maybe I needed a new bed; blame the bed! I’d met a man a few years before who was on workers compensation for back pain and his insurer had bought him a new bed. It sounded like a good lurk. In August 2000 my wife Christine and I went to the West Coast of America for my daughter Jo's wedding. While in America we visited the Egoscue Clinic in San Diego as paying customers. We went through their evaluation and spent a couple of days being supervised in a back care routine designed specifically for each of us. We also attended four early morning conditioning sessions and this is where I found myself wanting. I was pathetic at doing situps with my feet held. I couldn't do a superman back arch, it hurt too much. These are exercises I'd been led to believe were contra-indicated. They said, 'Just do them'. I couldn't do the air bench leg strengthening exercise for more than 15 seconds. The calf stretch was painful. They proved to me my shoulders were lacking in strength. I had lost the ability to successfully do the wheelbarrow exercise, where someone holds your legs while you walk around on your hands. They prescribed more exercises and different exercises to the ones I'd been doing. I was running a fitness centre at the time. I thought I was reasonably strong and flexible. I was wrong. No wonder I still had lower back pain. We arrived home in Canberra the night before the opening of the Sydney Olympic Games. I spend most of my evenings over the next couple of weeks lounging around watching television and eating chocolate sultanas. My back went from 70/100 back down to about 10/100. It felt worse than it had ever felt. All I got out of the 2000 Olympics was a crook back and a fat guts! Then I started thinking, ‘What’s holding me back from having a musculo-skeletal system in great shape. Is it laziness, ignorance, stupidity or attachment?’ Looking back now it was all four. I had to start doing something different.

That's when the penny dropped. I became serious about doing more of the exercises I needed to do to get my body back into alignment, in particular strengthening my abdominal and back muscles and loosening off calves, hamstrings and buttocks.

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I introduced more of the Egoscue exercises into the flexibility sessions in the concluding 20 minutes of my fitness classes.

I spend a couple of hours at home each evening in front of the TV doing three exercises, static back, supine groin, hip crossover and prone frog. I started doing the sit-up-straight exercise. It took me six months to stop falling over backwards I was so tight.

Gradually, over the next two months my back started to get better. Then one day I found I could sneeze and cough in bed without feeling like I had a red hot poker being rammed into my back.

In about six months time I started telling people it was back up to 90%. I only felt a twinge very occasionally and then not much.

24 months later and it was back to 95%. I did most of the exercises in this book seven or eight times a week in my fitness classes.

Now, nearly 20 years later, I’m not 97% fat free but I’m 97% pain free. I'm more conscious of my posture when I'm sitting at the computer - doing my best to maintain the 'S' shape, rather than a 'C' shape in my spine. (The best advice your mother ever gave you was to 'sit up straight'. The best advice I can give you is to sit with your abdomen pressing in against the desk and the back of the chair pressing in up under your shoulder blades.)

I'm not sure which exercises did the most good (I suspect there was a synergistic effect from doing them all), but if I had to single out a few important ones they would be: -

Static back

Supine groin stretch

Hip crossover

Sit up straight

Wall sit

Prone frog

Situps

Superman

If you’ve got back pain, after a couple of months doing these exercises for a couple of hours a day you should feel a whole lot better. You may start to feel an improvement after a few days.

Most people underestimate the time they need to spend doing the exercises, at least initially. Doing an exercise for a minute isn’t sufficient. For instance I recommend you do the hip crossover for about 40 minutes, five minutes one side, five minutes the other side, over and over again. In the supine groin, static back and hip crossover exercises let gravity do the work of relaxing some of the deeper muscles that are holding your body out of alignment. Because of the time it takes I recommend you do the exercises while you’re watching TV.

Hippocrates said something to the effect that the physician speaks with more authority if he's had the disease. Well, lower back pain is not a disease and I’m not a physician, but I can tell you one thing, I’ve had a crook back and it got better and I'm pretty certain that if you are diligent and willing to spend time on the floor doing the exercises I recommend, you can fix yours up too.

So who do I have to thank for all of this? Well, it started at the Speaker's Association Conference at 6 o’clock one April morning. What goes around comes around.

I want to thank my daughter Jo for giving us the reason to go to America and my daughter Lisa for her persistent encouragement. I want to thank my wife Christine who continues to inspire and motivate me to practice what I preach, and supports me in this work, and my mother, Doreen for asking, ‘Do you know any exercises that would be good for my back?’ Finally I wish to thank my business partner, Gavin Gilmour for his work in developing the Global Back Care website. So, are you ready for a breakthrough, or more of the same?

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2. THE INSPIRATION Let me lay out my credentials. I started my professional career as a physical education teacher and now earn my living as an author, public speaker and corporate health seminar presenter in the field of health, fitness and wellbeing. My most popular corporate health program is the Global Back Care Clinic based on the principles outlined in this book.

I’ve run a fitness centre.

In my time I’ve had back pain, shoulder pain, hip pain, knee pain, Achilles tendonitis and plantar fasciitis. I’ve experienced twinges in my knees and left hip. Hippocrates said, ‘The physician speaks with more authority if he’s had the disease.’ Whilst I’m no physician and joint and muscle pain is not a disease, I’ve worked out how to relieve the pain and restore poor function to good.

My work is directed toward inspiring and motivating people to keep themselves fit and healthy to the best of their ability, and encouraging them to open the doors of perception about what they can do to keep themselves in good shape.

To this extent I'm a critic of junk medicine; that is, medical practice in which pharmaceuticals designed to mask symptoms are the most common form of prescription. This type of medicine has narrowed the perception of how fit and healthy you need to be and has narrowed the selection of recommended options for getting your body back into good health, if and when any of your body systems become dysfunctional. It’s seduced people into thinking they don’t have to be physically active to stay healthy. It’s bunkum!

I stand in awe of the real medicine that only a few short years ago would have been nothing short of a miracle.

It is a general perception within our society that as we get older we can expect, as a matter of course, to become prematurely less healthy and more dysfunctional, as though we have no control over the matter. But we don’t lose mobility and function because we get older, we lose mobility and function because we don’t keep ourselves in good shape. Use it or lose it! Most people are quite capable of keeping themselves in reasonable shape until they’re well into their 70’s or 80’s.

What’s happening in our culture is that people are becoming older younger! They might be living longer, but the quality of their lives is diminished by their declining health status.

Leaving all that to one side, you’ve purchased this book because you have a particular type of musculo-skeletal dysfunction. I hold the optimistic belief that by doing the exercises I’ve recommended, there’s a good chance you’ll be able to restore poor function to good, significantly reduce your pain and/or become pain free. Doing the exercises in conjunction with a wide range of therapeutic modalities will speed up the rehab process.

Abraham Lincoln said ‘Most folks are as happy as they make up their minds to be.’ The same sort of principle applies to health generally and musculo-skeletal health in particular. The body is an amazing, complicated masterpiece with wonderful recuperative powers. Your task is to work out how to stimulate those powers. I believe that with only a few exceptions we have the power to make things better for ourselves, and that applies to fixing up our musculo-skeletal dysfunctions.

First, find what caused the problem and then work on fixing it.

I’ve been inspired by a lot of people.

I've read a small amount about Ida Rolfe and her Rolfing technique, mainly from Michael Murphy and Will Schutz. I'm certain that body-work is something we'd all benefit from. More importantly though, the work of these three people has stimulated in me a much better awareness of the body as an ecosystem. I love this quote about Rolfing:

Just as a tent will twist into a new shape with the re-tensioning of a single guy-rope, so the different parts of the body will tilt, shift and rotate in response to strain, warping into new and often dysfunctional relationships with each other and changing the relationship of the body as a whole to its larger environment.

The mind-body relationship is picked up again in the homoeopathic tradition, where one takes a 'head down, inside out and back in time' approach, first in the search for the cause of a dysfunction and then in its treatment.

Then there’s the esoteric ‘stuff’. Most people who’ve read Louise Hay’s book, 'You Can Heal your Life' have come away with a deeper insight about the cause and nature of their dysfunctions. For instance in her classification, low back pain is driven by fear and worry about money, knee pain by stubbornness and resistance and lower leg pain by fear of stepping forward into the future. Sore shoulders come from carrying life’s burdens and a sore neck is associated with either yourself or someone close to you being a ‘pain in the neck’. It’s all grist for the mill.

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The books written by therapeutic specialists provide differing interpretations as to what you need to do to get better. They’re worth reading. It’s my belief that therapy helps speed up the rehab process, but doesn’t take the place of the things you need to do for yourself.

I believe that a multi-modal approach to rehab is the way to go. The results of physiotherapists, chiropractors, massage and other therapists speak for themselves. The testimonials are too glowing to ignore. But having said that, I believe that the power of any type of therapy is enhanced by a good set of exercises.

Whilst bones may become better aligned and muscles may become looser by having someone do something to you, keeping the bones aligned by strengthening weak muscles and loosening tight muscles is something you have to do for yourself. I'm standing on Pete Egoscue’s shoulders because he provides a compelling, thoughtful and optimistic analysis of the likely causes of the common forms of musculo-skeletal dysfunction, backed up by the exercises to fix them.

If you suffer from back pain, I recommend you buy his books and go one of his clinics.

I know that the Alexander Technique brings good results for those who practice it, and having been to a Feldenkrais workshop know that it is a powerful force for good.

The modern physical education profession developed from the German and Swedish military style of physical conditioning. It’s the forerunner of what goes on in modern fitness centres and boot camps. But as the fitness industry continues to develop it is taking more and more from the Eastern meditative and gentle exercise traditions. If you've got any sort of musculo skeletal dysfunction I recommend you take an interest in yoga and tai chi.

And now as we reach the end of the second decade of the third millennium we have access to an increasing number of programs, gadgets and pieces of equipment, designed to help get your bones in better alignment. Some, like Sarah Key’s backblock and Ma Roller, and the Sacro Wedgy are simple, inexpensive and worth using. The electric Shiatsu cushion, with kneading rollers moving up and down your back is a back pain sufferer’s delight.

From this … … to this

(Model based on Alexander)

Long, slow deep mechanical massage from calf and foot massage machines greatly assist in the treatment Achilles tendonitis and plantar fasciitis. Andrew Weil, MD, introduced me to several concepts: his own 'Don't go to doctors for things doctors can't heal', and that of Lao Tzu who said 'the biggest problem in the world could have been solved when it was small'.’

Although this has got nothing to do with fixing musculo-skeletal dysfunction, I’m a great fan of the late James Rohn, international public speaker. I just love the mellifluous voice. His explanation of the parable of the sower is illuminating. Just as the sower kept on sowing so you can keep on training. Sooner or later you can expect some improvement in your condition, 30%, 60% or 100%.

For my part I've attempted to open the doors of perception and expand the spectrum of treatment, based on what I've read, seen, experienced and thought about. The rehab barometer comes from the success of sports medicine in dramatically speeding up the rehab process with intensive multi-modal treatments. Being a physical educator it's natural that there are sections on general strength training. And when I read some of the older books on arthritis, and reviewed the claims made about the nutraceutical products from the health food industry, there seemed to be good reason to include information about diet.

Finally I wish to acknowledge the inspiration I’ve received from countless people who have said to me, ‘Have you seen this exercise?’ ‘Have you read this book?’ Have you seen this piece of equipment?’ Many of the exercises in this book have come from these people. To them I am most grateful.

Except in the end stage, you can’t treat a fitness problem with a medical solution.

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3. THE MOTION STARVATION CONSPIRACY

The back side of the Western world.

When John Kennedy said, ‘The softening process of our civilization continues its persistent erosion’, you could have added, ‘He ain’t seen nuthin.’ Fifty years later he’d be rolling his eyes through to the back of his neck if he could see just how much softer people had become. This softening process is the major contributor to musculo-skeletal (and metabolic) dysfunction. Which ever way you look at it there is a conspiracy to strip motion out of our lives, to dumb down our health, fitness and wellbeing. There is a second conspiracy to get as much energy into our bodies in the shortest time, in the smallest possible package and at the lowest cost. The effect is the epidemic of self-generated musculo-skeletal, metabolic and psychological dysfunctions. Think about it. We’re hell bent on being as physically inactive as we can possibly be. The species designed to draw water, chop wood and climb trees can no longer tap a keyboard or push a pen without coming down with a crook back, stiff neck, ’cold’ shoulder, bung hip, game leg, dicky knee or limp wrist. Days that a few short years ago were spent walking, running, cycling, digging, lifting, pushing and pulling are now spent sitting down. You can sit down on the way to work, you can sit down all day while you’re at work and when you come home you can sit down until the wee hours of the morning in front of the TV screen. Never in history has there been so much sitting down. If we at least squatted it would be better for us, particularly our backs. I can give you a case in point. When I was a small boy, Mondays in our household were a day of frenetic activity. My mother had to chop the wood to heat the copper. Once the clothes were in it she had to agitate them with a big white stick - bleached by heat and Rinso. Moving a tub full of sheets was no mean feat. Once boiled the clothes would be levered on the end of the stick into the first trough for a rinsing. Then it was through the mangle and into the second trough for the second rinsing. Then back through the mangle into the basket and out onto the line. With a family of 6 there was a lot of work done on Monday mornings, my mother getting an exceptionally good workout, for free. Nowadays most of that work is done by the washing machine. It’s got an inbuilt agitator. It spins off most off the water. You can even avoid hanging the clothes out by stuffing them into the dryer. Designers of engineering marvels, small and large have unwittingly conspired to remove physical activity from our lives and unless you have a strategy to put some of that activity back into your life you’re facing grave consequences. In schools it’s now normal for children to be cooped up all day. It’s most un-natural. In an era when maths, science and English are the top dogs in the curriculum, children are moving around less and sitting down more. Poor child health is the foundation of poor adult health. It’s certainly the foundation of poor education.

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I see people who can’t do a sit up, can’t do a pressup, can’t squat down and up, have great difficulty sitting on the floor and standing up again, can’t hold the Superman pose for a minute and yet they wonder why they’re experiencing some sort of musculo-skeletal pain. No-one has ever told them that the underlying reason for their dysfunction is that they’re the victims of self-induced motion starvation. It is bizarre.

DON’T MENTION THE F WORD ‘Fitness’, the word that dare not speak its name.’ When musculo-skeletal dysfunction is one of the prime reasons why people end up in the surgery, you’d think doctors would regularly check to see whether their customers were physically fit, whether their strength, flexibility, mobility and skeletal alignment was adequate, whether it was improving or getting worse. That it should come to this; over the weeks, months, years and decades, people are becoming weaker, tighter, fatter, less mobile and further out of alignment; getting closer and closer toward the edge of the back pain cliff. They are quite unaware of what the softening process is doing to them. This decline in strength, flexibility and mobility on the part of people who don’t train is as inevitable as it is predictable, as well as it is preventable. In Fix Back Pain I let you know what you need to measure as part of your musculo-skeletal health management program. I give you a set of strength, flexibility, mobility and skeletal alignment standards to aim at.

PERSONALLY-GENERATED MUSCULO-SKELETAL DYSFUNCTION In this book I keep referring to the concept of personally-generated musculo-skeletal dysfunction. The incident gets the blame. The injury grabs the limelight. The underlying, personally-generated cause, lurking in the background, gets off, Scott free. It’s almost as if you need to ask yourself the question posed by Werner Erhard, ‘What is it in the background that appears as a breakdown in the foreground.’ You’d want to ask yourself, ‘Why has this happened to me? Where has it come from? What could I have done to avoid it? What can I do to restore poor function to good?’ So, the moral of the story is: 1. Keep yourself strong and flexible. 2. If you become dysfunctional, start training and improve your strength and flexibility. Any therapy that goes with it will speed up

the rehab process.

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4. THE SPECTRUM OF PERCEPTION

I'm indebted to Colin Wilson (The Outsider) for introducing me to the concept of the spectrum of perception, which in turn goes back to Huxley, Yeats and Blake. As Blake said, ‘If the doors of perception were cleansed (opened) every thing would appear to man as it is, Infinite. For man has closed himself up, till he sees all things thro' narrow chinks of his cavern.’

Modern medical practice is closing the doors of perception about

a. what we need to do to keep ourselves fit and healthy and

b. what we can do ourselves to restore poor health to good.

Open the doors of perception.

Professional healers have a tendency to get locked into narrowly defined positions by their education and then by their professions. It is for this reason that as therapists we tend to provide people with a narrow interpretation of what's caused a particular dysfunction and a narrow range of treatments to fix it up. My own profession in no less guilty than others.

Looking at the diagram, at one end of the spectrum are treatments based on the feeling, experiential and shamanic traditions - reike, acupuncture, a range of herbs and spices, auto-suggestion ... They’ve been around for a long time. They work for some people, they might work for you. The fact that we don't know why some of these treatments work shouldn't stop us from trying them. Take acupuncture; it's been around for a few thousand years and researchers still have difficulty putting a finger on how it works.

Conventional medical and allied health industries have taken the middle position on the spectrum of treatments. They involve someone doing something to you. Some of these treatments mask symptoms (junk medicine), others stimulate the rehab process.

At the other end of the spectrum are the things we can do for ourselves to get better - to become stronger, more flexible and healthier.

It’s time to open the doors of perception about what you can do to keep yourself fit and healthy.

ONE SIZE RARELY FITS ALL

Experience suggests that one size rarely fits all and that in working through a range of therapeutic modalities, there's a good chance that you'll find one or more that make a contribution to fixing you up. It is an individual matter.

My greatest encouragement is for you to listen to and read about what other people did to fix themselves up. In this respect the internet, particularly YouTube provides a marvellous resource. If it worked for them, maybe it will work for you too, regardless of what 'the experts' may say. Then, if it works, it works: if it doesn't it doesn't and what have you lost?

The pain is nature’s way of telling you to get your skeleton back into better alignment.

