Another self-help technique for back pain – the McKenzie method

I had lots of people getting in contact after my blog earlier this week on back pain, so wanted to quickly share this additional technique that has brought relief and recovery to many. I hope that some of you find that it helps.

For a lot of people (especially runners and cyclists it seems) back pain comes and goes episodically. For most the issue is a disc bulge (most people over 25 or 30 years-old seem to have them to some level), and the disc bulge moves slightly, compressing one of the 4 key nerves at that lumbar vertebrae level and sends white-hot pain, pins & needles and/or numbness down the leg, sometimes with symptoms in the bum cheek or hip as well.

Each nerve has a role for areas of the body and internal organs. If you are interested in understanding the link between the level of the spine (which vertebra) and the body, have a look at the spinal nerve chart: https://millerchiropracticclinic.com/spinal-nerve-chart/

A lot of people have found great relief through the McKenzie method

First of all, take this simple self assessment – answering yes or no to each of the questions:

  1. Are there periods in the day when you have no pain? Even 10 minutes?
  2. Is the pain confined to areas above the knee or above your elbow?
  3. Have you had more than one episode of low back pain or neck pain over the past few months or years?
  4. Do you feel worse during or immediately after prolonged bending or stooping; as in making beds, vacuuming, gardening, concreting, etc?
  5. Do you feel worse when sitting for prolonged periods or on rising from the sitting position, ie after watching TV or working on the computer?
  6. Do you associate your pain with any one particular activity but are generally pain-free when not engaged in this activity?
  7. Do you feel worse when inactive and better when on the move?
  8. Does your low back feel better when lying face down? (You may feel worse for a minute before the pain subsides, in that case, the answer to this question is yes).
  9. Does your low back pain feel better when you are walking?

The McKenzie Institute claims that if you have answered yes to more than 4 questions, your chances of gaining benefit from the McKenzie method is very good.

They say that if you answered yes to 3 or fewer, then you may require specialised assessment and treatment.

The McKenzie method is built on gentle spinal extension exercises

The theory behind the method is that most discs bulge out backwards, and therefore gentle extension exercises encourage the disc to change shape with more of the disc-matter at the front and take the pressure off the nerve that it is compressing.

Robin McKenzie’s book ‘Treat your own back’ is inexpensive and practical – giving a do-it-yourself plan for relief of lower back pain through postural changes, ergonomics, and simple exercises. It also provides a clear understanding of the causes and treatments of persistent back pain.

One last key tip

I think that anyone who goes to a physiotherapist with back issues is given spinal extension exercises. But I am not sure that everyone talks about technique, and it is really important. If you simply move into the spinal extension, then all of the muscles in the lower back shorten as you peel up. But if you engage your abdominals (especially the deep Transversus Abdominus) and then do the back extension, then the same muscles go into extension due to the reciprocal inhibition of the muscle pairing with the abdominals. This is what you want.

Love your feet!

I guess that I should have known how important feet are, but I will admit that I took mine for granted. And so when I lost all feeling in my right foot after my accident, I was still way too nonchalant. After all, the Paralympians run like the wind with blades – I was sure that I would learn.

The foot is so complex

Each foot has 26 bones, 33 joints (20 of which are actively articulated) and more than a hundred muscles, tendons and ligaments. Wow! And feet can move in so many directions and with amazing levels of control. And these link all the way up the leg into the lower back.

This is all so important to us, as tiny differences in the pressure and our movement at the foot level are all multiplied up through the body as the distance from the feet increases – with compensating and balancing to ensure that we stay upright and are able to do what we want to do. Think of how crucial footwork is in any fast-moving sport like tennis, squash, football, rugby, hockey etc.

So what should we be doing?

Given the importance of our feet, we really need to invest the same level of body care as we would in the other major muscle and movement centres. I went to a seminar with a physiotherapist who was proposing that runners should really do a 15 minute footcare workout every day in order to protect themselves from injury!

