Return to Running After Injury and Pregnancy

In 2016, I went from running 1 mile with pain to running 13 miles without pain.

The past 2 years have taught me a lot about running, injuries, and recovery. Like many of my fellow runners I was plagued with a chronic injury preventing me from peak training and performance. My most recent injury was traumatic, and it took me 6 years to recover. Years of seeing physicians, getting injections, exercises didn't help.

A little background... In August 2009, I slipped and fell on my back. Like most runners, I continued to run despite having pain in my right side sacrum (tailbone). I remember running on the Great Highway and thinking "ouch", some times out loud, each time I stepped on a patch of sand that had washed onto the path. I decided to change my form so my sacrum wouldn't hurt so much, and it worked for a very short period of time. About 2 months of pain free running into my training I suddenly started having what I call "dead quad' syndrome. My right side quadriceps felt like a brick. From there I had countless MRIs, x-rays, injections, chiropractic work, physical therapy unfortunately none of it helped. Flash forward to 2015. I started seeing an osteopath for prolotherapy with mixed results. One day he decided to check my glute strength in a way I never have seen. While on my stomach, with a towel roll under my ankle, I had to straighten my knee using my glute, and I couldn't do it on my right side. I had been performing clams, leg lifts, bridges...the typical glute strengthening exercises. It was at that point I realized I wasn't weak; I had trained my body to not use my glute muscles.

Once injured, we all want to resume our normal running routine as quickly as possible. Then we end up with injury after injury. I was one of those runners who felt fully recovered from my injury and returned to my "normal" running routine. However, my injury would just return in a matter of weeks sometimes only days. This was not good for the body (or the wallet with countless race entries that went unused). An injury, chronic or acute, changes our movement pattern, which in turn stresses our muscles differently. This quickly leads to imbalances and overuse injuries. Starting slow and focusing on form will help the body relearn the appropriate movement patterns, thus reducing the chance of re-injury.


In 2016, I decided to start at square one.  This was a huge investment of time into my physical and mental health. At the beginning I always wanted to run more than the 1 or 2 miles I limited myself to. However, by the end of my program, I felt the best I ever had. The discipline was worth it! I even ran several cross country races, continued running during my pregnancy, and was able to quickly return to running post-partum.
                                   

Cross country race in San Francisco

My Plan

January:
- Run 2 miles 6 days a week.
- Pick a pace 1 minute slower than comfort level for a 5 mile run.
- Focus on FORM.
- 1st week, no faster then 9 minute mile pain.
- 2nd week, no faster then 8:40
- 3rd week, no faster then 8:20.
- 4th week, I was able to run at 8 min mile pace.

February:
- Up mileage to 3 miles 6 days per week but slow pace down to 9 min miles
- Followed the progression above with adjusted times

April:
- I was able to transition to a more traditional running program.
- One long run, 3 easy runs and 2 challenging runs ranging from 4-6 miles.
- I increased my long run by 1 mile every week ( with a month vacation in June) so by September I was running 13 miles.

During this time frame I felt the best that I ever have! Even running in college I had a lot of aches and pains running that distance.
The fitness gained from the first 9 months of 2016 set me up to be able to run 8 of the 9 months of my pregnancy.

Running at 8 month. I could not avoid heel striking!

Post Partum 

Month 1- I'm not going to lie. When I started walking 3 days post-partum, it was HARD. My neighborhood has slight inclines ( ~2-3%) and my legs were tired walking "uphill" and shaking when going "downhill". I kept my plan. Walk for the 1st month. There was no minimum. Just get out and walk what I felt like.

Month 2- I was released to run at 4 weeks post-partum. My goal was to run every day of June. I start running 1 mile for 10 days, then 2 miles for 10 days finally 3 miles. Then I transitioned to a traditional training program. My goal was to run in a race by the end of July ( 7 weeks of training). That first mile was a challenge. I was sore. But my focus was on my FORM. After about 4 days, my soreness went away and the runs felt good.
Then came 2 miles. I thought it was going to be painful but to my surprise my 2 mile pace was faster then my 1 mile pace. Running 2 miles felt great. I felt my body get stronger and there was better control of my body. I was even able to join my team mate part of her easy runs.
Last, I had 3 mile runs planned for the final 10 days June. There were certain days that I had to slow down to focus more on form. It was most likely the days which the baby was up during the night crying. I adjusted my workout to make sure I was able to maintain my form at the pace I was running.

