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Low Back Pain- Are You Recovering or Overtraining?

Low Back Pain- Are You Recovering or Overtraining?

February 14, 2022

Transcription: Welcome back to the barbell therapy podcast. I am your host, Dr. Brett Scott, along with me here today is my mentor, Dr. E erson. religioso, also known as modern manual therapy. So today we’re going to talk a lot about recovery. And are you recovering? Are you overtraining? And are you just over complicating the whole topic of recovery on yourself. And some fun facts, we have some upcoming things is, I’ll actually be starting a course with erson, called Modern barbell therapy. So we’ll be rolling out a course online and in person soon, where I will be teaching clinicians how to look at strength training and how we can put that into or integrate that into the physical therapy space or movement practice space, and giving clinicians the tools they can use to assess things like the deadlift, the squat, the benchpress, in even the Olympic lifts, and what we can do to treat athletes a little bit better than we have in the past, as a lot of athletes have come to me where rehab is failed them. So I hope I can bring this to other clinicians that might not have a complete understanding of strength sports and strength athletes and how to best manage them. So look for that in the near future. And Ursin. Thanks for coming on.
Yeah, thanks for having me. Brett’s, it’s always good to be on your podcast. I know, we swap every once in a while. But yeah, I mean, in terms of your course, I think that is really needed to to I mean, I’ve lifted my entire life, I used to be quite a bit bigger than I am now. Because mostly I just run I do lifting enough to to maintain. But yeah, even after seeing a couple of your modules, I just thought I knew how to benchpress safely. And then after seeing, you know, someone who almost set the world record in juniors, and her forum, I just thought, I don’t know anything about benchpress. This course is so needed. Yeah, I think there’s a lot of misconceptions about how to do things and how to regress things, how to progress things, and how to recover. Clinicians, even if they have lifted regularly are not often strength coaches, or perform, you know, they don’t typically work with only that population. And even if you are coach, you may not know how to treat or manage injury. So I think that is a really needed, needed thing. Because one thing I’m sick of hearing, whether it’s for any kind of athlete, really, or anyone who enjoys a particular activity is just not to do that activity. There’s always ways around modifying the activity in doing the things you love, and taking it away completely is usually the answer.
Yeah, into lead right into that with our discussion for today is his recovery. And so from my perspective of what I’ve seen, over the years, is people come in, and it’s like, oh, I can’t, I just stopped doing this completely, because I couldn’t do it. And it was hurting. And I tried everything, and it just didn’t work. And part of that is been diving deeper with these patients and looking at, you know, is it the actual activity that was bothering you? Or is it something environmentally, with your recovery, or what you’re doing or maybe something you’re not doing. And I think these days recovery is looked at, as this activity where you have to go to one of these new recovery spas and you sit in the NormaTec for an hour, and then you get a liquid IV drop. And, you know, you’re making sure you’re sleeping 10 hours and taking all these supplements, when really,
we get about pure oxygen to Yeah, we need to get in the hyperbaric
chamber, and also the ice freezer there for 30 seconds. But really like we Yeah, like you said before, we’ve gotten along just fine up until this point without these things. And so what other things are we doing that we can look at as a patient, or someone that’s in pain that can that we can do to get better?
Right? I think one of the things is when someone says, you know, exercise ended up making me worse. I always say it’s the two hour rule. The two hour rule in general is if you’re doing a certain activity, or in our case, if we’re doing a certain treatment, people say like oh, so much better, so much worse. Many times you do a mobilization as a therapist, you do some kind of treatment or you prescribe a certain exercise, you’re like, oh, man, that made me so much worse or you think running makes you your knees worse, or you think deadlifts make your back worse. Typically, if something’s gonna make you worse, it’s gonna, it’s gonna flare you up while you’re in the middle of doing it. And not two to three hours later, if it’s two to three hours later, or even longer. Like the rule is, if it’s flares you up during or especially within two hours, whatever it is you’re doing, whether it’s a treatment or an exercise or activity. It could be that activity, if it’s like 24 hours later, like patients like oh, yeah, man. You did whatever you did. It made me so much worse. Oh, when did you start? To like two days later, or like the next day, if it’s the next day, and I saw you at like 8:10am, there is a big space between whatever it is we did that day. and everything else you did, there’s so many variables, it’s often something else that at least added on top of, they’re not going to completely absolve myself of making you worse. But there’s so many variables to say I only take credit for your worsening within two hours. And the same thing should be said of your own workouts too, right? But does this make you really make you worse? Or is it the fact that you sat all day before you did deadlifts you, like warmed up by going to the locker room to change your workflows? And then you immediately started deadlifting? You know, and then you start the rest of the day, you went back to your job where you set the rest of the day? Is it is it all the sitting and the lack of variability? That’s making deadlifts hurt your back? Or deadlifts really bad for your back?