The toes are very important – especially the big toes

I remember a friend having an accident when we were in our 20’s and after it being crushed on a building site, he had to have the first section of his big toe amputated. This meant that balance and running were always really difficult for him, and he almost always wore walking boots with ankle support to stabilise his foot.

But it does not need to be as severe as that for us to lose mobility – in our feet and all of the way up through our body. Here’s a quick test – can you do the ‘vulcan salute’ from Star Trek (splitting your fingers between the 2nd and 3rd fingers) with each hand? Can you similarly control each of your toes?

Toes are very trainable – you only need to type ‘painting with feet’ into YouTube to be inspired at dexterity that people can develop in their toes.

A couple of foot work exercises for the toes

When sat down, can you use your toes to pull a towel along the ground? (without lifting the sole off the ground).

When you are lying in bed – when your feet are pointing upwards can you move your big toe up and down without the rest of the toes moving? And then the other toes, without the big toe moving? And now when you move your foot to point your toes, can you do the same toe flex and curl?

Difficult? You can help your toe mobility by continuously challenging your toes. Do also massage under the foot – through the arch just below the pads in the forefoot, feeling each of the bone/muscle and ligament complexes that control each toe (go gently, as it is always tender in there!).  Then extend the massaging and movement to each of the toes – pushing against your hand in different directions and with your foot in different positions.

Also, do roll the arch on a tennis ball. Be amazed by the simple test of touching your toes and remembering how far your hands reach. After 30 secs of rolling the arch on a tennis ball, focusing on those gritty, grainy parts with smaller circles. Then touch your toes again and check your reach. Amazing! (Some people sneakily have a tennis ball under their desk to do this arch-rolling in the office during the day!)

The amazing ankle

For all that the ankle is a hinge joint, you can do so much more than just the dorsiflexion/ plantarflexion movement of pointing the toes. You can actually roll the ankle from side to side in the inversion/eversion movement where from the feet being parallel, you can then bring the soles of your feet together and then roll the soles outwards.

This movement is incredibly important and useful for stabilising in walking and all sports.

So exercising it is good. Sit on a chair and with our hands on our knees to stop them moving, roll the ankle from side to side, so that the weight is over the big toe and then over the small toe. This may seem difficult to at the start, but is very trainable.

The feet are controlled from the lower leg

A lot of what happens in the feet is influenced by the leg (and indeed all of the way up the body).

Releasing the muscles in the lower leg associated with the foot movement is also very useful. It needs a lacrosse ball and careful placement and flexing, but this is worth doing daily if possible.

More inspiration

If you are battling with this, I have found the following website and podcast interesting and useful. Best of luck with getting your feet supporting your movement in the best possible way – reducing pain and increasing performance. Best of luck!

https://corewalking.com/

Why you need to get out of pain, right now!

It sounds obvious doesn’t it? Getting out of pain has to be one of the key goals, if not the over-arching goal! But if you are badly injured, pain can become your constant companion – whether you are lying inactive, or trying to move around.  And when this situation lasts months or even starts to be measured in the years, getting out of pain seems to be impossibility. You get so used to the fact that even breathing hurts and you can start to lose sight of the goal of getting out of pain. But it is really important, and needs to remain front and centre.

You may have thought that pain is just an electrical signal

Back in biology class at school, you may have been taught that pain passes as an electrical signal up through the nervous system, in order to get the body to move away from the source of pain. More recent work has proved that even the electrical components of this are more complex (Pain Gate theory), as well as the fact that there is a chemical cascade that is set into motion by the nociceptors (the scientific word for the sensory receptors for painful stimuli in the nervous system). The nociceptors release Substance P and this triggers a release of histamine. Both of these chemicals are neurotransmitters, and the histamines are also involved in the inflammatory response.

The bad news is that these two chemicals have additional impacts – they increase the sensitivity of the nociceptors to pain, and the excess histamine has been linked to increased anxiety in the brain and inhibiting the release of serotonin and dopamine (classic feel-good chemicals in your system).