Month 3 - Over the next 20 days or so I ran 3-5 miles a day making sure I didn't increase my mileage too rapidly.
The week before the race I was able to comfortably run 5 miles in 8:30 pace. So I set a goal of running the 6 mile course in under 50 minutes.

Race Day

It was a long night with the baby the night before the race. My plan was to start slow so I can focus on my form and allow my muscles warm up. I gradually picked up the pace.  With the help of a couple of ladies who I coached while they were in college I was able to push my last 2.5 miles. A couple days shy of 12 weeks post partum, I finished 6 miles in 48 minutes! My time was 2 minutes faster then my goal time. I also negative split the race ( 8:10, 8:07, 7:59, 7:55, 7:47, 7:28). My body wasn't sore. But, it's better to test my body then to go all out with the possibility of being so sore I couldn't run for a few days.

Post race sweaty cuddles

What I learned was a slow return to running with a focus on form was the best way to recover from an injury. All the times of jumping back into a running" once I felt better" made it so my recovery was longer. It took months of slow, controlled running to get back on track. I wish I knew this years ago!
Please let me know your thoughts on recovering from an injury and return to running.

Stay tuned. Next blog post is on the core exercises.

My Running Analysis

I'm back! Some of you who have been reading my blog may have noticed I took a hiatus. Well, I now have a little to take care of. She is 6 weeks old today. 

I was feeling feeling miserable towards the end of the 1st trimester but able to resume running in the beginning of the 2nd trimester. I ran until I was 7 months pregnant. Then I decided it was time for my body to transition to walking. I resumed running at 4 weeks postpartum . For the most part, I feel pretty good. However, there is a bit of nagging foot pain on my right side. I decided to do my own running analysis. 

Analysis 

Like I suspected, the angle that my right foot contacts the ground is much steeper, 20 degrees vs 12 degrees, then my left (Bottom photos). The steep angle suggests a decrease in surface area that my foot has to dissipates force when it hits the ground. This causes increase stress to the structures on the outside of my foot. If left unattended, it can eventually lead to inner foot pain due to the larger distance my big toe has to reach the ground. 

Why is My Foot Doing That?

During swing phase my right foot turns out more that my left (top photos, a little confusing but the "right" and "left" is for stance leg). This is a sign that I circumduct or "circle" my foot as I swing my foot from back to front. The foot naturally turns up to make sure the big toe clears the ground when the foot makes contact. 

Circumduction occurs due to an improper push off from the ground. This is a result of ... WEAK GLUTES. When the glutes are strong the muscles function to control extension of the femur as the leg pushes back. However, when the muscles are weak, the femurs not properly controlled by the glutes. Due to gravity and weight of the leg, the foot turned outward.

Treatment

The best way improve form is to focus on proper muscle recruitment. I don't see this as changing my form. I see as training my body to use the appropriate use muscles. 

Stand tall and lean forward from the pelvis from both sides. You would be surprised at how different each side can be. Then "cycle" the knees. I use the cue "push the knee back" as it contacts the ground. Don't worry, your knee will never fully straighten. Using the "push the knee back" cue will force the femur to extend straight back. Having the appropriate posture will allow your body to be in proper alignment to use the gluteal muscles. If you were to stand up without a forward lean, you will most likely feel your quadriceps when you "push the knees back" cue. 

In latter part of the video, you can see in the "normal form" my body is behind my pelvis and I land with a heel contact. This leads to instability of my core and lack of control of my lower extremities. In the "cycling knees", my body is over my pelvis and I land with a mid foot contact. There is improve core stability and control of my legs ( and no pain in my foot) Now, I have to be able to maintain muscle recruitment through my run. Research shows initially the muscles will be activated for 20-30 seconds before fatigue onset (muscle and nervous system). I remind myself every few minutes to stand up straight, push my pelvis forward and cycle my knees.

