Getting Your Body Ready for Action

 

Your body can work for you or it can work against you…    

 

The correct preparation decreases your pain.   

 

Some of my patients keep themselves in good physical condition, and some of my patients do not. Either way, these patients have back pain anytime his or her back does something it’s not specifically prepared for. Like them, we all need the correct preparation to consistently have less back pain.

 

It can be done and it needs to be done.

 

To decrease your back pain you must increase your functional capacity by increasing your physical capabilities. To increase the physical capabilities of your muscles it helps to understand how your muscles can work for you as well as how they can work against you. Then you’ll “work smarter instead of harder” to increase your physical capabilities and decrease your back pain. Starting at any age, as well as in any physical condition, once you understand how your muscles function you can get your muscles to work for you instead of against you.

 

It also helps when you understand how your muscles are made, why they work, and what you have to change so they can work for you instead of against you. This understanding begins with learning the basics about the different types of muscle fibers as well as how these fibers function.

 

The different types of fibers include:

 

Intrafusal (reflex) muscle fibers;

 

Cross-fiber (connective) tissue; 

 

And extrafusal (bulk) muscle fibers. 

 

Your muscles can work for you–instead of against you–when you change three things: 

 

You need to retrain the contraction of the intrafusal muscle fibers;

 

You need to break up the cross-fiber tissues; 

 

And you need to increase the extrafusal fiber length.

 

Understand your intrafusal muscle fibers.

 

When a muscle lengthens too far or too fast, there’s a reflex inside the muscle that makes it tighten up to protect itself. It’s called the myotatic (stretch) reflex; it comes from a part called the muscle spindle, which is made up of structures called intrafusal muscle fibers.

 

The myotatic reflex is valuable because it can protect you from injury. It’s the way your muscles “put on the brake.” 

 

I saw this reflex on a “funny home video” television show. If you have one foot on the boat and your other foot on the dock when the boat moves away from the dock, your legs will “split” (and you’ll get wet) but the myotatic reflex in the muscles of your legs can prevent a serious injury. 

 

There are other times (like during a strenuous activity) when this reflex is working against you instead of protecting you because it tightens your muscles when you need them to be loose. Part of how you’ll decrease your back pain is by retraining this reflex; then you still have this reflex when you need it to protect you, but this reflex won’t make your muscles tight when you want them to be loose. 

 

Retraining the myotatic reflex isn’t easy but it’s certainly possible. On our track team in college I was amazed by how smooth over each hurdle the best hurdler was. He trained the muscles of his legs to stay loose as he brought his legs up and over the hurdle, then those muscles drove his legs back down to the ground. Consistent proper movements trained his muscles to work for him–instead of against him–and he was able to execute a smooth, powerful stride over each hurdle.   

 

To be smooth and powerful when you use your back you need to retrain the myotatic reflex in your back muscles. Just like a hurdler’s leg muscles, when you use your back muscles for strenuous movements you don’t want the myotatic reflex of your back muscles working against you.

 

Understand your cross-fiber tissues.  

 

Once you retrain the myotatic reflex, the next step to escape from your back pain is increasing your muscle length and range of motion. To do this you have to break up the cross-fiber tissues that develop in a muscle.

 

I believe most people have heard the expression “use it or lose it” and cross-fiber tissues are proof this is true. When a muscle is tight and stiff for a long period of time, it heals up this way. When it heals up tight and stiff, cross-fiber tissues develop; then this tissue binds the muscle, decreasing the muscle length and range of motion.

 

To escape from your back pain, you have to break up these cross-fiber tissues and re-align those muscle fibers. Once the cross-fiber tissues are broken up the natural length of the extrafusal muscle fiber is restored. 

 

Understand your extrafusal muscle fibers.

 

An overall increase in the length of the muscle enhances the muscles’ ability to handle a workload without injury or pain. To increase this muscle length you need to break up the cross-fiber tissues plus you need to expand the length of the extrafusal muscle fibers.

 

Extrafusal muscle fiber is made up of bundles of bands called myofibrils, and myofibrils are made up of sections called sarcomeres. Sarcomeres are made up of pieces called myofilaments, which are made up of proteins actin and myosin. When a muscle lengthens, the actin and myosin slide across each other in opposite directions.      

 

To increase the extrafusal muscle fiber length, you need to increase the filaments of actin and myosin–and there are times when your body will make more of what you use frequently. For example, the skin on your hand can develop a callous (extra skin over the area you’ve been using) when you are using this area more than usual. 

 

Research shows that when you consistently move and lengthen a muscle your body will produce new filaments of actin and myosin, which will increase the extrafusal muscle fiber length and increase your physical capabilities.