So if you get into long-term pain, the chemical soup is working against you  

Once you are into the chronic pain (pain that has lasted more than 3 months), you are likely to become more sensitive to pain for these chemical reasons. You can start to hurt in new places. And of course the impact on your mental coping strategies for the pain, and the loss of sleep can lead to irritability and depression.

This is why sometimes the medical team talk about taking blood tests to understand the levels of your inflammatory markers, in order to understand your situation better. On the basis of the imbalances (deficiencies or excesses) of neurotransmitters such as serotonin, GABA, dopamine and norepinephrine, the clinician can develop the right treatment plan for you.

How chronic pain can link to depression

Depression and chronic pain share some of the same pathways in the central nervous system of the brain and spinal cord, and the same chemical transmitters are involved.

In addition to some of the chemical reasons why chronic pain can make you feel very low, there is another negative cycle – pain creates anxiety, irritation and agitation in everyone. This tension and stress on your system , which can cause sleeping issues, physical incapability, loss of appetite and a sense of not being able to cope with all of the other issues.

Articles suggest that perhaps half of people who complain of pain to their Doctors are depressed. And depression makes pain feel worse. This in turn is even more depressing.

If you are worried that you have a lot of the symptoms of depression, do talk to your GP about it. Hopefully this blog has set up that a combination of the chemical and physical realities are the reason that people end up in this place. And hence a combination of medication and Cognitive Behavioural Therapy (also known as Talk Therapy) can help .

This is why you need to break the cycle

I found this excellent Pain Management guide from NHS Ayrshire and Arran – with full recognition of the excellent work from the NHS team there. I think that you may find working through it is a breakthrough for you.

https://www.nhsaaa.net/media/5071/pain-management-workbook.pdf

Within it, I would strongly recommend that as an injured athlete you turn to the section on ‘Managing Activity’, which starts on page 22. Mapping your activity and pain cycles may seem a little difficult, but if you keep some notes over a few days and then draw them out as a graph over time the patterns become very clear. Are you yo-yo-ing through an Over-Under cycle? Or pushing too hard with an Over cycle? (You can read more about these on pages 22 and 23).

You have got to get your activity down to a sustainable level

Whilst you may find these low levels utterly ludicrous and frustrating, you must give your body the chance by getting your activity down.

This means looking at your day and:

  • Planning – not going on feel and overdoing or underdoing it
  • Prioritising – you will not be able to do all of the things that you want or need to do, so prioritising will help you choose
  • Pacing – breaking things into more manageable chunks with more rest

This should help to avoid flare-ups, but they can still happen. So you also need to have in mind your plan of how to avoid them, and then how to minimise the impact and calm the system down again. For instance, if you go out – can you take a car or have the numbers of friends who might be able to pick you up if you need to get home quickly to manage a flare-up in pain levels.

You will have your own pattern of what causes flare-ups and how you can manage them. But having a plan can reduce the number and impact of flare-ups. (There are also some good worksheets in the booklet on pages 29 and 30 for this).

In summary

So in summary, don’t keep pushing through as the challenge of getting out of pain will only increase. There are things that you can do and it is both the right goal, and an achievable goal to get out of pain – even if you have to involve your GP and other clinical support.

Best of luck in your journey to pain-free!

When should pain stop my running?

Most of us have seen track athletes lying writhing in agony with the lactate in their legs, or even track cyclists suddenly vomiting from the amount of lactate that they have built up. And endurance runners always talk about it being painful and ‘pushing through the pain barrier’, so how does anyone know when they should actually stop, recover and rehabilitate? The goal of this is to help to create good training habits in terms of injury management and resilience for runners, triathletes and those who do a lot of running mileage as a part of their training (but it does not cover the impact of high lactate levels from very high intensity work using the anaerobic system).

