REVITALIZE METHOD:LOWER BACK PAIN &SCIATICAYOUR GUIDE TO LESS PAIN AND OPTIMAL FUNCTION

PAIN 1

Pain is an alarm system. It lets us know when our brian and nervous system thinks we’re in trouble. However, a lot of the time we can manipulate pain, turn down the volume of the alarm system and start to tease more movement and strength out of the injured area in the early stages of recovery to return you to basic activities.

This is what this first chapter is all about; turning down the alarm system, reducing pain and getting you back into basic activities

We work by the following principles

1. Move as much as possible whilst keeping pain below a 3/10 level of pain or preventing more than a 30% increase in pain

2. Implement pain relieving exercises before pain increases to prevent a flare up (i.e. if it’s painful to stand or carry after 60mins of doing so, complete your prescribed exercises every 40mins)

3. Keep effort around a 6/10; i.e. is 10 press ups is a 10/10 level of effort, do 6. If a 100kg squat is a 10/10 effort, squat 60kg

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Massage

Massage (tennis ball or foam roller needed)Massage is great for temporary desensitisation of a painful area and to improve mobility. Below are some self massage techniques for the following areas. Click on the titles to watch the recommended videos. Practice for 3 mins at a time

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Lumbar Erector Spinaehttps://www.youtube.com/watch?v=5hQ30vuArjU

Quadratus Lumborumhttps://www.youtube.com/watch?v=J8BmxgY92qY

Glutes (maximus and medius)https://www.youtube.com/watch?v=XeFk0sucLw4

Hamstringhttps://www.youtube.com/watch?v=o7dgElyANDk

StretchesStretches are a great way to temporarily improve mobility and desensitise pain. Hold for 2-5 sets of 90 seconds, keeping pain less than a 3/10 or a 30% increase

Only perform if pain free as stretches can compromise joint positioning

Lumbar Erector Spinae (rotation)basic: https://www.youtube.com/watch?v=VK75m-l3RSYadvanced: https://www.youtube.com/watch?v=ZwePF1UFEdk

Quadratus Lumborumhttps://www.youtube.com/watch?v=zKjzQTZBHTY

Glutes (maximus)https://www.youtube.com/watch?v=gE6mJ0VjK7Y

Glute max (standing pigeon pose; advanced)https://www.youtube.com/watch?v=y_ut4-xa1wI

Hamstringhttps://www.youtube.com/watch?v=ykOlGxeEnr0

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Phase One: Novel Movements

Novel MovementsRemember pain is an alarm system. If we take a painful movement, break it down and make it non-painful, this is a novel movement. If we practice these effectively enough, the nervous system will rationalise and start to silence the alarm system and pain will reduce.

Perform these exercises before pain comes on, as pain is increasing and when pain peaks to reduce pain to a manageable level. Once the shoulder can be loaded, these exercises are mainly useful for pain relief

Keep to 5 sets of 60 seconds per movement if pain free

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Quadruped Novel MovementsGreat to implement pain free movement in an offloaded positionflexion, extension, side bend: https://www.youtube.com/watch?v=Jn-3eU54vuA&t=77srotation: https://www.youtube.com/watch?v=MfUx9FCOb1E

Pelvic tiltsA great exercise to reduce pain whilst stationary. Try to perform before and after pain increases

sitting: https://www.youtube.com/watch?v=PdEKzbBFZrEstanding: https://www.youtube.com/watch?v=1VQ5ITSDpaI&t=3slaying: https://www.youtube.com/watch?v=gE018HYqqEMbrace with sitting hip flexion: https://www.youtube.com/watch?v=KZ40yziHPmY

Nerve Flossing (for sciatica)

sitting: https://www.youtube.com/watch?v=OMbKv94Bu_U&t=3ssupine: https://www.youtube.com/watch?v=GPAlnGFfxz0

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Phase Two: Basic Load / Isometric Load

When placing small amounts of load through the injured area, fresh tissue generation is encouraged. As well as this, your brain will naturally reduce your pain levels as it starts to improve confidence in the injured area. Follow the following rules of thumb

1. Only perform the exercises your practitioner has asked you to. Communicate with your practitioner if in doubt

2. Only commit to the exercises you are 80% or more confident at completing

3. Keep pain below a 3/10 and effort at a 6/10 or below

3.1. Once the pain and effort are far less than this, you’re ready for the next stage of exercises

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Isometric Exercises for the Supportive Muscles of the Spine (the core)

We’re going to use the below exercises to introduce strength based movements into the spine. We will be using the brace position quite a bit, which is where your core contracts to resist external forces.