Yeah, exactly. And I’ll always go back to these things with patience of exactly I’ll use something similar to that two hour window rule as well. And looking at, well, what else did you do that day or the day before that that could have you know, potentially flared you up, if you will, where, like you said, like, if deadlifts don’t bother you while you’re doing them. But you know, if you’re doing if you’re a manual laborer, or have a manual, labor intensive job, and you’re flexing all day, and then you know, that seems to hurt your back by the end of the day, and then you go sit on like the chase lounge with your legs up, and you’re kind of in the slumped, bent position all day. We can’t just blame deadlifts for that. So a lot of it can just come down to changing your position, or even like things like overhead press tend to bother some people or people think they bother them. And, you know, if we find they have like a spot positive Sperling steps where we put their head back, and that recreates the shoulder pain. But they’re spending most of their day overhead, and then they sleep on their belly, with their head like this in that same position, we can kind of know that those things are going to attribute to a sensitivity there, that instead of going to a hyperbaric chamber and all these things, what, what would you propose we could do arson?
Well, really big on movement variability, right? Like for most of my spinal patients, and some micro mini patients, you know, limbs, say like arms and knees, and whatever, I still recommend, just go on to regular walks a day, make sure that you break up, especially have a sitting job, make sure that you break up sitting as much as possible. I never understood sitting jobs, especially when people have low back pain. They’re like, Oh, man, it hurts so much to sit but literally just sit all day, and you don’t ever change positions. I worked for an insurance company for about five or six years while my clinic was just starting up. And I would always think to myself, I’m going to do one more phone call, I’m going to do one more case. Meanwhile, I actually had raging sciatica, my leg was going numb. And I would just think it was gonna be one more case, I could tell I could tolerate it. But you know, before I knew it for four or five hours have gone by, and it was very hard for me to calm it down then. So I developed a strategy, which I also tell, in addition to the daily walks to kind of break up, break up the activities and prevent things from like forward bending and sitting to promoting up I started drinking like 20 ounces of water almost every hour. Because what I always tell patients is you’re going to go to the bathroom, when you go to the bathroom, then you end up you know, reap and refill the water. And that’s that’s enough to separate that from adding up, because you’re sitting long enough to actually cause your back to hurt or your leg to go numb or your arm to go numb. But you’re not gonna pee your pants. I mean, and if you have, if you end up wearing depends, by trying out the strategy, then the strategy is not going to work for you. There’s probably some other issues. But that ends up being a good strategy because people literally have to be reminded if righted by their pain, they’re going to be reminded by the bladder. So that’s, that’s one of my favorite traders used to tell all spinal patients, it usually doesn’t hurt to be more hydrated anyway, because most people think their urine should be the color of Mountain Dew when it should not.
This is very true. Yeah. Our our 11 year old came out of the bathroom the other day, actually and said my pee was clear. Is that okay?
That’s like, yeah, that’s a really good thing. Actually, that’s the color usually shouldn’t be yes, yeah, she was concerned that it was not very it’s not a yellow color.
