If you experience back pain, you are not alone. Back pain is one of the most common and costly health problems in our culture. Anyone who has experienced a bad back knows it can be extremely frustrating, and often debilitating. Many back problems appear to be irritated by only minor, seemingly routine activities, or in many cases have no clear cause at all. Once present, back pain often interferes with our work, and prevents us from enjoying our favorite things, such as walking, playing golf, exercising, or gardening. In many instances back pain can even interfere with a good night’s sleep. To make matters worse, many common back conditions are slow to respond to traditional types of care, which often provide only temporary relief.

Now for the good news. A new treatment technique known as Active Release Techniques® (ART®) is proving to be very effective for treating many common back problems and is helping back pain sufferers to return to their favorite activities. But before we talk about why ART® works so effectively, we first need to understand how the back becomes injured in the first place

The back is actually the spinal column, which consists of a series of small bones called vertebrae that are stacked on top of one another. These bones are connected through a series of joints. The first joint is the intervertebral joint, which is formed when two vertebrae are joined by an intervertebral disc. The second and third joints are called facet joints. These joints are located on the back of the spine and consist of the small, bony processes that extend back from the vertebral bodies. These joints between each vertebrae allow the spinal column to bend, which is important to all of our everyday movements. However, spine mobility comes at a cost, because it makes the spine less stable. In fact, research has shown that by itself, the spinal column will collapse and buckle under as little as 20 pounds of pressure.

A complex series of muscles surrounds the spinal column to control movement and protect the spinal column from injury. These muscles are arranged in several layers. The deepest layers are very small muscles that attach to each individual vertebrae and control and protect each individual joint. The middle layers span several joints, and the outer layer consists of the larger, more powerful muscles that run the entire length of the neck, from bottom to top. This complex system of muscles acts as a series of guy wires that move and stabilize each vertebrae and prevent excessive motion and buckling of the spine. When each muscle group is adequately strong, flexible, and coordinated, the back remains protected and healthy.

Angling Stretch                                  Rolling Pattern Video                   Foundation Squat

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Angling Stretch is important to realign posture by slowly rolling the shoulders back while keeping the back straight against the wall. Hold in this position for 30 seconds and then return to a relaxed position, repeat 3 times.

Rolling pattern should be started on your back. For example, roll over on your stomach by only leading or using your right arm. Once on your stomach, lead with the same arm to return on your back, Go through each limb twice. For video instruction, click “Rolling Pattern”.

Foundation Squat gives the thoracic spine an extension and release to maintain healthy posture. Hold in this position for 15 seconds and repeat 3 times.

Pelvic Tilt Step #1                                   Pelvic Tilt Step #2                 Four Point Kneeling Video

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Cat-Camel Stretch Step #1              Cat-Camel Stretch Step #2                Neck Flexor Stretch

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Pelvic Tilt is important for stability in the lower lumbar spine. Hold this position for 10 seconds and repeat 4 times.

4 point kneeling is important for core, neck, and back stability as it deals with balance and coordination. While on all fours, reach your right hand out in front of you while also extending the opposite side leg and hold in position for 3-5 sec, then return back to all fours. Repeat this process 5 times then switch to the opposite arm and leg. Do 3-4 cycles of this exercise but for further video instruction, click “Four Point Kneeling”.

Cat-Camel stretch creates flexion and extension of the spine which releases fluid and tension in the discs of your vertebrae. Move back and forth 10-15 times.

Neck Flexor helps stretch the platysma muscle that surrounds your neck. Hold in stretch position for 8-10 sec and repeat process 3 times

Rib Grab T-Spine Rotation  Video           Cobra Extension                    Double Tennis Ball Extension

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T-Spine Mobility Foam Roller                                   Foundation Squat

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Rib Grab T-Spine Rotation releases tension in the thoracic spine while helping range of motion. When in position, pull opposite shoulder back and hold for 10 seconds. Do both sides of the body and repeat 3 times. Click “Rib Grab T-Spine Rotation” for further video instruction.

Cobra Extension allows the joints to extend and allow proper movement for stiff and discomfort in the back. Hold for 5 seconds, repeat 5 times.

Double Tennis Ball and T-Spine Mobility targets pressure points and tension which helps eliminate pain. Do these two exercises for a minute at a time, rest for a minute, and repeat.

Foundation squat gives the thoracic spine the extension and release to maintain healthy posture. Hold in this position for 15 seconds and repeat cycle 3 times.