The above pictures shows a change in angle after cycling the knees using the "push the knees back" cue. The angle of the right foot during swing went from 17 degrees to 10 degrees ( and left leg 8 degrees). The angle of the foot during initial contact with the ground went from 20 degrees to 8 degrees (left leg 12 degrees). There is a 2 degree range
in the different positions that I measured.

Please let me know what you think. 

With these techniques, during 2016 I went from running a mile with pain to being able to run 13 miles without pain in 6 months.

Here's baby JuJu ( 5 weeks 6 days) and I post videoing

Properly Performing Squats to Recruit Glutes

Gluteal activation seems to still be a mystery. There are new terms like “Dormant butt” syndrome or “Dead butt” syndrome, but the problem is still the same. Our butts aren't working! We perform strengthening exercises but the strength doesn’t translate to running. 

Over the past year, I have been researching the best way to get the glutes recruited while exercising and running (also cycling). 

The first thing I look at in my patients is “Can they isolate their glutes independently?”. This is important because when the foot makes contact with the ground, the glute contracts. Meanwhile, the other glute relaxes to allow the swing leg to move through the air. If the gluteals do not function independently, our body will allow the leg to swing and the stance gluteal will not contract. This is the basis of why we don’t recover from a gluteal strength based injury.

My first exercise seems easy, but requires a lot of focus. It lets me know if my client is able to independently contract the glute and if there is a difference in contraction between the sides. This exercise is a prone single leg glute set.

 



Lay on your stomach with a foam roller under the ankle. On one side straighten the knee then contract the glute muscle ONLY on that side. Hold it for 10 seconds. Now try the other side. Is there one side that is harder then the other? There usually is! Perform this exercise 10 times each ( no matter which side is weaker) 10 seconds 2-3 times a day. If you don’t have a foam roller, a rolled towel can be used. To make this more challenging put 2-5 lbs ankle weights behind the knee or use a theraband and use the opposite knee to anchor the band.

My next exercise is bridges. People commonly dig their heels into the ground when they lift up to bridge. This engages the hamstrings. Usually my older patients get hamstring cramps when bridging up. To focus on the glutes, shift the weight into the forefoot as you lift your pelvis up.  Perform this exercise with a 10 second hold 10 times. To advance rest ankle weights (or text books) across the abs. To further advance, perform a single leg bridge.

What about the squat? The squat is a basic exercise to strengthen the legs and glutes. We SHOULD feel the exercise in our glutes since they are typically weaker then the quadriceps. However, when I ask my clients which muscles do they feel when squatting, they say quadriceps.  I often have to cue my patients to squeeze their glutes. The quadricep are much stronger then the gluteals, so why is the work felt in the quads? I would like to argue it's mechanics and body positioning. 

The ready position in most sports, such as football, volleyball, tennis, involve being a squat position with weight shifted onto the forefoot. The legs can spring off the forefoot and push forward. With the foot fixed on the ground on the body in a forward lean position, the gluteals are forced contract to extend the leg.

My believe is squat form changed to compensate for preventing our knees from going over our toes. The easy fix is simply instructing people to sit back in the heels. This simple cue to save our knees in the short-term, may have doomed our butts. By shifting our weight into the heels we end up engaging the thighs, the quads and hamstrings. I started performing squats with my weight shifted into my forefoot while keeping my knees behind my toes. As I stand, my focus is to straighten the knee. Voila! I feel my glutes engage NOT my quadriceps.

For the past several months, I have been re-cuing my clients and patients to squat and lunge with their weight shifted forward and straightening their knee to stand up. They have been able to recover from their injuries faster. 

By using the cues to shift weight into the forefoot and focus on knee straightening to stand up, the gluteals will be better isolated. To add a variation I use these cues for a lunge matrix and single leg squat as well as jumping drills. By keeping these cues in mind, you'll be able to recruit the glutes and keep running!

Side note: If shifting weight towards the forefoot to recruit the glutes work, does this make an argument for forefoot (or mid foot) running?

