Fix Program. FOR BACK and NECK PAIN. The. Alison Figg PHYSIOTHERAPIST

Transcription

1 The Fix Program FOR BACK and NECK PAIN The 10 step physiotherapy program to flatten your abs, achieve core strength and eliminate back and neck pain for life. Fully revised 3rd edition Alison Figg PHYSIOTHERAPIST

2 TM The Fix ProgramTM FOR BACK and NECK PAIN Alison Figg BAppSc (physiotherapy) MCSP Member of the Australian Physiotherapy Association The Fix Program Australia

3 Getting started on a new exercise program TM The Fix Program for neck and back pain teaches exercises that are fantastic for spine problems. However it s always best to plan the exercise sequence you would like to try, and seek some expert guidance before you begin your new workout. Ideally, attend an assessment at a fix program near you, so that an individual set of exercises can be prescribed for you. Visit our website for locations and qualified physiotherapists: Not all the exercises in this book are suitable for all back conditions. If you can t get to a physiotherapist you could also get advice from your family doctor before beginning a new exercise. First published 2000 by The Fix Program Australia Pty Ltd Copyright The Fix Program Australia 2005 No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means (electronic, photocopying or otherwise) without prior written permission of the publisher. The Fix Program and the Fix logo device are registered trademarks of The Fix Program Australia Pty Ltd

4 Contents Introduction Pain: What We Know Is True And The Myths Step 1: Body Alignment And Posture Step 2: Finding Your Deep Core Trunk Muscles Step 3: Finding Your Anterior Trunk Muscles Step 4: Finding The Upper Back And Scapula Stabilising Muscles Step 5: Finding Your Posterior Trunk Muscles Step 6: Working Your Leg Muscles Step 7: Working Your Arm Muscles Step 8: Mobility And Stretching Things Step 9: Getting Back To Your Old Level Of Ability Step 10: Regular Home Workouts & List of Exercises Bibliography Acknowledgements

5 Introducing the Fix Program The Physiotherapy, Yoga, Pilates and Swiss ball exercises in The Fix Program will help you build core strength. Your core is a muscular system composed of layers, between your neck and pelvis. It is the foundation system for all movements of the body. Improving your core strength will give you a flat tummy, strong back muscles, easy movement, a slim waist, good posture and eliminate most aches and pains. The Fix Program is a ten-step program that will show you how you can safely use exercises to locate, wake up and strengthen your core. You will also improve your spinal posture by gently lengthening and strengthening the main back and limb muscles. Whole body muscle balance will be restored. Information about pain and it s effects will help you change your habits, set new goals, and reduce fear of injury with exercise. You will quickly be moving without pain and with greater freedom and confidence. Your physical abilities and fitness will improve dramatically. By the end of The Fix Program you will have: Firmer stronger abdominal muscles A flatter tummy Easier movement Great posture Improved all over muscle tone Confidence A sense of active control of pain Great pain relief! 1 The Fix Program

6 Pain: what we know is true and the myths Pain is a combination of electrical signals generated by the brain Many more factors than we previously thought are vital in helping the brain decide what hurts and for how long If pain is present for a prolonged time it can effect nearly all systems in your body Systems and organs effected can include muscles, nerves, surface of the brain, thoughts and beliefs The brain generates all pain! The effect of pain on your muscles There are 2 sets of muscles in your body; the deep set and superficial (or global ) set. The deep muscles are located deep within the body, close to your spine. They are small muscles generally attached to the vertebral (spinal bones). Most people have never heard of the deep muscles, especially the deep spinal muscles. They have unusual long names like Multifidis and Transversus Abdominus. The more superficial set of muscles in the body can be seen just under your skin and fat layer. They are usually large muscles attached to the long bones of your arms, legs and ribs. They are not usually attached to the spine. Usually people are aware of the superficial muscles because we can see and feel them working. They have names like Biceps, Quadriceps and Rectus Abdominus. The Fix Program 2