 

To increase your capabilities and decrease your back pain, you need to: 

 

Retrain your myotatic reflex: Then your muscles won’t tighten up when you need them; 

 

Break up your cross-fiber tissues: Then your muscles aren’t bound up or restrained when you need them; 

 

Increase the length of your extrafusal fibers: Then your muscles are re-structured and you’ll have more shock-absorbing ability as well as more power when you need it.

 

Here’s a general review:

 

TYPE OF FIBER: Intrafusal (reflex) muscle fibers.

WHAT THEY DO: They produce a myotatic reflex to protect you from damage.

HOW THEY CAN WORK AGAINST YOU: This reflex tightens your muscle when you want it (and need it) to be loose.

HOW THEY CAN WORK FOR YOU: This reflex is retrained to not tighten your muscle when it should be loose.

 

TYPE OF FIBER: Cross-fiber tissues.

WHAT THEY DO: They bind the individual fibers together.

HOW THEY CAN WORK AGAINST YOU: They will decrease your effective fiber length.

HOW THEY CAN WORK FOR YOU: They can be broken up to increase your effective fiber length.

 

TYPE OF FIBER: Extrafusal (bulk) muscle fibers.

WHAT THEY DO: They provide the total effective muscle length.

HOW THEY CAN WORK AGAINST YOU: A shorter length decreases your muscular motion and capabilities.

HOW THEY CAN WORK FOR YOU: A longer length increases your muscular motion and capabilities.

 

Doing nothing is easy, but it won’t really help.

 

Making these changes will be beneficial. Reconstructing your muscles improves your functional capacity and physical capabilities. Just giving your muscles a chance to relax–or avoiding the activity that caused pain–may feel good at the moment, but it won’t prevent future back pain! 

 

Relaxing your muscles–or not using them–won’t make the long-term changes you need to make. Just relaxing the muscle or avoiding the use of it doesn't retrain the myotatic reflex, break up the cross-fiber tissues, or increase the extrafusal muscle fiber length.

 

Changing your muscle is a long-term solution.

 

On vacation with my wife, I met one of my patients. This patient, her husband, and I had become friends over the years; coincidently, we were staying in the same hotel. We were talking by the pool when she mentioned how she had less pain “away from the job, the house, and the phone.” 

 

Several weeks after we all returned home this patient returned to my clinic. Once her restful vacation was over, unfortunately her pain returned. I wasn’t surprised: If relaxation of the muscles consistently eliminated back pain, then each of my patients who went on vacation and gave their muscles a chance to relax would stay pain free even after their vacation was over. 

 

To consistently eliminate your back pain you need to change your functional capacity. Temporary relaxation of your back muscles won’t eliminate your back pain because this relaxation doesn’t produce any long-term improvement in your functional capacity or your physical capabilities.

 

This is the change you need.

 

Research shows how increasing the specific capabilities of your muscles can produce long-term pain relief.  A study of low back pain by East Tennessee State University–as well as a study of autoworkers' lower back pain by Rush University in Chicago–showed how the incorporation of proper rehabilitative movement was instrumental in the continued reduction of pain (research studies #21, #22). 

 

This research demonstrates why relaxing the muscle or avoiding the activity that causes a problem doesn’t prevent future back pain. Many times I’ve explained to a patient why he or she needs to increase what his or her back can do, if they want to consistently decrease their back pain.  

 

She has a “can’t do” list.

 

I’ve had patients who avoid the activities that produce back pain as a way of reducing back pain. In the long run, it never works. Eventually, as he or she does less, the less he or she can do. Then, almost everything they do causes pain.

 

I have a patient who’s been coming into my clinic for years who tries to avoid all the things that bother her back so she won’t be in pain. I can’t talk her out of this approach, and I’ve seen this list of things she avoids doing just get longer and longer as a new thing gets added to the list every time she has back pain.

 

Now there’s very little she can do and she still has back pain. It’s easy to see her approach isn’t working!

 

Relaxing your muscle can lead to temporary relief, and avoiding activity can temporarily decrease your chance of back pain. However, if you want a solution that’s more than temporary you have to change how much your muscles can do–without pain–by retraining the myotatic reflex, by breaking up the cross-fiber tissues, and by increasing the extrafusal fiber length. Along with increasing the synovial fluid hydration of the tendons, ligaments, and cartilage, this is the way to consistently escape from your back pain. 

 

If it’s going to be done, it’s up to you.  

