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A Comprehensive Guide to Long-Term Healing for Back Pain, Disc Herniation, and Joint & Knee Pain

Updated: May 4

I was asked if I had any resources on my website about how to rehabilitate a spinal disc herniation. Since it is not a simple task to describe the nuances of spinal rehabilitation in a short article, this blog post aims to give the reader a clearer idea on the matter and to hopefully learn ways how to manage or prevent physical injuries. Please take part of the quick poll at the end of this article - it only takes a second.


In this blog, I want to explore the structure of a well-thought-through rehabilitation program so we can appreciate the procedures and understand why it takes time to gain sustainable outcomes. When this process is followed through with the guidance of a health professional, pain is generally eliminated.


In order to understand how to rehabilitate the spine, or really most musculoskeletal injuries, we must understand the relevance of posture and the relationship between the spine and the deep connective tissues of the core (the core musculature is between the hips and the ribs).


1)_The health practitioner/therapist needs to assess the person’s posture from head to toe in order to understand where the origin of the problem is. Simply massaging the area of pain is not sufficient in the long term, because posture is similar to architecture. When posture is suboptimal the center of gravity is shifted away from the middle center. We can think of the famous Tower of Pisa, where the base of support has to work incredibly hard to keep the structure standing. The entire structure is in a fight against gravity due to its misplaced center of gravity. 




Posture
The Tower of Pisa has a misaligned center of gravity

2) The spine must be thoroughly mobilized. This should be done by the patient regularly, not done by the therapist to the patient only. The therapist is to teach the patient how to mobilize effectively. Some helpful mobilization methods encompass Feldenkrais, Alexander Technique, and there are many more.


3) Based on postural assessments, the therapist is to educate the patient on which muscles are tight and which are not tight enough. Muscles are similar to the spokes of a bicycle. Some may be too tight, others not tight enough. Stretching all muscles as is sometimes mistakenly done in Yoga could lead to no sustainable outcomes. Depending on the patient’s unique assessments and findings, some muscles need to be strengthened while others need to be stretched.



Back Pain, Neck Pain
Muscles in our body can be seen as similar to the spokes of a wheel. If some spokes are too tight or not tight enough, the wheel functions sub-optimally.

Since every human body is different, a “one fits all” solution is as far as I know not yet known. Although I heard that some indigenous people, when experiencing back pain, would walk or run barefoot through a muddy riverbed, which would help realign the muscular-skeletal system.


4) After correcting tight and not tight enough muscle groups by stretching and strengthening, the deep muscles of the core must be evaluated. This deep core musculature is responsible for leading load away from the spine. In other words, when the core is inactive, the weight of the body sits on the spine, but when the core is firm and active, the weight is led away from the spine and nerve entrapments through the muscles and fascial tissue. Reconditioning the core is one of the most essential parts of rehabilitation.


It is noteworthy to understand that if the patient has digestion issues, this, by its very nature, has a deactivating impact on the core musculature. In other words, it is a prerequisite to recognize and eliminate foods that cause gut irritations. The reason is that if one eats something that bloats the gut up, the capability to activate the core is very slim (the bloated organs would push outward against the core musculature reducing the ability to contract the core mechanism). This means the key player in spinal support (the core musculature) is out of the game, and the spine is left to itself – we may call this a “naked spine”.


Important: The spine is not a weight-bearing column. The spine should never be carrying external loads; muscles are designed to lead the load away from the spine. This is why core activity is essential.


The deep muscles of the core are inserted with their fiber into the spine. When they contract, they lead the load away from the spine, similar to tightening a shoe leading to an evenly distributed “hoop-tension”. This is partially over-simplified, but if we were to take a look at the insertion of deep core muscles, we would find that they insert right into what is called the “thoraco-lumbar fascia”, which is the central point where all fascia comes together and it is connected right with the  spine. The fascia is a weblike tissue that provides support and structure to muscles, organs, and other internal structures in the body. When the core is active it contracts the fascia system in the entire body leading load away from the spine. 



Fascia
Visualizing Muscles and Fascia as Elastic Distributive Mechanisms: A Metaphor with Shoe Laces

It is furthermore noteworthy to understand that if a woman suffers from diastasis recti, scar tissue due to birth, and other post-pregnancy complications, this would again require a slightly different approach by the health professional. Namely, any trauma on the core would need to locally be rehabilitated first and foremost.  



Diastasis Recti
Diastasis recti is characterized by the separation of the abdominal muscles, often occurring during pregnancy due to the stretching and weakening of the abdominal wall.

Women's Health
An active abdominal wall without diastasis recti

No external weights should be introduced before the core is functioning again; otherwise, it could hinder the progress of rehabilitation or even create injury.


5) Stability and strength training should follow after completing the first steps of



In summary, if one wants to achieve long-lasting results, one needs to invest active time and trust in the rehabilitation process. It can take anywhere from months to years, but certainly a process I highly recommend, for when the patient gets it, and did it by themselves with the guidance of a skilled health professional, they will for the rest of their lives be able to handle their own inflammations and injuries and live a life of much less pain and discomfort.


Ready for a Quiz?

 

Which image represents Diastasis Recti?

  • 1)

  • 2)


Answer is below!


The answer is Image two! Stay tuned for a blog post on how to correct diastasis recti! Also, please take the time to participate in the very short survey below.



In what area do you experience persistent pain?

  • Neck, Upper Back and/or Shoulders

  • Lower Back and/or Hips

  • Knees

  • Ankles

You can vote for more than one answer.



Disclaimer: This text is intended for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your healthcare provider or qualified medical practitioner regarding any questions or concerns you may have about spinal rehabilitation or any other medical condition.





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