We rely on the muscles that support and control the spine for all of our daily activities. Whether we are bending down to put on a pair of socks, shoveling, vacuuming, or carrying a bag of groceries, the health of the back depends on the complex interaction of muscular contraction to move and stabilize each joint in our spine. If any of the muscles that surround the spine become tight, weak, or uncoordinated, excessive strain will be placed on the other surrounding muscles and on the spine itself. Over time, if imbalance in the muscles and the resulting abnormal back motion is allowed to continue, more severe back conditions can develop.

A variety of situations can cause tightness, weakness, and abnormal function of the back. For example, repetitive use with certain sports or occupations, poor posture, lack of use, lack of stretching, muscle imbalance, or previous injury can all affect the normal function of the back and the surrounding muscles, resulting in excessive strain to the area.

Over time this strain can develop into what is known as micro-trauma. Simply stated, micro-trauma is very small-scale damage that occurs in the muscles, tendons, joint capsules, and ligaments in response to small levels of strain. Initially micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although small, this damage needs to be repaired. The body responds to micro-trauma in a predictable way: by laying down small amounts of scar tissue to repair the area. Unfortunately, over time this scar tissue builds up and accumulates into adhesions. As these adhesions form, they start to affect the normal health and function of the muscles and related joints. In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow. This places even further strain on the back muscles, which in turn leads to even more micro-trauma. Essentially, a repetitive strain injury cycle is set up, causing continued adhesion formation and progressive spinal-column dysfunction. At this point pain and tightness will often start to become noticeable.

As the repetitive-strain-injury cycle continues, the ability of the back muscles to meet the demands placed on them diminishes. At this point it is not uncommon for the muscles to give way and a more severe and debilitating pain occurs. In fact, many patients come into our office saying they have back pain but they do not recall any specific incident that could have triggered the pain. When further questioned, these patients almost always describe some mild pain or tightness in their back that has been building over time. As you can see from the explanation of the repetitive injury cycle, these types of conditions can build up over time until they eventually develop into large-scale injuries.

When discussing any type of back problem, we also need to review the relationship that the back has with the other joints in the body, particularly the hip. Recall that the spine is designed to be flexible, but that excessive movement will lead to problems. The hip, on the other hand, is designed to provide a tremendous amount of movement. Unfortunately, it is extremely common for the hip to be tight and restricted. When this occurs it often will require the spine to move more than normal in an effort to compensate for the lack of motion at the hip. Excessive spine movement will result in low-back pain, but as you can see, the problem at the hip is the underlying cause.

A common example of how the back is influenced by the hip occurs with walking. During a walking stride the hip must extend backward as the upper body passes over the support leg. If the hip is restricted and does not extend properly, the back will have to extend excessively to compensate. This will in turn lead to “jamming” of the facet joints on the back of the spine and lead to pain. In this instance treatment directed at the back will be needed, but for full resolution, the problem at the hip will also require correction to reach a lasting solution.

Active Release Techniques® (ART®) can help resolve many common back conditions, including:

Facet syndrome
Muscle strains/ pulls
Sciatic nerve entrapment
Disc injuries
Sacroiliac (SI) joint pain
Lower cross syndrome
Flexion syndrome
Nerve entrapment
Quadratus Lumborum Strain
Piriformis syndrome
Mechanical low back pain
And many more…

How Can These Back Injuries Be Fixed?

In an attempt to relieve back pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include muscle relaxants, anti-inflammatory medications, rest, heat, ice, ultrasound (US), muscle stimulation (E-Stim), massage, acupuncture, joint mobilization, stretching and strengthening exercises, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying muscle dysfunction and scar-tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in and around the spine.

Passive approaches such as medication, rest, ice, and ultrasound focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as joint mobilization, stretching, and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercises are often less effective and much slower to produce pain relief or recovery from back pain.

artpurple-transparentART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART® treatment is highly successful in dealing with many types of back conditions because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissues. Locating and treating the soft-tissue adhesions with ART® allows the practitioner to 1) break up restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.

You can think of an ART® treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with his/her hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.

An additional benefit of ART® is that it allows us to further assess and correct problems not only at the site of the pain, but also in other areas of the kinetic chain that are associated with movement compensations, and are often contributing to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART® is how quickly it can produce results. In our experience, the majority of back injuries respond very well to ART® treatment, especially when combined with the appropriate self-directed neck stretching exercises. Although each case is unique and several factors will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in 4-6 treatments. These results are the main reason that many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART® can help with your running injury, simply call our office at (248) 477- 2100.