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Kit_L

Overcome back pain program live now

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11 hours ago, Kit_L said:

@nick_kuchedav: most definitely, my friend. And I will send you the e-book to look over, too.

I wrote all the topics, that I want to include :) (about 2 pages). But I will include a few photos to my post so I will post it in the next few days.

off topic: I also found a file on my computer- about one page answer to nutrition for pregnancy topic :) 

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@nick_kuchedav: please send the nutritional info. when convenient. Cheers, K

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I intended to start my story with the first LBP appearance in my life and all the tools I used (lessons I learned) but it would become too big of a post so if someone is interested in the full version I can write it down later.

At the beginning of 2015, I got my most severe low back injury. On one failed attempt on deadlifts (200kg, nearly 1RM back than) I tweaked my back. I was a huge SMR fan at this time and I smashed my glute max., med., QL and hammies.
In the next couple of days, the pain started to decrease until one day I decided to do nearly 1RM bench press and my low back got tight/painful/frozen again. I decided to smash my QL with a tennis ball again and the pain went so bad that this day I couldn't walk by myself to home.

This condition continued for the next few weeks (literally the max speed I could walk with was 100m for over 10min) and I couldn't sit, lie down, stand, sleep or be in any position without a terrible pain. 

Than a PT gave me a few Feldenkrais exercises and for the next almost year I did them religiously (a few times a day). After one month of doing them, I could function kinda normal (I started training again but felt a significant amount of pain every day).
About a year later (2016) I came across ONBP book and started my ST journey, which about a 1,5 year later brought me to a pain-free low back (for the most time).

This topic could include so many details, so here are a few cornerstones from my journey (and a few from my client's journey):

1. When I did LLD test from the book I had a huge difference between both legs (nowadays I believe the reason was one-sided psoas cramp). I put an insole in my shorter leg's shoe but I didn't notice any improvement.
2. At every stage of my development, I had a different weakest point. There wasn't a single test that helps me to speed up the process. I just started doing everything and when the time past one particular stretch/ body area became the obvious thing to work on (based on tightness, pain, asymmetry). Here are all of them in chronological order:

  • bent knee side spine stretch on the floor (a key point for my progress: bent knee)
  • floor piriformis knee hug (key point: directing the stretch right into piriformis muscle)
  • supine low back twist (key point: correcting asymmetry)
  • adv. piriformis stretch (key point: lying with the chest on the calf)
  • lungeHF partner stretch (I didn't feel any relief until first 6-8months of practice, just a very strong pain and resistance in my body. I continue to practice it because of Kit's words about its importance)
  • lats- stall bars side lever block with a partner (key point: letting the back to be hunched, which is so anti-fashionable, everybody "knows" that you have to never bend forward) 
  • elephant walk (key point: 1.consistency 2.lumbar spine side flexion+ pelvis twist 3.quad contraction)
  • one leg dog - Liv's version (long holds- I went up to 3min sets on each leg here)
  • relaxation practice (this taught me the skill of being relaxed in my daily life)
  • one arm hang with crossed legs (one ankle on the top of the another leg's knee; lateral hanging) (key point: how stretching QL feels like)
  • pissing dog exercise + Handstand Knee slides (key point: feeling what QL cramp is and how to use (don't use) this muscle in these movements)
  • QL- 3 amigos modified exercise with DB's (the strongest version I felt so far) 

So basically I started with the restoration of all movements of the spine (and specific muscles that influence these movements). And after that, I focused on specific muscles(stretches, building general and specific strength, and just moving a lot).

My two biggest problems back then (before the injury) were: stiffness (I could hardly touch my toes) and my program design (I wanted to do everything and to progress way faster than my body can adapt), for a lot of my clients the lack of strength is a huge problem, too.

So my long-term changes (both for me and my clients):

1. better load management
2. changing my squatting and deadlifting technique
3. first thing in the morning: limbering exercises (this is something I used with a few clients and it works great so far - supersets of horse stand holds and head to toes pulses for 2weeks. After this time the body seems to wake up limber and ready for movement)
4. gently moving (Feldenkrais style) during acute pain/injury/inflammation stage
5. low back skin pulling and solo joint cracking
6. lunge clinic sequence (combination of exercise that I give to my advanced clients- https://www.facebook.com/More2train/videos/320323811793731/ )
7. add slow speed walking daily
8.  strengthening exercises for the big three: psoas, QL, glute med (I heard about this concept from Jordan Shallow and I liked it a lot - these muscles control the middle of the body)
9.  strengthening exercises for the thoraco-lumbar fascia: lats, glutes, external obliques+TVA
10. moving and sweating a lot (nowadays I move a lot - I go almost everywhere on foot, I do 4 training session with barbells, 2 sessions with rings and ST, 2 dance sessions, 3-4 boxing session, 0-1 horse riding session, 3-5 handstand session and I do a lot of movements while showing them to my clients).