Mizuno Wave Rider 20 Review

The Mizuno Wave Rider was my training shoe of choice for years while racing in college and post collegiately.  When I heard the Wave Riders were getting a complete makeover, I was so excited to check them out. As a Fitfluential ambassador, I got the opportunity to review the new Wave Rider 20. 

Running shoe companies like Mizuno have continuously evolved their running shoes as new technology is developed, and this newest iteration of the Wave Rider is no different. The Wave Rider  showcases their new Cloudwave Geometry,  a new midsole and updated mesh.

Although the Wave Rider is categorized as a "neutral" or "cushioning" shoe, the Rider provides a level of ground response that makes these shoes feel more alive when running, and enough support which kept my foot on an even keel after stepping on a rut on the road or a rock on the trail. This does not mean that the shoe lacks cushioning; The legs rolled on and the miles kept accumulating without excessive fatigue associated with shoes that have gone thin. It is not a stretch to say the feel of this shoe is attributed to the new Cloudwave Geometry, it certainly did not make it worse. 

The fit is amazing! Through long runs the Wave Rider feels snug without rubbing my feet. The tongue stays up providing a nice padding for the front of the ankle through rolling hills. 

The only real critique is that while the shoe is responsive, the Rider has a heel bias typical with shoes of this type. During fast interval runs or runs trying to maintain mid-foot strike, this shoe can feel cumbersome, even tiring.

Overall, they provide great support and cushioning for most of my running up to fast tempo runs. 

Note: I received these shoes for a review at a small fee.

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Hydration and Performance Gels/Drinks

As the weather is getting warmer as summer begins. The key to a successful long run or race is good hydration and sports performance gels/chews. This is especially true for long distance runners. Since returning from the Western States 100, I thought it is a perfect time to discuss this topic. I started running in an era that sports gels and hydration packs were just blossoming, so it has been a learning experience over the years. I remember when Power Bar came out with Power Gel and tested it at Stanford Cross Country Invitational (1996?). Then hydration packs became more popular (2000?).

It seems very simple. Drink water... Or is it?

Dehydration 

Dehydration is a common ailment among athletes. This occurs when there is more fluids lost then ingested. Athletes, of course, are most vulnerable during intense exercise in the heat or in cold weather when athletes don't feel as thirsty. Newer athletes may be more susceptible to dehydration as they may not be as adjusted to drinking the amount of fluid they need. For runners, it can be difficult to carry water and the desire to keep running over powers stopping for water. However, proper hydration allows the body to function properly. The current guidelines is about 4-6 oz of fluid for every 15-20 minutes of exercise lasting > 30-45 minutes in duration. 1 gulp of water is 1-2 oz of fluid.

Signs and Symptoms 

In mild to moderate cases dizziness, headache, confusion and cramping are some signs and symptoms. In severe cases the athlete stops sweating and blood pressure decreases.

Hyponatremia 

The condition that is less heard of is hyponatremia. It translates to too little sodium. This occurs when there is too much fluid and not enough electrolytes. The first time I heard this was my senior year in high school when a former California State Champion (competing at Stanford) couldn't finish her race because she drank too much water and her electrolytes were imbalanced. She drank 1 gallon of water before her race.
Runners who run longer then 4 hours are more susceptible to hyponatramia. Since they are on the course longer they tend to take in more water not realizing that sodium is important too. To avoid dehydration runners will drink water at every aide station. However, ingesting more water compared to how much you are sweating will increase the chances of becoming hyponatremic.  This will increase the amount of water in the body but the sodium level decreases from sweating causing hyponatremia. An improper balance of water to electrolytes can cause a number of different symptoms and can lead to coma. This is why it's important to have sports drinks along with water.

Signs and Symptoms

Headache, nausea and vomiting, lethargy, and confusion, seizure are symptoms of hyponatremia.
The excess fluid moves from between cells to inside the cells causing the above symptoms. When it is severe it can move fluid into the lungs and brain.

