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Exercises that relieve Knee, Low Back, Sciatica, or Upper Back and Base of Neck Chronic Pain.

By: Richard Wills (LMP) Cell Phone: 360 370 5040

email: richard@nwamm.com www.nwamm.com

Preface: Done regularly, the exercises described in this pamphlet can reduce, and often even cure, the most common sources of chronic pain symptoms in the knee, sacrum, lumbar and upper back. This pamphlet is not intended to be a comprehensive guide to total fitness. It discuses only a few of the many possible exercises. It also introduces a few basic fitness precepts and a newer way of thinking about movement mechanics and treating chronic pain issues. Introduction:

In general, most chronic pain is a result of poor movement mechanics. Movement mechanics and posture are usually a function of guarding (protecting against painful movement). If standing straight and tall hurts, we stoop over. Guarding is a function of old, minor and maybe not so minor injuries... muscles are out of balance. Pain relief is nearly instantaneous when muscles are brought back into balance. NOTE: joint capsulitis (frozen shoulder or hip) results from extreme, long term, guarding. A therapist trained in James Waslaski's form of orthopedic body work can painlessly release a frozen shoulder during a single therapy session . However, that is beyond the scope of this pamphlet. Movement Mechanics: Our prevailing model for movement (kinesiology), assumes living movement works on the same principals of compression, levers and cables as a mechanical crane. They don't. Consequently, opioid drugs, muscle relaxers and pain

surgery address symptoms, not the underlying muscle imbalances actually responsible for most chronic pain. A newer, more functional model recognizes that our bodies are

more like this tent. Pressure or stress applied anywhere is distributed everywhere and slightly changes the overall shape. Our bones are like the poles in the tent. Muscles and fascia are like the tent fabric. (Fascia is web like connective tissue including tendons and ligaments, that literally holds us together).

This newer model is called “biotensegrity”. It provides a much improved explanation for how living organisms move and why both acute and repetitive motion injury can affect seemingly unrelated parts of the body. In general, pain happens when strong primary (agonist) muscles of flexion become locked short (tight or hypertensive), forcing the opposing (antagonist) extensor muscles to become weak, inhibited, and locked long (over-stretched). This distorts the web of fascia holding us together, and creates the distal pull and tension that results in chronic pain. Selective stretching and tonifying to treat pain is not a new idea. Pete Egoscue published a book years ago describing various pain treating exercises. There are now Egoscue clinics all over the country. You can go to http://www.egoscue.com/ for more

information. You can purchase Pete Egoscues' book “Pain Free: A Revolutionary Method for Stopping Chronic Pain” for about $10.00. on Amazon. Science and medical procedures change slowly. New research and understanding can challenge long held beliefs and procedures. Research supported new ideas or paradigms can take years to become accepted. Consequently, only a relatively few manual therapists have learned about, sought, and received this type of pain relief therapy training. Disclaimer: Please use common sense to evaluate the stretches and exercises suggested in this pamphlet. If any stretch or tonifying exercise causes pain, STOP. The idea that there is benefit from working through pain is a myth. Working through pain can easily exacerbate or cause injury. Don't do it. If you are currently under the care of any medical professional, it is probably wise to seek their advice before trying this approach. Please, ASSES, and take responsibility for YOUR RISK. Evaluate the ideas presented here. Compare these ideas with your therapy experiences. The exercises presented in this pamphlet are common, normal, everyday exercises taught by personal trainers, physical therapists and many other manual therapists. This approach is different only in that each tonifying or stretch exercise is specific to a specific symptom. I am not a doctor. Although I was a certified personal trainer and aerobics instructor for over 15 years, those certifications have lapsed. I am currently a Washington certified Licensed Massage Practitioner (LMP). I am hoping for (seeking) an updated,

nationally recognized, certification process that acknowledges the research and newer knowledge provided by the biotensegrity paradigm. Meanwhile, I am willing to share my paradigm and suggest common exercises and stretches that in my experience effectively treat many common pain symptoms. Biotensegrity Modifies Posture. These two pictures clearly show the short, tight chest muscles

