Chris Spurling

A good friend recently asked me ‘what are the best exercises for back pain?’ He was a bit disappointed when I told him that my answer to that question is always…. ‘it depends’. It depends on how long you’ve had back pain, the severity of the pain, and how easily the pain is triggered. For example, Patient A bent down yesterday to tie their shoelaces and their back ‘went’, causing pain of 9 out of 10 whenever they move. Patient B has a 10-year history of niggly back pain that reaches 3 out of 10 when they deadlift 100kg.  Clearly these two patients have very different needs and will benefit from different exercises of a different intensity. It depends (to some extent) on what tissues are causing the pain i.e. your diagnosis. However, it is notoriously difficult to pin down specific tissues are causing back pain, even when we use scans and x-rays. More important than the diagnosis is your ‘functional diagnosis’. That relates to the patterns of movement and loading that cause your pain. For example, Patient C and Patient D both experience pain with a rating of 6 out of 10 every time they do their favourite hobby. They’ve both had their pain for 3 weeks and they are both generally fit and well. However, while Patient C gets their pain while squatting and deadlifting at the gym, Patient D experiences pain when sprinting at the track. Even if all signs point towards the same tissues being involved, the pain is triggered by very different movement and loading patterns, and the patients will likely respond very differently if I give them the same set of exercises. It depends on the underlying problems that are creating overload in your spine. Patient E and Patient F both experience low back pain when they sit for more than an hour at their desk. Patient E has stiff hips, rounded shoulders and a severe curve in their mid-back, all of which force them to round out their back when sitting. Patient F has loose hips, and good mid-back and shoulder flexibility, but still rounds out his back at his desk. So, while Patient E is likely to benefit from hip, shoulder and mid back mobility and flexibility exercises, Patient F would be wasting their time. Patient F would be much better served performing movement control exercises and strengthening to help him maintain an improved posture at his desk. It depends on your general health. It depends on what you enjoy doing. It depends on how much time you have to do exercises. It depends what equipment you have access to. And more……. OK, so what TYPE of exercises should someone with back pain work on? Surely core stability exercises would be useful? Indeed, they have been shown to be effective in reducing pain in the short term for people with chronic back pain https://pubmed.ncbi.nlm.nih.gov/19217208/ However, other authors are less impressed, concluding: “There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term” https://pubmed.ncbi.nlm.nih.gov/25488399/ Perhaps movement control exercises are the golden bullet? One randomised controlled trial compared a low-load movement control programme for patients with back pain to high-load lifting exercises. Here the low-load group outperformed the high-load group in some measures. https://pubmed.ncbi.nlm.nih.gov/25641309/ However, a follow-up at one and two years showed no statistical differences between the groups. Perhaps stretches are the most effective exercises for back pain? This study showed that self-stretching exercises were just as effective as motor control exercises for people with chronic back pain. https://www.sciencedirect.com/science/article/pii/S1836955323000176 The reality is that research can be selectively chosen to support nearly any claim. While research should guide us, I prioritise the client in my decision-making process. I consider all the ‘it depends’ factors noted above and try to use a healthy dollop of pragmatism when prescribing exercises. If you want to know what to do first, this is the general approach I follow in the clinic: First, relieve pain. The human body doesn’t tend to function well in the presence of significant pain. Some muscles shut down, while others tighten, causing changes to mobility and altered movement patterns. Exercises can form part of a strategy to help reduce pain. Gentle mobility exercises and self-massage often work well at this stage. Next, restore mobility and soft tissue flexibility. It is difficult to exercise effectively if you don’t have the joint mobility or muscle flexibility to get into healthy and functional positions. These exercises include joint mobilisations and muscle stretches. Once you have the necessary range and flexibility, it is important to control and coordinate your movement patterns. At this stage, exercises are devised to control movement of specific joints or of whole-body movements. For some back pain sufferers, these exercises may be started immediately as part of their ‘pain relief’ strategy. Lastly, once you move well, you can think about adding endurance, strength, speed and power to your rehab. Be wary about following strength and conditioning plans for back pain if you haven’t first considered working on your mobility, flexibility and movement control. I believe that effective exercise prescription is about doing the right thing, at the right time for the right person. So, which exercises are best for you right now? It depends! Chris

