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11/26/2005 - Kris
Dr. Hope, thanks for the very insightful answer (11/21/2005)! Too much compression in the gym appears to be the main stressor, several days of sitting/sleeping extensively can be nearly as bad. I did extensions with feet out to the left while tilted to the right, then switched to regular McKenzie, would this qualify as a proper lateral procedure? Squatting in the 60-70% range usually works, if not stiff I can max out without causing lumbago. Cannot go very heavy on high pin pulls unless totally pain-free. I hear you about posture, will seek advice, thanks.

If I may still bother you:

1) Should I consider the Ironmind Super Squats Hip belt as a way of rebuilding some strength in the legs while lowering compression?

2) Can spinal compression build over time, i.e. the spine get progressively more compressed week after week? Am thinking in terms of doing a couple of weeks of reasonable loading (using first occurance of minor lateral shift as an indicator) followed by 1-2 deload/decompression weeks (perhaps only hip belt work here).

3) Should I ditch the reverse hypers altogether?

4) Does a stronger core equal less compression at all (my reason for focusing more on abs and the posterior chain)?

5) What would be good ways to relieve compression, how frequently should they be used?

6) Would you say my weak annulus will stop me from becoming competetive in the SQ/DL or is this something that might be resolved long-term with proper rehab and posture correction?

7) Would using equipment help at all in lessening compression? Currently raw, not even using a belt.

8) Would you recommend any specific supplementary activities (swimming, sled dragging...) for keeping my spine active without undue strain?

Sorry for the long list, but this is the first time I am getting any help from someone who understands PLing and I am eager to work out a plan of attack. Any advice would be much appreciated. Thanks for helping me out!

Glad too see you are resolving.

Ironically I just read an e mail from Vinnie 11/25/05 he was lifting and got injured what he describes is a lateral shift like yourself. I recently treated a SWAT officer with a lateral shift. Shifts are not common problems.

Some of his guidelines may help you in the future. I corrected his shift on day one. He did shift corrections for one day and was placed in a CASH orthosis. This brace does not allow him to flex. On day two his shift was corrected and he began extension procedures. He was to perform one side glide every hour to make sure he had no obstruction to side gliding. Once he was pain free for five days to test his stability I had him perform standing flexion 50x and sit slouched for twenty minutes. This produced no pain and created no obstructions to movement. His condition was resolved.

If down the road he developes low back pain he will perform sidegliding and extension to see if his motion is obstructed If it is he resumes his exercises 10x every one to two hours.

Before I answer your questions remember I try to to give what I believe are safe exercises based on science. I have been asked about RDL, Good mornings and GH raises. They are not rehabilitation exercises. I had a conversation about this approach with Stuart McGill a few years ago and he is in agreement about this point. He has testified in court against therpist who decided to use high compression strong muscle activation exercises for spinal rehabilitation. He had science on his side they had it was a good exercise on theirs.

Your questions
#1 Yes this would be a good place to start
would use a wide stance.

#2 spinal compression does not build up like you stated. It is increased with positions then reduced with others. This is known as creep and hysteresis. Using periods with safer exercises ( delaoding is probable a good thing) every other group gets some time off why not the spinal muscles.

#3 The revers hyper is a very good exercise to improve posterior chain strength and is necessary to have a heavy squat. You may try limiting how far the feet come under you. I would limit the arc to the point where you can keep the lordosis. There is no value of rounding your spine. Trying to generate a major contraction of the spinal musculature and hips from the flexed posture is not a good idea.

#4 Core training and improved compression is necessary to have a stable base from which to move from. The delimma that arises is how much stability is necessary. Power lifters are unique in that they are alwyas trying to lift greater loads which require greater support.

Athletes are not the same. In some cases less compression exercises will keep them playing. Training is used to bring up weaknesses, work on high risk areas of injury and selecting exercises that will improve their strength while minimizing injury during training.

#5 Most spinal compression is produced with sustained flexion( poor posture) and repeated bending. This again goes back to creep and hystersis. Good sitting posture more than bad is a good place to start. Implement extension or overhead reaching during the day to offset flexion forces.

#6 As the nuclues dries out and becomes fibrous,it is less able to exert fluid pressure, Thus the nucleus is less able to exert radial pressure on the annulus fibrosus. Consequenly, the annulus is subject to greater stresses Nucleus breakdwon is a normal painless process. There is science to suppport that not all changes are age realted, some are active metabolic responses to change in the internal stresses of the annulus( changes in Type 1&2 collagen.

If you continue to have frequent episodes of lateral shifting then you are continually weakening the structure so the disc material will take the path of least resistance.

Most athletes will have back pain like yours and think it is a muscle... So they stretch it out usually more flexion and greater chance of injury. They sit slouched on a bench between sets more chance of injury( plus hysteresis). Those pains in my opinion are early warning signs and it aint muscle sending those messages. It is the disc. 50% of the time it is the disc that is causing pain.

#7 The belt is not favoured by some exercise specialist because they read the research that belts dont help prevent low back pain and may lessen the muscles ability to supprot the spine. This assumption can not be made with heavy lifting. This information came from back pain suffers. Not guys squatting 700 lbs. I would say with heavy squatting use a belt it will act as a counterforce to the abdominal pushing out.

#8 James Smith and I have had this conversation we are both in agreement that you should pick something that has diffrent movement patterns and loading patterns.

Because of my back ground i like heavy bag training work both punching and kicking. Remember No one said you had to be good at something to like it. Your body is forced to move out of the sagital plane. this is the moving pattern that all squatting and deadlift are done in as well as benching.

Remember if you can't perform low level compresssion exercises safely most likely the big ones will be worse.

Exercise selection is misunderstood when treating low back pain. Good exercises for strengthening need to be put into the program when appropriate. No one would tell a torn ACL afer four weeks to begin depth drop jumps on to a single leg if they have never done loaded lunges with out buckling or pain.

One more consideration science is realizing that resolved low back pain athletes still have firing latencies. This may mean they are still suspect when it comes to protective movements.

Call me Michael not Doctor

If you require further assistance you can call me 315 422-2912

what a long answer,
Michael Hope

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