(pectoralis major and minor), and the resulting weak, inhibited, overstretched rhomboid and upper trapezius back muscles. Notice my medially rotated arms. Normally, palms should be parallel to the thigh, not facing to the rear. Tight (contracted) pectoralis major and subscapularis muscles (not visible) are the cause for the rotation. My right shoulder is also both elevated and rotated anteriorly in its

socket. All of these imbalances are pretty easily corrected during a typical orthopedic manual therapy session. However, because of the joint capsulitis (frozen shoulder) a trained manual therapist was needed in addition to the self care (exercises) that corrected the imbalances. NOTE: I had a classic “frozen shoulder” when these photos were taken. My frozen shoulder was released, painlessly, in less than an hour, by the international therapist educator James Waslaski, who trained me in the principles of orthopedic manual therapy. The success

achieved using his training is the reason I feel so strongly about the efficacy of this type of pain relief therapy. If you look closely, you can also see some functional scoliosis caused by my right hip being slightly forward (anteriorly) rotated. General Exercise Principals: Correct form dramatically enhances pain free, non injurious, fitness improving exercise. These tips are not intended to be all inclusive. They are not intended as a substitute for a well educated exercise trainer. The tips do apply to almost any exercise you choose to perform.

1. Research shows that the eccentric (letting the weight down) muscle contraction, not the concentric (lifting the weight up) improves strength (tonifies muscle). Therefor, the eccentric contraction should last twice as long as the concentric contraction. I.e. Lift to count of 2 and set down to count of 4.

2. With few exceptions (maybe the yoga cow) the chest should be lifted (pushed out) whether stretching or strengthening. Doing so helps protect your low back. Visualize being pulled like a child's pull toy, with a string attached to the middle of your sternum.

3. “No Pain, No Gain” is a myth. If you are exercising into pain, you are probably injuring yourself.

4. Research by Aaron Mattes indicates that active isolated stretching is the fastest way to improve flexibility. Hold a stretch for 2 to 3 seconds, release, take a breath, exhale, then repeat. Do this 3 or 4 times for each muscle group being stretched.

5. Short, tight, contracted muscles inhibit, weaken and stretch (lock long) their opposing muscles. Consequently, posture improving benefits happen more quickly if you stretch short tight flexor muscles, before you strengthen the weak

inhibited, overstretched extensor muscles. In general, during this pain therapy period of exercise, I suggest focusing on bringing muscles back into pain free balance rather than improving overall fitness and strength.

6. If you have been sedentary for a period of time, you may find yourself becoming addicted to regular exercise. I suggest waiting until you are relatively pain free before pursuing a more aggressive and comprehensive fitness program.

7. Research indicates that the majority of fitness improvements happen with only one set. This means that you do not have to spend hours in the gym to see (and feel) remarkable fitness improvement. A set is the same exercise done for several repetitions.

8. Research also indicates that the most efficient amount of resistance for strength improvement is a weight that you can only do for 8 to 12 repetitions in good form. This means that if your form starts getting sloppy at 7 reps, the weight is too heavy. If you can do 15 reps, the weight is too light.

9. All resistance exercises are best done slowly and controlled. The concentric contraction (lifting the weight) should last 2 seconds. The eccentric contraction (lowering the weight) should last 4 seconds.

Finally, lets get to the exercises:

Low back (lumbar) pain: Lumbar pain is most often caused by tight psoas muscles pulling the lumbar spine into an excessive forward curve called lordosis. If

