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The Mysterious Pain

Spine Flexion
Oh woe – spinal flexion

I had a client come this week with low back pain among other things. She dutifully pulled out her latest MRI results for me to study. I had to tell her that:
a) I’m not medically trained to interpret lab results (although I find them interesting, always ask for a copy and then google the hell out of it)
b) I’m not allowed to “treat” specific ailments as a personal trainer
c) MRI results can be very misleading.

Let me explain.

First of all, when we have a pain, we really would love to know the source of that pain. We go to the doctor and ask for a diagnostic test so that we can “see” inside the body and thus, find the culprit. Once that culprit is identified, we can treat accordingly. Some treatments include:

  • rest
  • anti-inflammatories or other pain relieving drugs and injections
  • surgery
  • physical therapy
  • massage or other hands-on manual therapy
  • exercise

Officially (and legally) I fall into that last category. Restorative Exercise™ is still exercise, even though we define “exercise” and “movement” separately and I consider what I do more analytical than a traditional strengthening protocol.

As well, sometimes when we think we have an answer, we stop looking. That becomes “the story” and also sometimes, our excuse. I can’t do “x” because I have a slipped disc – even if that slipped disc happened many years ago. The story becomes our history. It starts to define us, and then we behave differently than if we didn’t have that story. We move differently, make different choices. Also, it is well known that many people will exhibit pathological findings on an MRI and be non-symptomatic, or, be symptomatic with no pathological implications on MRI type diagnostics. So just how reliable are those tests?

As a low back pain sufferer myself for decades, I know that exercise in the traditional sense did not alleviate my symptoms. I was told that Pilates would help by strengthening the core. I took Pilates classes and loved them. I became a Pilates teacher. I had a regular Pilates practice. I also had regular back episodes where about once a year I would spend a week lying on the floor in agony. I assumed that I was just not strong enough, or I wasn’t doing my exercises enough times per week or enough hours per day. I would work harder, become stronger. I could do some pretty advanced moves in the Pilates repertoire. I would often be called to demonstrate things in workshops. So why was my back injured? I too requested diagnostic imaging. This found much degeneration in the lower back vertebrae among other things. I was “falling apart.” So what to do?

I tried all the things on the above list, and more. Nothing worked for long. The core strength I acquired by my Pilates training served as a band aid to “brace” the spine and keep it strong while the muscles were there protecting it, but one false move (or more like many, built up) and kapow! Back on the floor in agony. The episodes came less frequently, but they still came.

Once I discovered Restorative Exercise™ it made sense to me on many levels. I started practicing it, and eventually I stopped practicing Pilates. I didn’t even have my spine in mind, the pain was such a part of my life that I never even considered that I was doing RE™ specifically for back pain. I just started aligning myself according to the bony landmarks, discovering where I was unable to achieve this alignment and why, and then going off in that direction, exploring my boundaries and limitations and weaknesses in a way I never had before. Then after a few years, I realized I’d not had my pain episodes in a long while. I hadn’t been bracing or holding or workout out or doing ab strengthening exercises, and yet – no back pain. Weird!

This continued until one day a colleague invited me to her Pilates studio to do a workout. It had been a few years since I’d done any Pilates. I was mildly curious to see if all the RE™ and walking I’d been doing would hold me in stead for the kind of workout I used to do. I admit I might have been a bit competitive in the class, but I did hold my own and was happy to see that even though I hadn’t been practicing the same type of work, my muscles had not lost tone for doing other kinds of things.

And then the next day happened. Kapow! Back on the floor in agony. For a while after this, I blamed flexion – the rounding of the lower back that is inevitable in roll downs, roll overs, rolling like a ball etc. I just assumed that my lower back was toast and that flexion was doing me in.

Early this year I went back to my second RES™ week. This is where you spend a week at the Restorative Exercise Institute and study and learn and immerse yourself in all things alignment. Katy Bowman led a class in…spinal flexion. OMG – I was so confused. Do I do the class and just take my chances? Excuse myself and watch? I didn’t know what to do, but trusted that I could stop if things got dicey. Well things got very interesting, but they never got dicey. I had a bit of an epiphany that day as I explored (carefully and thoughtfully) lumbar flexion. I discovered that because I had a hyper mobile segment in my low back, I also had a hypo mobile segment. This means that one part of my back moved too much, and one part didn’t move enough, putting too much stress on that part that could move. This took years of study and a very subtle and advanced practice to discern. I don’t think a beginner could expect to make such subtle distinctions about themselves. It’s possible for anyone to do eventually I believe, but you need to slow WAY down and start to listen to your body like you never have before.

