Movement Nutrition not Exercise for Back Pain

Back pain is one of the most prevalent orthopedic issues affecting at least 80 percent of people at some point in their life. A recently published article from the National Institute for Occupational Safety and Health (NIOSH) reports that more than 1 in 4 (26%) working adults experience low back pain. It is also the third most prevalent reason for people seeking medical care (mayo clinic proc. 2013).

“You know your in trouble when your back goes out more often than you do!” This is a pretty funny meme but for people suffering from back pain, it may be even painful to laugh at this.

As Physical Therapists, one of the most common questions we are asked is “what exercises can I do for my back pain”. The answer to this is both straightforward and complicated.

The easy answer is that once you have back pain conventional or general exercise may actually aggravate or perpetuate back pain.

At INVIVO Physical Therapy, we advocate for a program of “movement nutrition” for treating back pain*. The following key points illustrate our physical therapy treatment philosophy.

1. All Back Pain is Not the Same

In general, back pain can be categorized into two diagnostic groups.

Flexion-biased back pain is pain that is aggravated by movements such as bending forward, sitting and squatting.

This type of pain usually results from a reduction of the natural curve of the back, either from a rapid and traumatic movement or from chronic and sustained postures.

The painful anatomical structures may include a broad, supportive ligament called the Posterior Longitudinal Ligament (PLL), the anterior disc and the muscles that support the spine.


Extension-biased pain results from sustained postures or rapid movements that increase the natural curve of the back and apply forces to the posterior spine, or the back-of-you-back.

Painful structures affected may be the facets or joint surfaces of the spine, the posterior portion of the disc or a pars defect which is part of the bones you feel when you touch your spine.

2. Exercise vs. Movement Nutrition

Most people think of exercise as the stuff you do at the gym –squats, crunches, burpees (who doesn’t love saying that?), and stretching.

Exercise is typically defined as “activity requiring physical effort, carried out to sustain or improve health and fitness”. The problem with thinking about exercise as an intervention for back pain is that exercise is meant to “sustain or improve health”.

Unfortunately, those who are suffering from back pain are past the point of sustaining or improving health. The goal of treating back pain is to heal tissues and restore normal movement.

When we talk about “movement nutrition,” we are talking, in part, about movements and postures that reduce the stress on the affected anatomical structures and help to promote proper healing.

We like the term “movement nutrition” because it conjures an image of using movement postures and patterns to feed the body the right kind of elements to promote healing.

These movement protocols have a very different intention and look and feel different than conventional exercises. They are specific to the back pain classification and are intended to promote healing by taking the stress off the injured tissues and reprogram the nervous system from a protective state to a facilitative state. The overall goal is to restore normal movement.

3. Types of Movement Nutrition Patterns

The following are some examples of the types of movement patterns that are commonly used to treat Flexion and Extension-biased back pain.

We recommend that you consult an orthopedic Physical Therapist before you begin these movement patterns.

If these exercises aggravate your symptoms or if your symptoms do not seem to be improving in one to two weeks you should consult your physical therapist before your acute pain becomes chronic.

EXERCISES and MOVEMENT PATTERNS

Figure Four
Lie down on your back. Bend your knees and place the soles of your feet flat down on the floor. Cross your right ankle on the left thigh keeping the right foot flexed and active.

Thread your right arm through the space created between the legs, and interlace your fingers around the back of the left thigh or around the left shin for a deeper stretch.

Lengthen your tailbone down toward the ground to maintain the natural curve of the low back, and find the action of pressing your right knee away from your body.

Hold for 30-60 seconds or 5-10 deep breaths. Repeat on the other side.


Sciatic Nerve Glides
Lay down on your back. Bend your knees and place the soles of your feet flat down on the floor. Lift your right leg so your knee is bent to 90 degrees, shin parallel to the floor, and interlace your hands around the back of your thigh with both hands.

Begin to straighten your right leg and flex your toes back towards your shin. When you can’t straighten the leg anymore, bend your knee and point your toes down toward the floor.

Repeat this pattern as smoothly as you can 10x. Repeat on the other side.


Lower Trunk Rotations
Lay down on your back with your knees bent and soles of your feet on the floor. Your knees and feet are together with your inner knees touching. Open your arms wide out to the side. Your palms can face up or down.

Press the backs of your shoulders firmly into the floor and slowly drop your knees as far to the left as you can. Keep your right shoulder pressing down into the ground and keep your legs together. Then repeat to the right side while pressing your left shoulder down.

Continue alternating trunk rotations moving slowly and smoothly right and left 10x.


Standing Quad Stretch
Stand on one leg. If you need support, hold onto something solid, such as a wall or chair, for support. Bend your right knee and bring your heel toward your buttock. Reach for your ankle with the same hand.

Slightly tuck your tailbone in, bring your right knee next to your left knee and draw your right foot towards your buttocks until you feel a healthy stretch along the front of your right hip and thigh.

Hold for 30-60 seconds or 5-10 deep breaths.
Repeat on the other side.


Clamshells
Lie down on your side using your bottom hand or a pillow to support your head and neck. Make sure not to lift your head, but keep your neck long and neutral.

Bend your knees to approximately 45 degrees. Your head, shoulders, hips, and feet up shoulder all form one straight line.

If you are on a yoga mat line yourself up with the back edge of the mat.
Gently lift your bottom side waist away from the ground so that your top waist and bottom waist are both long. Try not to collapse into your bottom waist.

Keeping your feet together, lift your top knee just as far as you can without moving your pelvis and then lower it with control. Continue this motion until the muscles of the top hip feel fatigued.

Perform 10-15 repetitions. You can also perform this exercise with a theraband or mini band around your knees for added resistance.


Bent Knee Side Leg Lift
Lie down on your side using your bottom hand or a pillow to support your head and neck. Make sure not to lift your head, but keep your neck long and neutral. Bend your knees to 90 degrees. Your knees will be bent right in front of your hips.

Gently lift your bottom side waist away from the ground so that your top waist and bottom waist are both long. Try not to collapse into your bottom waist.

Flex all ten toes back towards your shins. Place your top hand on the floor in front of you for support.

Lift your top leg up just slightly higher than hip height. Lift your foot and knee evenly so that your shin stays parallel and your knee and toes are facing forward towards the wall you are looking at. Then lower back down.

Perform 10-15 repetitions. You can also perform this exercise with a theraband or mini band around your knees for added resistance.


Sidelying Hip Abduction
Lie down on your side using your bottom hand or a pillow to support your head and neck. Make sure not to lift your head, but keep your neck long and neutral.

Gently lift your bottom side waist away from the ground so that your top waist and bottom waist are both long. Try not to collapse into your bottom waist.

Bend your bottom knee 45 degrees. Straighten your top leg and bring it into one line with your spine. Engage your glutes to slightly pull that leg back, BUT DON’T EXTEND YOUR SPINE. Now flex the foot of your straight leg and rotate that thigh inward (heel up, toes down). Slowly lift your top leg as high as you can without moving your hips and lower it down to touch the floor.

Perform 10-15 repetitions. Repeat on the other side.


Turtle
Lie down on your back and fold your knees into your chest. Lift your heels so you have a 90-degree bend at your knees.

With a slight bend in your elbows, press the heel of your hands against your thighs with maximum effort. Simultaneously press your low back down into the floor. Tuck your tail as if you could curl it up off the floor.
Feel your abdominals contract.

NOW MAINTAIN THAT EFFORT for a goal of 1 minute. You may need to build up the stamina for that so start with 20 second holds. Repeat 3x.

* we use the term movement nutrition and intend this term to be distinct from the copyright business Nutritional Movement ©.