you are wearing jeans and a belt, your belt is probably high in the back, and sloping sharply downwards in the front. Ideally, men should have around 10 degrees or less of anterior pelvic tilt. Women should have 10 to 20 degrees of anterior tilt. The line of your belt can be a fair indicator of tilt. Part of the reason a beer belly hangs over the belt buckle is that the abdominal contents are spilling over the rim of an anteriorly tilted pelvic bowl. The psoas muscle attaches between the lumbar spine and the top of the thigh. When it is short and tight and your feet are anchored to the floor, (or you butt is anchored to a chair), it pulls the pelvis forward (anteriorly) and increases lumbar curve. Left untreated, a herniated (slipped disk) and or spondylosis eventually follows. These conditions are assumed to be age related. Using the updated model, we now understand lumbar pain and slipped discs are really just symptoms of muscle and fascia imbalances. The best non-invasive treatment is to stretch and release the shortened psoas followed by strengthening the weakened, inhibited abdominal muscles. As the lumbar curve returns to normal, a herniated disk can start to heal and lumbar pain becomes a memory. Short term pain relief is achieved by frequently (several times a day) stretching the psoas and daily strengthening of the abdominal muscles. Long term pain relief happens as the disk heals.

Psoas Stretch: 1. Stand with feet pointed straight

ahead and shoulder width apart. 2. Hold onto something, as pictured, for

balance. 3. Step back with one leg, feet still

shoulder width apart, and both feet pointing straight ahead.

4. Keeping hips square, and chest up, lower your body by bending your knees.

5. A vertical line down from the front knee stays behind your toes.

6. Press hips forward keeping your upper body erect. 7. It is OK if rear heel lifts off the floor. 8. Hold for 2 seconds, take a breath and repeat 3 or 4 times. 9. Done correctly, you will feel this stretch down the front of the

groin and upper thigh of the rear leg. Strengthen abdominals:

1. Lay supine, with lower legs up on an exercise ball, chair, or stool. NOTE: a traditional sit up engages the already short tight psoas muscle once you exceed 15 degrees of flexion. Crunches do not.

2. Place finger tips behind your ears, not behind your head. (Do not pull your shoulders off the floor by cranking on your neck. If you have

a weak neck, support your head in your crossed arms). 3. Crunch your chest towards your hips. The back only has 15

degrees of flexion. This is not a military sit up. If you put your thumb in your navel, and long finger on your pubic bone, you will notice they close towards each other. This means the abdominis rectus muscle is contracting. Come up to count of two, and return to count of 4.

4. I like to do 10 crunches to the front, then alternate with 10 more to each side, in order to work the obliques as well.

5. A primary goal is to lift the front of your pelvis. Holding an exercise ball between your ankles and doing a reverse crunch by lifting the pelvis off the floor shifts the exercise to the lower fibers of the abdominal muscle.

6. NOTE: During a full military sit up the targeted abdominal muscle contracts during the first 15 degrees of flexion only. After that, the psoas muscles take over. Conversely, our goal is to stretch the psoas and strengthen only the abdominals.

Low back (lumbar) pain with posterior tilted pelvis: The pelvis in some small percentage of people with lumbar pain tilts posteriorly. Most of these persons seem to have no butt when standing. It's there, just tucked underneath because of the posterior tilt. Their belt is higher in front, and lower in back when they are standing erect. The primary muscle pulling the pelvis into a posterior tilt is the

gluteus maximus. Therefore, the best remedy is to stretch it. Stretch Gluteus Maximus

1. Lay on your back. 2. Pull one knee up towards your

chest and across the body towards the opposite shoulder.

Low Back (sacrum) and Sciatic Pain. Caution: On rare occasions, sciatic pain is caused by a compressed sciatic nerve as it exits the spine. A trained body worker can easily assess for a spinal nerve compression injury. If you are not sure, or if you have already been assessed with a compression injury, do not do abdominal or back exercises unless

cleared by a doctor. Exacerbating a compression injury can possibly cause paralysis. Almost always, when a client describes either sciatica, or sacrum pain, I find that one ilium (pelvic rim) is tilted more that the other. The following exercise is effective in most of these cases. It looks very similar to the psoas stretch above.

Stretch Iliacus for Sacrum Pain 1. Start by standing with both

feet shoulder width apart. 2. Hold onto something for

balance. 3. Step back with one foot,

and place it directly behind the front foot.

4. Look, and make sure both feet are pointing straight ahead.

5. Place your hand on your pelvis on the same side as the back leg. Use that hand to help focus awareness that your hips are square (perpendicular) to your legs.