Dehydration vs Hyponatremia

The symptoms of dehydration and hyponatremia are very similar. In the past, the best way to monitor is to weight your self before and after running. If you weight less, there is less water. You're dehydrated. If you weight more, this means have you're over hydrated possibly leading to hyponatremia. However, this way of checking is unreliable. The latest research supports moving away from using weight as the sole monitor.

You can be dehydrated AND hyponatramic (weighing less). In the past, the athlete would have been given more water. However, drinking more water can further put you in hyponatremia.  Being more aware of your hydration strategies is the best option. Make sure you drink a adequate balance of water and sports drinks/gels.

Sports Drinks, Gels and Energy Chews

For long distance events (> 60 minutes), sports drinks, gels and chews are important to provide your body with energy and keeping a good electrolyte balance. They contain a specific percentage of carbohydrates.  Research shows that 6-8% carbohydrates is the best for the stomach to absorb. A 100ml drink should have 6-8 grams of carbohydrate or 14.2 - 18.9 grams per 8 oz of fluid. Higher percentage decreases gastric emptying which leads to gastrointestinal stress (cramping, vomiting). With the increase in GI stress, the amount of fuel being delivered to the muscles is decreased. So you're left with GI issues and lead legs. Fruit juices and soda contains 10-12%. They can contribute to GI stress if they are not diluted.

If your gel pack states to drink 6 oz of water. Drink 6 oz. of water. This ensures the proper percentage of carbohydrates. That is 3-6 gulps of water per pack. If you ingest multiple gel packs, let's say 3 over an hour, that would be 18 oz of water which can be a lot if you're not use to it. Or, if you drink a performance drink with the gel, it will increase the concentration of  carbohydrates to an undesirable amount. If you're not use to drinking water with your gels or chews and/or use more then you would typically, you can be causing GI stress on race day.

For example- A GU pack typically has 22 grams of carbohydrates, you should have approximately 10 oz of water with the GU for proper percentage carbohydrates. If you ingest 2 packs, you should have 20 oz of water.

Of course, everyone is different. Some athletes feel fine with more or less then the recommended amount. Know your body. If you end up with GI problems you can rebalance your body by drinking more water if you have had a lot of sports performance drinks/gels or taking more sodium if you haven't had electrolytes with your water.


***These are the basic of hydration and performance aides. There is a lot more detail such as protein ratio, caffeine, etc, but would make this post into a book. Please contact me if you have further questions.


Leiper JB, Prentice AS, Wrightson C, et al. Gastric emptying of a carbohydrate-electrolyte drink during a soccer match. Med Sci Sports Exerc 2001;33:1932-1938. 

Murray R, Bartoli W, Stofan J, et al. A comparison of the gastric emptying characteristics of selected sports drinks. Int J Sports Nutr 1999;9:263-274.

Posterior Tibialis Tendonitis

Tibialis posterior tendonitis is an injury that affects a few runners a year. This injury affects mostly people who have pes planus ( flat feet) and/or over pronate. Tibialis posterior tendinitis is painful on the inside of the foot and ankle region. The most stress is during mid-stance, when body weight is fully on the foot. 

What contributes to Tibialis posterior tendonitis?

Limited ankle dorsiflexion

Dorsiflexion is the movement of your foot towards your body, or in standing, when the shin bone moves over the foot. Dorsiflexion is required for proper walking and running mechanics. When the ankle is limited, the body makes up the motion elsewhere. One compensation is the foot splays outward. This will increase stress to plantar fasciitis and posterior tibialis tendon. Over time, the stress leads to injuries of those structures as it is unable to tolerate the load.

The top picture shows the ankle joint when the foot is pronated.
The bottom picture shows the ankle joint when the foot is
supinated. Less ankle dorsiflexion is shown when the foot is
pronated. The motion is taken up at the foot stretching the
tibialis posterior.

What contributes to limited ankle dorsiflexion? 