The key is learning to understand the signals from your body

Development in training is built on the principle of progressive overload of the muscles, and so there is likely to be a level of soreness when you are training hard. This can be during and immediately after the run, or 12-72 hours later in the form of Delayed Onset Muscle Soreness (DOMS).

The reason that you get this muscle soreness is that exercise creates micro-tears in the muscle and with rest these recover and grow back even stronger, ready to do the challenge again. This cycle is called adaptation. You can help this process by doing a few good things:

  1. Getting some nutrition into the muscles within 30 minutes of finishing your workout. The muscles need protein to build the muscle and carbohydrates to replace the glycogen stores that you have used up. Testing of 4:1 ratio of carbohydates to protein have found these to be good at building lean muscle mass and restocking the glycogen – so things like chocolate milk can be very good (especially as liquids get into your system a little faster than solids)
  2. Giving your body enough time to recover with quality sleep and rest.
  3. Compression clothing on the legs has also been shown to have benefits immediately after exercise (as long as the foot is also covered), which is thought to be from reducing blood pooling in the leg muscles, and pushing all of the waste products out of the muscles and into the bloodstream.

DOMS is an additional level of soreness and lasts much longer. It is often characterised by agony going down stairs – check out the DOMS Stair Test within the Fellrnr wiki: https://fellrnr.com/wiki/Delayed_Onset_Muscle_Soreness.  Many people find that gentle movement is best – walking or very slow recovery runs on smooth, flat surfaces will help to flush out the toxins and let you recover. If you are routinely experiencing DOMS, then you are probably progressing the length and intensity of your runs too quickly, so scale back and replan your training.

But what about those pains that are not just soreness?

There is a different territory of pain: sharp, spikey pains with clear pain centres, or any pains that you would describe as burning, prickling, cramping or spasms. These words tend to match pains that go beyond the muscles, into the harder-to-repair areas of tendons, ligaments, joints and nerves.

I am in the process of writing other blogs on nerve pain, and reviewing some of the excellent material on the impact and treatment of nerve pain for runners and other athletes. But in the meantime the headline is that there are dimensions of pain that if you find yourself describing them with these words, the indications are that it is a lot more than muscle soreness.

This is where a good training logbook is worth its weight in gold

Hence these are all pains to take very seriously and get straight onto monitoring. If you keep a training logbook or diary, you should note down any level of aches and pains, so that you can look back and see when did you first have even a minor twinge in this area, how fast has it progressed, and is there is a pattern of low-level pains. For instance, is there a pain that you get only when running on certain surfaces? Or at certain intensities? Or distances?

In turns out that there is no measurable unit of pain

Whilst most things in life have a measurable scale, pain is sufficiently complex and individual that it has to be scored individually and subjectively. There are lots of different scales https://paindoctor.com/pain-scales/ but the most common one (and used by most UK healthcare professionals) is scored by the individual on a 0 to 10 scale, where zero is no pain and 10 is the worst pain that they have ever experienced.

It is really hard to think about this when you are in pain, so here are some words that might help:

Pain Level Description
0 No pain
2 Pain, but it can be ignored
4 Pain interferes with tasks
6 Pain interferes with concentration
8 Pain interferes with basic needs
10 Pain requires bed rest

But what does this mean for running?

I know how hard people find it to decide when to stop running, so here is my personal suggested scoring for pain:


My table of pain scale and what it means in running, with a suggested recovery action for you to take

I would suggest that whilst racing may take you to all of the way up to a level 5 (where in training you should stop immediately), you need to listen to your body and know whether this is a race that you should choose to DNF or ease back to simply make the line, vs hanging in there at all costs.

And I really hope that in training, at a 3 you would be walking and deciding whether to get your phone out and get a lift home to let your body recover for another day.

I always believe that the mark of a great training plan is the consistent build-up of sessions that progress you, but leave you ready to do the next session with quality, to get yet another progression.

Best of luck out there on the roads and trails! Make good decisions and look after your body!