6. Bend your knees to lower your body.

7. Press your hips (keeping them square and upper body erect) towards the front.

8. Done correctly, you feel this stretch alongside your tailbone; usually on the same side as the back leg.

NOTE: Occasionally, stretching one side can increase, or turn sciatic or sacral pain on like a light switch. Stop immediately.

9. Switch sides, and gently try the other side. Often, this will turn the light switch off and the original pain diminishes or disappears. If this happens, only stretch the pain free side. If you have increased pain on both sides, don't do this exercise.

Alternative Sacrum Stretch: 1. Lay on either a massage table, a

bench, or a firm bed. 2. Let one butt cheek hang off the

edge. 3. Allow that leg to stretch towards

the floor 4. At the same time, clasp your

hands around the other knee and bring it up towards your chest and opposite shoulder.

5. Hold for about 2 – 3 seconds, take a breath, release, and repeat.

6. Like above, try the other side. If pain increases, only stretch the side that decreases or eliminates the pain.

Bonus Back strengthening Exercise. The Horse Stance:

Horse Stance Continued: There are small muscles attached between the vertebrae called multifidi. These muscles help stabilize the back and assist in rotation and flexion. If the erector spinae (primary movers) are weak and inhibited, the multifidi are recruited. Because they are small muscles, they are very easy to strain. This exercise “torques” the spine and dramatically strengthens these small stabilizing muscles.

1. Start on your hands and knees. Hands just under shoulders. Knees just under hips. Lower legs parallel. Arms bent so back is parallel to the floor.

2. Balance a dowel on your spine, touching your sacrum and the back of your head. This helps provide feedback on correct form.

3. First, lift one palm just slightly off the floor, just enough to slip a piece of paper under it.

4. Next, lift the opposite knee just off the floor, again, just

enough to slip a piece of paper under it. 5. Hold for a count of 4 then release. 6. Repeat on the other side. 7. Once you recognize correct form, you no longer need the

dowel. 8. I suggest 8 to 10 repetitions, done 3 to 5 times a day

(provided time and environment permit). Knee pain:

The knee is actually fairly complex. If your knee is unstable, do not try this remedy; it could further destabilize the knee. Pain inside the knee needs to be assessed by a professional to determine the actual cause. However, even when x-rays show “bone on bone”, the pain can sometimes be easily remedied by someone trained in orthopedic bodywork (manual therapy). There are three simple and very easy to self remedy, knee pains. They are: 1. pain just below the patella (knee cap); 2. pain on the lateral (outside) of the knee, just below the knee; and 3. pain on the medial (inside), just below the knee cap. Muscles in the upper leg attach to the tibia just below the knee cap. They attach to condyles (knobs) on, you guessed it, the two sides, and just below the patella, indicated by the red arrows. Picture pinching a small hank of hair between thumb and forefinger. Now, pull firmly and steadily. Pretty soon, the spot where the hair attaches to scalp will start hurting. Release the pull, and the pain instantly stops. That is precisely what happens during the 3 common sources of knee pain we are describing here.

Thigh Muscle Release:

1. Sit in a chair with feet flat on the floor.

2. Use your finger tips to “hook into” the muscle and fascia (underneath the skin) high up on your thigh, in a line above your pain, (medial, lateral, or center).

3. Using firm, side to side pressure, at about a 45 degree angle, visualize lengthening and spreading the fibers under your finger tips. Do not slide over the skin.

4. Instead of sliding, take a new position slightly below the previous position and repeat.

5. Do this from upper thigh to just above the knee joint. 6. Repeat 3 or 4 times per session, for several sessions per

day. I have suggested this approach to several people who have declared that weeks even months of debilitating pain simply disappeared. Sometimes after just the second or third session.