High Heels

When you wear heeled shoes, the foot is constantly pointed downward in plantarflexion. Over the course of the day the ankle joint progressively stiffens in that position. Even if you’re sitting with your shoes on, the foot is always pointed down. When you are out of the heel shoes and in running shoes, your heels are now closer to the ground. This requires more dorsiflexion at the ankle joint and muscle length of the calf. In order for the body to move over the foot,  the ankle needs to bend. But when ankle dorsiflexion is lacking, the motion is achieved by bending at the foot, specifically the navicular bone. This is the bone which the tibialis posterior tendon attaches to. With each step, the tendon is getting stretched. Over time this strain leads to tendonitis.

Prior Injuries 

Have you ever had a mild ankle sprain that you just ignored? There was a little swelling and pain but symptoms subsided. The swelling limits your ankle mobility and within a couple of days your ankle will get stiff. Your body compensates by getting the motion in your foot. Over time the mobility of the ankle will be more limited. Like above, the tibialis posterior tendon gets stretched. 

Weakness of Glutes 

Our body is connected by muscles, fascia and bones. If there is weakness in one region, it can affect another body part several joints away. The gluteals can affect the ankle. One of the functions of the gluteals is to externally rotate the thigh. Since the femur is attached to the shin, the lower leg bone will lift the arch up when the glutes contract. When the glutes are weak, the femur rotates in, which causes the lower leg to rotating in. This will allow the arches flatten. Try this at home.  Squeeze your glutes and watch what your foot does. 

Pelvic Mal-alignment

The pelvis is made of the ilium on each side and is separated by the pubis in the front and sacrum in the back. The ilium moves independently but one side affects the other.

When the pelvis is rotated, the hip socket, which is on the illium, moves up or down relatively. This affects the entire leg. When one illium rotates backwards, it makes the leg longer and the other leg shorter. This is called a functional leg length discrepancy. There there is actual difference in the length of the leg bone, it is called anatomical leg length discrepancy. This causes a problem for the body because it wants to stand level. The side that longer will pronate while the side that is shorter will supinate. The prolong pronation will stretch the tibialis posterior tendon. 

Placing the book under my foot, makes my leg functionally longer. My right foot is
pronated and the heel is angled away. 

Running Form 

Landing excessively on the outside of
the foot increases stress to the Tibialis
Posterior tendon.

Landing equally across the foot decreases
the stress to the Tibialis Posterior tendon.

Normal running form is to strike the ground on the outside of the foot, then roll to the inside. This is called pronation. However, some runners strike the ground too far on the outside portion of the foot.This places a lot of stress on the tibialis posterior tendon whose role is to slow down pronation. The more the foot strikes on the outside,  the tibialis posterior has to work more to control the motion. 

Treatment

1) Improving ankle mobility and strength will decrease strain on the tibialis posterior tendon. Follow the video in this blog post. 

2) Gluteal and core strengthening program is important to indirectly control the lower leg. There are numerous post on how to strengthen the core. The core video in this post is a great progression. 

3) Correct a pelvic malalignment

Put your hands on your hips and feel for a bony landmark on each side with your thumbs. This landmark is called posterior superior iliac spine, PSIS for short. If your right side is lower, that leg is functionally longer (shown above). If your left side is lower, that leg is functionally longer.



To correct a right posteriorly rotated SI joint, we are going to use the right hip flexors to rotate the illium forward and counter using the glutes/hamstrings to rotate the left side backwards. Lay on your back with your knees bent. Bring your right leg up and use your hands to resist at the knee. At the same time dig your left heel into the ground. Hold this for 6 seconds and repeat 3 times. Next take a hard object ( I like using my foam roller) and squeeze between your knees for 6 seconds 3 times. 

4) Form
Practice landing with equal force across the foot. This decreases the distance the medial side part foot has to lower to the ground which will lessen the stress to the tibialis posterior tendon.


These are some of the contributing factors I look at when assessing a runner with tibialis posterior tendonitis. 

Please let me know if you have any questions.

Sciatica

Sciatica is a common injury that can impact up to 40 % of people at some point in their lives. For runners, it can be devastating as it impacts training and preventing participation in the "goal race". Sciatica is merely a description of a symptom, which is inflammation of the sciatic nerve. It does not provide a cause. The sciatic nerve can be pinched in the hip region or the back. This article is going to focus on the back. There is an article I wrote which discusses how ankle stiffness can lead to sciatica.

