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chiropractic, exercise, muscles, Uncategorized

McKenzie Exercises and Lower Back Pain

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The visual that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back.  Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode.   Feelings of pain and helplessness are some of the reasons why low back pain is of the most common causes for patients to seek emergency care!1

In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months2,3!  That’s pretty… painful to think about, actually.

On top of this, chronic low back pain is considered the second most common form of disability worldwide,3 and one of the most common causes for adults to see a family physician.4

In the past, patients were told to “take it easy” during a flare-up of low back pain.  They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax spasming muscles and ease pain to more tolerable levels.

However, times have changed.  Treatment guidelines instead recommend specific exercise4, gentle stretches, and other ways of staying active during the recovery process.  Total bed rest is to be avoided.

In my practice everyone who come in with lower back pain get homework (exercises) to do. No mater how much pain they are in.

Why the change?

Part of the reasoning is anatomical.  Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles5.

Superficial muscles are used to perform motions like bending and twisting.  These muscles are strengthened by exercise that places stress on the muscles.  Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.

Photo by Sabel Blanco


Deep muscles, on the other hand, help stabilize the spine and maintain posture.  Physical activity such as yoga, walking, and more, helps keep them in shape.  Picture the jogger going for a mile or two before breakfast: they’re working on deep muscle strength.

A common scenario is bending over to pick something off the floor.  You may hear a “pop” in your low back, followed by pain and muscle tightness.  You’re bent over, unable to fully stand upright, and your world suddenly hurts no matter what you do.  You go to bed – and stay there, unable to move because movement equals pain.  You call out of work because you can’t get out of bed.  You remain largely sedentary for a week, under the guise of “waiting it out.”

When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength.  This is a process known as atrophy.6

As the pain subsides and the person feels some improvement, activity is slowly resumed.  In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back.  Although they can function in this capacity, superficial muscles are NOT well-adapted for this function!  These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.

This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries.7,8

There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine.  Doctors of chiropractic regularly prescribe exercise to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness.8 

Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury.4 “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.

McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care. 

In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely. 

When you are experiencing a disc bulge or herniation, the disc material will often protrude posteriorly. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. Although in some severe cases surgery is necessary, the body has the ability resorb the disc naturally. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.

McKenzie extension exercises work because they force the spine to go into an extended position (when referencing the lumbar spine this means an “arched” back position.) This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This was visualized in the anatomical section of the course. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.

Before performing these exercises there are a few things you should pay attention to:

  1. While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.
  2. If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving.  Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely

How do we perform these exercises? 

You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.

If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises. 

A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.

Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember – it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.

References

  2. Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.
  3. “Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  4. Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530.
  5. Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.
  6.  Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.
  7. Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.
  8. Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.
  9. “Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain.
muscles, Uncategorized

Different Types of Muscle Strains

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Uncovering the Facts of Different Types of Muscle Strains

Have you ever experienced a muscle strain?  What is a muscle strain, anyway?

A muscle strain is an uncomfortable injury or trauma to the belly of a muscle.  Minor strains often result in a stretch to the muscle, like pulling a rubber band.  More severe strains can overstretch the muscle to the point where the muscle can have a partial or even complete tear.  Strains often occur in the low back or hamstring muscles1, but any muscle in the body is vulnerable to a strain injury! 

Strain injuries do not discriminate.  Many athletes, active lifestyle, and sedentary individuals suffer from muscular strains.  They can occur in various scenarios ranging from repetitive or overuse injuries like running or throwing a baseball, or sudden onset situations such as lifting a heavy box while moving.  Many people often describe a muscle strain as feeling like a “pulled” muscle, and they are not wrong – a muscle strain often results from a muscle being pulled too hard by outside forces2!

While strains occur to muscles, they have a cousin you may know as well: the sprain.  Sprains have a similar stretching mechanism of injury, but sprains happen to ligaments instead of muscles.  For the sake of this article, we will keep it simple and discuss muscular strains; however, an injury is sometimes also considered a sprain/strain because there may be a strain to the muscle and a concurrent sprain of ligaments at the joint.

Muscular strains can be put into two categories: chronic overuse, and acute traumatic strains.  

An overuse strain can be confusing at first because there is no single “event” that can be pinpointed that resulted in pain or injury.  A traumatic strain injury, on the other hand, often has a single and significant event results in injury; think of lifting a TV and suddenly, your low back goes into spasm!  Ouch!

Over-Use Strain (Chronic)

The Cumulative Injury Cycle

The Cumulative Injury Cycle3 represents the process in which over-use injuries and pain may occur.  This cycle is not limited to a particular activity, but anything you do repetitively!

The chronic cycle begins with Overwork, such as the long duration of sitting or longer-distance running.  Yes, even long periods of sitting can overwork muscle groups in addition to increasing your chances of developing deep vein thromboses, diabetes, and undoing the benefits of exercise.3  The engagement of muscle groups in the same activity – day in, day out – may lead to muscular imbalances and Weak, Tight, and Tense soft tissues, like muscle.2,3

These weak and/or tight muscles lead to excessive Friction, Pressure and Tension to the local muscles, ligaments, tendons, and fascia2.

In turn, this results in Decreased Circulation and Swelling and Hypoxia (lack of oxygen) to the area.  The lack of proper oxygenation to our soft tissues results in the formation of Adhesions and/or Scar Tissue to the area, which decreases the function of the local structures.  