7 Changes in the deep spinal muscles due to pain Pain is such a powerful thing it can actually switch off some of the deep muscles close to the back and neck. This can happen very soon after you first get a pain in your back (possibly within the first 48 hours). The deep muscles in the low back and abdomen normally provide support to the bones (and discs) of the low back area when you move around. The deep set of muscles in this area are often referred to as your core stabilising muscles. Sometimes the core stabilising muscles are likened to a deep corset. It doesn t seem logical that when you have pain in your back, the supporting muscles go on a holiday, and stop working for you, but it s true. The same thing happens when a person gets neck pain. There are deep muscles near the larynx (voice box) which switch off or become inhibited when neck pain is present. When back pain eventually goes away, our core stabilising muscles in the back and neck region do not automatically switch on. Special muscle retraining exercises are needed to wake up the deep core stabilising muscles in most people who have ever suffered with a painful back. The Fix Program will teach you how to do these exercises, to wake up and strengthen your core. 3 The Fix Program

8 The important deep core muscles in the low back area Diaphragm Pelvic Floor group Multifidis (deep in the back) Transversus Abdominus (deep in the low tummy overlying your bladder) Transversus Abdominus Changes in the superficial muscles due to pain The deep muscle set becomes inactive (or at least under active and slow) when you have pain in your back, pelvis or neck. The superficial muscles of the body respond in a much different way to pain. Pain usually results in your superficial muscles becoming hyper vigilant, tense, sore and tight. Think of a pulled hamstring. The normally soft hamstring area becomes overactive staying tense all the time. Many of the other superficial muscles react in the same way if they become strained of injured. The Fix Program will teach you how to re-balance the changes in your muscular system. After an injury you need to turn on the deep core muscles close to your spine that have become inactive, and sometimes turn off or relax any compensating superficial muscles. For example after a whiplash injury the deep neck muscles need to be re-trained to work again and the superficial neck and shoulder muscles need some help to relax. The Fix Program 4

9 The effect of pain on your thoughts and beliefs When you have had pain for a while, or when your pain keeps coming back year after year you can start thinking differently. Psychologists talk about Unhelpful Cognitions. Thoughts that might be unhelpful in the case of back pain are: If I do any exercise I will reinjure myself If I am in pain, and I keep moving, and working I will harm my body If I notice a pain I need to stop what I am doing and avoid it in future If I feel an increase in my pain I have really damaged something Most people don t know that these statements are unhelpful. Most people are not aware that these thoughts are not always true in the case of back pain. Unhelpful thoughts about pain and fear of pain and moving are very common, but can unfortunately make your pain increase rather than decrease. The Fix Program will help you to replace any unhelpful thoughts with more helpful thoughts to eliminate pain. 5 The Fix Program

10 The effect of pain on your nerves and brain tissue Nerves are like long, flat telephone (or internet) cables. Nerves carry electrical signals. When you have pain your nerves can become more sensitive and actually change their structure to become more effective in conveying electrical messages. This is especially true in the nerves that convey messages travelling from your muscle tissues into the spinal cord and further up to the brain. Have you ever felt like all your nerves are humming? Also the central nervous system can become very sensitive in the presence of pain. The central nervous system is a term used to refer to the brain and spinal cord. The surface of the brain can actually change and re-organise itself very easily in response to changes in your body. The area of the brain s surface where the back is represented can change. Pain can be one of the things that cause these changes. Did you know that all your body parts are represented on the surface of your brain? Primary motor cortex Hip Trunk Arm Hand Research suggests that changes in brain tissue may then cause a change in the number and type of messages sent out from the brain, along the nerves to the tissues in the back and the neck area. One effect of this might be to switch off your core muscles whenever pain is present. Foot Face Tongue Larynx Exercises to reduce sensitivity in the nerves, as well as muscular exercises for the deep core muscles, are needed to really get rid of persistent pain. Fix will teach you these exercises. Have you ever been to the dentist and come away feeling like your lip is very fat? It has actually been shown that the lip area on the brain surface changes and enlarges temporarily after such a visit! The Fix Program will reverse changes in muscles and nerves caused by pain, and also replace negative thoughts and beliefs about pain with positive ones. We ve seen it work for hundreds of people who have followed the Fix program of exercises. The Fix Program 6

