Friday, November 30, 2018

Can Movement & Massage Provide Chronic Low Back Pain Relief

            Chronic low back pain is defined as pain in the lumbar region of the spine that lasts longer than 3 months.  According to the US Department of Health & Human Services Center for Disease Control and Prevention 20.3% of U.S. adults experienced low back pain in 2012!1  This is one of the most common musculoskeletal disorders in the United States and yet there is still no easy answer on how to fix it!  (Note: Acute low back pain could occur from a serious injury or trauma such as a fall.  This is not the same as chronic low back pain and you should go get checked out by a medical professional immediately.)

The causes of chronic low back pain:
1.     Issue with an internal organ
2.     Muscle strain due to excess force during a movement
3.     Postural issues such as staying in one position for too long causing stiffness
4.     Disc issue
5.     Spinal cord issues
6.     Nerve pain like sciatica
7.     Breathing issues
8.     Emotional and psychological stress
9.     Issues with joints other than the spine

These are just some of the possible umbrella causes of low back pain.  As you can see, they are all very broad.  So what does this mean for you and how to manage your own symptoms? 

It means you should follow a path designed to treat YOUR specific signs, symptoms, and pathologies.  The first step you should take is to go see your primary care physician who can hopefully direct you to a specialist that can treat your specific ailments.  This could be a surgeon, a pain doctor, a physical therapist, a chiropractor, a massage therapist, or a personal trainer.

According to both WebMD2 & the National Institute of Health3, an appropriate exercise and nutrition regiment can help prevent and treat some cases of low back pain.  The important part is that a professional who can properly assess the issue comes up with a plan specifically for your pain.  There is no cookie cutter formula to treating this disabling issue!

At Triad Wellness Philly we specialize in assessment of not only the musculoskeletal system but also lifestyle and nutrition to help manage low back pain.  After assessment, a plan is formed between our trainers and massage therapists to help you feel better and get back to doing the things that you want to do!

Stephen Cornely LMT CPT
Triad Wellness Philly

Tuesday, November 20, 2018

Some of what you want, some of what you need, and some of what you hate.

This thought/motto is one of the things I think about when designing a training program for my clients.  Below I will talk about WHY I believe this is helpful for making a well rounded program.

1.  Some of what you want:
            We all have fitness and athletic goals even if you cant think of any off the top of your head, they are in there!  As a trainer, it is not my job to decide what your goal should be but rather open your world to the possibilities and allow you to decide.  This is the most important question to ask a client because it will help them remain consistent in the beginning if they know they are working toward a goal that THEY PERSONALLY CHOSE AND DECIDED UPON!
There are two main ways people go wrong when deciding what they want:
1.     Not having a performance based goal.
2.     Having a trainer who is unrealistic with you about how difficult or easy your goal is.

As I’ve preached many times before, losing weight is more about nutrition and lifestyle rather than working out.  So instead of setting this as your goal, think of a performance based goal.  Examples of this are doing so many reps of pull-ups, running a certain distance, becoming proficient using a barbell etc.  Remember you cannot out-train a bad diet and weight loss is about simply creating a calorie deficit!
So if you tell me that you want to be generally healthy, in my head I think we should be working on general strength in all ranges of motion, cardiovascular endurance, and work capacity/general physical preparedness (think about if I asked you to move a pile of bricks from one end of town to the other how quickly could you do it).  Once we start working on some of this stuff your goals will manifest themselves upon getting a better understanding of your likes and dislikes.
Someone with a more focused goal like, I want to run a half marathon better start getting their heart and lungs in top shape, their legs in shape for long cyclic motion, and their joints healthy and enough to bear the impact of running (most people focus on the first two but neglect the third leading to injury…more on this later).
The second point about the trainer being able to give you a realistic timeline is more difficult.  Everyone adapts differently.  Everyone has consistency and compliance issues.  There will be unforeseen issues and injuries along the way need to be dealt with.  Here is a rule of thumb though to guess how long it will take you to anything:
Step 1: take an educated realistic guess
Step 2: multiply it by 3

2.  Some of what you need:
            What you need is basically the stuff that the trainer and you know will help you accomplish your goal in a quicker, safer manner but it is boring or tedious.  It could also be something that you may not realize has a connection to your goal but the trainer knows the connection.
            Lets go back to the example of a runner.  Most runners when they start a program just start running.  Seems pretty obvious and understandable that this is how one would get into this because after all, humans were “Born to Run”.  Well unfortunately, you’re pretty far being human if you’ve worked a sedentary 9-5 job for 10 years after being in school for 15 years.  Your body didn’t evolve to be treated the way we treat it.  Its meant to move and unfortunately our lifestyle habits take that away.
            So if you want to start a running program you should probably start by assessing whether your joints can handle the new impact of all your body weight slamming into the ground over and over again.  Can your legs propel you forward efficiently? Can your tendons and other connective tissue adapt to the stimulus of starting a running program or are they so fibrotic (thickened/scarred tissue that doesn’t move well) that they don’t absorb force well?
            So what you NEED, is to probably start with strength and mobility stuff in a less load bearing situation than running.  A more controlled situation like a fitness center would be better.  At the same time as dealing with the things you need you can certainly still work on running as a skill but a good trainer would monitor the volume to mitigate injury risk.

3.     Some of what you hate:
And then there is this…… some of what you HATE!  I struggle with this part when dealing with my clients because at the end of the day I am a service provider. However, I continue to program it because I believe we learn life lessons in the weight room by doing things we hate.
            What do we learn by programming what we hate? 
            First and foremost, we typically hate what we suck at.  For various reasons, what you suck at also falls under the category of what you NEED because it displays a weakness. You are only as strong as your weakest link and your weakest link is most likely the part of you that will get injured.  The biggest culprit here is stretching and mobility work.  Its painful, slow, and longggg but it is necessary for any athlete or person with any goal to continue to maintain (and sometimes expand) end ranges of motion in every joint in their body!
              Another reason we tend to hate things is because we are fearful of them.  I program things people hate to help them overcome fear.  Sometimes they are so fearfull that I trick them into doing something they aren’t aware of.  For example, I had a client with a knee replacement.  11 weeks post op it was time for her to start squatting again (this is not a universal rule but rather an individual who made steady progress under my eyes and my expertise and her pain level told me her body was ready).  However, I knew she was scared to try squatting which is completely understandable. 
So what did I do?  I told her to sit on the bench.  She obliged.  Then I told her to stand up, which she did.  Then I told her sit again and I asked her how her day was going and she started telling me about it.  While she was talking I signaled for her to stand up and then sit back down again.  She kept talking and I repeated this until she had sat and stood up about 8 times.  After this, I interrupted her and asked her how her knee felt.  She said fine! I replied, “Great, you just did 8 squats!”
The final reason I will program things people hate is because I believe what we do in the weight room is metaphor for life.  It has certainly taught me so many life lessons!  In the weight room, the trainer controls your movements.  In life there will undoubtedly be things that we must do that we don’t want to do but another human forces us.  So when a trainer tells you to carry a sandbag up a set of stairs 10 times and you complain about it, maybe just power through with all your might it will be easier!  Wasting time and energy complaining about it never helped anyone. (Plus carrying a sandbag up a flight of stairs 10 times has carry over to literally every living human being’s current lifestyle so it’s not a complete waste of your time!)

Programming what you want will help keep you coming back for more.
Programming what you need, will help you keep doing what you want.
Programming what you hate will help defeat your greatest enemy… yourself.

-Stephen J Cornely
Triad Wellness Philly
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