 

I have patients who don’t want to change anything. Each hopes his or her back pain will “just go away.” That’s unlikely! To decrease your back pain you need to improve the structure and function of your back. It helps if you know how you’ll make these improvements as well as why you need to make them.

 

Making changes beats the alternative.

 

Making the proper physical changes in the structure and function of your back doesn’t have to be painful, time consuming, or inconvenient–but having back pain will be. Some of my patients will learn the hard way: If you don’t take control of your back pain, it can take control of you.

 

It’s what you can expect.

 

Some of my patients never took any time to make the proper physical changes in the structure and function of his or her back. Its capabilities never improved then their back pain increased because their capabilities decreased. You can expect the physical capabilities of your back to decrease–not stay the same–if you don’t take any time to improve your capabilities.       

 

Then your physical demands don’t go away, but your capabilities do. To meet your physical demands without back pain you must train your back for what you need to do, and want to do–the way you need and want to do it.

 

Preparation is the solution.

 

I believe the workload of your life can be as physically demanding as any sport. In sports, preparation is essential; you’ll succeed in sports when you prepare yourself for each challenge. Likewise, you’ll decrease your back pain when you prepare your back for each of your physical demands. This is also true for more than just back pain.

 

Many of my patients want back pain relief, plus he or she is looking to improve his or her overall health. To help my patient get the overall health he or she wants, I’ll explain some of the things I believe everyone needs to do. For your overall health, doing something may be better than doing nothing but it doesn’t mean you’re doing the best things.

 

Are you “just going through the motions?”

 

Some patients get upset when I tell him or her why they need to exercise because they think they’re already exercising. For example, a common battle I have with my patients is the difference between walking when it’s an activity and walking when it’s an exercise.

 

I have a friend who walks almost every night. He goes the same distance, at the same speed. He thinks because he walks he’s getting his exercise, but for the entire time he’s been on this routine his overall physical condition hasn’t significantly changed and it probably won’t.    

 

Walking can be an exercise or an activity depending on how far or how fast you go. He thinks by walking he’s getting exercise but I think it’s just an activity. I believe his walking is an activity–not an exercise–because the speed and distance he walks are usually not strenuous enough to produce any changes in his endurance, strength, or flexibility. Just being active doesn’t mean you’re doing what you need to do, and making the changes you need to make.

 

For example, last year I had several patients who signed up to do a charity walk (sixty miles over three days) to benefit breast cancer. It was a significant physical challenge for each of them, yet for several months they continuously increased the speed and distance they walked. Their overall condition improved and they easily met this challenge. Their walking proved to be an exercise, not just an activity.

 

I explain the difference between activities and exercises to my patients this way: 

 

Activities are physical movements well within your current capabilities of endurance, strength, or flexibility. Because they do not make significant structural or functional changes, they use–but don’t improve–your endurance, strength, or flexibility;

 

Exercises are physical movements that push the limits for your current capabilities of endurance, strength, or flexibility. Because they make significant structural or functional changes, they improve your endurance, strength, or flexibility. 

 

Exercises you may be familiar with.

 

Practical examples of exercises include participation in sports (football, basketball, baseball, hockey, rock climbing, martial arts, track and field, softball, volleyball, soccer, etc.), as well as physical training (running, weightlifting, biking, stretching, aerobics, etc.). These are examples of exercises because they’ll increase your endurance, strength, or flexibility; but there’s a “key.”

 

It’s what you do, as well as how you do it.

 

The “key” is intensity. Earlier I mentioned walking could be an exercise or an activity, depending on how far or how fast you go. This is also true for exercise in the gym.

 

I have a patient who told me she goes to the gym and lifts weights three times each week. When she described her workouts, she mentioned she lifts the weights very slowly and she only lifts lighter weights so she can avoid any possible injury. By going so slowly, I don’t think she’s preparing her muscles to do anything new or practical; plus I think the weights she’s lifting are too light to make any real changes in her physical capabilities.

 

I told her I respect her dedication, but she isn’t pushing the limits of her endurance, strength, or flexibility. She may be dedicated, but I would consider her workout to be an activity–not an exercise. 

 

Both an activity and an exercise can make you tired. If I lift a toothpick thousands of times or walk very slowly in place I will eventually get tired, but just getting tired doesn’t mean I’ve really exercised. Your fitness routine may make you tired but it’s an activity–not an exercise–when it doesn’t make any structural or functional changes that improve your endurance, strength, or flexibility.

 

Different efforts produced different results.   

 

When I coached junior high and high school pole-vaulters, some of my athletes performed much better than others. The better performing athletes broke many school records, won district, regional, and state championships, plus several received college scholarships.