Given that we spend abot a third of our lives asleep, it’s crucial to sleep in a position that supports our body’s physical recovery. A good sleep position can relieve stress on your spine, while an unhealthy position can increase pain or stiffness in your back, neck, arms, or shoulders, all while contributing to lower-quality sleep quality. In this post, I’ll explore the four most popular sleeping positions for those struggling with low back pain, along with some additional tips for a more restful night’s sleep. Side Sleeping: Side sleeping can be beneficial for low back pain, especially when the spine is properly aligned. Try lying on your side with your knees slightly bent and a pillow between your knees to keep the hips, pelvis, and spine in alignment. Avoid curling into a tight foetal position if you tend to experience back pain when bending forward or sitting. However, if you have degenerative back pain that is worse when you stand and walk, the tightly curled foetal position may ease your pain. If you have wide hips and a small waist, side-lying tends to be most comfortable if you have a softer mattress or use a thick mattress topper, allowing your hips to sink in and maintain a neutral spinal position. If you have narrower hips, a firmer mattress may help you maintain a neutral spinal position. Back Sleeping with Knee Support: One of the most comfortable positions for low back pain is sleeping on your back with a pillow placed under your knees. This position helps maintain the natural curve of the spine and reduces pressure on the lower back. Experiment with the number of pillows that makes you feel most comfortable. Typically this will be more pillows for someone with degenerative back problems, and less pillows for someone with discal back pain. Ensure the pillow is positioned comfortably under the knees to provide adequate support, without causing strain. Stomach Sleeping (with Caution): While stomach sleeping is generally not recommended due to the risk of straining the neck and upper back, some people find relief of their low back pain in this position. If sleeping on your stomach is most comfortable for your back, try placing a pillow under your pelvis to help maintain the natural curve of the spine. Be mindful of your neck position and consider using a thin pillow or no pillow at all for the head. Reclined Position: For some individuals, sleeping in a reclined position can offer relief by reducing pressure on the lower back. Use an adjustable bed or supportive pillows to prop yourself up slightly while sleeping on your back or side. Experiment with different angles to find the most comfortable position for your back. Additional Considerations for Better Sleep and Back Health:   Pillow Selection: Choose a pillow that complements your sleeping position and provides adequate support for the head, while maintaining a neutral neck and spine position. Back sleepers: Opt for a pillow with medium thickness that cradles the head and neck while maintaining alignment with the rest of the spine. Side sleepers: Choose a thicker pillow to fill the gap between the shoulder and ear, ensuring proper alignment and preventing neck strain. Stomach sleepers: Consider using a thin pillow or no pillow at all to avoid excessive strain on the neck and lower back. Mattress Choice: An old, saggy mattress or one that is either too firm or too soft can exacerbate discomfort. Opting for a mattress that offers the right balance of support and comfort is crucial for achieving restorative sleep. As mentioned above, consider adding a topper to a firm mattress if you have wide or bony hips and you sleep on your side. On the flipside, consider investing in a new mattress, or simply placing wooden boards under your mattress if the combination of bed and mattress lack support. Exercises: Perform simple exercises to loosen your back muscles before bedtime. Applying heat therapy locally, such as using a hot water bottle, can also aid in relaxing and relieving soft tissues around the spine. Relaxation techniques: Incorporate relaxation techniques into your bedtime routine. Mindful meditation or relaxed breathing have been proven to reduce the perception of pain and may contribute to improved sleep. There are lots of free Apps and YouTube videos that offer guided meditations or relaxation advice.