11 Myths about pain Pain always tells us there is an injury or damage in a body part NOT TRUE! Chronic pain means your injury hasn t healed yet NOT TRUE! The body tells the brain when and where there is pain. Pain is a message travelling up from the tissues into the brain NOT TRUE! There is a single pain area in the brain NOT TRUE! New facts about old aches and pains It appears that the brain produces all pain messages. The brain does this when it perceives a danger to your body tissue. It makes sense to think that the brain generates this pain message when it concludes that you need to take action to get your self away from this danger. If the brain can be convinced that the danger is no longer present, the pain messages should not continue to be generated. Or if your brain could be convinced that you have taken action to get yourself out of danger, then the pain messages should stop. Our experience at Fix tells us that this information is a useful, accurate way to think about short term and long-term pain. We believe that exercises to strengthen and support your spine, along with education about pain, is certainly taking action. You will get pain relief if you follow the Fix program. Ask us about reading the amazing book Explain Pain by David Butler and Dr Lorrimer Moseley! Visit to read sample pages of this book 7 The Fix Program

12 Step 1: Alignment and Posture The Fix Program 8

13 Step 1: Alignment and Posture Sitting Alignment and the Active Sitting Exercise Starting Position To find correct sitting alignment: Sit forward on the chair and place your hands on your hips Have your knees and feet as wide as your hips. Have your feet firmly on the ground directly under your knees, toes parallel Push gently through your feet, working your legs and feel that your spine lengthens as the feet connect with the floor Imagine the pelvis is a bowl full of water; rock the pelvic bones backward to tip the water out the back rim of the bowl. Now tilt your pelvis forwards to tip the water out the front of the bowl. Notice this changes the shape of your spine Finding the neutral pelvis is the position where the imaginary water in the pelvic bowl is level, midway between the tilted back and tilted forward position. The Movement Place your hands on your hips. First practice tilting your pelvis backwards (water falling out the back rim of the bowl). Then move gently into the opposite position (water tipping out the front of the pelvis). Do this very slowly, 10 times and come to rest in the level pelvis or neutral pelvis position. Practice holding the neutral sitting position and try to gradually build up your tolerance very slowly. Start at 30 seconds hold. See if you can build up your tolerance by another 30 seconds each day until you can sit unsupported (using your core strength) for 10 minutes. You might feel your inner tummy and low back muscles working as you practice this new type of active sitting alignment Hot Tips Notice how your work chair and other chairs influence whether you are sitting in the forward tilted pelvic position or the backward tilted position Take special note of how you sit on the couch What happens to the pelvis position when you put your feet up on the coffee table? Assess your posture and adjust your chair, being conscious of how you sit throughout the day 9 Level 1

14 Step 1: Alignment and Posture Standing with Good Alignment Starting Position Stand on your mat or beside it with your feet hip width apart Unlock your knees Place your hands on your hip bones to check your alignment Find the pelvic neutral position by thinking again about the imaginary bowl of water in your pelvis. Rock from the backward to forward pelvic position a couple of times and come to rest in the level pelvis position The Movement Balance your body weight through your feet firmly and evenly, spreading it between the heel and the inner and outer front foot Spread your toes and gently pull up your inner arch on both feet Keep knees unlocked but grow tall in the spine, lifting your ribs up out of the side waist and lengthen the neck Slowly straighten the knees but don t push back or lock them, rather pull the skin on your front thighs and inner thighs upwards towards the hip bones Hot Tips To grow tall in the spine try thinking of gently lengthening down through the tailbone while lifting up the breastbone Working your legs will give you a feeling of length and freedom in your back when you stand up When you pull up the inner arches of the feet, don t lift the big toes Try these ideas in standing everyday. Start with 30 seconds and see if you can increase the time by 30 seconds each day. You could start doing it twice per day when you clean your teeth Level 1 10