I can write so much more on every topic in order to show the bigger picture and the results I see in my work, but it is damn hard to summarize it. Probably it is best to say that my approach is to start working on a particular goal/problem and gradually work on everything else.

 

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Brilliant, @nick_kuchedav:

Reading this detailed description tells me that you absolutely have got the ST method, completely. Really, ST is nothing more than tinkering with your body and mind, over time, taking notice of what leads to greater comfort/relaxation, and what doesn't, and going with only the former. Bravo. 

What you describe parallels my own journey almost identically, too.

You wrote:

Quote

nowadays I believe the reason was one-sided psoas cramp

I am certain this is accurate—and in my own case, when this happens, there is no pain in psoas, only in QL on the same side. I think this is massively unknown in the practitioner world. I developed our floor HF stretch exactly to be able to still do when the back is in spasm—and the stronger ones flowed naturally from this.

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Thanks, Sensei! 

7 hours ago, Kit_L said:

I am certain this is accurate—and in my own case, when this happens, there is no pain in psoas, only in QL on the same side.

And IMO the stronger (and longer) the spasm becomes- 1.the greater the pain, 2.the worse your assessment about what is happening will be.

I had a period of time that it was just so terribly painful without the ability to define where the pain is. 

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On 10/17/2018 at 2:23 AM, Kit_L said:

I have taken this program down for now; we will be re-launching with a free e-book, containing all my latest thinking on this widespread problem.

By taking down the program do you mean a new edition of ONAP is going to be released or there's going to be a new series introduced?

Or is it just taking down the ONAP information website?

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@Nmnb: I mean that I have "unpublished" (to use Vimeo's jargon) the follow-along 6-program series (Overcome back pain, so 'OBP') while we work out the best way to promote it using the free ebook. We are not marketers, so this will take a little time. The current edition of the book (Overcome neck & back pain, 4th edition, with its accompanying DVD Update, available on Vimeo) is still available.

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@Kit_L My bad, I didn't realize this was OBP and not ONAP.

I've been following S&F and so far so good, also considered getting ONAP for friends and family. I don't know if they'd benefit more from a video follow along or a book, so I'm still questioning what to get.

If it can serve as data, I can share on how I managed to get by back pain under control (herniation with localized pain in the lumbar area but not enough to cause numbness in the extremities, from deadlifting at a increased volume during a deload week where incorrect form and lack of flexibility might have been the cause). Mind you I also fall into the camp of those that chose to rest instead of keeping active for the 1st - 2nd week, which is a terrible thing to do and potentially slow down recovery immensely (I didn't start rehabilitating more consciously until a week and half, almost 2 after the injury).

At first I tried mobility and stretching, but it only got the pain worse. After researching a bit I tried stability and realized this is what I lacked, so I incorporated stability work. I started doing the following:

  • Cat-Camel mobility work as warm up.
  • McGill big 3 for the stability portion (McGill sit-up, Side plank and Bird-Dogs). I found out although my front core was 'ok', the sides and erector spinae were lacking in comparison.
  • Walking. This helped IMMENSELY.
  • Segmental rolling, didn't know these could help so much.

A week-in of stability everyday I decided to add more mobility and some stretching, this was the time I could handle it and the pain was reduced almost to a 70%.

  • McKenzie exercises
  • Chair side lower back stretch
  • Reverse hyperextensions

I could say now that I'm about 85%-90% full recovery as I slowly start adding more elements from S&F, mostly stretches targeting the obliques and QL. And more importantly it's watching out my posture throughout the day and sleeping/sitting positions.

 

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@Nmnb: no problem. In addition to being a complex system, there are many parts and acronyms...

A bit of history. We made the six follow-along 10–15' programs we call "Overcome back pain" (OBP) because our read of the market is that learning styles have shifted massively in 15 years. The book "Overcome neck and back pain, sub-titled *now includes arm, hand, and shoulder pain", is in its 4th edition, is current, and is available in the printed form from the usual outlets, including Amazon. As well, if someone wants to see many of the exercises demonstrated, we have a Vimeo program called "Overcome neck & back pain DVD Update" available as an inexpensive download. Variations of the book exercises and new material is included.

OBP is the most recent of my offerings to the back-pain suffering population; little theory, but short and practical solo exercise routines that will return the body to a mobile state. Much of the material s available free on YT, if anyone cares to do the work of searching and collating, but most do not. 

I have written a small (16 pages) ebook "The hidden caused of back pain" which we will distribute far and wide once we have worked out the best way to do this. If you email me, I can send you the Dropbox link; I will be interested in your responses.

