Get Your Back to Basics
REHABILITATION
Dr. Jean M. Ciola
Prevention is defined as “the action of stopping something from happening or arising.” As stated in the definition, it is an action—not a passive behavior. The biggest misconception we hear about chiropractic is that it is used as a reaction to something that has happened, such as helping with someone’s back or neck pain. Simply stated, it is used to remove interferences to the body-mind’s healing abilities and provides the body with the essential ingredients for its natural state of health.
The first step in any prevention behavior is starting with a body that is functioning at its best state possible. When you have these body-mind connections in working order, patients are able to better handle what life throws at them by increasing the ability to adapt to the environment in a more efficient manner.
The Mental Core
Chronic anxiety can lead to physical manifestations, such as chronic pain or other systemic symptoms, including high blood pressure, chest pain, or headaches. As Walter Anderson said, “Nothing diminishes anxiety faster than action.” When patients recognize and face their emotions and challenges wholeheartedly, their anxiety decreases. Stressing the importance of strengthening the mental, emotional, and spiritual core increases the mind’s balance and adaptability to prevent future injury. A few of my favorite mental core exercises for patients include:
Meditation: This practice gives us the time to “get it all out,” and the result is a quieter peace of mind. Neuroscientists have found that meditators shift their brain activity to different areas of the cortex; brain waves in the stress-prone right frontal cortex move to the calmer left frontal cortex. This mental shift decreases the negative effects of stress, mild depression, and anxiety.2
Gratitude: Teach patients to scan the horizon for positivity, not negativity. The simple act of gratitude has been scientifically shown to balance our heart rhythms and nervous system, which leads to favorable changes in immunity and hormonal equilibrium, as well as increased production of the anti-aging compound DITE A.1 Challenge patients and their loved ones to think of new things each day to be grateful for in their lives. As Oprah Winfrey said, “You radiate and generate more goodness for yourself when you're aware of all you have and not focusing on your have-nots.”
Affirmations: Whether some of us realize it or not, we are constantly talking to ourselves. Teach patients to make their
incessant mental chatter purposeful and positive! Find an affirmation that feels good for them. Keep it simple and uplifting. Focusing on thoughts such as "I am enough" or "I trust the process of life" will boost self-love and reduce anxiety.
The Physical Core
Along with a solid, balanced, and more consistent mental core, there is a solid and balanced physical core for prevention of injuries. Core exercises challenge muscles in integrated, coordinated movements using multiple muscles groups simultaneously. This helps to improve balance, posture, athletic performance, and control of muscles for daily movements.
There is also data to suggest that a stronger core decreases chance of lower back injury. “Substantial evidence exists demonstrating core muscle recruitment alterations in low back pain (LBP) patients compared with healthy controls.”3 There ai e many different places to reference good core exercises, and most of them aie safe as long as you take into consideration any restrictions or limitations your patients may have and modify the exercises accordingly. Here are a few of my favorite core exercises:
Planks: Poor planking form can just end up aggravating low back problems and not working the abs at all, so quality is key. Patients can start on elbows and toes and hold in a neutral position while making sure the back is not dropped or arched. Encourage them to keep their head in neutral and stare at their
fists. Start holding for 30 seconds and work up to a minute.
Increase intensity with more reps or longer holds. Once they’ve mastered this, intensity can be increased by lifting legs or changing arm position.
Abdominal crunch: Make sure patients feel the work in their abs and not their neck.
Start with heels on the ground and hands behind the head.
While keeping elbows wide and lifting with the chest, they must be careful that they do not curl their neck into their knees. Movement should be slow and controlled, and concentration should be on the abdominals.
Bridges: This exercise incorporates other muscles involved in the core and emphasizes the muscles in the lower back and hips. Have patients perform the bridge by lying on their back with knees bent and feet on the floor. Picking up hips as high as possible, encourage them to keep their glutes tucked in and a straight line. Muscles in the back and hips work together to coordinate the lifting of the hips. Either hold in an isometric contraction for a given time, or isotonically lift hips off the floor then back down again.
Chronic anxiety can lead to physical manifestations, such as chronic pain or other systemic symptoms, including high blood pressure, chest pain, or headaches. "
Fitness ball back extension:
This exercise works great if patients do not have access to a gym with a back extension machine. Position the large stability ball under the patients’ lower stomach and hips, with legs straight out behind them on the floor. With hands behind head, have them lift their back up until their body is in a straight line. Repeat 10 to 15 times. They should feel the lower back muscles engage with this exercise. Have them push hips into the ball while keeping their pelvis tucked to get more glute engagement with this exercise.
Additional Prevention Aids
Along with keeping your patients’ “machine” strong and balanced, it’s important to keep muscles long and lengthened, and properly stretched out so they perform the way they should. Beyond stretching, there are some tools they can use that help facilitate the process.
The foam roller works great for any level of fitness. Basically, it performs self-myofascial release, or self-massage, to release
trigger points and tight muscles. As they roll over the roller, the pressure helps to break down tight muscles, scar tissues, and fibrous adhesions. The roller helps to soften and lengthen the fascia between the muscles. Some rollers have stiffer ridges or knobs to get a more intense fascial release, based on patient comfort level and pain tolerance. Two recent studies out of Memorial University of Newfoundland (St. John’s, Canada) support the effectiveness of myofascial rolling. The studies concluded that as little as two minutes of myofascial rolling with foam rollers and a mere five seconds of rolling with a roller massager significantly increased range of motion (ROM) without any significant detrimental effect on muscle strength.5
Another device that works well for posture and spinal health is a neck support or cervical roll. Based upon physical examination, you can determine if there are contraindications for your patient regarding these, but the basic idea here is to relieve upper cervical or occipital muscle tension, correcting forward head posture, relaxing the upper back and shoulders, and restoring a normal cervical curve. All curves, including the lordosis in the neck, help balance the spine and protect it from the compressive effects of gravity. In fact, the curves work together to do this. Carolyn Kinser and Lynn Colby, both physical therapists and authors of Therapeutic Exercise'. Foundations and Techniques, Fourth Edition, comment that the flexibility contributed by the curves offers 10 times more resistance to this type of compression than a straight spine.4
In Conclusion
Although there is obviously no guarantee against injury, patients can take many steps toward prevention. From decreasing the body’s reaction to stress (mental practice) to strengthening and stretching by keeping the core strong and muscles loose, the chance of injury can be decreased. In doing so, patients also set themselves up for a faster recovery should an injury occur.
References:
1. Natural News: http://www.naturalnews.com/047287_gratitude_reverse_aging_stres s. html#ixzz44t4 sO 8 C 6.
2. Colin Allen, Benefits of Meditation, April 1, 2003: https://www. psychologytoday.com/articles/200304.
3. Kellie C. Huxel Bliven, PhD, AT; Barton E. Anderson, MS, ATC, AT; Core Stability Training for Injury Prevention; Sport Health 2013 Nov; 5(6): 514-522.
4. Loss of Cervical Curve and Cervical Kyphosis: http://backandneck. ab out. com/od/conditi ons/p/rever secervcurv. htm.
5. Akron, OH (PRWEB) August 06, 2013: http://www.prweb.com/ releases/MyofascialRollingStudies/Behm/prweb 10993179.htm.
Dr. Jean M. Cióla, DC, CAc is owner and chiropractor citAGADA Chiropractic & Integrative Health Center, LLC. /N Cióla went to Luther College as an All-American and graduated from Northwestern Health Sciences University in 2004. She has been in practice for more than 12 years and continues to grow her practice in Minnetonka, Minnesota.