15 Step 1: Alignment and Posture Finding neutral pelvis lying down Starting Position Lie on your back on your mat with your knees bent up Place your hands on your front hip bones The Movement Imagine the pelvis is a bowl full of water; rock the pelvic bones backward to tip the water out the back rim of the bowl onto the mat Now tilt your pelvis forwards to tip the water out the front of the bowl. Notice this changes the shape of your spine Finding the neutral pelvis is the position where the imaginary water in the pelvic bowl is level, midway between the tilted back and tilted forward position Why worry about pelvis alignment? The spine has 3 natural curves. Your pelvis sits below your spine and is the foundation for all of your back bones. The back bones are stacked one on top of the other, all the way up to your neck bones. Your skull balances on top of the upper neck bones. Aligning your pelvis into a neutral position ensures that all 3 natural curves of the spine are maintained. The individual bones of the pelvis lock in when the pelvis is in the neutral position, and provide a strong supporting foundation for your whole spine. When the 3 curves of the spine are maintained, there is less stress on your back and you are less likely to injure yourself. All the exercises in the Fix Program are done with a neutral pelvis alignment 11 Level 1

16 Step 2: Deep core trunk muscles 12

17 Step 2: Deep core trunk muscles The Basic Relaxed Position Starting Position Lie on your back on a mat. Use a small towel under your head (folded approx. 8 thicknesses) if you feel like you need it Bend your knees and stand your feet on the mat. The feet should be placed hip width apart and parallel Place your hands on your hipbones to check the alignment of your pelvis is neutral The Movement Notice any tension in the feet, imagine it running out of your toes Now do the same for any tension in the legs Gradually work up through the body towards the neck and head, letting any tension melt away Don t forget the area around the front throat and jaw Let go of any tension This relaxed exercise position is the starting position for many of the mat exercises Hot Tips End the exercise by checking your pelvic alignment is neutral Use the same pelvic awareness skills you learned when positioning yourself in active sitting and in standing You can think of your imaginary pelvic bowl of water Try this Focus on the feet, tense the foot muscles for 5 seconds, then let go of any tension. Move your focus to your legs, tense the leg muscles for 5 seconds then let it go. Continue this tensing/ relaxing sequence upwards through the body with all the muscle groups. This is known as progressive muscular relaxation and can really help relieve pain. Making a diamond shape with your hands and placing hands, palms down on your lower abdomen so that your thumbs are in your navel, and your fingers point downwards to the pelvis can help you check pelvic alignment in lying down. Simply make sure that your thumbs are not higher or lower than your finger tips. 13 Level 1

18 Step 2: Deep core trunk muscles Breathing Wide and Deep Starting Position Lie on your back on a mat. Wrap a yoga strap or scarf around the lower ribs and cross it over at the front. Keep hold of the scarf and gently tighten it in around the ribs The Movement Breathe in through the nose feeling your ribs widening into the scarf. Feel that you widen across your mid back. Get a sense of how much your lower ribs widen Breathe out, letting the air fall out of your mouth very softly gently pulling the scarf in Your sternum should sink as the air falls softly out Do 5 breath cycles Level 1 14

19 Step 2: Deep core trunk muscles Breathing + Pelvic Floor lift + deep tummy action Starting Position Lie on your back on a mat Get into the basic relaxed position and check the alignment of your pelvis is neutral, placing your hands on your front hipbones. The hipbones are facing directly up to the ceiling. Your tailbone is firmly down on the mat Keep your hands on your hip bones during the exercise to feel for any pelvic movement The Movement Breathe in to prepare, breathing deeply, widening through the mid back and lower ribs As you breathe out draw the Pelvic Floor muscles together, and gently lift the Pelvic Floor upwards Breathe in and relax Breathe out and repeat the Pelvic Floor action trying to coordinate the breastbone sinking down with the lift up of the pelvic floor muscles Breathe in again As you breathe out see if you can turn on your pelvic floor and gently draw your navel area towards the spine Do 5 breath cycles activating your core muscles each time you breathe out Hot Tips The Pelvic Floor muscles are like a sling reaching from the pubic bone in front, to the tail bone behind At first it is good to think of sliding doors as you try and close the muscles around the urethra (and vagina in women), imagining that you need to stop urinating Once the doors are closed it is useful to imagine lifting the pelvic floor gently upwards Locating the pelvic floor can help to activate the deep tummy and back muscles that become lazy when you have back pain Progression Try and hold the muscles on throughout both the in and out breath for 5 cycles 15 Level 1

