Time to rethink and reset?

Are the exercises you are doing helping or hindering? Sometimes it pays to reset your routine.

Earlier this season, I had a patient present to the office with a primary complaint of neck pain. It was a pretty acute problem and had been getting worse. He finally decided he needed to do something about it. Through the history and evaluation process, I found that in addition to his neck trouble, he suffered daily from low back pain, which had been constant for years. He was not as concerned about it because the pain was not as severe as his neck, and he had lived with it for a long, long time.

The neck and upper back trouble was pretty straightforward stuff. I knew we could turn that around fairly easily. His lower back trouble, on the other hand, had piqued my curiosity. He told me he manages the lower back pain by doing some daily core exercises.  “And these exercises make it feel better?” I asked. “No, but they keep it from getting worse,” he replied. Of course, he had no way of knowing they kept it from getting worse because he did them every – single – day.

Once he walked me through his exercise routine, which involved mostly flexion (bending forward) exercises, I could see why his lower back trouble never went away. He asked if there were different exercises he should be doing. I told him there are absolutely better exercise choices, but that we were going to start by simply removing the ones he was already doing. I worked on his neck and asked him to come back the following week.

Within a week, his neck pain was significantly improved. After removing his daily core exercises, his lower back also was feeling much better. In fact, it was better than it had been in a long time. No manipulation, no active release, no corrective exercises.

The patient – intolerant of flexion, aggravated by sitting, having pain worse in the mornings – likely had a mild annular tear. His routine of crunches and inappropriate stretches reproduced the mechanism of injury on a daily basis. It never made the pain crippling, but kept it mildly but constantly irritated.

Having an accurate diagnosis, good hands-on treatment, and an appropriate exercise prescription often yields excellent results. But progress can be stifled by not removing the activities that will cause set-backs.

I am not advocating bed rest or cutting out all exercise, or sidelining athletes for every little problem. Nor am I saying this fellow didn’t need hands-on treatment and additional exercises. He did. But, by simply removing inappropriate exercises we were able to achieve quick and measurable results.

When confronted with pain or decreasing performance the first question often asked is “What exercise should I add?” However, more often than not, we are better served by evaluating what we already are doing, perhaps removing an exercise or two, or by resetting our program completely and starting fresh.