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5. THE KNOWLEDGE GAP When it comes to searching for the cause of the personally-generated musculo-skeletal dysfunctions there appears to be a gap in both literature and practice about what to look for and where to look for it. The gap extends from medical research, through radiology departments, into surgeries and from there spreads out through the broad range of therapeutic modalities. There is a cause, in fact it is usually more than one cause of most of the personally-generated musculo-skeletal dysfunctions; you just have to know where to look for it. There are clues that are not difficult to detect. Think about it, we’re dealing with body mechanics here. If we were motor mechanics we’d be out of a job if we didn’t know what to look and listen for when someone brought their car in for repair. A frequent cause of back pain is a herniated disc or as one radiology report outlined, ‘ … there is a central disc protrusion with a focul annular tear … facet joint arthropathy and ligamentum flavum hypertrophy … there is a disc bulge which is paracentral to the left side and extended in to the foramen and far laterally … there is mild crowding of the cauda equine ….’ Whilst it’s all well and good to know what’s going on in your back, we need to go back a stage and find out what has caused the ‘central disc protrusion with a focul annular tear … facet joint arthropathy, ligamentum flavum hypertrophy … and disc bulge.’

Overlooking the need to search for the cause is why people end up at the chemist shop. But pain masked is not problem solved. Back pain is not caused by a lack of medication! Whilst this may be a generalization, in the manipulative therapy industry there is always the temptation to rub, crunch, heat, vibrate, electronically twitch or shock the spot where it hurts and not treat the underlying cause(s) of the problems caused by tight muscles taking the skeleton out of alignment and a lack of muscle strength. This is understandable; it’s what the customer expects. It’s the quickest way to relieve pain. How good it is in the long term is debatable, particularly if the problem is generated by a lack of strength and flexibility in parts of the body far removed from the place where it hurts. As a rule of thumb, if the problem is generated by a lack of strength and flexibility then failure to prescribe strength and flexibility exercises falls short of the mark of best practice. The gap seems to be narrowest in the fitness industry where practitioners have an intuitive feel for these matters. They know that people who have a regular strength and flexibility training program are less likely to suffer from poor musculo-skeletal health. They know that pushing out, pulling back, pushing up and pulling down against a resistance does wonders for musculo-skeletal health – as does 20 minutes of flexibility exercises at the end of a workout. Closing the gap The encouraging note in all of this is that the knowledge gap is not very wide and closing it is not a tough assignment. This book is designed to provide you with clues as to the cause of your dysfunction and ways to speed up the rehab process.

THE ENEMY IS WITHIN

There is no need to sally forth, for it remains true that those things which make us human are, curiously enough,

always close at hand. Resolve then, that on this very ground, with small flags waving and tiny blasts of tiny

trumpets, we have met the enemy, and not only may he be ours, he may be us.

Walt Kelly

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6. THE QUEST FOR A PAIN FREE LIFE

Your quest is to search for the causes of your pain then treat them. There may certainly be more than one cause and different therapists may provide you with different insights. Limiting yourself to one therapy is probably not the wisest thing to do. Ignoring the role that strength and flexibility exercises play in the process is particularly unwise.

When looking for causes, bad luck is often tagged as the usual suspect. The real causes, poor posture, misalignment of bones and a lack of strength and flexibility are frequently discounted.

Most people with back pain have a personally-generated musculo-skeletal dysfunction. Tight muscles have taken the pelvis and the bones above it out of alignment. That’s the bad news. Pain is the symptom that this has happened The good news is that if the pain is personally generated there’s a fair chance it can be personally ungenerated with the right amount of the right exercise, particularly if you can catch the problem in its early stages.

I usually work on the Pareto Principle, the 80:20 rule. By this I mean that for 80% of people, 80% of musculo-skeletal dysfunction is eminently fixable, to the point where function is restored to 80% of normal, (in about 80 days) providing you work at it.

For some people, starting a general strength and flexibility training program is sufficient to restore musculo-skeletal function to normal. If you're lucky the dysfunction can disappear almost overnight.

For others it may take a few short weeks or months. For some it may take a year of continuous exercise and therapy. In my own case it took a couple of months for my back to get better, two months for my hip to get better, four months to get rid of Achilles tendonitis, a month to get rid of knee pain and plantar fasciitis and twelve months for my shoulder pain to disappear.

Some people need even more time than that, with a more specific program to strengthen, loosen and realign their bodies.

As for the time it takes to get back in alignment, it may be related to the time it took for the dysfunction to appear. Unlike a sprained ankle, which happens in the twinkling of an eye, back pain can take 20 years to develop. Whilst it will take less time than that to fix it up, it may take months rather than days or weeks.

If you fall into the 20%, where neither a general fitness nor a specific strength and flexibility program worked, at least you know you gave it your best shot before you resigned yourself to either long term chronic dysfunction or a more radical medical solution. Most people underestimate they amount of time they need to set aside during the first couple of months of a musculo-skeletal rehab program. A couple of half hour sessions with a therapist are not sufficient. It’s why a lot of people never got better.

Life has been a harsh struggle since the beginning of mankind; nature is not kind to creatures lacking awareness.

Moshe Feldenkrais

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Back Pain

Principles

If we spent a good deal of the day squatting like this, the Incidence of lower back pain would be reduced dramatically.

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7. THE CARDINAL RULES OF JOINT AND MUSCLE PAIN

A body in alignment stays in alignment unless acted upon by a force. When it comes to musculo-skeletal dysfunction, the forces that take bones out of alignment are forces that come primarily from within your own body. The enemy is within. These forces are very subtle, so subtle that over the years and decades you aren’t even aware of their action until, suddenly, bammo, there’s an incident where you’re tipped over the edge into some sort of musculo-skeletal pain.

The incident gets the blame. Attention is diverted away from the real culprit. It stands to reason that if the blame is misplaced, then likely as not the treatment will be misdirected.

My approach to musculo-skeletal dysfunction rests on the following assumptions.

▪ It’s a system problem that needs a system solution.

▪ Look after the system and the parts will look after themselves.

▪ Muscles cause bones to move out of alignment. That’s the bad news. The good news is that muscles can be retrained to move bones back into alignment – just start doing the right strength and flexibility exercises.

▪ If you have joint pain, the pain is telling you that the muscles designed to keep that joint in correct alignment are not doing their job properly. Some of those muscles are far removed from where the pain is.

▪ The pain in your joints and muscles is telling you to realign your bones.

▪ The cause of the pain is rarely at the site of the pain (trauma excepted), so the rub down, crunch, hot pad and a snip at the spot where it hurts doesn’t treat the cause of the problem.

▪ Every dysfunction has a cause. Find the cause and treat it. Musculo-skeletal dysfunction rarely comes from 'out of the blue'. It's stretching things a bit far to keep blaming bad luck, the chair, the steering wheel, the step, the box ... There is a cause, lurking in the background.

▪ If you can't find the cause, your search for the cure is likely to be fruitless.

▪ It's a big ask expecting your body to get better by having someone do something to you. Soon or later you have to do something to yourself - like the exercises, which strengthen, loosen and bring the body back into better alignment.

▪ Musculo-skeletal dysfunction is most likely the symptom of a fitness problem.

▪ You can’t solve a fitness problem with a medical solution.

▪ If a fitness problem becomes a medical problem then it needs to be solved with a medical solution.

▪ Musculo-skeletal dysfunction is eminently fixable - particularly if you catch it early enough. If you catch it too late then you may need a medical fix. One is cheap and simple, the other expensive and complicated.

▪ Drugs to mask the pain do nothing to get bones back into better alignment.

▪ You can’t out source your own strength and flexibility training program.

▪ To crunch bones back into alignment, without retraining muscles to keep the bones in alignment, misses the point. Whilst a quick crunch may realign the bones, the muscles will pull them back out of alignment again, necessitating another crunch, and another, and another ...

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▪ Musculo-skeletal dysfunction goes with a body that is generally in poor condition. The aim of a good physical conditioning program, one which includes the aerobic, strength and flexibility elements of fitness is to restore poor function to good function in the shortest possible time.

▪ Musculo-skeletal dysfunction goes with a body that’s 20Kg of more over weight.

▪ If you can't work out the cause yourself, and it is often difficult to analyse your own posture, go to someone who can; someone who has a good eye for spotting misalignment, someone who can give you a thorough postural assessment. This may be a masseur, yoga teacher, physiotherapist, osteopath, fitness practitioner, physical educator, doctor ..., but certainly make sure it is someone who has a good reputation in the field of postural analysis.

▪ Most big problems start of as small problems that you don't address.

▪ The most likely cause of musculo-skeletal dysfunction is misuse of one sort or another, usually over a long period of time. If you've spent 20 or more years sitting down at a desk all day in the slump dog position and don't have a regular and systematic strength, flexibility and postural alignment program you can be certain that you're on the way to musculo-skeletal dysfunction; that’s if you don’t already have it.

▪ Getting someone to give you an anti-inflammatory tablet and a rub down might give you a warm feeling under your singlet for a couple of days but it won't provide the long term fix which comes with strengthening and loosening the muscles that are designed to keep your body in correct alignment.

▪ Treat joint and muscle pain as a symptom of dysfunction not a cause.

▪ The body acts as a unit and dysfunction in one area may lead to dysfunction in another area. For instance, wrist pain may come from a shoulder dysfunction, which in turn may come from a pelvis dysfunction which in turn may come from tight hamstrings or feet that are out of alignment.

▪ The cause of the pain is rarely at the site of the pain (trauma excepted).

- Tight muscles attached to the pelvis - front, back and sides - will alter the alignment of your pelvis. If one side is tighter than the other your pelvis will tilt, twist and move out of both horizontal and vertical alignment. The collateral damage is back, neck, hip, knee, Achilles and foot pain ... As bones get dragged out of alignment, you’ll feel the pinch in ligaments tendons and muscles throughout your body. In the vertebral column, discs will become herniated and press into your spinal column and interrupt the signals going down your sciatic nerve.

- A misaligned pelvis and feet that are not square will contribute to knee pain, hip pain and foot pain.

▪ Most people have slight postural imperfections, which end up causing pain in other parts of their body. It may take years and years for the problem to manifest itself as pain. You can spot these imperfections quite easily;

- feet splayed out - heels leaning in - knees knocked in or out - bandy legs - hamstring and buttock on one side tighter than on the other side - one shoulder lower than the other - backs of the hands facing forwards in the gorilla posture ...

▪ Postural imperfections are magnified and exacerbated by such things as slouching over the computer, holding the phone between ear and shoulder, and by hand and foot dominance in the sports most regularly played. For many men, placing their wallet in the right back pocket of their trousers twists their pelvis every time they sit down. After 20 years they’re permanently twisted and wonder why they’ve got back pain. The last thing you want is a therapist getting their hands on your wallet!

To gauge how simple procedures carried out over a long period can affect your posture, Try turning your head to the side opposite to that which you normally turn to when you are reversing your car. Feel what it’s like to wipe your bottom with the ‘other hand’ and see how unnatural it feels.

▪ An X-ray and an MRI scan are probably less useful tools for the diagnosis of the cause of your dysfunction than the eyes and a camera. The latter is more likely to provide you with graphic illustration of the nature of your dysfunction. You can send photographs of yourself in various postures to the http://www.globalbackcare.com website and have us provide you with clues as to the cause of your dysfunction.

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▪ It's not the chair, it's how you sit in it. Once you habitually change the natural 'S' shaped curve of your spine into an habitual 'C' shape curve you're setting yourself up for lower back, neck and shoulder pain.

▪ If you habitually cross your legs, or place one leg behind the other while sitting at your desk, you may end up with knee pain. You can work out for yourself what the remedy is!

▪ If muscles are not getting stronger they're getting weaker. If they're not getting looser they're getting tighter. People without a regular and systematic strength and flexibility training program are setting themselves up for musculo-skeletal dysfunction.

▪ Don't ask what your therapist can do for you, ask what you can do for yourself.

▪ Don’t leave it to a therapist to take full responsibility for your dysfunction. If you do something to yourself, like strengthening, stretching and managing your posture better, there is a good chance you’ll restore poor function to good.

▪ Therapy helps speed up the rehab process but it doesn’t take the place of the things you need to do for yourself.

▪ You're wasting your time going to doctors and therapists who don't do their level best to determine the likely cause of your dysfunction and who don't attempt to affect a cure. Whether you’re into masochism or touchy-feely, it’s an expensive exercise.

▪ An anti-inflammatory, a muscle relaxant and a cortisone injection are unlikely to cure your dysfunction! By all means take them to relieve the pain, just don’t think they take the place of rest, followed by your own strength and flexibility training program.

▪ Some therapies when used on their own only provide temporary relief from the symptoms and are not aimed at fixing the underlying cause of the dysfunction.

▪ It is poor form for someone to do something to you without giving you some insight as to what has caused your dysfunction and without supplying you with exercises to go with the therapy.

▪ It is an advanced case of stupidity not to do the exercises that a good therapist provides.

▪ Stretching is necessary but not sufficient. You need to strengthen the muscles which support your body in correct alignment, with specific strength exercises as well as the general exercises that come as part of a regular and systematic strength training program.

▪ Nutritional supplementation may make a significant contribution to easing joint and muscle pain. I've heard optimistic reports about glucosamine, chondroitin sulphate, brassica juncea, green mussels and vitamin B5.

▪ There is a synergistic effect when it comes to restoring poor function to good. Use a wide range of modalities, regularly and intensively to speed up the rehabilitation process. Most people spend less time in two years than an elite athlete would spend in two weeks. That's why they never get better.

▪ Stacking a range of modalities up one on top of the other and increasing the intensity of the rehab process may speed up the recovery process. This is what sports people do to get better quickly. I call it Formula 1 Rehab.

▪ If you're on workers compensation for musculo-skeletal dysfunction, treat the rehabilitation process as a full time job. If you're used to spending eight hours at work, spend eight hours doing what athletes do to get better quicker.

▪ When you embark on a strengthening program, work at an intensity level that doesn’t cause pain. Work up underneath the point where it hurts. Gradually over the weeks and months you’ll be able to lift heavier weights for more repetitions without it hurting; the pain will go away.

▪ In any strength and flexibility program, from time to time you may feel twinges. You may even injure yourself. This is normal. Put up with it. Train easier on the injured muscles until they get better.

▪ If you only do your strength training once a week, you may be stiff and sore the next day. It’s best to train three times a week, for best results.

▪ In the case of the personally-generated musculo-skeletal dysfunctions, the search for external causes is pointless. The enemy is within.

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8. THE BODY AS AN ECOSYSTEM The body is an ecosystem. What this means is that all parts of the body are connected.

Soma - the ‘body’, Psyche - the mind If something goes wrong with one part of the system,

a. there’s a fair chance that it will stimulate the symptoms of dysfunction in another part of the system and/or

b. it may actually bring about dysfunction in another part of the system.

In this respect we’re familiar with the psycho-somatic relationship. What’s going on in the mind, particularly the subconscious mind may show up in other parts of the body as high blood pressure, irritable bowel, sleeplessness, rashes, musculo-skeletal pain …

What we are less familiar with is the somato-psychic relationship, where things happening in other parts of the body will affect our mind. One thing I know is that people with back pain are more likely to be miserable than people who don’t have back pain.

THE MUSCULO-SKELETAL ECOSYSTEM The musculo-skeletal system is an ecosystem in its own right. Tightness or weakness in one part, may lead to misalignment and pain in another. Hence the maxim, the cause of the pain is rarely at the site of the pain.

In my experience it’s a pretty safe bet that lower back pain, sore shoulders and a stiff neck are intimately associated with tight muscles attached to the pelvis.

The key homeopathic principles are head down, inside out and back in time. In the musculo-skeletal arena the principles are:

▪ the foundation of alignment starts with the feet, the legs and the pelvis. If they’re out of alignment you can be pretty certain bones further up the body will be out of alignment.

▪ because it can tilt forward, back, up, down and around the pelvis plays an especially critical role in the alignment of bones above and below it.

Human nature is such that we are frequently prevented from seeing that what is taken for today’s unorthodoxy is

probably to be tomorrow’s convention.

Charles of Windsor

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9. THE MUSCULO-SKELETAL FIREWALL If your aim is to keep yourself at arms length from the medical and therapeutic industries, you’re going to have to put in place a musculo-skeletal firewall. Whereas therapy is a cost, putting in a firewall is an investment. Being dysfunctional to the point where you’ve got to go and get therapy means putting up with a lot of pain and angst, and wasting massive amounts of time and money.

Your personal firewall is the strength and flexibility exercises you do to keep your body in alignment. Less than 10% of people have a decent strength and flexibility training program. Make a choice, a bit of time and effort doing some exercises, or a lot of pain, time, and expense at the therapists.

THE DISTINCTION We need to make the distinction between injuries and dysfunctions. Dysfunctions are personally generated. Injuries are the result of accidents. However people with musculo-skeletal dysfunctions predispose themselves to injuries that someone in better shape may avoid. The classic example is an ‘injury’ caused by lifting something. For a strong person who is in good alignment, lifting a heavy weight will not be a problem. For a person who is weak and already out of alignment, lifting even a light weight can become a big problem. In the workplace, the number of incidents where privately generated musculo-skeletal dysfunctions have been labeled as work-related injuries are legion. Whilst I can’t put an accurate figure on it, my experience is that a significant proportion of musculo-skeletal incidents in the workplace are not work-related. They occur as a result of bodies that are out of alignment, bodies that are weak. As one manager said to me, ‘the staff here treat this organisation as a branch office of Medicare!’ But having said that, his company doesn't have a firewall in place! What does he expect? He’s not managing the risk. Profits are going down the medical/therapeutic black hole. What organisations need to do to prevent the personally generated dysfunctions from being treated as work-related injuries is put in a firewall. The firewall consists of regular musculo-skeletal risk factor assessments, a 10 minute strength and flexibility session for all staff each day and longer training programs for people at risk. No organisation can continue to put its workers compensation arrangements in jeopardy by neglecting to educate staff about the importance of being strong and flexible, and giving them a small amount of time each day to do a few exercises.

In our culture it’s a big ask expecting to stay healthy without being fit.

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10. A WORD OF WARNING

There is always the concern that lower back pain may be a reflection of something far more serious than a symptom of a body that is out of alignment.