Your joints won’t move but your muscles will contract. Push as hard as is less than a 3/10 level of pain and around a 6/10 level of effortNormally we prescribed 5 x 60 second contractions 3 times per day

Exercises for the front of the core

Basic abdominal activationhttps://www.youtube.com/watch?v=YpmbiHwFaHE

Abdominal activation with heel slideshttps://www.youtube.com/watch?v=38xz_sRgj8Q

Dead bugshttps://www.youtube.com/watch?v=4XLEnwUr1d8

Exercises for the spinal muscles

Quadruped hip extensionhttps://www.youtube.com/watch?v=sVMcWLTZmOM

Glute bridgehttps://www.youtube.com/watch?v=8bbE64NuDTU

Quadruped Superman plankhttps://www.youtube.com/watch?v=KR7y5_C6W9s

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Phase Three: Resisted Movement

The more tolerant we are to load, the more resilient we are to trauma in our day to day activities. The brain will once again rationalise to make the movements it is tolerant to, less painful.

Please follow the guidelines below

1. Only perform the exercises your practitioner has asked you to. Communicate with your practitioner if in doubt

2. Only commit to the exercises you are 80% or more confident at completing

3. Keep pain below a 3/10 and effort at a 6/10

3.1. Once the pain and effort are far less than this, you’re ready for the next stage of exercises

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Spinal and Supportive MusclesExercises to strengthen the supportive muscles of the lower back

Glute bridgehttps://www.youtube.com/watch?v=8bbE64NuDTUSingle leg glute bridgewall: https://www.youtube.com/watch?v=RnMJHfUPFq8floor: https://www.youtube.com/watch?v=fDxl-0uZMJo&t=7s

Lower crunchhttps://www.youtube.com/watch?v=wnXPsXygnVI

Clam (when pain is experienced in the outer hip area)https://www.youtube.com/watch?v=m7RyKQV4XhE

Side leg raisehttps://www.youtube.com/watch?v=jgh6sGwtTwk

Advanced resistance exercisesInfluencing functional movement more applicable to daily activities

Swiss Ball Roll Outshttps://www.youtube.com/watch?v=QbZs_zjTbRw&t=28s

Leg Raises (scale from single leg)https://www.youtube.com/watch?v=JB2oyawG9KI

Hyper Extensionfloor: https://www.youtube.com/watch?v=4sx36cI3QaMswiss ball: https://www.youtube.com/watch?v=IWRM3eC2GT0machine: https://www.youtube.com/watch?v=ph3pddpKzzw

Side Plankscaled from knees: https://www.youtube.com/watch?v=K2VljzCC16g

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Scaled Introduction into Weight Training

Weight training is hugely beneficial to spinal health if it is done correctly. There should be minimal spinal pain when attempting to weight lift unless your practitioner says otherwise.

Focus on keeping a neutral, braced spine and follow the following rules of thumb

1. Drop the weight until the pain reduces to below a 3/10. If pain persists with no weight, you’re not ready yet

2. Drop the repetitions of the weight until pain is below a 3/10

3. Gradually increase load by 5-10% each gym session unless your practitioner says otherwise

4. Keep to the movements you are 80% confident at performing

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The SquatSpinal muscles are actually more active during the squat than the are during the deadlift. This makes it a great strengthening exercise but it must be performed properly. The following exercises are in ascending difficulty levels

1. Chair squathttps://www.youtube.com/watch?v=vVpojWs8lQg

2. The wall squathttps://www.youtube.com/watch?v=hV_rDOloxCI&t=4s

3. Goblet Squathttps://www.youtube.com/watch?v=MeIiIdhvXT4&t=2s

4. Pause Goblet Squathttps://www.youtube.com/watch?v=-fCG0oJT8Ps

5. Barbell Squathttps://www.youtube.com/watch?v=Or79sJFfvTA

The DeadliftThis is a great exercise to teach the hip fold position which is applicable to lifting things from the floor. This makes it a great strengthening exercise but it must be performed properly. The following exercises are in ascending difficulty levels

1. Take a bow (hip hinge useful for sciatic pain)https://www.youtube.com/watch?v=RO1whOyaFs0

2. Pause Romanian Dead Lift (pain must be low, start from the top)https://www.youtube.com/watch?v=nbgrmqZhMFA

3. Block Pull (pain must be low)https://www.youtube.com/watch?v=jfSxbT-65ow

4. Deadlifthttps://www.youtube.com/watch?v=4AObAU-EcYE&t=1s

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Phase Four: Explosive Strength / Pylometrics

Explosive strength is essential for most sporting activities, even casual jogging. We must practice it to become tolerant to it. This, accompanied with function specific exercises is the final stage of your rehab. Once we complete this stage pain free, you can be confident in your injury’s recovery however you may be recommended to book in for check up visits to maintain the good work we have done together

Please follow the guidelines below

1. Only perform the exercises your practitioner has asked you to. Communicate with your practitioner if in doubt

2. Only commit to the exercises you are 80% or more confident at completing

3. Keep pain below a 3/10 and effort at a 6/10 or below

3.1. Once the pain and effort are far less than this, you’re ready for the next stage of exercises

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Rotational Based Explosive ExercisesFor torsional sports such as boxing or rugby

Medicine Ball Throwhttps://www.youtube.com/watch?v=SgcyVVYytwY

Extension Based Explosive ExercisesFor sports such as tennis and swimming

Weighted Hyperextensionshttps://www.youtube.com/watch?v=X2BOcITSPUA

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