 

I believe what made them better was how they pushed their limits and made their workouts productive. Almost every day they made structural or functional changes and improved their endurance, strength, or flexibility. 

 

Some of my other pole-vaulters were not as productive. They didn’t push their limits, they didn’t make any real changes in their endurance, strength, or flexibility, and they didn’t show any real progress over the season. They came to practice but their results proved their workouts were an exercise less often–and an activity more often.    

 

Some exercises work better than others. 

 

To consistently escape from your back pain you have to increase how much your back is able to do without pain. This increase is produced by exercise, not just by activity. Not only is exercise more productive than activity, some exercises are more productive than others.   

 

I’ve learned–from research and experience–how using a specific type of exercise movement is the best way to increase the functional capacity of your back and increase how much your back is able to do without pain. Exercises that don’t use this type of movement are not the best way to increase how much your back is able to do, so they’re not the best way to decrease your back pain.

 

Life can be hard work.

 

I believe the physical demands of real life are pretty forceful. They include bending, lifting, and twisting, as well as sitting or standing for an extended amount of time. I also believe the only way your back can consistently handle these demands is to be prepared for them.

 

The key is preparation by duplication.

 

I introduced this concept in the “Introduction” section; when the goal of your exercise is to decrease your back pain, the correct exercise should duplicate the force, direction, and movement of what usually causes your back pain. For example, you prepare for most sports with exercise that duplicates the force, direction, and movement of that sport. The key is using exercise movements which prepare you for a task by duplicating the demands of that task.  

 

Passive movements are less beneficial than active movements.

 

I’ve learned from research and experience how the best exercises for decreasing back pain use active movements. An important difference between passive movements and active movements is:

 

Passive movements are when something else (like a machine, or another person, or a muscle from another body part) moves a body part or region. For example, my back uses passive movements when I’m bending over to touch my toes and I’m using the help of a machine, or with the help of another person, or I’m using my arms to help me bend over;

 

Active movements are when the muscles around a body part or region move this body part or region. For example, my back uses active movements when I’m bending over to touch my toes and I’m using just my stomach and back muscles to do it.

 

Static techniques are less beneficial than dynamic techniques.

 

In addition to active movements, I’ve learned from research and experience how the best exercises for decreasing back pain use dynamic techniques. An important difference between static techniques and dynamic techniques is:

 

With static techniques you get into a position and then you hold this position;

 

With dynamic techniques you continuously move. 

 

The most popular isn’t the most productive.   

 

When you tell your doctor you have back pain, he or she will usually give you a booklet of exercises. I’ve seen many of those booklets and most of the exercises (like the one where you lay down on your back, then your arms pull your bent leg up to your chest and hold it there) use passive movements with static techniques. 

 

I know very good doctors who continue to recommend those exercises to their patients. I believe these doctors are doing what he or she feels is best, but I don’t believe those passive, static movements in most back exercise booklets prepare your back for what you need to do, and want to do–the way you need and want to do it.

 

Many patients have come into my clinic because he or she still has back pain, even though they faithfully did those passive, static exercises they got from another doctor. I believe these patients still had back pain because those passive, static exercises didn't improve his or her functional capacity and physical capabilities.

 

I know those exercises are popular and I certainly don’t believe they do any harm. Yet when I’m asked about those passive, static exercises I tell my patients: “Those exercises aren’t very useful because they don’t prepare your back for what you do all day long!”

 

Here’s a general review:

 

TERM: Activities.

DEFINITION: Physical movements that are well within your current capabilities; they don’t push your endurance, your strength, or your flexibility.

RESULT: No significant structural or functional changes, and no improvement of your endurance, your strength, or your flexibility.

 

TERM: Exercises.

DEFINITION: Physical movements that use your maximum current capabilities; they push your endurance, your strength, or your flexibility.

RESULT: Significant structural or functional changes as well as improvement of your endurance, your strength, or your flexibility.

 

TERM: Passive Movements.

DEFINITION: The body part or body region is moved by a force generated from outside this body part or body region.

RESULT: The structures of the body part or body region are not fully engaged during the entire movement.

 

TERM: Active Movements.

DEFINITION: The body part or body region is moved by a force generated from within this body part or body region.

RESULT: The structures of the body part or body region are fully engaged during the entire movement.

 

TERM: Static Techniques.

DEFINITION: You get into a target position and then hold yourself at your target position.

RESULT: Your structures are only fully prepared for static movements.

 

TERM: Dynamic Techniques.

DEFINITION: You are continuously moving into and out of your target position.

RESULT: Your structures are fully prepared for dynamic movements.