This is one reason why I suggest you get yourself checked out by your doctor. There may be a medical reason for the pain - like a tumor of some kind, kidney disease … Or you may have cracked vertebrae, or as one person I saw, floating fragments of bone.

So just to be on the safe side, get yourself checked out to make sure it’s safe to embark on a strength and flexibility training program.

However, as the Australian National Health and Medical Research Council (NH&MRC) points out in its report on musculo-skeletal pain; ‘The majority (approximately 95% of cases) of acute low back pain is non-specific; serious conditions are rare causes of acute low back pain.’ ‘Non-specific’ means that the NH&MRC doesn’t have clue as to what causes low back pain. Go figure!

Based on their findings, it is my belief that in the majority of cases, lower back (or any musculo-skeletal pain) is not a medical problem, it’s a fitness (strength and flexibility) problem and you can’t solve a fitness problem with a medical solution. The problem is you are not strong and flexible enough to keep your spine in good alignment.

Most people don’t understand that musculo-skeletal pain is the body’s way of telling them to get back into alignment and to become stronger so the body can be supported in its correct alignment. Pain is not a call to merely deaden the pain. It’s a warning sign, like the light that flashes on the dashboard of your car telling you that you’ve run dangerously low on oil. There are two ways to turn the light off - put more oil into the engine, or cut the wire.

Usually, all it takes is a keen pair of eyes watching someone in a few exercise postures to see what’s causing bones to move out of alignment. Like this.

In these two diagrams, tight calf, hamstring and buttock muscles have tilted the pelvis back creating an inability to sit up straight. Because the pelvis has moved out of alignment, the bones in the spinal column have been moved out of alignment too. The ‘S’ shaped curve of the spine has become a ‘C’ shape.

Or this. One of the first of the objective diagnosis tests should be to see whether your weight is evenly distributed over your feet.

If it’s not, you’re out of alignment. Muscles on one side of your body are pulling tighter than muscles on the other side.

Observing people standing front, back and side-on will provide clues as to the nature of the problem.

Tight muscles on the lower half of the body, coupled with weak trunk muscles, front, back and core, lie at the very heart of back pain.

If you know what to look for and what to measure you can indeed get clues as to why the bones of the pelvis and spinal column are out of alignment. You don’t get those clues from an X-ray or MRI.

The Australian National Health and Medical Research Council (NHMRC) reports that whilst some people with bulging discs, arthritis, lumbar spondylosis and spinal canal stenosis experience blinding pain, others don’t. It’s pretty much the luck of the draw.

On the other hand there are a lot of people walking around thinking their back is in good shape, quite unaware that they’re teetering on the edge of a cliff ready to fall in a screaming heap on the rocks below. All it takes to bring it on is lifting a bag of fertilizer into the trunk of your car or swiveling round to pick up a phone book. If it happens at work it’s booked out as a work-related injury and work has to pay to fix it up.

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By all means get yourself checked out by your doctor. Get an X-ray to make sure you don’t have cracked bones or something deadly serious. Then read through the chapters of this book and see whether you can get clues as to why you’re experiencing back pain. When you’ve done that, start doing the exercises. Sign up for the Clinical Diagnostic Assessment at Global Back Care. To give you some immediate relief, spend time doing these exercises. You’ll find the descriptions further on in the book.

Sample of essential exercises for squaring up the pelvis

Static back

Supine groin stretch

Hip crossover

Sit up straight

Wall sit

Prone frog

Situps

Superman

When was the last time you bent down to touch your toes? Did you get there?

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11. THE RESEARCH

WHAT CAUSES LOW BACK PAIN? I’ve combed through the literature. I’ve consulted the Australian National Health and Medical Research Council, the Cochrane Collaboration, the Arthritis Association and a host of reputable websites. No-one seems to have a clue what’s causing the epidemic of low back pain.

RISK FACTOR SCORES RELATED TO CURRENT CONDITION In 2007-08 I conducted a survey of 953 people, each of whom completed the Musculo-skeletal Risk Factor Profile (see page 51). The results show that if you have a good strength and flexibility training program and you’re close to your ideal weight, the chance of succumbing to musculo-skeletal dysfunction is dramatically reduced.

Only 30 people (.3%) gave themselves a score of 10/10 for the current status of their musculo-skeletal system. This is an exceptionally low number of people and says something about the poor musculo-skeletal health of the Australian community. Their average score on the risk factor profile was 73.

People in pain - the 54% scoring 5/10 or less on the current condition question - average score 45.

The 15% of people in severe pain, scoring 0/10 for current condition - average score 26.

STRENGTH AND FLEXIBILITY TRAINING PROGRAM Only 5% of people had a reasonable strength and flexibility training program. Their average total score on the musculo-skeletal risk factor profile was 84. The average score for current condition was 7.3.

The 64% of people who didn’t have a strength or flexibility training program scored an average of 46 on the profile and had a current condition score of 5/10.

BODY COMPOSITION Being more than 15Kg over weight is a good predictor of future musculo-skeletal dysfunction.

For people close to their ideal weight the average score was 65.

10 - 14 Kg overweight: - 25% - average total score 50

15 - 19kg over weight: - 8% - average total score 40

20Kg or more over weight: - 127 people 13% - average total score 36

STRENGTH Squat test of leg strength People who did 15 or more squats - 41% - average score - 63

People who couldn’t do a squat - 7% - average score 30

Situp test of front of body strength

People who did 25 or more situps - 9% - average score 72

People who couldn’t do 1 situp - 25% - average score 38

Pressup test of upper body and arm strength People who did 25 or more pressups - 11% - average score 75

People who couldn’t do a pressup - 13% - average score 32

People who lack leg, front of body and upper arm and shoulder strength are setting themselves up for musculo-skeletal dysfunction.

Improving the strength of these three body segments takes less than 3 minutes a day.

Squats, situps and pressups, together with Superman back arches are must do exercises.

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SHOULDER FUNCTION Weak shoulders and dysfunctional shoulders go together. In the workplace employers need to protect their staff from shoulder dysfunction otherwise the employee’s doctor is likely to diagnose the dysfunction as a work-related injury. Those scoring 10/10 for shoulder function (47%) - had an average profile score of 60. The average number of pressups they could do was 15. Those scoring less than 5/10 for shoulder function - (18%) - had an average profile score of 37. The average number of pressups they could do was 11. Those scoring 0/10 for shoulder function (.25%) - had an average profile score of 24. The average number of pressups they could do was 7. Pressups are a very good predictor of musculo-skeletal risk.

FUNCTIONAL MOBILITY People who could sit down on the floor and stand up straight 15 or more times in 30 seconds (31%) - average score 68. People who couldn’t sit down and stand up at all (9%) - average total score 29.

IN A NUTSHELL There is a compelling reason for everyone to have a regular and systematic strength and flexibility training program; utterly compelling. If they did, doctors, physios and chiros would be sitting around twiddling their thumbs, playing golf on Wednesday and knocking off early on Friday. Any workplace that doesn’t implement a strength and flexibility training program for all staff is leaving itself wide open to workers compensation claims. 10 minute a day is all it takes to save millions of dollars. Any workers compensation insurer that doesn’t measure risk and rate their premiums accordingly is not looking after the interests of its proprietors. Any government workers compensation authority that doesn’t provide strict guidelines for measuring and managing the risk or musculo-skeletal dysfunction is taking a cavalier approach to its occupational health and safety responsibilities. One senior executive in a regulatory organisation said to me that despite there being yellow lines all over the place, people in steel capped boots and coloured vests, everyone sitting on $600 chairs, injuries still keep happening. The enemy is within.

Keeping fit and healthy is an investment. Therapy is a cost.

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12. THE MECHANICS OF JOINT AND MUSCLE PAIN – it’s the system

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Looking at the spine and pelvis side on …

Pelvis in good

alignment, normal ‘S’ shaped curve of spine.

Pelvis tilted forward. Exaggerated ‘S’ shaped

curve of the spine.

Pelvis tilted back. ‘C’ shaped curve

of the spine.

THE (EXAGGERATED) CLASSIC POSTURE OF SOMEONE WITH LOWER BACK, NECK AND SHOULDER PAIN

Due to the action of tight muscles attached to the pelvis - front, back and sides - but particularly the hamstring and buttock muscles, the pelvis is taken out of alignment. There’s collateral damage as bones in the lumbar spine are dragged out of alignment. The ‘S’ shaped curve of the back becomes a ‘C’ shape. Ligaments, muscles and tendons are stretched, beyond their pain threshold, resulting in continuous pain. Discs prolapse, with the nucleus pinching the spinal column. It feels like someone’s shoving a red-hot poker in your back every time you sneeze of cough. Your experience sciatic pain as the prolapsed disk pinches the sciatic nerve

Tight calf, hamstring and buttock

muscles pull pelvis back and down.

Bones in the upper part of your spinal column are pulled out of alignment. Head and shoulders move forward placing stress on soft tissues around the neck and shoulders. It’s a principal cause of sore shoulders. It feels like your upper back, neck and shoulders are on fire. You’re always hanging out for a neck and shoulder massage. You’re always off to the therapist to ‘pop’ the bones back into alignment. Back pain is not due to a lack of rubbing, crunching, heating, vibrating, doping or surgery.

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So what we’re looking to do is go …

From this … … to this and from this … … to this

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13. CAUSES OF LOWER BACK PAIN

a. SHAKY FOUNDATION For many years our family lived in a house built on clay soil. In summer time the clay dried out and the foundation of the house slumped a little. When the foundation moved the walls and chimney cracked. We can treat the pelvis as the foundation of the ‘house’ that’s built on top of it. Cracks in the walls are the metaphor for misalignment of the vertebrae in the lower back. Cracks in the chimney are the metaphor for misalignment of the vertebrae in the upper back and neck. Therapy that doesn’t address this foundation of alignment has to be repeated, over and over again.

� The foundation on the right hand side of the house has dropped. As a result the wall and chimney on that side of the house have cracked. The solution, underpin the house and jack it up so the foundation is level again.

A man once said to me that he had the best chiropractor in Canberra. He went for treatment every three weeks. Well, hello! The chiropractor manipulated his bones back into alignment. Within three weeks the man had pulled the bones out of alignment again. What we did with our house was get it underpinned. We got a builder in to dig a hole under the corner that was sinking. He filled it up with concrete, then jacked the house up and kept it in position with bricks and wedges. No more cracking. It’s the same with vertebrae that are out of alignment. Get the pelvis, the foundation, squared off and, with the right strength and flexibility exercises the vertebrae will gradually drift back to where they belong. All it takes is the right exercises done for the right amount of time. Treating the site of the pain without providing exercises to treat the cause of the pain is not best practice.

b. COLLATERAL DAMAGE There’s a high likelihood that the pain you’re experiencing in one part of your body is collateral damage caused by the action of muscles elsewhere in the body. The pain is the symptom of a system problem. Fix the system. It’s the positioning of the pelvis that seems to be a major contributor to collateral damage experienced in the lower back, shoulders and neck. Once the pelvis moves, the bones above it are likely to move. (The bones below it will probably move too and you may end up with hip and knee pain and perhaps persistent pulling of muscles in your thighs and lower leg.) Where does most of the tightness come from? It comes principally from motion starvation, in particular sitting down without a strength and flexibility training program and from hand and foot dominance where we persistently rotate the body in one direction whenever we kick, throw and hit.

Pelvis tilts, drops and rotates; bones

above it move out of alignment.

Muscles attached to the pelvis - front, back and sides - become tight and weak. Bones are moved out of alignment. Muscles on one side are usually tighter than muscles on the other side, hence, as well as pulling you pelvis down and back, it rotates and drops on one side. That it should come to this; your muscles are neither strong enough nor flexible enough to keep your body in correct alignment.

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c. POOR ALIGNMENT? - categorically If your pelvis is out of alignment it’s highly likely that the bones up above and below it will be out of alignment.

Ideal position of the pelvis. Ideal ‘S’ shaped curve of the spine

Pelvis tilted too far forward, increasing the hollow in lumbar spine and putting pressure on the vertebrae above it.

Pelvis tilted too far back, moving vertebrae out of alignment, turning the ‘S’ shaped curve of the spine into a ‘C’ shape.

In the sit down, don’t exercise, motion-starved society it’s the third scenario, pelvis tilted back too far that is the cause of a high proportion of back, hip, neck and shoulder pain.

When bones are out of alignment, ligaments, tendons, muscles will be stretched beyond their pain threshold and discs will herniate.

The pain is your body’s way of telling you to get your vertebrae back in alignment.

Bulging disc and herniated disc, due to misalignment of vertebrae.

The pain that occurs when ligaments, tendons and muscles are stretched beyond their plain threshold and made worse by the disc nucleus pushing onto the spinal cord, is telling us to fix the alignment problem.

We do this by squaring up the pelvis.

We do that by loosening tight calf, hamstring and buttock muscles and strengthening the muscles designed to keep the bones in correct alignment.

You can see the effect in these diagrams of a pelvis that tilts back, rotates and drops on one side.

‘S’-shaped spinal curve turned into a ‘C’ shape

‘Gorilla position’ pelvis tilted back, causing rounded shoulders and forward-facing knuckles.

Pelvis rotated, with one side lower than the other and - the sign being that the back of one hand is further to the front of the body than the other.

Uneven weight distribution. One side bearing more weight than the other.

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Misalignment of feet and legs A significant proportion of people with back pain have feet and legs that are out of alignment. Ask them to sit with their legs straight out in front of them and they can’t square their feet off. The muscles on the side of their lower legs have forgotten that they have to keep the feet in good alignment. They have bandy legs - ie they can’t keep their knees and ankles together when standing up. Their knees are rotated either in or out - ie the lower and upper leg bones are not in alignment. The misalignment works its way up to the pelvis.

Feet that won’t square up Bandy legs Knees knocked in Knees twisted out

d. BLAME TIGHT CALF, HAMSTRING AND BUTTOCK MUSCLES - absolutely Lower back and neck pain is a symptom of a pelvis that is out of alignment.

The theory of collateral damage Due to the action of tight muscles attached to the pelvis - front, back and sides - but particularly the hamstring and buttock muscles, the pelvis is taken out of alignment. There’s collateral damage as bones in the lumbar spine are dragged out of alignment. The ‘S’ shaped curve of the back becomes a ‘C’ shape. Ligaments, muscles and tendons are stretched, beyond their pain threshold, resulting in continuous pain. Discs prolapse with the nucleus pinching the spinal column. It feels like someone’s shoving a red-hot poker in your back every time you sneeze of cough. Your experience sciatic pain as the prolapsed disk pinches the sciatic nerve.

Tight calf, hamstring and buttock muscles pull pelvis back and down.

Bones in the upper part of your spinal column are pulled out of alignment. Head and shoulders move forward placing stress on soft tissues around the neck and shoulders. It feels like your upper back, neck and shoulders are on fire. You’re always hanging out for a neck and shoulder massage. You’re always off to the therapist to ‘pop’ the bones back into alignment.

The problem is exacerbated by the variation in tension between muscles on one side or your body and muscles on the other side. For instance, being right or left hand and foot dominant and spending years hitting, throwing and kicking using one side of the body may gradually cause a twist in the pelvis, which is translated into the bones above it. This supplies further evidence to support the view that lower back pain is collateral damage caused by the action of weak and tight muscles in the lower half of your body.

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If your pelvis is tilted back, has dropped on one side and/or rotated, you will probably be experiencing pain somewhere in your spinal column. If you’re not experiencing pain then it’s a sure bet that sooner or late you will, as the misalignment gets progressively worse. Also the misalignment predisposes you to injuries doing the simple tasks that a person with good strength and good body alignment can to do with ease.

If the cause of the pain is rarely at the site of the pain how do you find out where the cause is? Here are some body positions which will provide you with clues as to what may be causing your dysfunction.

Hamstring and buttock muscles are too tight The action of hamstring and buttock muscles will determine whether your pelvis is in correct alignment. If they’re too tight the pelvis tilts back; the ‘S’ shaped curve becomes a ‘C’ shape. When muscles on one side are tighter than the other the pelvis twists and tilts.

You find it impossible to sit in close to the wall with your legs straight and you can’t square your feet off. The collateral damage is a ‘C’ shaped spine. You get back pain, a stiff neck and frozen shoulders.

The wall-sit exercise Ideally you should be able to sit up straight against a wall, bottom pressing in tight to the wall.

If you’ve got tight calf and hamstring muscles you won’t be able to sit in close to a wall. You’ll look like this. The tight muscles are dragging your pelvis backwards.

When lying in the supine groin stretch position, you may find that one side feels tighter than the other. The tightness may occur at different points in your body.

The difference is symptomatic of your pelvis being out of alignment. This exercise done for 20 minutes each side each night helps settle and relax the muscles around the pelvis and back. When this happens the pelvis and the bones above it are gradually drawn back into alignment.

In the doorway stretch position you may find that the hamstring muscle on one leg is tighter than that on the other leg.

If the legs are different, there is a high probability that the tightness will have twisted your pelvis. The bones above it will be forced out of alignment through collateral damage.

Good function. The upright leg is flat against the wall and the lower leg flat on the floor. The right buttock is close in to the wall.

Poor function. Tight hamstring of the upright leg. When lower leg is flat on the floor, the right buttock has to be away from the wall.

The sit-up-straight exercise

Ideally you should be able to sit up straight with one leg crossed over the other and hands folded behind your back.

If you can’t sit up straight in this position it’s because your buttock muscles are too tight. Being over weight doesn’t help. The tight muscles are dragging your pelvis backwards. The collateral damage is a ‘C’ shaped spine. You get back pain, a stiff neck and frozen shoulders.

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The hip crossover If you’ve got a painful back, neck or shoulders there is a good chance that when someone presses into your buttock muscle when you do the hip crossover, the buttock muscle will be painful. For some people it’s so painful they can hardly bear to be touched. It's a very good clue to the cause of the problem further up the spine. With this exercise you may notice that one side is tighter than the other; another clue that the pelvis is twisted. One or both feet may not be able to touch the floor in the crossover position because the hip and back are so painful.