Once I made this discovery I started putting some flexion back in the rotation of exercises. The things I’d been avoiding become possible again. And then recently I had another epiphany. The problem was not flexion per se, but the pressure I was creating by flexing. Often times in Pilates (and other modalities) you are cued to suck in the belly, (navel to spine) or tilt the pelvis, rolling vertebra by vertebra through the low back with a strong posterior tilt to initiate. Most of us modern people spend a lot of our day sitting on our tailbones, in a posterior tilt. I think that the movement was too extreme on one area, but more than that – it was the increase in pressure along the spine that caused the pain. We aren’t used to thinking of loading or pressure when it comes to our bodies. We are used to thinking of moving. “When I move this happens.” “It hurts when I do this.” So we stop moving, take that (perfectly reasonable) movement out of our repertoire and thus the muscles that create the movement atrophy and the health of those tissues gets worse…and we feel worse…leading us to more diagnostics and ever more invasive treatments.

Thinking in terms of what is being loaded and how (there are different kinds of loads and different ways to create them) and pressure differentials within the body’s spaces (and in my case, within the discs) can be an eye-opener. And a game changer.

https://www.painscience.com/bibliography.php?brinj
https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php
http://www.hopkinsmedicine.org/news/media/releases/costly_diagnostic_mri_tests_unnecessary_for_many_back_pain_patients

 

Comments

5 thoughts on “The Mysterious Pain

  • Hi Curly Top. That’s a great question, but I’d have to first ask: what is your objective for rolling down with a rounded back? Are you asking about a functional movement such as bending down for foot care, or to pick something off the ground, or are you asking what is the best way to practice rolling down through the spine for the sake of exercise (i.e., Pilates for example)? If it’s the latter, the objective is usually to ascertain sticky spots in the spine that are not articulating as well as other spots (some spots may be over compensating for the sticky spot such as in my scenario in the post above).
    In my opinion, repeating the forward bend standing in a repetitive fashion doesn’t really do much to un-do the sticky spots and will over-load the areas that are hypermobile, the weight of the entire torso/head are hanging from them. Bending the knees only accommodates the hamstring tension and doesn’t really “spare” the lumbar spine (in fact it adds more load). There are better ways to un-stick the tension areas and decompress the areas of overuse.
    As well, there’s the issue of the amount of time most people spend in lumbar flexion to their detriment, do you really want to be training it?
    I’d say forward bending for functional purposes is a natural thing to do and would occur naturally but occasionally, but doing a bunch of forward bends is not so natural 🙂

  • This post really hit home for me. I have been doing pilates with a physiotherapist for about 8 months now for mid back pain and I’ve started taking a weekly Reformer class at a studio, but while my body has become stronger, my pain has not been eliminated. The physiotherapist told me my lower back is “too flexible” but that I just need more core strength and my pain will go away. But my knots are more widespread than they were before. I’ve read a little of Katy Bowman’s work, but I’m definitely going to give it a closer look after reading your post.

  • Hypermobility (too much movement) is indeed very common in the L4-S1 region – that’s what my problem was (is). So strengthening muscles is not wrong per se, but it’s not the whole prescription because it’s the loads created at that site that resulted in the hypermobility in the first place. So strengthening will often work on the short term, as a band-aid solution, but if you keep on loading the site in the same ways (sitting, sitting a certain way, practicing something that creates loads there such as cycling, Pilates [all the flexion and a lot of pressure with abdominals], stomach sucking in…) you won’t ever get beyond that. Pre-order Katy’s new DR book when it comes out (very soon!) because the pressure info. applies here, and it’s a great book. Thanks for commenting!

  • Thanks for your reply! I will definitely keep an eye out for her new book and I look forward to exploring the rest of your blog 🙂

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