Now to your self-treatment protocol: I recommend against the McKenzie exercises, instead suggesting flexion and lateral flexion exercises done from a chair, which you are already doing. What sources are you following for these exercises, if I may ask? The reason I recommend against extension exercises in the beginning is that for most people, protective tension in erector spinae and quadratus lumborum makes floor extension movements painful (the back muscles can cramp). In the same vein, I would not recommend reverse hypers yet—if you can do these, there's little chance that you have done anything serious to your back. Strictly speaking, if done properly, both standard and reverse hypers are glute–hamstring strengthening exercises that also stabilise the spine isometrically. Although extension and hypers (of both sorts) are excellent movements, experience has shown that these are better left to a later time in the full recovery process, once the pain has fully settled.

Don't forget that almost 70% of non-low back pain sufferers have disk extrusion "pathology" but without symptoms or dysfunction; this has been shown in the best MRI studies in the New England J. of Medicine (July 1995 issue, from memory); this research has been replicated many times since then.

Movement is critical to recovery, and walking is the best of it, as you have experienced. 

If this ever happens to you again, active recovery is the way to go (so walk every day) and once the acute phase shifts, then flexion, lateral flexion, and rotation can all be done carefully. Once you enter the strengthening phase, the other movement, extension, usually can be added safely then.

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@Kit_L Thank you very much for the detailed response. 

I think I'll end up getting ONAP too just to read more about the theory behind back pain.

I have some relatives that might benefit from OBP more, since it's more a follow along program with little theory behind. I also have to mention how one relative in particular have been to multiple PTs (be it private or public service) and none of them have helped so far since most of the PT field here is considered more as a massage therapist. From what I've heard from her experience it was mostly massage, no explanation to the cause of the pain and no routine given to follow at home (except for the public PT, but I don't know if she was consistent enough to follow the routine) so ultimately she resorted to cortisone shots. 

Another point to keep in mind is their consistency to follow the program and their belief in it, so I think my best choice would be getting more familiarized with the method before any suggestions of OBP are made. I'll try reading both S&F and ONAP to get more familiarized with the system.

As for my main sources of information I used the information provided by Steven Low on his website and a PDF available for the stability exercises from Stuart McGill, mainly:

I must agree on what you mentioned about the McKenzie exercises and the reverse hypers, I actually tried them during 1st day or 2nd day and the pain got worse the following day. At one point I ended up using back braces to relief part of the pain until I finally started doing the routine I mentioned earlier. I believe my injury wasn't that serious but it got worse due to my poor posture in general and/or maybe doing extension exercises plus reverse hypers recklessly, this aggravated the situation to the point that by the 4th or 5th day my walking was accompanied with pain and some numbness. 

16 hours ago, Kit_L said:

If this ever happens to you again, active recovery is the way to go (so walk every day) and once the acute phase shifts, then flexion, lateral flexion, and rotation can all be done carefully. Once you enter the strengthening phase, the other movement, extension, usually can be added safely then.

Duly noted. Since my back is better now, I'll add carefully more elements into my routine and remove those elements that could potentially aggravate the pain.

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On 11/3/2018 at 1:13 AM, Nmnb said:

I must agree on what you mentioned about the McKenzie exercises and the reverse hypers, I actually tried them during 1st day or 2nd day and the pain got worse the following day.

You experiences mirror hundreds (thousands now) of patients I have worked with, and my own experiences. These exercises are completely the wrong direction to go in in the first week (or two); protective tension is the reason. Ditto McGill's material: too early in the process; no problem later.

Whatever triggers the initial response, the body's second response is protective tension—so any strengthening or stabilising work done then will have the opposite to the desired effect, just because those exercises create more tension. It's almost impossible to work the muscles you want to work and not affect the pain-signalling ones. Stretching gently, relaxing, walking and getting on with the rest of your life while the process the body have entered into simply happen is the better approach. This initial phase can last up to a month, but a week, or sometimes two, takes care of 85% of people who come down with acute back pain. All this is discussed in detail in ONBP, with the evidence from the literature, including long-term studies.

In short: do whatever you can to reduce the protective tension until pain has settled (this includes gentle stretching, walking, learning how to relax) > increase the lengthening/stretching intensity until pain has gone > add strengthening and stabilising exercises until back feels completely normal. Identification and reduction of L–R differences in key functions is critical in all parts of the approach, too (lateral flexion, hip flexors, rotation, hamstrings). Again, all this is explored in detail in ONBP.

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@Kit_L Thanks for the detailed answer!

I just received a copy of ONBP and would proceed reading it alongside SF, really like that assessment section in OBNP.

 

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