Hamstring and buttock stretch Not being able to grab the toe of a straight leg is a sure sign that your hamstring, buttock and back muscles are too tight. You’ll probably find that one side is tighter than the other, a sure sign your pelvis is being twisted by tight muscles.

Superman If you find it painful to do the superman exercise you’ll know the muscles in your back are not strong enough to support it. There is as compelling a case to do your superman back arches to strengthen the muscles on the back side of your body as there is to do situps to strengthen the muscles on the front side of your body.

Buttock stretch This exercise stretches your buttock muscle, but in a different aspect to the sit-up-straight exercise. People with back and neck pain find it extremely painful when someone pokes the buttock muscle in this position; more clues to where the cause of the problem lies. Prone frog A lot of people with painful backs, necks and shoulders squeal like stuck pigs when someone pokes them in one of the buttock muscles in the prone frog position. Often the pain is more severe on the left side than the right. Sometimes the pain extends right down into the hamstring muscles.

Hip stretch. If you’ve got back pain you may well find that when you do this exercise one side is tighter than the other. Doing this exercise persistently over and over again, for about 1 minute each side, for 20 minutes at a time will, gradually, over weeks and months contribute to the process of bringing you back into better alignment. Shoulder test An inability to stand with your back, forearms, wrists and fingers flat against the wall is a good sign your calf hamstring and buttock muscles are too tight. When the pelvis tips back the shoulders go forward. Your wrists lock up, you painful wrists. The cause is attributed to repetition strain (RSI) or the dreaded occupational overuse syndrome (OOS). The other interesting thing about this test is, if you can’t put your head back on the wall while looking at the skirting on the other side of the room, you know your head is too far forward of the body. The cause; tight calf, hamstring and buttock muscles.

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Tight neck muscles If the muscles at the back of your neck are painful to touch when you ‘pull your head in’ you can be pretty certain that your head is too far forward of the position that it should be in. The likely cause is tight calf, hamstring and buttock muscles. You can’t stand up straight.

e. FEET AND LEGS OUT OF ALIGNMENT It may all start from your feet. A large percentage of people can’t sit with their legs straight and feet square. Some people have bandy legs, others have knocked knees or knee-caps turned out. These skeletal abnormalities of the feet and legs can affect the bones above them. The message is to square yourself off.

f. DYSFUNCTIONAL HIPS

You can check to see whether hips are working well by seeing if your knees will reach the table when standing in this position. In these diagrams the left hip is OK. The right hip is dysfunctional. There is tightness in there somewhere that gets translated into mis-alignment further up the spine and further down the legs. It could be a precursor to hip, back or knee misalignment – or all three.

You can check to see whether hips are working well by seeing how close the knee of the bent leg drops down to the floor.

g. TIGHT CALVES Here’s a good way see how tight your calves are. Get a piece of chipboard and a 10cm square block of wood. Place the chipboard on the block on an angle that is not uncomfortable, but gives your calves a good stretch. Your heels should be flat on the chipboard and against the wall. Over the days, weeks and months gradually increase the angle - and the stretch.

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h. LACK OF SPINAL MOBILITY Not being able to take your heels over your head is a sure sign that you’ve lost a lot of general mobility in your spinal column. The good news! Gradually, week by week, poor function can be restored to good.

i. BLAME A WEAK MUSCULO-SKELETAL ECOSYSTEM - definitely If there’s something wrong with one part of the musculo-skeletal ecosystem you can be pretty certain that there’s something wrong with other parts. Lack of strength plays a pivotal role in keeping your body in alignment There are a huge number of muscles involved in keeping the body in alignment. Most people don’t exercise any of them and then express surprise when they experience back pain. When we’re dealing with the musculo-skeletal eco-system, the whole of the system needs to be kept strong, not just a few parts.

My mother used to say, ‘Look after the small things and the big things will look after themselves.’ When it comes to your musculo-skeletal system, the inverse proposition holds true: look after the system and the parts will look after themselves.

That’s why you need a good all round general strength training program as well as a specific program designed to target particular muscles that are weak.

A lot of people have weak muscles. They go to lift something and because the thigh and buttock muscles are weak they use their back to do the heavy lifting. If thigh and buttock muscles are weak you can bet your life the back muscles are weak too. The back can’t take the strain, bones move and soft tissues are stretched beyond their pain threshold. A lot of people fixed up their back problems by doing a general strength training program in a gym. Some did it at home. I recommend these four strength exercises to do at home. Squat

Situps - feet held

Pressups

Cobra

A lot of people got better by attending a yoga or tai chi class, a Pilates or Body Balance class, or the Global Back Care Clinic. But whilst physiotherapists are in agreement about the need to strengthen weak muscles, particular core muscles and in particular the multifidus muscle, you can be pretty certain that there are muscles right throughout the musculo-skeletal ecosystem that need strengthening; leg, buttock, abdominal, hip flexors, the long and short muscles of your back ... I’d like you to consider the proposition that all muscles attached to the pelvis and spine are core muscles.

j. BLAME MOTION STARVATION? - certainly A major cause of musculo-skeletal dysfunction is motion starvation. We don't move enough. We're not in good enough physical condition to maintain good function. The body that was designed to climb trees, chop wood and draw water can no longer push a pen or tap a keyboard without becoming dysfunctional! If you want a good example of motion starvation look no further than your shoulders and arms. Due to lack of systematic exercise most people have lost the ability to lift and carry their own weight. As an illustration, next time you're at a children's playground see if you can traverse the full length of the monkey bar.

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There is a good chance you won't be able to do it because the last time your did it you were stronger, maybe 30 or 40Kg lighter and you had a higher strength to weight ratio. (WARNING this is a potentially dangerous exercise for people who are overweight and have lost the strength of their arms and shoulders. You could suddenly let go and land flat on your back.)

k. BLAME SITTING DOWN? - unequivocally We sit in chairs all day. Here are three pictures of muscles designed to keep your vertebrae in correct alignment. If they’re not getting stronger they’re getting weaker. I can assure you they don’t get stronger sitting down. Most people are not strong enough to sit in a chair for long periods of time without becoming dysfunctional. They can’t do a sit up or a pressup; aren’t game to do a superman back arch; they never do any squats to strengthen buttock and thigh muscles. If you sit in a chair for 20 years, your calf hamstring and buttock muscles tighten up and tilt your pelvis back. You end up with a back pain.

If you’re going to sit in a chair all day, here are some of the muscles you need to strengthen.

l. UNDER-USE AND IMMOBILITY IN CHILDREN You can be certain that the next generation of adults will suffer from musculo-skeletal dysfunction even more than their parents. The lack of regular aerobic physical activity in our children is being manifest by their growing levels of fatness. Their lack of strength and flexibility is exhibited by their slump dog posture and their inability to touch their toes or do more than a couple of pressups. They are spending infinitely more time cooped up in classrooms being intellectualized. We’ve just about reached the point in time where only thing children need to take to school is their head. At home they spend their time slouching in front of computer monitors and lounging around watching television. If you think things are bad now, wait ‘til later!

m. UNDER-USE AND IMMOBILITY IN OLDER-AGED ADULTS Prolonged under-use is a major contributing factor in osteoporosis of older-aged people. Healthy bones need weight-bearing exercise. You can't get it from sitting down! That's why I recommend to people of all ages that they join a gym and participate in a systematic weight training program, similar to that outlined in this book. The oldest person in my gym was Adolf aged 83.

Lack of strength, along with a lack of general mobility is probably the most significant contributor to falls in older-aged people. The number of people who can’t lift themselves up from a squatting position is very high. You can't fix a lack of strength with a handrail! That's why we all need a general, life-long strength training program. I believe that every retirement village and every nursing home should have a gym and dedicated fitness practitioners or nurses who’ve done a fitness course. After all, anyone involved in the health game should be able to design and supervise a basic fitness program.

n. BLAME WORK? - hardly It is drawing a long bow to blame your work for your musculo-skeletal dysfunction. Most of the people I see with crook backs, sore shoulders, necks and arms are not keeping themselves strong or flexible enough to do their job without becoming dysfunctional. They’re not strong enough to click a mouse without getting a limp wrist, let alone lift a bag of cement into the back of a pick up truck. Then they expect work to pay for their rehab program. Go figure!

Not that long ago, if you weren't strong enough to wield a pick and shovel you didn't last long in a pick and shovel job. Nowadays, few people would believe they needed to have a strength and flexibility training program to sustain the demands of sitting at a desk tapping on a keyboard.

Nevertheless it's true. If you want to protect yourself from sore shoulders, RSI and back pain, start training.

A word for managers. A systematic occupational health, fitness and wellness program stops personally-generated body system dysfunctions from being passed off as work-related injuries.

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o. BLAME OVERUSE? - on the contrary Occupational over-use is, in the main caused by under-use. Usually it refers to painful wrists and is presumed to be caused by too much typing. The experts bring in the gel pads and $600 chairs. Rarely do they track down the real cause of the problem, lack of strength and flexibility, coupled with poor posture. As part of occupational health and safety everybody needs an induction program teaching them how to sit up straight. It is the responsibility of every manager to make sure their staff have good sitting posture. Painful wrists are a symptom of weak and tight muscles, some of them in the wrists themselves, some of it in the shoulders, some of it in muscles elsewhere in the body. It’s unlikely that the cause of the pain lies excursively at the site of the pain. Treatment on the wrist itself may be necessary but it’s not sufficient. You’ve heard of the occupational over-use syndrome (OOS). The word ‘syndrome’ is medical speak for ‘we don’t know what causes the dysfunction.’ If you’ve got the dreaded OOS, there is a good chance your body is out of alignment and you aren’t doing enough of the right strength and flexibility exercises to meet the needs of your job.

p. BLAME THE CHAIR? - doubtful It's not the chair but how you sit in it and whether your calf, hamstring and buttock muscles are loose enough to allow you to maintain the proper ‘S’ shaped alignment of your spine. It’s not the chair but whether you can sit up straight while you work. My advice is to lock yourself in so the back of the chair is pressing against your shoulder blades and the desk is pushing in to your abdomen. On top of that you need strong postural muscles to enable you to sit in an ergonomically safe position for long periods of time. In the diagram opposite, the back of the chair isn’t giving the pelvis and vertebrae the support they need. It is not pushing up under the shoulder blades. The abdomen is a long way from the desk. This bloke is heading for a disaster. He’ll complain to his boss about his crook back and stiff neck. His boss won’t have a leg to stand on because he didn’t 1. teach the fellow how to sit up straight and 2. insist the fellow sat up straight with abdomen pressing into the desk all

the time.

The classic slouch, leading to the classic crook back, stiff neck, sore shoulders and ‘limp’ wrist.

The ideal sitting position is with the back of the chair pressing in against your shoulder blades and the desk pushing into your abdomen.

You’re locked in.

In the long run it's muscle strength and flexibility, and sitting locked in by your chair and the desk which will protect you from a pelvis which tilts backwards, a back that's lost it's natural ’S’ shaped curve, slouching shoulders and poking head that lead to lower back pain, neck pain and RSI.

Despite the best intention of your mother and primary school teachers, it's impossible to sit up straight for long periods of time unless your stomach and back muscles are strong, and the muscles attached to the pelvis (and lower down) are flexible.

Locked in and sitting up straight.

By all means spend some time each day sitting up straight without using the back of your chair to support you. This will help train the muscles designed to keep you sitting upright to do their job properly. But remember that if muscles are weak and tight they will not be able to keep you in this position for very long. As soon as you get absorbed in your work you’ll probably find you start slouching again. That’s why you need to lock yourself in close to your desk.

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Balans Chair Spend sometime each day sitting on a Balans Chair. The reason the Balans chair works to correct spinal misalignment is because it takes the effect of tight hamstring and buttock muscles out of the sitting equation. You can sit up straight with a natural ‘S’ shaped curve in your spine. My advice is not to sit too long at a time in this position. Some people find that they get sore knees.

Balans chair lets you sit up straight.

Sit up with legs resting on a ‘bench’ under the table. This will prevent hamstring muscles from shortening.

Spend part of the day kneeling on a pouffe. Kneeling takes hamstring and buttock muscles out of the sitting-up-straight equation. You’ll find it easier to maintain the hollow in lumber spine.

Spend part of your day standing up. Get a box large enough support your keyboard and mouse pad. Tilt the monitor back and/or lift it a bit higher so you can see the screen.

q. BLAME THE EQUIPMENT? - unfairly It would appear that bad workman the world over continue to blame their tools!

It's not the mouse. The great tragedy of modern office ergonomics is that the chair, the desk, the keyboard, the screen and the mouse are blamed unfairly for the cause of musculo-skeletal dysfunction. On the contrary it is the person with a strength, flexibility and/or postural problem who succumbs to dysfunction.

Imagine how strong your arm and shoulder muscles have to be for you to sit down all day with your arms out in front of you. Well, guess what? That’s how half the Western world spends most of their day – with their arms stuck out in front of them typing.

If your arms are not strong enough you’ll soon end up with arm, wrist and shoulder pain. You’d be a mug not to be doing your pressups on a regular basis. If you can’t do forty in one go, men on their toes and women on the front of their thighs, you’re not keeping yourself strong enough to spend the day typing.

You can’t blame work for that.

r. BLAME YOUR FOOD? - maybe It's widely considered that some musculo-skeletal complaints, particularly arthritic complaints are diet related.

The nation that started off lean and tough and wiry has ended up fat, weak and miserable, and addicted to the high fat, refined starch, sugar, caffeine and alcohol diet.

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A high proportion of people are starving on full stomachs, starved of the essential vitamins, minerals and essential fats required to maintain good health – and that includes musculo-skeletal health.

Flour and sugar are probably high on the list of suspects. Lay off flour and sugar for a couple of weeks and see what happens.

Secondly, it does none of us any good to stick religiously to a high energy diet. Not many people would be aware that it takes 40 minutes of vigorous aerobic exercise to burn off 100 grams of chocolate; twice that to burn off a litre of chocolate milk. The heavier you get the more weight you put on joints, the less mobile you get. Any one who’s 20 or more kilograms over weight will find it hard to touch their toes, get up and down off the floor and ease themselves out of a chair. It’s hard for the doctor to fix that.

If you have arthritis you may be intolerant to the deadly nightshade foods – tomatoes, potatoes, egg plant …

It’s always wise to lay off the junk food (ie food which is high in fat, flour and sugar) and eat plenty of fish and vegetables. You'll benefit from the omega 3 and 6 fatty acids in the fish and the minerals and vitamins in the vegetables.

s. BLAME YOUR STRESS? - sure can It is well known that when we get anxious we induce the fight and flight reflex, the net effect of which is to tighten up muscles. Tight muscles become sore muscles. They start to pull unevenly on bones. You end up with misalignment, leading eventually to dysfunction and pain. Anxiety will bring with it changes to the function of the liver and the adrenal glands which can affect your metabolic processes in a variety of ways, some of which may have an effect on the functioning of your musculo-skeletal system. The esoteric literature has arthritis linked with anger. Think about that. Maybe the right diet for you is a diet free from anger!

t. BLAME YOUR WEIGHT? - yessiree Even being a little overweight can alter your balance and tip your body out of alignment. Being over-weight comes at a huge cost to mobility. You have great difficulty getting onto the floor and standing up again. You have to lie on your bed to put your socks on. It's well known that back pain and obesity go together; for some people because the extra weight around the abdomen tilts the pelvis too far forward, for others because they 'hold themselves in' so their abdominal adiposity doesn't show so much, thereby tilting the pelvis too far back.

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14. THE WISDOM OF THE ANCIENTS Never overlook the wisdom of the ancients in dealing with age-old complaints. Even Hippocrates himself who lived around 500BC said as much.

I do not claim that one should throw overboard ancient medicine as if it did not exist at all, or that its investigations were wrong, if it is not accurate in every respect. ... But I believe that we have to consult further and to admire its discoveries which have been made in spite of much ignorance.

The ancients had the belief that arthritis was caused by a build up of toxic waste within the body. The solution; get rid of it. This meant fasting, purging (from both ends) poulticing, cauterising ... All of these processes were used to varying degrees of effect until quite recent times. When it comes to arthritis, the works of the ancients provide interesting reading.

Those who have swellings in the neighbourhood of joints or pain as a consequence of fever, take too much food ... All diseases originating from over filling (plethora) are cured by elimination. Hippocrates (Circa 500BC)

Patients suffering from sciatica are benefited by vomiting even more than by purgation downward. Galen (129-201)

When nature produces pain, there it accumulates morbid substances and want to eliminate them. If nature does not succeed itself in this purpose, the physician must make an artificial outlet, right on the sick spot and thus cure quickly the pain and inflammation. Paracelsus (1493-1541)

Modern junk medicine seems to be just about as effective, the principal objective being to mask the pain, not restore poor function to good. The tablet that gets bones back into alignment is yet to be invented! The junk medical industry is increasingly becoming set on ignoring the wisdom, not only of the ancients but of any other professional group that might have some ideas about musculo-skeletal dysfunction. The common wisdom these days is to take a pill and plough on. We are increasingly being drawn away from the principle that the body heals fastest when its own recuperative powers are stimulated. The junk medical industry has become master in the art of masking symptoms, not treating causes. It continues to shut the doors that lead to the restoration of poor function to good. A lot of good wisdom came from the orient. If you want goof musculo-skeletal health start doing yoga and/or tai chi. If everyone did a bit of yoga each day, doctors, radiologists, chemists, surgeons, physiotherapists and chiropractors would be sitting around twiddling their thumbs, playing golf on Wednesday afternoons and knocking off early on Friday.