Think of these adhesions like a tube of superglue that leaks out and gets into the carpet.  The nice fibers of the carpet are no longer smooth, and the carpet is not as effective in cushioning your feet due to gluing the synthetic fibers together.

Overworked, weakened muscles, coupled with excessive friction and tension and decreased circulation, result in a vicious cycle that both weakens and tenses muscles and soft tissue.  The cycle keeps on churning until the body sends off the alarm system that something is wrong.

At some point in your life, you probably stepped on something painful.  You may not have known it was even on the ground, waiting to ambush the bottom of your foot, until you stepped directly on it.  Our bodies can act very similarly.  We do not know something isn’t working correctly us until our internal alarm system goes off.  That alarm system comes in the form of pain!

Now that we know how chronic and repetitive injuries can occur with strains, what about severe episodes?

Acute Strain

The dreaded acute or traumatic strain.  It is a sudden onset of extreme discomfort or pain, and it can be life-altering for a stretch of time depending on the “grade” of your strain.  Strains can come at different levels, known as Grades4; in particular, Grades I, II, and III.  Read on to learn more about the different grades or levels of injuries for strains:

Grade I Muscle Strain

In a Grade I muscle strain, the muscle or tendon is overstretched and may have small tears to the muscle, like papercuts.  You may have mild pain with or without swelling.  Grade I strain is also called mild muscle strain.  For Grade I muscle strain, simple home remedies, such as applying RICE (rest, ice, compression, elevation) therapy may be just enough to manage symptoms.  These are usually self-resolving in a small time frame, although can be uncomfortable during the healing process.

Grade II Muscle Strain

Also called moderate muscle strain, Grade II strain occurs when the muscle or its tendon is overstretched with more of the fibers torn.  Symptoms may include marked pain with swelling.  The area of injury is tender and uncomfortable to the touch and may include bruising.  Movement can be difficult to perform because of the level of discomfort and muscle involvement.

Grade III Muscle Strain

Grade III strain, or severe muscle strain, is the most serious among the three grades of muscle strains. Most of the muscle fibers are torn!  In some cases, the muscle is completely torn or ruptured, resulting in a potential loss of function.  Pain, swelling, tenderness, and bruising are usually present.  Movement is usually difficult.

Moderate and severe muscle strains should be seen by a qualified health care provider, such as a chiropractor, for a thorough evaluation!

Now that you know about the different levels of muscle strains, what can be done to help prevent this kind of injury in the first place?

Preventative Measures

Here are some corrective strategies to decrease the chances of the over-use strain or acute traumatic strain injuries.

Keep in mind, even if everything is as perfectly as possible, you still may end up with strains and sprains if your sport or activity is strenuous in nature.  Even the best preparation cannot fully prevent injury, but it certainly can cut down on the chances of it happening!  Some things we can do are:

Corrective exercises: This will help combat against muscular imbalances that cause biomechanical issues and increased strain on the body.

Micro-breaks: Break up the repetitions of your activity or sport.

Ergonomics: Well-fitted sporting equipment, changes in exercise gear, or alterations to a work environment may be necessary to reduce the likelihood of injury.

Proper Technique: Less strain on the body from optimal efficiency and performance.

Rest and Recovery: Helps get the body back to a steady state and prevents excessive fatigue.

Equipment: Key to performance, efficiency, and reduction of strain on the body.

Should injury occur regardless of these factors, there are things you can do to ensure your body heals.  Anyone can get a strained muscle, and the amount of time you need to fully heal depends on the individual and the type of injury.5

Treatment Options

If a strain injury does occur, there are many treatment options one can consider in addition to the afore mentioned PRICE1,4,6 methods.  In our office, we typically utilize traditional therapeutic modalities such as electrical muscle stimulation, taping, ice, etc.

In addition, we provide 3 key treatment options that not all clinics do, and they are as follows. You can click on each one for more detailed information on our treatment interventions:

  1. Types of soft tissue treatment
    1. Active Release Tech.
    2. Graston
    3. Deep Tissue massage
    4. Ultra sound and IFC (Electrical Stimulation)
    5. Active stretching’s

It is important to see a doctor if you have a painful sprain or strain to get the appropriate evaluation and treatment.  Your knowledgeable chiropractor may also suggest changes to your exercise routine, sport habits, computer or desk setup, or other lifestyle factors to help improve your recovery.

References     

  1. Muscle strains. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/muscle-strains/symptoms-causes/syc-20450507. Accessed October 2020.
  2. Walls R.M., et al. General principles of orthopedic injuries. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed October 2020.
  3. Leahy, P.M. Cumulative trauma disorder defined. Retrieved from http://www.sportdc.com/art/leahy_art.shtml. Accessed October 2020.
  4. Mangusan, D. “Back muscle strains.” Retrieved from http://www.physiotherapynotes.com. Accessed October 2020.
  5. “Sprains and strains.” National Institute of Arthritis and and Musculoskeletal and Skin Diseases. Retrieved October 2020 from: https://www.niams.nih.gov/health-topics/sprains-and-strains
  6. Sprains, strains and other soft-tissue injuries. American Academy of Orthopaedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries. Accessed October 2020.