But anyways, hydrated. Yes. And, and these things are so simple. I actually had a case similar to this come in the other day of someone I’ve worked with on and off for a while. And he’s had this referred hip pain. He works as a contractor all day and he just goes drives around to different job sites gives quotes, but he really doesn’t get out of his car much from what I’ve gathered. And so he’s sitting in his car eight to 10 hours a day and not really getting out much. And every time he gets up if he every time he goes on vacation, he’s snowmobiling. He’s doing all the things to his back in his hip. Don’t bother him. Every time it gets back to work, it gets worse. And so we discussed a lot of different things. And my, my treatment plan for him was get out of your car and walk more, do more repeated extensions. Try to vary your position in your car as much as you can. And he was just flabbergasted that I didn’t give him any crazy exercises to do or any crazy manual therapy, because he keeps continuing to get better when he just doesn’t sit in a in a position for a prolonged period of time. It doesn’t have to be that complicated.
It doesn’t Yeah, people are really shocked that they are often doing this to themselves. And the solutions can be as simple as move more often. Yeah. Right. The best position is that next position. That’s right. Yeah, it’s not like you have to sit with a lumbar roll, you have to sit with some kind of pneumatic Posture Support. If you just moved around, like I’m sitting on a ball right now. And just like, it does move around a lot more. Sitting won’t add up.
Yeah. And so we talk a lot to a lot of people that have seen me before, know that I am big on repeated motions. A lot of people would you get that, bro, I got it from this guy right here. So people have done plenty of prone press ups with me. Repeated extensions and standing side glides, people know it as the little teacup exercise or little tea pot exercise. So you want to talk a little bit about that and why some of these exercise can be so important for someone with either back or neck pain, or even, you know, lower or upper quarter pain.
Sure. The thing with extension denial is like in neck extension where your you know, head your head is looking head nice look up your forehead should be able to within a certain age range should be able to be forehead parallel to the ceiling, which most people think that’s crazy, without having to backward bend your back like you are doing a limbo contest, and your backward but you should be able to backward bend not quite as much as you forward bend. Unless you’re like a hyper mobile person, like a gymnast or dance or something, you should be able to backward bed quite a bit as well. You know, the thing I like in the spine, to the elbows, if you think of your elbows, the way that we moved our spine, our elbows would have problems if we treated them just like our spine. So the thing with their elbows is that when we are walking around, our arms are typically straight unless we’re running and our elbows are flex. But most of the time when you’re walking around, you move your elbows through a full range of motion. Your spine recent very simple research basically shows that the average person bends forward two to 3000 times a day. And that’s independent of deadlifts and squats and any other program that you might be doing, where your sport where you’re bending forward a lot. And you know, you add up on to the fact that you are sitting in a slump position. In addition to those bending forward to two to 3000 times a day, it becomes exceedingly hard to extend your spine. So back to the elbow thing. And what I always tell patients if you flex your elbows two to 3000 times a day, but then instead of holding them at your side straight, you kept them all the way flex and you held them there the rest of the day. But the time the end of the day, by the time you extended them, how would they feel? Most people say like oh, when feel good, it would feel pretty stiff. But that’s just after one day. You do this day after day after day. And it really adds up. And then we’re like, oh here deadlifts are good for runners. Everyone should do. You know, strength training is great for injury prevention. Yes, it is. But I mean, it’s it’s injuries in pain tend to happen when your activity exceeds your capacity. If you don’t have the capacity to load or extend, and all of a sudden you end up doing like snatches or deadlift or something that requires Mitel extension. It’s not going to feel good if you literally don’t go into extension. But if you just extended more regularly, maybe you wouldn’t have all that low back then.
Yeah, exactly. And the other thing, too, I think is people get fearful of extension sometimes because it can hurt sometimes when they first start to do it. And do you want to you want to discuss a little bit about that too, because we have a lot of patients that will we’ll start there and they get a little apprehensive of like, I don’t know, every time I’ve bet my back in the past, it’s hurt. So what kind of things do we need to think about when we’re trying to restore our extension? Whether it be in our neck or our back?