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15. THE LAW OF TOO MUCH - what is it that you do too much of? 1. Sitting down - becoming less aerobically fit, weaker and tighter

A sure-fire way to get back pain is to spend your life sitting down. The muscles of the calves, hamstrings and buttocks shorten dragging the pelvis back, resulting in the ‘C’ shaped posture. Because you do too much sitting down you need to spend more time standing up, more time walking around, more time in a whole range of fitness-type activities; aerobic, strength and flexibility. I'd encourage you to have two desks at work, one that you can work at sitting down, the other that you can work at standing up. Don't for a moment think that your expensive ergonomically designed, luxuriously foam padded chair can protect you from back pain.

There are a variety of different aids to assist you in supporting your back and

helping you to sit up straight. None, however will take the place of a good strength and flexibility training

program and sitting with the back of the chair bolt upright and your abdomen pressing into the desk.

Simply relying on the support of a brace may lull you into the false impression

that you’re back in good shape.

The fitball is a popular piece of seating

equipment, though my advice is not to sit on it for too long each day. And remember, it’s just as easy to sit poorly on a fitball, as it is to sit poorly in a chair. You really have to stay focused on sitting up straight. Make sure your abdomen is pressing in to the desk.

The fitball stand with back rest arrangement

looks like a cool bit of gadgetry! For myself I used to use a little fold up chair recommended by a yoga teacher and I

kept it pushed in as close to my desk as possible, with my abdomen pressing in against the desk. You certainly don’t need an expensive chair.

There are offices where as soon as someone complains of back pain they wheel in

an $800 chair. It doesn’t seem like a good investment to me when a $10 chair, positioned properly would do. Buying an expensive chair and not doing the exercises designed to keep the skeleton in good alignment doesn’t sound like a good proposition.

I’ve now got a typist’s chair and still keep myself pressed in against the desk, with the

back of the chair pushing in up under my shoulder blades. I don’t think it’s any more comfortable that the fold up chair, but being on wheels it’s easier to get in and out of.

2. Stressing yourself out As I've said, when you get stressed, muscles tighten, taking the bones out of alignment; you feel the pain in your back or neck. Because your lifestyle is too stressful you need to spend more time getting the vigorous physical activity which cools down an

over-stimulated sympathetic nervous system, which washes out of your body the chemicals that are tightening you up. You need to spend time meditating and doing yoga, thereby stimulating that part of your nervous system that calms you down and relaxes off tight muscles.

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3. What is it that you eat too much of? There is a long list of the foods known to affect people with arthritis. They will not affect everyone, but they may affect you.

▪ White flour based products ▪ Milk ▪ Egg yolks ▪ Fruit of various kinds ▪ Alcoholic beverages ▪ Additives; preservatives, flavourings, colourings, emulsifiers, surfactants, monosodium glutamate … ▪ Soft drinks ▪ Pepper ▪ Meat ▪ Nightshade family of vegetables - tomatoes, potato, chilli ...

Conduct an experiment where you eliminate certain foods and see what happens. If you feel better you know to steer clear of the foods you've eliminated. Alternatively, go on a detox program, starting off with a juice fast, then eating just boiled vegetables and gradually including other foods. As soon as you include anything that is disagreeable you'll experience an unpleasant reaction. Keep in mind that the reaction to some foods may not occur for a number of days or weeks. There are a number of proprietary detoxifying programs you can embark on. Visit your local health food shop to purchase one. You'll feel better once you've done it. If you’re a person who feels tired all the time or gets frequent headaches, take the wheat experiment. Lay off anything with wheat in it for a week and see what happens. A lot of people are finding that they’re intolerant of the lectin which is part of the wheat’s immune system.

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16. THE LAW OF TOO LITTLE 1. What is it you do too little of?

It sticks out like a sore thumb: ▪ too little general exercise ▪ too little flexibility exercise to keep your skeleton in good alignment ▪ too little strength exercise ▪ too little time spent meditating ▪ too little time spent buying food which lovingly nourishes the cells of your body.

2. What is it you eat too little of? The list of foods and nutraceuticals which may be missing from your diet are legion. Check through this short list. You can search the literature and the internet for a longer list. • Vitamin, A, B2, B5, C, D and E • Calcium, magnesium, sodium, zinc, potassium, manganese • Omega 3 fatty acids • Glucosamine and chondroitin sulphate • Juncea Brassica • Celery.

Once again, you have to experiment until you work out for yourself what you need to eat more of. A clue? Magnesium. I’d rush out and get some.

The US Surgeon General hit the nail on the head in 1978 when he said 'You, the individual, can do more for your

own health and well-being than any doctor, any hospital, any drug, any exotic advice.'

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17. THE ESOTERIC INTERPRETATION OF BACK PAIN

The mental and emotional causes of lower back pain have been well documented throughout the ages. Louise Hay in her book, ‘You Can Heal Your Life’ identifies a number of causes, one of them being fear and worry about money. The literature also talks about back pain as a cry for love, insecurity, guilt, self-hatred, fear of career, feeling powerless, anger, and an inability to accept pleasure. John Harrison in ‘Love Your Disease’ writes, ‘Causes of back pain and the reason they respond to psychotherapy are too numerous to list. Changes in life direction are frequently accompanied by a change in back pain.’ Adam Rostocki in the book ’Cure Back Pain Forever’ discusses the concept of physical pain being a manifestation of repressed emotionality. His thesis is that the mind creates pain to distract us from worrying about psychological matters. It might also just be the case that by taking responsibility for our physical being we begin to stimulate greater responsibility for our emotional being. Rostocki writes:

‘The subconscious mind knows that back pain is convincingly physical, and will hold the conscious attention of the sufferer better than almost any other pain condition. This is the reason why the subconscious has chosen to make back pain the number one epidemic of pain in the world today! The pain syndrome has almost no chance of being discovered for what it truly is, a mere distraction!

▪ My pain is due to psychological issues, not from any physical problems or injuries.

▪ My pain is harmless and will not leave any lasting effects on my body.

▪ My body is strong and has the ability to heal itself from all injuries and suffering.

▪ My pain is caused by my repressed emotions. The most common of these are anger, anxiety, fear guilt, insecurity, and worry.

▪ The physical pain is trying to distract me from thinking about these painful psychological issues.

▪ I can live a normal, pain free life and do normal physical activities.

▪ I will take back control of my life!’ So, as well as the physical stuff, you may wish to consider the emotional and mental stuff and look for ways to deal with it. As well as embracing the underlying psychological causes of your back pain, embarking on a physical exercise program means, in the first instance, that you’ve taken back responsibility for your dysfunction. Maybe it’s handing over that responsibility to doctors, pharmacists and other therapists that’s preventing you from embarking on the inner journey of examining both the physical and psychological causes of your dysfunction. The benefits of taking control and deciding to embark on a physical exercise program has the potential to stimulate a profound effect on your physical and psychological wellbeing. It might just fix up your back pain as well. So when it comes to therapy, don’t discount psychotherapy as part of the therapeutic mix.

What a man needs in gardening is a cast-iron back, with a hinge in it.

Charles Dudley Warner

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18. THE COMPLEMENTARY ROLE OF MANIPULATIVE THERAPY

Throughout this book I’ve made back-handed comments about therapies that involve rubbing, crunching, heating, cooling vibrating, electronic muscle twitching and doping. This has been intentional, if not overstated, to make the point that

1. the twin pillars of primary health care for joint and muscle pain are the strength and flexibility exercises that get your body back into better alignment and keep it in better alignment

2. the manipulative and pharmaceutical therapies are complementary to this process, contributing to palliative care and speeding up the rehab process

3. too often therapy begins and ends with the manipulative and pharmaceutical therapies, without the prescription of a good suite of strength and flexibility exercises

4. too often the manipulative therapies are directed at the spot where it hurts and not at the muscles that have fallen down on the job of keeping your body in good alignment.

My comments are not directed at those doctors and manipulative therapists who make sure their clients are doing the strength and flexibility exercises they need to do to get their bodies back into better alignment - as well as practicing the manipulative and pharmaceutical arts.

An underlying premise of the Global Back Care concept is that a high proportion of musculo-skeletal pain is personally generated. Without a regular and systematic strength and flexibility program, muscles become progressively weaker and tighter and over time the body works its way out of alignment. Thus begins the inexorable march toward the edge of the cliff and the painful abyss that lies at the bottom of it. An incident occurs that tips the person over the edge. The incident usually gets the blame, not the lack of strength and flexibility and the underlying spinal misalignment.

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19. THE TWIN PILLARS OF REHABILITATION THERAPY If the underlying cause of the muscle and joint pain is a lack of strength and flexibility, it follows that the twin pillars on which the rehab process rests are strength and flexibility exercises

What manipulative therapy does is speed up the rehab process. What it doesn’t do is take the place of the strength and flexibility exercises you need to do for yourself. An intensive process that involves strengthening weak muscles, loosening tight muscles, getting your body back into alignment and which also includes the manipulative and pharmaceutical therapies in the therapeutic mix, will have a dramatic effect on restoring poor function to good. That’s what the next chapter is all about.

My recommendation is that you avail yourself of whatever manipulative and pharmaceutical therapy you can lay your hands on in your quest to speed up the rehab process. Just don’t get lulled into the false sense of security that you don’t need to do anything for yourself. In the diagram on the right, if you’re not getting stronger you’re getting weaker. That’s the first hump of the camel’s back.

If you’re not getting looser you’re getting tighter. That’s the second hump of the camel’s back.

All it takes is a ‘straw’ to lob on your back and you’re in big strife.

The straw lobs; you reach for the pill and rush down for a rub down, crunch, hot pad and electric shock. The pain eases for a while but the underlying cause of the problem is not addressed.

If you don’t add strength and flexibility exercises to your therapeutic mix, gradually over time you can expect your condition to get worse.

If you do the right strength and flexibility exercises for your condition, your body will gradually get back into better alignment, exercise by exercise, day by day, week by week, month by month. 80% of the fix will come from what you do yourself. The other 20% is what you can expect from a wide range of therapies.

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20. FORMULA 1 REHAB

Just as the technology developed in Formula 1 motor sport filters down to ordinary motor cars, so the rehabilitation of musculo-skeletal dysfunctions and injuries benefits from the spin-off from sports medicine, particularly in dramatically reducing the time it takes for injuries to heal. As well as what you can do for yourself, various therapeutic modalities, when used intensively will speed up the rehab process. Keep in mind though that what works for one person may not work for someone else. Some modalities will work wonders, others may be useless. You need to experiment. Taking the therapeutic route can be an expensive process. On the other hand a regular and systematic strength and flexibility program requires only a small investment in time.

FORMULA I REHAB BAROMETER The Formula 1 Rehabilitation barometer contains a range of modalities, which can be banked up one on top of the other for hours at a time as a means of speeding up the rehabilitation process. However, the most important ones are those at the bottom of the barometer, the ones you can do for yourself. Sports people can spend up to eight or more hours a day churning through the different modalities so they can get back on the playing field in the shortest possible time. You can do the same thing. You owe it to yourself to restore musculo-skeletal dysfunction to good function as quickly as you can. I suggest you adopt the same approach to fixing your body as you do to fixing your car. Spend some time, effort and money keeping it in good shape! And when it breaks down, do the things you have to do to fix it up quickly. And just as you wouldn't think that a quick paint job was the best treatment for a spot of rust on your car, don't think that an anti-inflammatory, a hot wheat bag, a rub down, the ray lamp and a spinal crunch every three weeks is sufficient for your body!

TIME AND INTENSITY OF TREATMENT I frequently see people with musculo-skeletal dysfunction who have spent less time in a couple of years working on a systematic and intensive rehabilitation program than an elite athlete would spend in a couple of days. Lolling around waiting for something to get better is not a sensible rehabilitation strategy. I saw one person with crook back who had spent two years lying on a couch (and by the look of him eating chocolate and ice cream) and going to a physiotherapist twice a week and wondered why his back hadn’t got better. No strength training, no flexibility training, nothing - and the insurance company kept paying. You couldn’t run a Premier League football club that way.

Consider the wisdom of the ancients

Drink more water

Improve ergonomic set-up at home

Improve ergonomic set-up at work

Improve manual handling technique

Meditation

Change and break up repetitive tasks

Improve posture at work and home

Anti-inflammatory drugs

Change diet, include nutraceuticals

Lose weight

Change diet

Traditional Chinese medicine

Osteopathy and chiropractic

Massage

Bowen therapy

Acupuncture

Physiotherapy

Improve general fitness

Ice and heat

Strength training

Flexibility training

FORMULA 1 REHABILITATION BAROMETER

If you think you’re going to get better over night you’ve got another think coming. There are few miracles in this business. Just cast your mind back and think how long it has taken for your body to get into its current shape? Years? Don’t expect it to get better by tomorrow morning.

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ASSESSMENTS

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21. HEALTH CLIMATE SURVEY Before we get started I want to give you the opportunity to reflect on how your health, fitness and wellbeing are generally. It’s frequently the case that musculo-skeletal dysfunction is just one of many dysfunctions you’re carrying. Completing the Health Climate Survey may provide you with the impetus to not only work on your musculo-skeletal system but also to work on other body systems. After all, we’re here to live the fit, healthy, rich and fulfilling life. Circle the number appropriate to the degree to which you experience the symptoms on the left hand side of the page. The greater the symptom, the higher the score.

None Hardly any A fair bit A lot

1. Headaches (including migraines)

2 . Lack energy and vitality

3. Furry tongue, thrush, jock itch, tinea...

4. Poor sleep (Score 10 if you frequently use tablets)

5. Snoring, sleep apnoea (Score 10 if using mask)

6. Musculo-skeletal pain

7. Frequent colds, flu and sinus

8. Reflux unsettled stomach (Score 10 on tablets)

9. Overweight (1 pt for every 2kg over ideal weight)

10 Irritable bowel, constipation, trots...

11. Shortness of breath from asthma

12. Low level of fitness (Your estimate)

13. Chest pain, palpitations

14 . Itchy, rashes, skin outbreaks, psoriasis...

15. Mouth ulcers, cold sores ...

16 . Elevated blood pressure (Score 10 if on tablets)

17. Elevated blood cholesterol? (10 if on tablets )

18. Elevated blood glucose? (Score 10 if on tablets)

19. Shakes, nervous tics and mannerisms

20. Grinding teeth

21. Alcohol intake (2 points per drink/day)

22. Smoking behaviour (1 point/cigarette/day)

23. Caffeine intake (1 point per cup)

24. Anxious about life, insecure, apprehensive

25. Are you depressed? (Score 10 if on medication)

26. Are you in the wrong job?

27. Do you feel under appreciated at work?

28. Do you have a poor work/life balance?

29. Unhappy with your family life?

30. Unhappy with your financial status?

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

The score of a normal, fit and healthy human being is less than …….... TOTAL ______

To find out what the ideal score is, go to page 84.

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22. MUSCULO-SKELETAL RISK FACTOR ASSESSMENT

The Musculo-skeletal Risk Factor Assessment will provide you with an estimate of the risk you are running of musculo-skeletal dysfunction. If you already have some dysfunction, your assessment scores may provide you with clues as to why you have it. The pass mark is 70. The lower the score the higher the risk of musculo-skeletal dysfunction. If you don't have a regular and systematic strength and flexibility training program you will probably be hard pressed to achieve the pass mark. It is highly likely that lack of training may have contributed significantly to your dysfunction.

THE MUSCULO-SKELETAL RISK FACTOR ASSESSMENT Give yourself a score out of ten, appropriate for your performance on each of the ten questions below. A good score is a high score. A poor score is a low score.

1. How would you rate the current condition of your musculo-skeletal system?

Dreadful Good

Points 0 1 2 3 4 5 6 7 8 9 10

2. Body Composition How many kilograms are you over your ideal weight?

Your current weight? …….. Your ideal weight ……..

No. of Kg over your ideal weight …..…

Kg >35 <35 <30 <25 <20 <15 <10 <8 <6 <4

% fat F <40 <40 <35 <30 <28 <25 <23 <20 <18 <15

% fat M >50 <50 <45 40 <38 <35 <33 <30 <28 <25

Points 0 2 3 4 5 6 7 8 9 10

3. Abdominal strength How many situps can you do until exhaustion – or ’til you’ve completed 30. Lie

down on your back with feet flat, knees bent at 90 degrees and arms crossed with hands clasping your shoulders. Sit up so your elbows touch your knee caps.

No. ……..

<5 5 7 9 11 14 17 20 23 25 30

0 1 2 3 4 5 6 7 8 9 10

4. Upper body strength How many pressups can you do until exhaustion – or ’til

you’ve completed 30; women on the front of the knees and men on the toes. For women make sure your knees, bottom and shoulders are in a straight line; ie your backside shouldn’t be sticking up in the air. Don’t count belly flops!

No. …….

<5 5 7 9 11 14 17 20 23 25 30

0 1 2 3 4 5 6 7 8 9 10

5. Squat From a standing position, how many times can you squat down (until exhaustion

or ‘til you’ve reached 30), with your backside just below the crease at the back of your knees, and stand up straight? You may use a heel raise (as illustrated) if you need to.

No. ……..

<5 5 7 9 11 14 17 20 23 25 30

0 1 2 3 4 5 6 7 8 9 10

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6. Sit and reach – hamstring flexibility In a sitting position, with legs outstretched in front of you, see how far down

past your toes you can reach with your fingers. Keep your legs straight and the backs of your knees on the floor. Score 4 if you can get your fingers to your toes, 5 for the first knuckle, 6 for the second and 7 if you can get to the palms. Score 10 if you can get your wrists past your toes.

Poor Good Can’t touch toes Fingers Palm Wrist 0 4 5 6 7 8 9 10

7. Sit up straight – buttock flexibility With legs crossed and hands clasped behind you back, see if you can sit up

straight without falling over backwards. Your score is based on the worst score for each side. Falling over backwards on either side scores 0.

Fall over backwards with hands clasped. Just Good

0 7 8 9 10

No. ……..

8. Shoulder function - wall test - subjective assessment Stand with your back to the wall. Place your hands in the surrender position with

elbows, forearms, wrists and fingers flat back on the wall. Score 10 if you can do this with ease. Score low if you have difficulty getting into this position or lower still if your elbows and wrists are a long way from the wall.