A  number of nerves exit the spine and come together to make up the sciatic nerve. The nerves exit between lumbar spine 4- sacral spine 2. It travels through the pelvis and descends down the back of the leg. Pinching of the nerve causes pain, numbness, tingling and if severe enough, loss of strength.  There is a distinct pattern of pain, weakness and loss of sensation which allows the clinician to know which nerve root(s) is affected.

Causes

Herniated disc

A herniated disc is when the disc between the spine pushes into the space where the nerves live. Due to the the structure of the disc, the soft material gets pushed backwards onto the nerves. This usually happens when the body is forward flexed and there's a force. Squeezing or coughing while bent forward is a common way to sustain this injury. When the disc is herniated, any sitting or bent forward position increases pain. This position puts more pressure onto the disc which pushes onto the nerve.

Stenosis

This injury occurs when the space the nerve exits the spine narrows. This happens when the disc looses it height or when the arthritis in the joint. When the disc loses it height the ligaments surrounding the spine buckle which takes up space where the nerves are. Imagine a curtain on a wall and what it would look like if the ceiling height got lowered. The curtain will buckle. This type or injury gets inflamed with upright activities and be more comfortable sitting.

Treatment 

Alleviate the pain

This is the 1st step! The body will compensate and muscles are shut off when there is pain. Number one goal is to decrease the pain to allow the nerve pathways to the muscles. This can be achieved by using ice/heat, resting positions and taking pressure of the nerve.
People often think they are improving because their pain is decreasing. In reality, they may not feel pain because MORE nerve fibers are being pinch and they are losing sensation. Eventually the muscles no longer get the signal from the brain and will get weak.
For a true herniated disc, laying on your stomach will help to take pressure away from the disc. These are known as Mckenzie Extension exercises. While for stenosis, sitting or laying with the legs at 90 degrees will allow opening of the joints. These are called William Flexion exercises.
Traction in these positions will further accelerate the healing process.

Core stability

Focus on developing the muscles that stabilize your spine not move your spine. People have a tendency to perform big movements like back extensions and sit- ups. However, when your back isn't stabile these movement can contribute to shearing of the spine leading to early degeneration arthritis. Poor posture allows the core stabilizers to atrophy. Bigger muscle groups function as stabilizers. This contributes to nerve pain as the spaces narrow.

Mobility Above and Below

You want to make sure the area above and below the region is strong and mobile. This helps to take the pressure of the spine. Often the areas above and below a painful segment is stiff and tight which forces the injured area to move more. This leads to over use and also lead to early arthritis
Most commonly the thoracic spine and hips have limited mobility.

Hips 

The hips and pelvis are important region as it serves as a base for the lumbar spine to sit on. However, it's mobility is often limited. When I walk into an exam room, I see my client's back rounded. To improve posture, hip mobility needs to be assessed.

Good sitting form: Hips are at approximately
90 degrees and back has good curvature

Poor sitting form: Hops are rounded forcing the
back to round.

They are unable to get > 90 degrees of flexion in the hip. This is problematic because it leads to poor posture. There is an increase stretch to lower back, poor alignment and shuts down muscles.

Thoracic spine 

The thoracic spine area is a victim of gravity. Gravity pushes down on the shoulders while we sit and standing causing the thoracic spine to curve forward. The thoracic spine is also stiff due to it's job as the protector of all things vital... our heart and lungs. Due to the rib cage, the thoracic spine doesn't have a lot of motion compared to the neck and lumbar spine. However, this area should have the most ROTATIONAL motion of the spine. It's inherent stiffness limits mobility forcing rotational motion upon it's neighbors, the neck and low back. Have you ever heard of anyone with thoracic spine arthritis? It's highly unlikely because the low back and neck usually works harder to make up make for the lack of motion in the thoracic region. That is the reason arthritis is so prevalent in the low back and neck.


****Stay tuned for the next post! I'm traveling for 7 weeks! How to stay injury free and fit while on the road!