Sure. Well, I mean, this is also a video podcast. Yeah. Okay. Yeah. So I have these models, right? That are very accurate. And the I just show them you know, your spine is supposed to extend and it’s supposed to flex, just like how your elbow is actually supposed to flex and your elbows supposed to extend and for some reason, people don’t fear hip extension. They don’t care elbow extension. They don’t fear the extension. And people always think like, well, I’m going to crank out my hamstrings and a crank and other things. But they don’t, not to say that you should crank on your spine. But it’s again goes back to my elbow example, if you do this day, after day after day, this is certainly going to feel stiff. And it certainly it may even hurt to do, if you’ve been doing if you’ve been holding your elbow like this for years, and then someone’s like, hey, you know what, start doing this. It’s not like pro press ups and extensions, they’re a great exercise. But if you haven’t done it in a long time, it’s certainly going to feel stiff, and possibly hurt. And that’s where certain treatments like manual therapy and needling soft tissue work, that kind of enables you, it kind of convinces your brain that these motions are okay to do and these positions are okay to do. Because if you do something enough, you’re never STEM is either gonna say, give it a green light and say this is okay to do. And then, but if you don’t, if you don’t keep up with it at a high enough dosage, you just lose the ability to do it again, because your brain is always trying to protect you. If it thinks that a spinal extension is dangerous. And you you know, you maybe you go to a chiropractor or PT, they do some manual on you, you get extension for like an hour or two, you know, keep up with it and high enough dosage, you lose it. That’s where that whole term called grooving comes from, you know, grooving. Yeah, grooving is kind of like, if you’re skiing or snowboarding down a mountain, the first couple times you make the path, it’s hard to make the path. So once you make the path, you have to continue grooving that path to make it set. And it seems like it’s mobility. Mobility is something that also in a way you have to train, if you’re an athlete, and you’ve lifted a lot, you have a certain training regimen. And you’re you’re, you know, you’re disciplined enough to actually lift at a high enough intensity to hypertrophy and build up muscle. But if you don’t train mobility, if you just kind of stretch when you need to assuming mobility is the problem. But you don’t groove it, it’s your groove, the path is just going to snow and the path is going to be gone. Again, mobility is something that needs to be trained, and it needs to be loaded. So not only that stretching needs needs to be done. But one of my favorite things is to gain the mobility and then load it with weights. In the new mobility, mobility, it’s not just like active motion only resisted into the new range, it’s also very important for you to to load up those joints as well. So
well on that aspect too. I don’t even tell people we’re stretching anymore. Because I think stretching has a connotation that it’s something you do when it hurts or anything else where we do mobility training, where this is going to be a regular part of your regimen where we need to do this regularly, you know, hopefully daily, maybe three to four times a week, depending on the intensity and the duration of it. But it is it’s certainly something that’s can be part of your training. Or maybe this is part of training, your recovery, and just getting you out of the positions that you’re in all day. Again, we’re flexing our spine two to 3000 times a day, recovery can be extending the other way. Just a few times an hour even.
Yeah, it can be going for walks, it could be swimming, it could be recovery doesn’t mean sitting around and being a slot. If you’re one of those Taipei who needs to literally do something every day, you might need to actually take a break and literally do nothing like once a week. I mean, it might be good for you, you know, have a beer or wine or something, listen to relaxing music or do some mindfulness. But I mean, if you’re one of those people that absolutely cannot sit still, like I used to be when I was in my 20s. You know, I just like slap VFR cups on and go for a walk to make it seem like I’m still like getting a little bit of workout. And you might get a little bit of increased human growth hormone release with that. So you can still be active on your recovery days. But it shouldn’t be. It shouldn’t resemble a heavy intensity of what you’re doing on your trading days. Because that’s again, it’s easy. It’s an easy thing to remember, the injury or pain happens when your training or activity exceeds your capacity, you have to build up a high enough capacity to do things that your training involves.
And I think another question too, that I think a lot of my patients or prior patients would have is with extension in I get a lot of nerdy coaches and things to that like to nerd out over some of these things. But sometimes it’s almost unexplainable if we find you know, with through your course and thanks to if any other clinicians out there listening to this, but we’ll find limitations in lateral tibial glide knee internal rotation, hip internal rotation, and then sometimes I’ll just put someone in prone on elbows or prone press up for a few minutes. And all of a sudden
it goes away and then it goes away. Oh better. Oh better. Yeah. And
why is that? So? So what is it about getting our spine out of flexion all day and turning it into or giving it some extension? What happens there?