Poor Good

Vertical forearms 30 come from wall 5 6 7 Wrists flat on wall

0 5 6 7 8 9 10

9. Strength training behaviour Do you have a regular and systematic strength training program?

No. of sessions per week .…..

0 1 2 3

0 1 2 3 4 5 6 7 8 9 10

10. Flexibility training behaviour Do you have a regular and systematic flexibility training program?

No. of sessions per week ……..

0 1 2 3

0 1 2 3 4 5 6 7 8 9 10

The pass mark is 70. The lower the score the higher the risk of dysfunction. TOTAL

YOUR RISK OF MUSCULO-SKELETAL FUNCTION IS ASSESSED AS: -

▪ Low if you scored over 70

▪ Medium if you scored between 50 and 70

▪ High if you scored less than 50

If you scored less than 50 I suggest you embark on a serious strength training program at the gym and do the squats, situps, pressups and Superman exercises at home. Do that and you should get your musculo-skeletal system back into very good shape in a few months.

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23. CLINICAL DIAGNOSTIC ASSESSMENT Having completed the Musculo-skeletal Risk Factor Assessment you may have a better idea of your general musculo-skeletal condition and clues as to why you have become dysfunctional.

Based on how you fare in the assessments below, you’ll gain an even greater understanding as to why your body is out of alignment and why you are experiencing pain.

1. How old are you?

There may be some musculo-skeletal deterioration with age, but it shouldn’t be all that much. The older you are the more time you’ve had to train! In my experience, age doesn’t count for as much as we give it credit for. To pass off the cause of your dysfunction as being due to old age diverts out attention away from looking for the real cause of the problem – a body suffering from the lack of a regular and systematic strength and flexibility training program.

2. How many kilograms are you over your ideal weight?

Poor Good Kg >25 <25 <20 <17 <15 <12 <10 <8 <6 <4 <2 Points 0 1 2 3 4 5 6 7 8 9 10

The fatter you are the higher the risk of musculo-skeletal dysfunction.

Once you become 20Kg over your ideal weight there is a high chance you’ll become a victim of musculo-skeletal dysfunction.

How many kilograms you are over your ideal weight. ……….

3. Do you stand up straight?

Poor Good Kg Points 0 1 2 3 4 5 6 7 8 9 10

Are your hands hanging with palms facing the side of your body or do you stand with your knuckles facing forward?

Knuckles facing forward is a symptom of a pelvis that’s tilting backwards due to tight calf, hamstring and buttock muscles. Pelvis tilts back, shoulders slump forward. You end up with a crook back, sore shoulders and a stiff neck.

Are hands by the sides � Are knuckles facing the front. �

Good Poor

4. Do you stand up straight?

Poor Good Points 0 1 2 3 4 5 6 7 8 9 10

Are your shoulders square, or is one lower than the other?

Do you lean to the left � or the right �

Is the body twisted, with one hand further round to the front of the body than the other?

Left hand further around to the front �

Right hand further around to the front �

Good Poor

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5. Is there more weight on one side of your body that the other? Your score is based on how many kilograms more that you weigh on one

side that the other.

Poor Good Kg >9 <9 <8 <7 <6 <5 <4 <3 <2 <1 0 Points 0 1 2 3 4 5 6 7 8 9 10

Leaning to the left by ………. Kg

Leaning to the right by ………. Kg

6. Can you put your socks on standing on one leg?

An inability to put your socks on while standing up is a symptom of tight muscles on the back side of your body, from calves up to your shoulders.

Left leg

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right leg

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

You may also be restricted by excess fat around your body. Increased fat dramatically reduces your mobility.

Which side is tighter? Left � Right �

7. Can you sit up straight, close in to the wall?

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

An inability to sit up straight, bottom in close to the wall is symptomatic of tight calves and hamstrings.

When that happens pelvis is tilted backwards and spinal column adopts a ‘C’ shape rather than the ‘S’ shape, placing pressure on muscles, tendons, ligaments and discs of your spinal column.

Good Poor

8. Can you keep your feet in good alignment?

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

An inability to keep your feet in good alignment reflects on the ability of muscles on the side of your lower legs to do one of the jobs they’re designed to do.

Good Poor

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9. Can your sit up straight with legs crossed and hands

clasped behind your back, a hollow in lumbar spine and shoulders back?

Left leg under right

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right leg under left

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

An inability to sit up straight in this position is symptomatic of tight buttock muscles.

One side may be tighter than the other, in which case the body will be twisted. You may be able to sit up straight on one side, but topple over backwards on the other.

Good

Poor

Which side is tighter? Left � Right �

10. Can you get the buttock and thigh of the vertical leg in

close against the wall while the horizontal leg is flat on the floor?

Left leg upright

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right leg upright

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Good Poor

Which side is tighter? Left � Right �

11. Do you have difficulty twisting your body in the hip crossover position?

Twisting to the left

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Twisting to the right

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Can you get your feet comfortably on the floor?

Which side is tighter? Left � Right �

Does it hurt when someone pokes you in the buttock muscle?

Yes: Left � Right �

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12. Do you have painfully tight buttock muscles in the

reverse frog position?

Left buttock

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right buttock

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Does it hurt when someone pokes you in the upper part of the buttock muscle? It is likely that one side will be tighter than the other. Which side is tighter? Left � Right �

13. Do you have painfully tight buttock muscles in this

position?

Left buttock

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right buttock

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Does your buttock feel tight and painful when in this position? Does it hurt when someone pokes you in the buttock muscle while in this position? It is likely that one side will be tighter than the other.

Which side is tighter? Left � Right �

14. Do you have painfully tight hamstring muscles in this

position?

Left hamstring

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right hamstring

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

It is likely that one side will be tighter than the other. Which side is tighter? Left � Right � Does it hurt when someone pokes you in your butt muscles?

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15. How tight is the back side of your body?

Left hamstring

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right hamstring

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

With shoulders flat on the floor, can you comfortably grab the toe of a straight right leg with the hand of your left arm - and vice versa?

You’ll feel the stretch around your hamstring, buttock, lower back and up under your shoulder blades.

If you can’t grab your toe, grab the laces of your shoe. If you can’t grab the laces of your shoe, grab your sock, or the leg of your trousers …

Which side is tighter? Left � Right �

16. How well do your shoulders function?

Left shoulder

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right shoulder

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Points to look for.

In the surrender position, with heels, bottom and shoulders against the wall, can you comfortably get the back of your forearms, wrists and hands against the wall.

If you’re shoulders are dysfunctional, you will have great difficulty getting your arms, wrists and fingers against the wall.

Good: forearm and wrists on wall.

Poor: forearms and wrists well away from wall.

Which side is more dysfunctional? Left � Right �

17. Can you comfortably get your head back, flat against the

wall while you’re looking straight ahead?

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Points to look for.

Can you get your head back flat against the wall so your eyes are looking straight ahead - or when your head is against the wall are you looking up at the ceiling.

Good form Poor form

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18. Knee function

Left quadriceps

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

Right quadriceps

Poor Good

Points 0 1 2 3 4 5 6 7 8 9 10

1. Stand about 30cms away from a kitchen bench. You may need

something to hold on to for balance. Place the toe of your shoe on the bench and standing up straight with a hollow in your lumbar spine, lean back toward the bench.

You should feel the stretch in the quadriceps muscle at the top of your right thigh.

Which side has the tighter quadriceps muscle? Left � Right �

2, At the same time, observe how close the knee of the leg on the bench is away from the supporting leg.

Which knee is furthest from the supporting leg. Left � Right �

Which knee is sorest? Left � Right �

Bad knee Good knee

19. Hip function To check hip function lie on your back with one leg on top of the ottoman and the other bent with foot resting against the side of ottoman. Move the lower leg up and down for 20 repetitions. If it's functioning well, you'll be able to hit the floor with ease. If it is dysfunctional it won't go down onto the floor and by the end of 20 repetitions it will be tired. Repeat on the other side. Report on how well you can do it and if the sides are different. Which side is less functional? Left � Right �

20. Sitting at your desk working on the computer Get someone to take a picture of you sitting at your desk working on the computer. Get the person who is taking the photos to shoot the picture when you are least expecting it.

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24. SUBJECTIVE RATING OF THE CONDITION OF YOUR MUSCULO- SKELETAL SYSTEM

Select a number. 10 is good. 0 is dreadfully painful.

Left side

All Right side

What’s wrong

Neck

Shoulders

Elbows

Forearms and wrists

Hands

Thoracic Back

Lower back

Hips

Knees

Calves

Achilles

Shins

Feet

Toes

Treat therapy as counting for only 20% of the rehab process.

What you do for yourself counts for the other 80%.

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25. GOOD ERGONOMICS

All the ergonomic furniture in the world won't protect you from musculo-skeletal dysfunction unless ▪ it's accompanied by a regular and systematic strength and

flexibility program for the muscles that are designed to keep you sitting up straight

▪ you have the chair and desk set up properly and ▪ you sit in the chair properly. If you want to know how good your sitting posture is, get someone to take a photo of you at your desk when you’re least expecting them.

AT WORK Make sure you have a work station that supports your body in its correct alignment. The chair You need a good typist's chair without arms so you can get your body in close to your desk. Your posture Raise the back rest of the chair so that it pushes in under your shoulder blades. Your backside should poke out the bottom of the chair, a sure sign that you have a hollow in your lumbar spine. Contrary to popular opinion it is not the lumbar roll pushing into your back that creates the ‘S’ shaped curve in your spine. Rather it is the very act of you sitting up straight, pelvis tilted slightly forward. Make sure the desk is pressing into your abdomen and the back of the chair pushing in up under your shoulder blades. Then you’re locked in.

Typist's chair with back rest pushing up under the shoulder blades, abdomen pressing into the desk, bottom poking out the bottom of the chair, feet flat, wrists slightly below elbows, bottom of desk a centimetre above the thighs.

The desk Set your desk at the right height, particularly if you're typing a lot - ▪ feet flat on the floor ▪ knees about the same height as your hips ▪ top of the desk top (or key-board support), close to the top of your thighs, ideally within about a centimetre. Typing position When typing aim to keep your ▪ wrists slightly below your elbows ▪ fingers slightly below your wrists. Copy holder If you can, place the copy holder between the keyboard and the screen so you don't have to keep turning your head from side to side.

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The monitor If you're a touch typist, set the top of your monitor level with your eyes. If you're a hunt and peck typist, with your eyes on the keyboard most of the time, lower the level of the monitor so you don't have to lift your head so far to look at it. Recognise that you're seeking a happy medium in this respect. Separate work-station It would be ideal if you could have a separate work-station for typing because the height of the working surface needs to be lower for typing than writing. Your phone Poor phone technique is a significant cause of neck strain. If you’re one of those people who use their shoulder to keep the phone close to their ear, get yourself a phone holder and put your phone on the other side of the desk each month so you don't have your head permanently tilted to one side. Get a head set If you make lots of calls and write or type at the same time, get a head set.

LIFTING Key reasons why back injuries are caused when lifting are: - Legs aren’t strong enough. If your leg muscles aren’t strong enough to lift a weight, chances are you’ll transfer more of the weight to your back muscles. And if the leg and buttock muscles aren’t strong enough, then it’s a surefire bet that your back muscles aren’t strong enough either. You do your back in. Rarely, if ever will you blame lack of strength in your legs. It’s a tough assignment lifting anything with your heels off the ground. It’s not a strong lifting position and there’s a chance you’ll fall base over apex in the process. Take a leaf out of the weight training book. Start with feet flat. The big muscles of the thighs and buttocks do the heavy lifting. When legs are extended the back comes into play, but, there is already momentum working in its favour, and, once your legs are straight your back is not far off vertical .

This is a poor lifting position. It’s hard to lift anything while you’re standing on your toes. You‘ll topple over.

Lift the way weight-lifters lift. Let the big muscles of your legs do the heavy lifting.

Sharing the load You’ve got to share the load over the major muscle groups in the lower part of your body. You can’t leave all the heavy lifting to the spine. It’s not designed for this work. It collapses under the strain. Whilst the back and arms have to be strong enough to support the weight, most of the heavy lifting should be done by the legs You'll be sharing the load when your legs are doing most of the work. Unsafe swiveling technique, using too few joints and muscle groups to share the load. Lack of safe lifting equipment. If you’re frequently lifting heavy objects, get a hoist.

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To reduce the chance of back injury

▪ keep the load as close to the body as possible

▪ bend the knees

▪ share the load when swiveling

▪ slide the load toward you, then lift

▪ lift each load within the optimal lifting zone - which is between 30cms and a metre high.

▪ store heavy boxes within the safe lifting zone

▪ lift with your feet apart and spaced around the load

▪ use lifting equipment

▪ wear a protective back brace

▪ use lifting equipment

▪ wear a protective back brace

▪ where possible split the load into two lighter loads

▪ if possible push or roll the load rather than lifting it

▪ get help when lifting heavy objects.

AT HOME Your bed Have you got a decent bed? You need good support from a firm mattress

Lift with the load in close to you body.

Around the home There are hazards lurking all over the place.

When cooking, slide heavy pots to the front of the stove before lifting.

Take extreme care when moving furniture, particularly while vacuuming.

Use your legs to take some of the pressure off your back when starting a motor mower.

Slide the load towards you, then lift.

Your easy chair It’s no use sitting on an $800 chair at work and then spending half the night slouching on a $50 couch at home.

The chair at home is often as significant a contributor to lower back dysfunction as the chair at work. Lounging with the lumbar spine unsupported is a recipe for disaster.

A safer bet is a reclining chair which supports your lumbar spine as you lean backwards.

While driving Adjust the angle of the seat to give your lumbar spine good protection. If you need a bolster, buy one.

A reclining chair will provide you with better lower back support.

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KEY EXERCISES

TO RELIEVE

BACK PAIN

Succeeding chapters of the book contain some of the key exercises you need to do to first get and then keep your body in better alignment. If you can achieve that there’s a good chance your pain will disappear. Treat your back pain as the indicator of how well your body is aligned, of how strong and flexible it is. The exercises in this book are designed principally for people who have gradually let muscles pull bones out of alignment. If you are experiencing lingering back pain from a traumatic incident, your lack of progress toward recovery may be being impeded by a body that is generally out of alignment and lacking in strength and flexibility. I see this a lot. Someone with back pain will say it was caused by an incident that happened 20 years ago. I check them out and find they’re tight and weak and their skeleton is out of alignment. No wonder they’re not getting better. A rub down and a crunch every second week hasn’t restored poor function to good. Time to start exercising.

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26. A WORD ABOUT SCIATICA Sciatica is the pain you experience when the sciatic nerve is pinched, either by a herniated disc or by some of the muscles it passes through on the way down your buttock and leg. It’s a form of electrical interference. The exercises for fixing back pain may have a significant impact on reducing sciatic pain. By getting your vertebrae back into better alignment, the pressure on a herniated disc is released and it starts to move away from the sciatic nerve. Similarly loosening off some of the muscles in your buttock and thigh may reduce the pressure on the sciatic nerve. These lower back and thigh stretching exercises below may be particularly helpful.

It’s a big ask expecting to get better by having someone do something to you; sooner or later you have to do

something to yourself.

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27. BACK PAIN FLEXIBILITY TRAINING PROGRAM

FLEXIBILITY Flexibility refers to the ability to maintain a wide and healthily normal range of movement about the joints of the body. When they are not stretched regularly, muscles and tendons shorten and the range of movement around the joints decreases. The implications for postural alignment are far reaching, because if one muscle is pulling tighter than another, bones move out of alignment. Sooner or later you experience pain in one or more joints. Often it’s collateral damage from tight muscles nowhere near the painful spot.

Back pain goes well with tight back, buttock, hamstring, hip flexor and calf muscles. Similarly with neck and shoulder pain, both of which benefit from stretches that are focused on parts of the body lower down - as per the belief that the cause of the pain is rarely located at the site of the pain.

If you loosen the muscles attached to the pelvis so that you stand up straighter, you may well find that your neck and shoulders start to feel better.

By far the greater proportion of people who complete the Musculo-skeletal Risk Factor Assessment do not have a regular and systematic flexibility (or strength) training program. Is it any wonder they have some form of musculo-skeletal dysfunction?

RELAXATION EXERCISES I recommend spending time on the floor spending between 10 and 20 minutes relaxing in an exercise position. It gives tight muscles extra time to relax off. You don’t have to do anything, just relax. You can read a book, watch TV or drift off with the fairies.

I recommend you do the hip crossover exercise for 40 minutes.

The relaxation exercises are outlined on the next two pages.

ONE MINUTE FLEXIBILITY TRAINING PROGRAM I recommend the one minute flexibility training program for anyone with lower back pain. What this means is that you need to do each of the exercises listed on the following pages for at least a minute to get any benefit from it. If you can stretch for longer, so much the better. Many of the exercises will enhance joint function if you stretch for between two and five minutes, some even longer.

The reason why you need to stretch for at least a minute is because the initial reaction of muscles to being loosened is to tighten up. Imagine walking across a slipper floor and your slip. You don’t just gracefully do the splits; you tighten up.

So, to loosen off a muscle (and loosen off is a much more appropriate description than ‘stretching’), wait while it gets the message that it’s safe to loosen up. That takes at least a minute. Or, every time you breathe out, feel the muscle relaxing off. Don’t force it. After 20 deep breathes you’ll be surprised how much progress you’ve made.

If you do the exercises listed on the following pages regularly and systematically there is a good chance that your back, (neck and shoulders) will start to feel better.

If you're having trouble finding time to do your stretches I suggest you do them while you're watching television. That way you can take your time and spend as long as you like doing them.

ISOMETRIC STRETCHING - PNF I recommend isometric stretching, where you push against a resistance and then relax. The technical term is proprioceptive, neuromuscular facilitation (PNF).

It is an effective way of loosening tight muscles. The beauty of the isometric stretches is that you strengthen muscles as well. This is particularly important for the neck muscles. Many people lack sufficient strength in the muscles designed to keep their head on the top of the shoulders. Rarely, if ever do they strengthen these muscles. Doing neck flexibility exercises is necessary but not sufficient.