In the Physio7 clinic, I use a 4-step system to treat complex, chronic and persistent pains. The system ultimately enables you to take ownership of your body. The human body has a tremendous capacity to self-heal. If you cut yourself, you can watch it heal. There is a process and it takes time, but it happens, usually without you doing much to help. If it is a deep cut, you might get stitches and put a dressing over it, but those interventions are simply there to provide conditions for your body to heal itself. So, when I see someone suffering from persistent and chronic pains, I ask myself what are the underlying problems that are preventing that person from healing? With that in mind, the 4-step treatment system is built on a thorough assessment. I hope to establish which tissues are causing your pain (I’ll admit, this is easier said than done, as patients with chronic and persistent pains usually present with multiple pain-producing tissues), and more importantly, the underlying reasons why those tissues are damaged or sensitive. I aim to uncover stiff, tight and weak links in your body and the imbalances that have caused excessive loads on the painful tissues. I will look for which areas are moving well and which aren’t moving enough; which muscles are functioning well and which aren’t pulling their weight; and which ingrained movement habits are contributing to the problem.            Assessment is an ongoing process. For complex, persistent pains, it can take a while to fully understand all aspects of your problem. I urge you to have patience and persistence. Quick fixes are possible, but if it has taken years for the underlying problems to develop, are you willing to spend the time to fix them? STEP 1: RELIEVE I love to get to the root cause of your aches and pains. But I also know that your first priority is to get out of pain as soon as you can, so I make that my primary short-term goal. This step can include desensitising painful tissues, relieving inflammation, relaxing muscles in spasm and teaching you simple pain-relieving postures and exercises. I’m also a big believer in finding trigger points (knots in your muscles) that are producing symptoms. Did you know that there is a muscle in the side of your hip that can create pain right down the side of your leg as far as the ankle? This muscle can mimic sciatic pain, and I’ve seen targeted treatment relieve years of pain in a few minutes. STEP 2: RELEASE In the Physio7 clinic, I spend a lot of my time releasing stiff joints and tight, restricted muscles. One reason is that movement keeps the tissues healthy. a. JOINT RESTRICTIONS Let’s take our joints. The joint surfaces are bathed in synovial fluid, our very own WD40, which provides lubrication and nourishment. Moving the joint increases the production of synovial fluid within the joint. As your physio may tell you, ‘Motion is lotion’. However, not all movement is good. When joints move, there is a very specific pattern of roll, spin and glide that occurs at each joint surface. Joint surfaces are enveloped by an elasticated sleeve called the capsule. If the capsule is too tight, it changes the axis of motion. Now the roll, spin and glide occur in places that were never designed to tolerate this load. Parts of the joint become too compressed or opened, and there may be increased shearing of the joint surfaces. Imagine a runner who takes 50,000 steps during a marathon. 1000s of unwanted shearing forces can lead to premature wearing of the affected joint. If the main joint restriction is in the joint capsule, this needs to be mobilised in specific ways by a skilled practitioner. Once roll, spin and glide are restored, joint pressures should normalise. b. MYOFASCIAL RESTRICTIONS The second reason I spend time releasing stiff joints and tight muscles, is that restricted regions can act as stiff links in the chain, leading to pain elsewhere in the body. For example, a tight hip flexor on one side of the body can lead to a malaligned pelvis, leading to a twisted lower back and compensations right down to your feet. It can also lead to excessive extension movement in the lower back, causing irritation of facet joints and secondary spasm in the lower back muscles. Stretching is sometimes effective in releasing a tight muscle, but not always. I am always asking myself why that muscle is tight. Is it in spasm to protect a nerve or a painful joint? Is the muscle weak and trying to protect itself? Is the muscle glued together by scar tissue after old injuries? It is only after careful examination that we can decide upon the best way to release restricted areas. That could involve the use of active release techniques, massage, instrument assisted release, vibration or percussive massage, hold-relax and contract-relax PNF techniques or stretches. STEP 3: CONTROL What about if you are someone who has loads of joint and muscle flexibility. That’s good right?! Not necessarily. In fact, extreme flexibility may leave you more prone to injuries. Loose, floppy joints that don’t have muscular control leave the joint surfaces and surrounding tissues at risk of strains, sprains and other injuries. So while we aim to increase the mobility of stiff joints and tight muscles, it is just as vital that you can control all that movement. Think about the wheels on a car. Those wheels need to be aligned and in balance if we want the tyres to wear evenly, and to give us extra years of use. Granted, our bodies can adapt and repair in ways that car parts never can, but it is known that if our movements are well controlled by well synchronised muscles, we develop less wear and tear and injuries. Movement control exercises can help improve the stabilisation and alignment of joints and reduce our likelihood of

For those of you working from home, we have put together some resources to help you set up your desk, set up a temporary standing desk, and perform some exercises during your breaks:

Easy Strength  How to Get a Lot Stronger Than Your Competition—And Dominate in Your Sport By Pavel Tsatsouline and Dan John Buy here on Amazon REVIEW BY CHRIS SPURLING Easy Strength is essentially a transcript of a strength and conditioning conversation between Pavel Tsatsouline and Dan John.The basic premise of the book is to do only what is essential to improve your strength and conditioning, and to devote most of your time to improving your sport. Put simply, get strong with the minimum of effort, and then apply that strength to your sport or life.Yes, the writing style can be a little chaotic, which makes it difficult to grab the essential information first time around, but the book is based upon solid principles, and contains lots of great training ideas. I’d consider it essential reading if you’re considering adding strength work to your training. Easy Strength in a Nutshell:• Lift heavy. • Keep your reps and sets low. • Stop your sets and your workout before you get fatigued. EASY STRENGTH PRINCIPLES 1. Use a limited number of “big bang” exercises. 2. Lift two to three times a week.(Although some say 5 times per week, others say daily) 3. Keep the volume around 10 reps per lift.e.g. 5 x 2 reps, 3 x 3 repsOther set/rep schemes to consider are 343, 424, 1234, 4321, 1423, and 12321. You may stay with the same weight or vary the weight from set to set.Barry Ross (who coached Allyson Felix to world and Olympic 200m success): “This allows our athletes to leave exhilarated rather than exhausted. It also allows them to exit the weight room and start immediately on event training.” 4. Keep the reps in the 1–5 range, emphasizing doubles and triples (as above).Two or three is a great rep range to emphasize in an Easy Strength program. Singles, doubles, and triples are pure nerve force training. Singles, however, are very demanding on the nervous system. Do a few, but don’t abuse them.Four or five is where neural training and muscle building meet, which means you could end up with some hypertrophy. This is out of the question in sports like endurance running. 5. Rest approximately 5 minutes between sets.Try to relax the muscles completely between sets so you are ‘fresh’ when you begin each new set.”Not only do these breaks allow for nearly complete energy replenishment in the muscle, but they also allow the athlete’s nervous system to recover, which is very important for continuous gains. 6. Train in the 80% to 95% 1 RM intensity zone. Always leave at least 1 or 2 reps in the bank.Barry Ross’s athletes lift 2 or 3 × 2 or 3 with 85% to 95% of their 1 RM with 5 minutes of rest between sets and never to failure. Explains Ross: The benefit is much more rapid strength gain. By keeping sets and reps low, timed and without lifts to failure, lactic acid was minimal or non-existent. 7. Go for a PR, single or rep, when you are feeling exceptionally strong, but stop short of an all-out max. Set a “sort of max.” Always back off after a PR for at least two weeks.Every time Ben Johnson set a personal record, be it in the gym or on the track, his coach made a point of backing off immediately. He literally stopped the workout. Then he had Johnson back cycle for 10 to 14 days. Others say that period should be 3 weeks. 8. Vary the intensity of every workout, either through cycling the powerlifting style or through less structured advances and retreats.If the previous workout has been spectacular, pull back and force an easier workout as a matter of principle. The athlete will usually want to build on a spectacular workout and train even harder…. this can lead to overtraining and injury 9. Don’t stop strength training in season, but reduce the volume to two-thirds to one-half. For example, do 3 × 2 instead of 5 × 2 or 3 × 2 instead of 3 × 3. You may switch from three to two strength workouts a week.Professor Nikolay Ozolin recommends cutting back to two-thirds of the volume without reducing the weight. 10. Finish your workout feeling stronger than when you started. Stop the workout if your performance is less than perfect, and come back another day.You might prescribe five repeats of a sprint drill but stop the athlete if he hits a PR on the third.After each repetition, erase any flaw detected so the next repetition will be even smoother. OTHER TAKE HOME MESSAGES Stability must come before strength. Follow these seven rules for safe sporting participation: The athlete must have enough strength to perform the techniques of his chosen sport. The athlete must have enough joint mobility to perform the techniques of his chosen sport and the special exercises. One must start by addressing the weakest link that demonstrates itself first during the performance of the competitive exercise. The athlete must not have muscular rigidity and excessive tension. The coach may not evaluate the ratio of the components in an athlete in the conditions of significant fatigue. This compromises the coordination, changes the ratio of the components, and makes it impossible to accurately identify the leading and lagging components. The coach must remember that different components develop and detrain at different rates. The result in competition gives the final grade of the ratio of the components. Consider when to perform your strength session- an Easy Strength lifting session can be performed before running, but running before lifting will have a negative effect. The reason for that is the amount of footfalls. Runners apply force at ground contact at two or three times bodyweight.… at every ground contact! Trying to lift sufficiently heavy weights to improve performance after a running session becomes very difficult. For most sports people, an austere recipe consisting of 80% sport skill practice, 10% strength training, and 10% of everything else works well, recognising that the athlete’s time, energy,

Stiff Ankles? Achilles Problems? Check This Video Out   Physio Chris Spurling shows you some simple home treatment techniques for those hard to treat Achilles tendon problems.