Tension and Pain, Base of Neck and Upper Shoulders. Look again at the pictures of my chest and back close to the beginning of this pamphlet. You can see that my chest muscles are short and tight. The law of reciprocal inhibition mandates that the upper back muscles become inhibited, therefore stretched and weak if the chest muscles are short and contracted. Therefore, the most effective treatment for base of neck and upper shoulders is to first stretch the chest muscles followed by strengthening the upper back muscles. Although having someone

rub your neck and shoulders may feel good short term, it is actually counter-productive in the long term. There are two primary chest muscles: 1. The pectoralis major adducts the arm across the chest. It also medially rotates the arm, indicated by cupped hands pointing to the rear. 2. The pectoralis minor pulls the shoulder (scapula) forward, and /or down. Stretch Pectoralis Major:

1. Stand with feet shoulder width apart.

2. Bring your arms out to the sides.

3. Back bend as far as comfortable while:

4. Squeezing your shoulder blades together for a count of 2 then release.

5. Repeat 3 or 4 times, changing the height of your arms above your shoulders.

Stretch Pectoralis Minor:

1. Stand with feet comfortable distance apart.

2. Place your hands low on the back of your neck.

3. Exhale, while pulling your elbows back.

4. Hold about 2 seconds. 5. Relax, inhale, and repeat.

Strengthen upper back muscles:

1. Sit with a stretch tube or latex band stretched over the balls of your feet.

NOTE: This can also be done with the band anchored around a door knob, or on a seated row resistance machine.

2. Elbows can be bent, in order to increase resistance of

your band. However, the exercise is actually done with your back muscles.

3. Squeeze your shoulder blades together (contract your rhomboid muscles).

4. Contract for count of two. Release for count of 4. Remember, the eccentric

contraction (releasing the resistance) is the part that actually strengthens the muscle. Repeat for 8 to 12 repetitions.

Strengthen Lats and Mid Back Muscles:

1. This exercise looks similar to the previous one, except the band is anchored higher than your head. You can do this by slipping your

band through a knotted loop and anchoring it at the top of a closed door. A lat pull down resistance machine is a great alternative if available.

2. Exhale, pull your elbows down and back for the count of 2. 3. Inhale as you release for the count of 4. 4. Repeat for 8 to 12 repetitions.

About the Author: I have personally experienced, and recovered from, most of the chronic pain symptoms clients bring to my table. This fact alone, perhaps, gives me a slightly unique perspective for pain therapy. It might seem that I grew up in an abusive household. I did not. I was pretty active, and apparently had brittle bones. I broke one leg 3 times, the other leg 4 times and both wrists before I was 20. When I was 11, I managed to pull about one ton of sheet rock, leaning against the wall, on top of me. The bones above my left ankle were pulverized. I spent the next year in a cast. After healing, my left leg remains about a half inch longer than my right. You can imagine what that must be doing to my spine and everything connected to it. I retired from Army Air Defense after 24 years of active service. Towards the end of my army career, I got fat, and really out of shape. I discovered that I could not jog one fourth of the way around a quarter mile track. I weighed 295 pounds. I set out to loose weight and get back in shape. I spent time in the library learning about physical fitness and weight loss and lots of

time on the track or in the gym. I lost 100 pounds, and started maxing the PT test. Part of my fitness program involved aerobics classes. They were a lot more fun than running. Eventually, I became a certified aerobics instructor and personal trainer. After retiring, I was half owner of an aerobics business employing almost 20 instructors. After that folded I became an EMT. Eventually, I moved back to the Pacific Northwest, and bought a live aboard sailboat. I was the assistant manager for a fairly large fitness club for the next 11 years. After that, I became a handyman. Lots of sheet rock, ladders and hard physical labor. I was now in my mid 50's and could not lift my arms above my shoulders without excruciating pain. That's when I went to massage school. I feel lucky that I learned about effective pain relief therapy shortly after becoming licensed. I am now a certified teaching assistant for James Waslaski, the educator who either developed and or refined many of the techniques that effectively remediate chronic pain symptoms. My passion is helping people get out of pain. I am certain that following the suggestions in this pamphlet will dramatically improve the quality of life of nearly everyone who sticks with the suggested exercises for more than two weeks. If you want to speed up the healing process, call and make an appointment for hands on therapy. If you have questions about your pain, or the suggested exercises, call me. I am happy to make an appointment and see you for a complimentary pain therapy consultation. We can quickly discover if what I do is actually effective for treating your pain symptoms.