When the body is used rightly, all of the structures are in such adjustment that there is no particular strain on any

part. The physical processes are at their best, the mental functions are performed most easily, and the

personality or spirit of the individual possesses its greatest strength.

Wilfred Barlow The Alexander Principle

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28. RELAXATION EXERCISES This chapter contains some of the key exercises you need to do every night while lying in front of the TV or reading a book. The exercises are designed to let your body settle down and take pressure off the painful spots. All you have to do is relax and let gravity do the work of loosening tight muscles.

Static back – 20 minutes This is the most comfortable position for anyone with lower back pain. It lets the muscles supporting the hips relax and takes pressure off the lumbar spine.

Lie in this position for 20 minutes or more.

Supine groin stretch – 20 minutes each side Like the static back exercise, this one helps to relax the muscles which keep pelvis and back in correct alignment. If you have any musculo-skeletal complaint I recommend you do this exercise.

Lie with one leg comfortably on an ottoman or chair, the other extended on the floor. Have a smaller block in place to stop the foot of the lower leg from turning out. Lie in this position for 20 minutes or more.

You may notice the sides are different, which suggests that your pelvis is twisted. Gradually, over the days, the weeks and the months this exercise will help relax the muscles that are pulling your pelvis out of alignment; it will get you back into better alignment; pressure will come off your lumbar spine; pain will go away. Hip crossover – 40 minutes This is a five star exercise for anyone with back pain. It mobilizes the hip, groin and lower back.

Start with the heel of the right foot up toward the top of the left knee. Relax abdomen and lumbar spine and push the right knee further way from you. Then drop the right foot and left knee (together) onto the floor on the left side of your body. Repeat on the other side

Gradually push the right knee further away from you.

You might find the sides are different, suggestive of a pelvis that’s out of alignment. Gradually, over the weeks and the months, this exercise will help get the pelvis back into better alignment.

Build up to 5 minutes one side, then five minutes the other side for 40 minutes.

If you can’t get one of the feet on the ground because it’s too uncomfortable, let the foot rest on a pile of books. Keep changing from side to side every five minutes. As the hip loosens off, gradually start taking the books away. There’s a good chance that after 40 minutes the hip will have loosened up enough for the foot to rest on the floor.

Over the weeks and the months this exercise will play a critical role in squaring up your pelvis and getting the bones above it in better alignment. There’s a good chance the pain will be dramatically reduced.

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Supine frog – as long as you like This is an ideal stretch for the adductor muscles of the groin and inner thigh. Relax for as long as you like with knees out and soles of feet together. While you're there, tilt the pelvis forward and back. When you tilt it forward you'll get a hollow in your lumbar spine. When you tilt it back, the lower part of your back will flatten itself onto the floor.

Reverse cobra – 10 minutes Another excellent lower back mobiliser and complement to the cobra stretch. Place a cushion underneath your knees. Do this exercise for as long as you like. As you get used to doing the exercise use a higher cushion. Lying face down with your elbows propping up your upper body is also a good exercise. Read a book while your doing it. It will gradually put the hollow back in lumbar spine the sitting down takes out.

Static back against wall

Hamstring stretch

Lie down on the floor with legs straight and up against a wall. Push your bottom in as close to the wall as you can. Aim to get the backs of your knees flat against the wall. It may be more difficult to do that with one leg than the other - because your pelvis is twisted. As you relax off, gradually move your bottom closer in to the wall. Stay there for 10 minutes.

Using the corner of a wall, get your bottom as close to the wall as you can, with one leg extended up the wall and the other extended on the floor. Chances are you’ll have difficulty getting the vertical leg close to the wall with the other leg flat on the floor. Hold for 10 minutes. Every minute push your foot hard against the wall for 5 seconds, then ease your bottom closer to the wall.

The true miracle of modern medicine is … in making not only individuals but whole populations survive in

inhumanely low levels of personal health.

Ivan Illich

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29. FLEXIBILITY EXERCISES Apart from the exercises already outlined in the previous chapter, there are a number of fundamental exercises that you need to have in your stretching repertoire. These exercises require a bit more effort than the passive exercises. Of course there are many others, but if you back pain, here’s where I’d start, on the floor. They’re designed to straighten your up.

Prone frog – as long as you can! The advanced version of supine frog. When you’re lying face down the weight of your body puts extra pressure on the muscles at the front of your thighs. The exercise is designed to put the hollow back in lumbar spine (that sitting down takes out) by loosening off tight groin muscles. It’s designed to get the ‘S” shaped curve back again. To begin the prone frog exercise, rest on forearms and knees with knees as wide apart as you can get them and feet together on the floor. Lower your pelvis to the floor. The push you knees hard into the floor for 5 seconds, relax and lower your abdomen closer to the floor. Do this sequence 3 times. You'll get a marvelous stretch in your groin.

Cobra This is the classis stretch for lower back pain. Do it after the prone frog – you’ll get the best cobra you’ve ever done. It stretches stomach muscles and provides glorious relief for the lumbar spine. If you do it after the prone frog you'll get a marvelous stretch. Start in a front-lying position with hands wide and forward of your shoulders. Stretch upwards, keeping your pelvis on the floor. With every breath you breathe out, feel lumbar spine loosening off. Some therapists express caution on this one, but they’ve been doing it in yoga

for a thousand years or so. But, be careful and start gradually.

If you find getting up onto your hands too difficult, start by raising yourself up onto your elbows, and gradually, day by day, week-by-week and month-by-month increase the stretch.

Frog variation Sit up as straight as you can and gradually push you knees out with your elbows.

Hip stretch Tuck the left leg over the thigh of the right leg and then pull the right knee over onto the floor on the left side of the body. Push both knees together for 5 seconds, relax and let the legs ‘flop’ further towards the floor. Do this sequence 3 times. Repeat on other side.

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Sit up straight buttock stretch This exercise will provide you with a very good idea of what's stopping you from sitting up straight and getting the natural hollow back into your lumbar spine. It will provide a vital clue as to the cause of your lower back and neck pain.

Start in a sitting position with both legs straight out in front of you. Place your left leg under the right and then your right leg over the left. Lean forward. You should feel the stretch in your right buttock muscle. Repeat on the other side.

If your buttock muscles are loose, you’ll be able to sit up straight with your hands clasped behind your back. If they’re too tight you’ll fall backwards and to one side.

With knuckles on the floor, push forward with hollow in lumbar spine and head and shoulders back. You’ll feel the stretch rip into your buttock muscles. One side may be tighter than the other in which case your pelvis is twisted.

Wall sit This is one of the key exercises you need to do for at least a minute a day in order to loosen off hamstring and calf muscles and get you sitting up straight, getting the hollow back into lumbar spine and reinforcing good posture.

A large proportion of people will find this exercise most uncomfortable due to a loss of flexibility in calves and hamstrings. At first, you may have great difficulty sitting up straight and getting your bottom close in to the wall. Your calves and hamstrings may be painfully tight.

Start, sitting against a wall, hands on your lap, legs straight.

The cost of the luxury of sit down job is doing a minute’s worth of wall sit a day. Persist with this one; it’ll be worth it.

Sit up straight with a hollow in lumbar spine, shoulders pushing back against the wall, head back and chin tucked in so you are looking at the skirting on the other side of the room.

Pull the toes back toward your chest and tighten the quadriceps muscles at the top of your thigh. Let your stomach muscles hang loose.

Then lean forward off the wall, keeping the hollow in lumbar spin, shoulders pinned back and looking straight ahead.

Use your hands (on the floor) to shuffle your bottom closer into the wall. Do 4 repetitions in a minute.

Alternative buttock stretch

If your leg and buttock muscles are so tight you can’t do the sit up straight exercise, or if you’re over weight, try the alternative stretch.

Place one leg over the other and then pull the top knee up toward your opposite shoulder. This will really rip into your buttock muscles.

Sitting back in close to the wall. Push your shoulders hard against the wall and increase the hollow in your lower back; hold it for 10 seconds, relax and then push your bottom closer in to the wall.

Modified sit-up-straight exercises If you are too tight to sit up with your hands off the floor, try some of these variations. If one side is decidedly tighter than the other, spend more time on it. Hold the stretch for at least a minute.

Lean forward and with every breath you breathe out, lower yourself closer to your knee. 20 breaths and you’ll get a good stretch.

Pulling forward The super butt stretch. Get in close to the wall and gradually lower yourself to the floor.

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Get a friend to push down on the shoulder on the side that you’re stretching. After 20 breaths, creeping down each time you breathe out, you’ll sit up much straighter.

Use the opposite arm to the buttock being stretched to push your self further toward the floor.

With leg bent, lean forward. 20 breaths.

Hamstring stretch on bench Another useful hamstring exercise is with one foot on a table with you leaning forwards. This is another bathroom stretch. Stick each leg in turn on the vanity unit and lean forward. Every time you breathe out take your navel a little closer to your thigh. After 20 breaths you’ll make a lot of progress. Start standing up straight with hollow in lumbar spine and shoulders back. Then lean forward. It is not a competition to see how close you can get your head to your knee; rather the aim is to gradually lower your navel to your thigh. Don’t force it. With every breath you breathe our, just lower yourself a millimeter closer to your thigh.

Do each side for at 20 slow breaths. This is a good exercise to do after you’ve had your shower.

Hamstring sequence Here’s a sequence hamstring flexibility exercises.

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With legs straight reach forward and grab hold of your shins. Lean forward.

Holding your shins, raise your knees off the floor a couple of inches and slide your hands down further.

Lock your knees back to increase the stretch. Do this 4 times. If you’re flexible you’ll be able to hold your toes.

Hamstring isometric (PNF) stretch

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This is partner stretch for the hamstring muscles. Your partner holds the front of your foot while you pull back toward your head for 10 seconds against your partner’s resistance. (This is also a very good hip flexor isometric strength exercise.) After 10 seconds, relax and let your partner push your leg back toward your head. Do this five times. You will be amazed how much the hamstring muscles loosen off.

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Hamstring stretch in the shower Here’s a hamstring stretch you can do in the privacy of your shower. Warm your back up and then bend down with bent legs and grab your shins. Then straighten your legs. Hold for a few seconds. Repeat 4 times, going a little lower each time. Don’t overdo it by grabbing hold too low down. Start with a modest stretch and over the days, weeks and months grab hold lower down.

Buttock stretch This is yet another buttock stretch, but loosening off a slightly different aspect to those already outlined. It will also be helpful in loosening off a piraformis muscle which may be trapping your sciatic nerve.

Start on hands and knees. Place right leg over the left, onto the knee and the laces and then slide it back and prop on your elbows. To increase the stretch, take the back leg further back along the floor and lower your chest closer to the floor.

Spend a minute working each side, with an extra minute on the tighter side.

The lower you take your chest to the floor the more effective the stretch is on the shaded area of the buttock muscle.

Super hamstring, butt and back This is a great stretch for hamstring, buttock and all the way through up under your shoulder blades. Grab hold of the toe of a straight right leg with the hand of the left arm. If you can’t grab your toe, grab your shoe laces, or your sock or the leg of your trousers.

A minute a side will be a tough assignment. Do an extra minute on the tighter side.

Tough, but highly recommended.

Back stretch Pull your knees in tightly to your chest. You can rock gently back and forth.

It’s a good way to loosen yourself up before you get out of bed.

Goes well with its mate, one leg up at a time.

Legs over your head If you really want to give your spine a good workout, take your legs over your head. You'll know you're getting reasonably flexible when your feet touch the ground.

This is a difficult exercise for anyone who is overweight, but when you analyse it, it’s not much different from bending down with legs bent while you’re standing up.

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Cat stretch �

Dog stretch

The cat and the dog go together.

Cat stretch mobilizes thoracic spine.

With hands close together under the chest, tuck the abdomen in, push the pelvis forward and get a high arch in thoracic spine. Breathe out. Alternate with dog stretch.

Helps to restore the natural curve in the lumbar spine. Done with cat stretch, this is an excellent mobiliser for the lumbar spine.

With hands close together under your chest and head up, poke your bottom out and get a hollow in your lumbar spine. Breathe in. Alternate with cat stretch.

Hip stretch variation

Hip stretch variation

Hip flexor stretch Helps to restore natural curve in lumbar spine by loosening hip flexor muscles Start resting on one knee with the other foot well forward, pelvis tilted forward and back straight. Stretch forward and take the leading knee out over the front foot. If you’ve got sciatica this exercise may be helpful.

Calf loosener Never under-estimate the power of tight calves to have an effect on lumbar spine dysfunction. For some people this is where it all starts.

Stand for 10 minutes with your back to the wall on a sloping board; 5 minutes with feet square and 5 minutes with feet pigeon-toed.

As you become more flexible increase the incline. This is a much more effective stretch than trying to push walls and trees over.

To set the board up, purchase an off-cut of chipboard and a 10cm square block of wood.

Fold up stretch This is a good position to get into to relax your back.

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Back block stretch I got this from physiotherapist, Sarah Key’s book ’New Back in Action’. She swears by it, says it makes her work a lot easier. Place the back block, a piece of wood about 7cms thick (or some thing about as big as the average city phone book) underneath the top part of your bottom. Relax, and you’ll feel a pulling sensation, as you gently open out the lower back, ‘just like pulling out a concertina.’ The Sacro Wedgy, described on page 150 will have a similar effect.

Back Block

Sacro Wedgy

Portacovery The Portacovery is a plastic lumbar arch support device, ideal for loosening off tight muscles and opening up your vertebrae.

Place your head on the block and lie with your back over the arch. Gradually you’ll feel your back muscles loosen off.

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30. GENERAL STRENGTH TRAINING PROGRAM Strength is the ability of a muscle to exert a force. There are over 600 muscles in the body all capable of exerting forces and moving something. Most of these muscles move bones, some just make you blink, swallow, smile or frown. Your skeletal muscles have to be strong enough to hold your bones in correct alignment. The muscles also provide the body with protection; weak muscles don’t provide much protection and they lack the ability to exert much force. I hold to the belief that 80% of work-related ‘injuries’ occur because people aren’t strong enough to do their work. They’re not strong enough to push a mouse or a pencil, place a book on a shelf or lift a bag of cement into the back of an SUV without getting a crook back, stiff neck, the ‘cold’ shoulder and a limp wrist. There are compelling reasons to keep yourself strong. The main one is that if you don’t, you’re setting yourself up for all manner of musculo-skeletal dysfunction. I suspect a lot of people injure their backs when lifting because their thigh and buttock muscles aren’t strong enough to do the heavy lifting. They transfer the weight to the muscles of their back. However, you can be pretty certain that if leg muscles aren’t strong, back muscles won’t be either, so back muscles will come under excessive pressure and give way. That’s when you really experience back pain. You need a good, general strength training program, at home and at the gym. It’s the foundation of musculo-skeletal health. If you have any sort of inclination to restore poor musculo-skeletal function to good, the first place to think about going is the gym. In fact you’d be a mug if you didn’t go. Embark on a regular and systematic general strength training program.

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31. GENERAL STRENGTH TRAINING PROGRAM AT HOME The beauty of these exercises is that you can do them anywhere, any time, at home or at work, without expensive equipment. It’s imperative that you do them - either to restore poor function to good, or to stay in good musculo-skeletal shape. I find that it is not a difficult assignment to slip into a routine where you do a few strength exercises either as part of your morning exercise routine, or just before you go to bed. For the strength exercises you might have to build up to it gradually by doing a minute's worth (or less) of exercise in small doses. (For instance, spacing 40 sit-ups out over five sets of 12, 10, 8, 6 and 4 repetitions will add up to a good minute's worth of activity. Sooner or later you'll be able to do 40 on the trot.)

UPPER BODY STRENGTH Pushups on the toes King of core strength, plus arm and shoulder strengthening exercises. The 'men's' pushup. Starting position: fingers forward, thumbs shoulder width apart and body straight. Lower body to the floor so the front of the trouser; shirt and nose almost touch the floor. Then push up. Aim for 25 in 30 seconds. When you can do 40, report back! This is an exercise you need to do at least every second day.

Pushups on knees Queen of shoulder strengthening exercises. The 'women's' pushup*. Starting position: fingers forward, thumbs shoulder width apart, lower part of the body resting on the front of your thigh, not your kneecaps and body straight. Pressup handles I recommend you get a set of rotating pressup handles. They ‘make’ you go down lower..

Keep the knees, bottom and shoulders in a straight line. Lower body to the floor so the front of the trouser, shirt and nose almost touch the floor. Then push up. Aim for 25 in 30 seconds. When you can do 40, report back! This is an exercise you need to do at least every second day. The plank You’ve heard of the plank exercise, designed to improve trunk strength, front, back and sudes. It’s a good exercise and if you’re not used to doing it you’ll soon start to shake. The interesting thing though is that the pressup performs this same trunk strengthening function while you’re pressing up and lowering yourself down! In fact there is a high and positive correlation between your ability to do pressups and freedom from back pain.

Pressups are plank in motion.

* It is only a physical education convention that has made this the recommended pressup for women, principally because a lot of women have great

difficulty doing even just one pressup on their toes. This is not to say that it’s not possible. At 66, Valda who used to come to my fitness classes could do 30 pressups on her toes. Women fitness instructors can blitz a lot of male fitness instructors in the pressups stakes. But, regardless of gender it's the place to start for anyone who has weak shoulders, arms or wrists.

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ABDOMINAL STRENGTH - situps in a variety of positions Back Pain goes with weak muscles down the front of your body.

Situps without feet held The starting position is with your feet flat, shoulder width apart, knees bent at 90 degrees and arms extended with hands resting on the upper part of the thigh. Sit up so that your fingers get to about the bottom of your kneecap. Build up to doing a minute's worth on the trot.

Situps with feet held Start in the lying down position with feet supported under a piece of furniture, hands touching ears. Sit up so the right elbow touches left knee. Lower yourself so your shoulder blades touch the floor and repeat the situp so left elbow touches right knee. When you can do 40 on the trot, report back!