Well, there’s a lot of theories. I mean, these his way to look at it is like the neck rules the upper body roost and the low back rules the lower body roost, Maxine people who’ve been referred To me for testicular pain, an extension made them better at a guy who had turf toe kicked something he couldn’t do planks, or push ups and extensions made him better. And it really seemed like it served him. But no kind of treatment made it better, but spinal extension made it better. The guy who was referred to me for testicular pain, I’m like, I don’t know why your doctor referred me, but I’m gonna try this. And luckily, a stickler thing got better. I didn’t palpate it. By the way, he just knew that. I think the easiest way to explain to clinical or non clinical is that flexion tends to also place a load a neuro dynamic load, meaning like a stretching, stretching type, or extensibility type load on the nervous system. So if you have hip limitations and the limitations, your are your nerves move between your muscles and your bones, I always say just like, assuming you don’t have a super tight fitting shirt, it should move like with with like your arm in a in a loose fitting sleeve. So if any part of the sleeve is tight, then that nerve could be a little restricted. Plus, when you when you flex your head, you flex your hips, you’re essentially playing tug of war with the nervous system, like if I was trying to get, you know, hamstring or hip extensibility. But I’m always flexing, and I’m never extending flexing places load on a nervous system from the spinal cord down to the nerve root. So you’re always going to have less mobility at the distal end, if I pull on my head, like my flexing for it to flex my chart board, I’m pulling the spinal cord upward. But then I’m also trying to like stretch my hamstring or stretch my hip in some kind of like, you know, like frog position or something like that, like tactical frog, or whatever it’s called. If you’re doing that, and your head is oh flex, like maybe try doing with your spine and your head extended, because that way you’re slacking person. But if I if I gave a lot of slack from from the top of the rope, the other end of the rope is going to have more mobility. And that’s that’s one of the theories as to what least why I think extension because it ends up slacking so many things. It also ends up slacking muscles that are typically tight. Right? So slack and muscles that are tight, would be like previously, when a muscle has tight, tight tone. That’d be like trying to get your arm not to move easily. But when you extend things, now the sleeve is loose. So the nurse can slide and glide a lot easier. That’s why I think, you know, spinal cord spinal extension, helps plus also from a low bar, but not too much cervical standpoint. Let’s see if you can see this year. Where is my cuts? So can you see this? Yep. Good. Yeah, it should be a blue nucleus that kind of pops out with with flexion. So the blue nucleus should pop out? Do you see that? Yep. So if you have like a spinal, if you have like an actual disc issue, flick a lot of flexion makes the makes the nucleus pop out. Extension makes it go in. So that’s actually a specific model that I had developed for me, where the guy who the chiropractor who invented these things and actually literally had makes them they’re amazing model. He you know, his was red. And I’m like, Well, can we make a blue nucleus? Because red nucleus always makes it seem like oh flamed. And, you know, from a clinical perspective, it’s no SIBO I’m like, let’s just make it blue. So this is my blue nucleus model.
For anyone just listening to this on a podcast, you’ll have to go back and look at our YouTube video, because that’s the coolest spy model I’ve ever seen. And I might have to get one of those.
I’ll send you the link. Yeah.
And kind
of to wrap this up a little bit. Are there certain individuals or certain reasons people shouldn’t extend their spines like this?