20 Step 2: Deep core trunk muscles Breathing exercises can help to activate your core muscles It s not always clear to people why you need to practice breathing exercises to fix your back pain. It s because the muscles in your trunk have two interlinked functions: supporting your back and helping you to take breaths in and out. The diaphragm muscle and the intercostal muscles help you to breathe. Using these muscles can also trigger activity in your deep abdominal muscle layers. So just breathing deeply, especially breathing all the way out, will wake up your core muscles and help you to get them working again. It s even better if you practice co-coordinating Breathing plus Pelvic Floor activation. This can result in the lower abdomen really drawing in, helping the deep core tummy muscle, Transversus Abdominus(TA) to switch back on and stay on! Check your Transversus muscle by putting your hands over the lower abdomen, and feel some tension 1cm in from your front hip bones. The deepest abdominal muscle, Transversus Abdominus forms a girdle of strength and support for your spine. It wraps around the trunk and protects your spine. When using your Transversus muscle correctly the lower abdomen hollows in. Hot Tips If you think you have a problem with your Pelvic Floor buy the great book womenswaterworks by Dr Pauline Chiarelli from Fix. One in three women may be affected by incontinence and it can be helped, by strengthening your Pelvic Floor muscles. Also available online at Sitting on top of the Transvsersus are the Oblique Abdominal Muscle layers and the Rectus Abdominus or six pack muscle, which is the most superficial muscle layer in the abdomen. Level 1 16

21 Step 2: Deep core trunk muscles Standing Core Activation Starting Position To find correct standing alignment: Stand on your mat or beside it with your feet hip width apart Unlock your knees Place your hands on your hip bones to check your alignment Find the pelvic neutral position by thinking again about the imaginary bowl of water in your pelvis. Rock from the backward to forward pelvic position a couple of times and come to rest in the level pelvis position The Movement Breathe in deep and wide Breathe out and imagine drawing your pubic bone up towards the navel and your navel towards the spine Try and contract and lift the pelvic floor Try and hold this abdominal wall hollowing for five slow breath cycles, throughout the in breaths as well as the out breaths Hot Tips Try placing a rolled up towel or yoga block between your upper thighs. Squeeze in on this block working your inner thigh muscles too This can help increase the pelvic floor contraction Remember to keep a neutral spine Check back to the standing alignment exercise on page 10 to remind yourself about neutral pelvis and working the leg muscles It s easier to activate your core as you breathe out. Its hard at first to hold the core on and breathe in but keep practicing 17 Level 1

22 Step 2: Deep core trunk muscles Balancing Challenge Starting Position To find correct standing alignment: Stand on your mat or beside it with your feet hip width apart Unlock your knees Place your hands on your hip bones to check your alignment Find the pelvic neutral position by thinking again about the imaginary bowl of water in your pelvis. Rock from the backward to forward pelvic position a couple of times and come to rest in the level pelvis position The Movement Breathe in deep and wide Breathe out and activate the core in standing as described in the previous exercise Bend your right knee up, transferring your weight onto the left leg Keep your pelvis and front hip bones level Try and balance there for 10 counts breathing in and out slowly Repeat on the other side Progression Try and keep balanced while you close your eyes for 5 counts Hot Tips Try not to drop your hip on your standing leg Try not to crunch down in your waist, keep the side waist long Level 1 18

23 The Fix Program has freed many hundreds of people from back and neck pain. We can free you too. We sincerely hope you get something out of this book. For more personalised exercises and the remaining chapters of the book in printed form: Contact us or message us