There is conjecture about whether doing situps with your feet held is a safe exercise. The fitness, physical education and physiotherapy professions are evenly divided on this matter. I believe it is safe and that as well as strengthening abdominal muscles, it strengthens the muscles on the front of the lower leg, top of the thighs and hip flexors. It is a very good, all round, front of body strength exercise. If you find that doing it hurts your back, then stop doing it for a few days, then gradually start doing it again. Start with 5 repetitions and build up. If you feel you shouldn’t do it at all, don’t do it. Do one of the other situp suggestions. Situps in supine frog position, heels together and knees wide apart. Place your hands on the upper part of your thigh and sit up so that your fingers get to about the bottom of your knee cap.

Situps with feet on a stool When you can sit up so your hands touch your ankles you’ll know you’re in pretty good shape. When you can do 20, report back!

Abdominal crunches Lie on the floor with hands behind head. Lift chest, head and arms off the floor. Hold for 3 seconds. Lift up, rather than curl up, looking at the ceiling as you lift off the floor. Aim to do as many as you can.

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BACK AND BUTTOCK FUNCTION Back pain goes with weak muscles down the back side of your body. Opposite arm and leg raise A gentle strengthener and mobiliser of the back and buttock muscles. Stage one for back strengthening. One arm and opposite leg up. Repeat on the other side.

Lead in to Superman

If you find the superman exercise too difficult, start by doing it this way, or with your hands underneath your chin. Take it easy and gradually build up to a minute’s worth of gentle ups and downs. Superman King of exercises for strengthening the muscles on the back side of your body. Lift knees and feet off the ground first, then chest and arms.

HIP AND THIGH STRENGTH Air bench This is an exercise you can do anywhere. It gives your thigh muscles an excellent strength workout. Sit against the wall, pelvis tilted backwards so the lumbar spine is flat against the wall, weight more on heels than toes, head on the wall, chin tucked in so you are looking at the skirting on the other side of the room. Build up to 2 minutes. If you find this a tough one you’re not alone. Fitball roll Roll the body up and down the wall. Go down far enough for the hips to be just a bit lower than the knees.

Slow squat Slowly squat down so your backside goes as low as it can towards your heels and stand up again. If you‘ve got tight calves and Achilles tendons you may need to raise your heels to maintain your balance. If you have really sore knees you may like to put a bucket or something under you backside to make sure you don’t go down too far. If you have trouble getting up, place your hands on a rail and get your arms to lend the thigh muscles a hand.

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The Pelvic Bridge

The pelvic bridge and its variations are designed to strengthen your buttock, hamstring, back and core muscles, at the same time increasing lower back mobility.

Lie down with legs bent. Lift your bottom off the floor to create a bridge between your feet and your shoulders. You can either hold it for a minute or do 10, slow ups and downs. Using the ottoman increases the level of difficulty and provides your lower trunk musculature with a wonderful mobilizer. Leg cycling Improves the strength of the hip flexor muscles. Just lie on your back and go for a ride. As the muscles get stronger you can extend your legs further from your body. Pillow squeeze Strengthens the adductor muscles of your legs - the muscles that bring the legs together. Sit up straight, hollow in lumbar spine, abdominal muscles relaxed with a pillow between your legs. Squeeze gently, hold for three seconds and relax. Do sets of 10 repetitions. Leg raises with ottoman If you use the ottoman for static back or supine groin stretch, at the end of those sessions do a set of 10 leg raises. Hold it at the top for 3 seconds. It will increase the strength of your hip flexors and adductor muscles - the muscles that bring your legs together.

Train smarter, longer and harder.

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32. GENERAL STRENGTH TRAINING PROGRAM AT THE GYM If you have any sort of musculo-skeletal dysfunction you need a good, all round general strength training program in the gym. It’s an indispensable part of a good musculo-skeletal health program. Over the weeks and months, lift by lift your body will become stronger and more capable of doing every day tasks without breaking down. The gym program is the foundation on which to build specific exercises for particular body parts.

SUPERSET ROUTINE I recommend you do what’s called a superset routine. In a superset routine you do two exercises at the one time, for instance the bench press, (which involves the muscles that push the weight away from you) alternated with the upright row (which involves the muscles that pull the weight back towards you.). What this does is keep the general activity in one area of the body, whilst giving each muscle group time to recover before the next set of repetitions. It saves a lot of time hanging around waiting for muscles to recover. They recover while you’re doing the next set of the alternate exercise. I've grouped the exercises in such a way that you can work through the exercises quickly and systematically at the same time giving each large group of muscles a rest between sets. I recommend you ▪ start with the upper body and arms, ▪ then move to lower body and legs ▪ then on to upper body again ▪ and finish off with abdominals, lower back and hip flexor muscles. In effect you are doing a mini-circuit, but one which is much more effective in increasing strength and muscle bulk.

COMBINATION EXERCISES I also recommend you do combination exercises - where more than one muscle is strengthened at the same time. For instance in the bench press, both triceps and pectoral muscles get a good work out. The combination exercise routine saves time, while still giving you a good, general, over-all workout.

SETS AND REPETITIONS I recommend you do four sets of 12, 10, 8 and 6 repetitions, increasing the weight with each set. That way you get a good mix between improvement in strength and muscle bulk. You need a bit of muscle bulk. Don’t be afraid, you’re not going to end up looking like champion body builder Arnold Schwartzenegger. The first weight for 12 repetitions needs to be light enough to provide you with a warm up. You should aim to comfortably reach the 12 repetitions. Gradually over the weeks and months you’ll find that you’re able to lift more weight or do more repetitions during each set. Gradually as you become stronger you’ll be able to get the 12, 10, 8 and 6 repetitions with increased weights.

NUMBER OF TIMES A WEEK Three times a week is ideal. Less than that and the improvement in strength is too slow. With once a week you’ll find you’re always stiff the next day. You’d be very short-sighted if you had any sort of musculo-skeletal dysfunction and you didn’t have a regular and systematic strength training program at the gym.

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THE EXERCISES

Bench press

Upright row

Strengthens chest and triceps muscles at the back of your arms. Strengthens muscles of your upper back and biceps, the muscles at

the front of your arms.

Leg extension

Leg curl

I’ve chosen the leg extension in this format because it’s very good for fixing your knees as well as strengthening thigh and buttock muscles. I recommend you do 3 sets of 12 repetitions. Start with a light weight for the first set and then progressively increase it for the 2nd and 3rd sets.

Strengthens muscles at the back of your thigh.

Shoulder press

Lat Pulldown

Strengthens shoulder muscles and triceps. Strengthens long muscles down the outside of the back, and biceps.

Hip flexor

Back strengthener

Situps

Strengthens the hip flexor muscles that lift the leg up. While you’re there, work on strengthening your leg adductor and abductor muscles.

Strengthens the back. I recommend you do 3 sets of a dozen or so push-backs. I think this is a good, dynamic exercise. Start easy and gradually build up to it.

I recommend you do one set of situps; build up to 40 or 50.

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CURL, SHOULDER PRESS AND LAT PULL DOWN Another recommendation for shoulder press and lat pull down. Do a set of dumbbell curls and then go straight into the overhead dumbbell press; 4 sets of 12, 10, 8 and 6 repetitions. Start off with a weight you can lift comfortably and progressively increase the weight for the 2nd, 3rd and 4th sets. Alternate with the lat pull down exercise. Bicep curl

Shoulder press

Lat pulldown

Treat complementary therapy as counting for only 20% of the rehab process.

What you do for yourself counts for the other 80%.

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33. PAIN RELIEF AND THERAPEUTIC MODALITIES

CONSTANT ICING Ice has long been recognised as a treatment for strains and sprains. In the case of back pain you’ll need to slip the ice pack under your shirt and keep it in place with an elastic bandage. You can buy icepacks in large supermarkets in the section where the lunch boxes are displayed. Get a packet of three so you can recycle them through the freezer during the day. Each one stays cold for over an hour. Keep icing the area for as many hours a day as you can.

HEATING If you’re going to ice the area you may as well heat it as well. You can buy hot/cold packs. Alternate them under shirt. Simply heat the pack up in some hot water. Just make sure you don’t burn yourself. The hot spa is a very good alternative.

MASSAGE By all means use massage. There are experts out there who have the touch of magic in their fingers and who will be able to speed up the rehab process.

The aim is to loosen tight muscles and make non-compliant muscles more compliant.

Compliant muscle, healthy muscle can be stretched, shortened, twisted or compressed without restriction or pain. It exhibits good circulation, flexibility, strength and endurance.

On the other hand non-compliant muscle is stiff, tender, and sore, with a feeling of painful knots or tight bands in the muscle. It exhibits poor circulation, reduced flexibility, weakness and easily fatigues. Non-compliant muscle is susceptible to injury in the same way a worn tire invites a blowout. Non-compliant muscle creates barriers that hastens fatigue and restricts peak performance. Personal massager

The stick

A hand held rolling machine, recommended by athletes for loosening up calf muscles.

Tens Machine

The tens machine works in a different way to palpate the muscles. You can have it on while you work, gently squeezing and relaxing painful muscles and tendons.

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PHYSIOTHERAPY Physiotherapy comes highly recommended, the aim being to speed up the rehab process using a variety of treatments.

The physiotherapists have the latest treatments in infra-red heat, diathermy, interferential, ultra sound and all manner of electronic rehab aids, plus hands on massage, manipulation and palpitation. Diathermy

Interferential

Low level laser therapy

Hand-held ultra sound

You may be able to purchase some of these physiotherapy tools at an economical price for home use.

A good physio will save you money and get you back in good shape in the shortest possible time - but they can’t do the exercises that you need to do yourself.

CHIROPRACTORY ’Crunching’ bones back into alignment makes a sound that convinces people that bones are being shifted back into alignment. Whether they are or not appears to be open to conjecture, Here’s what chiropractor Ron Grassis has to say:

‘During a back adjustment, your back undergoes quick, gentle stretching of the spinal facet joint, so you may hear a cracking or popping noise. This is caused by small pockets of air or bubbles, which are in the fluid that surrounds your joints. When joint tissues are stretched during a chiropractic adjustment, the pockets of air "pop," which creates that cracking sound you hear. After this treatment, you may feel more movement in your back. However, the muscles may still be sore and tight.’

So, if bones are actually ‘crunched’ back into better alignment there’s every likelihood that in between crunch sessions the bones are likely to be drawn back out of alignment by tight muscles. You’re back where you started. You have to keep going back, eventually coming away with a hip pocket nerve problem! Having said that, the claims of success are too large to ignore.

At the intersection where push meets shove, this may be the catalyst that frees you up and gets you moving, but someone manipulating you isn’t an excuse to stop doing the exercises. As I’ve said on numerous occasions, therapy speeds up the rehab process but does not take the place of that which you need to do for yourself.

BOWEN THERAPY Bowen Therapy is an holistic system of healing based on the work of Australian osteopath Tom Bowen. Bowen Therapy involves a gentle, rolling motion, over muscles and tendons. Whilst you’d swear nothing was happening, the rolling motion either tightens or loosens off muscles depending on the way the move is done.

The Bowen therapist will stimulate sets of points, often with two minute pauses, to allow the body to use the move and integrate it into the body's system. It is not a form of massage, though it does claim to release areas of built-up stress in the muscles.

A view held by some Bowen Therapists is that the specific way that Bowen Technique addresses the muscles is to 'stimulate the stretch and golgi tendon reflexes as well as joint proprioceptors in a way that heightens the sensory awareness of the body in the area worked on.' These sensations are sometimes mistakenly associated with some form of ‘energy healing’. By increasing sensory awareness the move taps into the body’s ability to self regulate which, in turn, practitioners claim, stimulates the body to heal itself. It is widely accepted by Bowen therapists that it is a stand alone therapy, not mixed with other treatments. Bowen himself was very specific about his clients not receiving other treatments for at least seven days after a Bowen session and did not perform any other therapies himself.

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ACUPUNCTURE Acupuncture is a useful treatment for back pain. A lot of people swear by it. Having been around for a 3000 years it’s worth a try. Acupuncture may be used in the immediate vicinity of the pain or more distant points along the energy meridians to help address pain and reduce inflammation. Acupuncture may also have significant benefits in creating an optimum environment for healing to take place.

ANTI-INFLAMMATORY MEDICATION Should you or shouldn’t you? The answer is maybe. Use it as a short term therapy. Prolonged use of anti-inflammatory drugs is not best practice medicine. Poor function is not permanently restored too good. While you’re masking the pain you could be doing further damage. And while you’re masking the pain there is always the temptation to stop doing the exercises. You think you’re better. You’re not. Having said all that, if you do take anti-inflammatory drugs, don’t take them for too long and while you’re taking them rest, the only exercise being stretching and gentle strengthening. Also you need to understand that the long term side effects, particularly on your stomach, liver and heart may not be pleasant. You may have read reports on anti-inflammatory drugs which have had to be removed from the market. These were drugs that prior to the recall were considered safe and widely prescribed. Who knows what the long term effect of drugs currently on the market is? What is the effect for taking some of these drugs for 20 years? The anti-inflammatories are designed to speed up the rehab process, not to mask the pain so you can keep plowing on and making the injury worse.

CORTISONE Should you or shouldn’t you? Your doctor may recommend it thinking it’s the wonder drug. You are standing in dangerous territory if you think cortisone is going to fix the underlying cause of your dysfunction. Chances are it won’t. Back pain isn’t caused by a lack of cortisone. If you do succumb to the advice, take it just once. But don’t stop doing the exercises. If anything take the opportunity of a spot of pain relief to increase your strength and flexibility training program. The problem with taking a cortisone injection is that you’ll think you’re OK, and go about doing your normal activities as if nothing had happened. But you’re not OK. Likely as not in a month or two you’ll be back where you started. You’ll think about another one, then another and another and sooner or later your back will suffer irreparable damage. It’s not worth the risk.

A good score on the HEALTH CLIMATE SURVEY (on page 50) is less than 20. Not bad is less than 40. Over 40 and you’ve got some work to do to get back to the ‘shape’ of a normal fit and healthy person. Over 80 and you’re putting up with a lot of ‘back-ground noise’. Over 120 and the ‘back-ground noise’ becomes unbearable. Over 150 and you’re at your wit’s end. For most people there is a good chance that they can halve their score in three months if they are diligent. You’ve got a choice: mask the symptoms with drugs or fix them up with a good health, fitness and wellbeing program. (I do understand that there are some conditions that need medical treatment and some conditions that may be extremely difficult to treat and/or for which there may be no known treatment.)

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34. THE BACK PAIN PRESCRIPTION So, if you were to ask me, ‘What you can I do to eliminate my back pain?’ my response would be to

1. Take responsibility for the cause. (If it was caused by a traumatic event I’ll take that back.)

On the other hand, I see lots of people with back pain that was caused by a traumatic event that happened over 20 years ago. When I give them the once over I can see that tight and weak muscles are preventing them from getting better. I see that therapy hasn’t achieved its desired aim.

2. Take responsibility for the treatment. If, over the years, therapy hasn’t done much to restore poor function to good, start doing

something for yourself.

Here’s the recipe I give people in Canberra.

▪ Take a couple of weeks off work to work on your recovery. Treat your rehab as a full time job.

▪ Get out of bed and warm your back up with a hot shower.

▪ Go for a walk for at least 30 minutes. This will warm you up from the inside.

▪ Have breakfast.

▪ Spend a couple of hours on the floor doing the 12 key Flexibility exercises, followed by 4 key strength exercises.

▪ I tell people to go out to the Australian Institute of Sport where they have hot and powerful spas. You can probably find a place that has a hot spa somewhere near you.

First go for a swim. If you don’t particularly like swimming get a pair of flippers. It takes the hard work out of it. Get a pair of

goggles as well.

After the swim put ice on your back for 10 minutes then get into the hot spa for 10 minutes and let the jets massage your body, around where it’s painful and around muscles that are tight. Do this sequence 3 or 4 times.

The effect of the heat and cold will be to reduce muscle spasm. While you’re in the spa move your pelvis around to help loosen

it up – along with the bones directly above it. ▪ Go home and have lunch and then spend another hour or so doing the realigning exercises.

▪ Go for another walk for at least 30 minutes.

▪ Spend another hour doing the realigning exercises.

▪ Go back to the Institute of Sport and repeat the heat and cold treatments.

▪ Come home and have a rest before tea, with your feet up in the static back position.

▪ Have tea and spend the rest of the evening doing your exercises on the floor in front of TV.

▪ On alternate days go to the gym and do your strength training using the machines.

The reason for the focus on doing physical things during the day is to stimulate the somato-psychic response – it’s called the exercise-led recovery. Not only will your back feel better, you’ll feel better. Modify your diet; lay off flour and sugar. For many people this change in diet will provide an almost immediate feeling of more energy; you’ll have fewer headaches. You’ll lose weight.

Boost your diet with vegetables and fruit. Start taking some of the nutraceuticals. Drink green tea, not coffee

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As well as all that, get out an exercise book and start pouring onto the page your thoughts about the things that have made you sad, angry, regretful …, all that sort of stuff. Write down things you like and dislike about your work, your personal relationships ... Write down the things you’d like for your health, your family, your career, your finances and your friends. Treat this time as an opportunity to focus on yourself, physically and mentally.

After a fortnight of this routine there’s a good chance you’ll be feeling much better.

Things change when you change. Your back will get better when you get better.

So make a decision.

COMMITMENT

Concerning all acts of initiative (and creation), There is one elementary truth, The ignorance of which kills countless ideas And splendid plans: That the moment one definitely commits oneself, Then Providence moves too. All sorts of things occur to help one That would never otherwise have occurred. A whole stream of events issues from the decision Raising in one's favor all manner Of unforeseen incidents and meetings And material assistance, Which no man could have dreamt Would have come his way. I have learned a deep respect for one of Goethe's couplets: ‘Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it.’ W.H. Murray from The Scottish Himalayan Expedition

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A body in alignment stays in alignment unless acted upon by a force.