Yeah, for sure. I mean, there are three outcomes of any possible treatment, movement, strategy, exercise, whatever, it’s better, worse or no change. And people shouldn’t extend or close down or load if it makes them worse and worse is it during the treatment is the last the nor the lasting effect, because someone could actually have technically have pain every single time to do the motion, but overall, they feel better and they’re walking, they’re moving around, they have better mobility afterwards. It’s technically Okay, that’s not really what I like to do. I like to actually make the treatments be as pain free as possible, and then have the net result of being better. But typically, again, if you think about someone who is in extension all day, they may actually need to flex. Like my wife is someone who has typically has fear or avoidance of flexion. She doesn’t like to flex too much. She doesn’t like doing deadlifts. She doesn’t have great posterior chain mobility. She loves extension, she does extensions all the time. And, you know, after we’ve had several of our kids, we have six kids. So they’re experienced that that, you know, she’s like, Oh, my back hurts. We need treatment. And usually what she means by that is can I have a massage? And normally I’ll say like, oh, have you been doing your extensions, you know, been doing exercises. So She’s like, I tried my extensions. And this is again shortly after we had we had a child, but they’re not working. I’m like, Oh, well, let’s try flexion. Because if you think about someone who has, has been, you know, huge anterior pelvic tilt stuck an extension for an IT for an entire third trimester, that’s three months of being more an extension and flexion other patients who I know, if you’re a swayback, like meaning that your overall stiff, if when you’re standing up, your shoulders actually are in back of your pelvis, the majority of time you’re upright, you are extended, you actually might need flexion. But McKenzie, who kind of came up with the whole concept of repeated loading, when I got certified 2004, we’re talking about a clinician who loaded someone 50 5060 times a deflection 5060 times an extension or even more, I’ve seen his diplomats extend someone for 45 minutes before they made a conclusion, which is really boring to me. But you know, that’s how their decision process goes, I kind of take lots of shortcuts, McKenzie himself when I got certified 2004, said he had never seen an anterior derangement, which is what I call flexion, rapid responder, meaning he’d never seen someone rapidly respond to flexion. It’s just, it’s not impossible. It’s not a it’s not a unicorn in the Santa Claus. But it’s rare, because the majority people are flexing so much, but they’re getting certain body types, maybe even certain jobs, or even certain injuries. I also saw someone once who fell in her garden, but she fell in like a super hyper extended position. She responded to flexion, too, because her injury was extension, most people have an injury based on flexion. And plus, they’ve already they’ve already been flexing their entire life, then they go to a clinician who all they do is unload and stretch more various variations on flexion. And that’s why it’s not working, because it’s just more of the same thing. But there, but there’s not a one size fits all, it’s not Extension helps everyone, it just it’s based on the law of averages. Since most people are flexing and unloading extension seems to be more novel and a more novel solution.
So the moral of the story is, if we want to recover better, and make our joints and our body feel better and perform at a higher level, we should typically go in the opposite direction of where we usually are.
Usually, yeah, yeah, he’s pretty simple. Yeah, it’s pretty simple. Move, move, well move often, and move in the full range, your full available range as much as possible. Don’t take don’t take your spine for granted. And just extended as well. We extend most of our other joints, with the exception probably of our hips, although most of our other joints kind of go through at least 80% of range or so. But now in response, their spines are kind of like I would just want to stick to this 50% The forward, forget about that backward.
We’ll protect it as much as we can.
Yeah, you ever go backward? Yeah.
And are there anything else you’d like to add?
No, hey, you know what, if you find this stuff useful, I do post a lot of stuff, which is generally helpful just to athletes in the public as well. You can follow me at Mater manual therapy on Instagram, Facebook, and YouTube. Cool. And I’m for our modern barbell therapy course coming soon. For pts and for coaches as well. And any PTs, OTs athletic trainers Cairo Sport, Sport, right? Rehab mind and Kairos. Yep, curious people, I guess.
Yeah, literally pretty much anyone that wants to learn more about dealing with strength athletes, or people that like to lift weights that are in pain, and you don’t feel like you have the best handle on managing them. As a movement provider. I would say this would be a good course for you. And so, yes, if you guys have any questions, I would definitely follow Ursins content. Like he said, you can also shoot me a message as well at barbell therapy on Instagram, or shoot us an email through our website barbell therapy in performance comm I can answer some questions too, as well about what the course will contain us. We’ve recorded most of it now and we’re just finishing up the the final touches on it before we put it out there. So I hope you guys enjoyed this podcast and I hope to see you next time.
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