How to cure pain without getting off the couch!
Remember when you used to go to the doctor and they would say “take an aspirin and call me in the morning.” Now it seems to be “do these exercises and see me in a month.”
Exercise is such a standard part of the treatment and rehabilitation of injury, we hardly give it a second thought yet it is difficult to find any evidence to support its use.
A study from the Netherlands recently published in the Australian Journal of Physiotherapy showed that 8 weeks of intensive exercise in chronic low back pain patients, had some, small, short-term benefits in overall wellbeing but no increase in strength or other outcomes after 8 weeks or 6 months(1).
Even in ankle sprains, where strengthening exercises should show some benefit, no reduction of symptoms or recurrence was found in a large multicentre trial in Holland between those doing supervised exercises and those doing no supervised exercises(2).
Neither of these findings would come as any surprise to Michael Owen or Dean Macey who, despite having careers as professional athletes and having access to the best of medical advice and treatment, have been repeatedly side-lined by injury.
Obviously there is a time for exercise. If you’re a couch potato and your exercise routine consists of opening the fridge door twenty times a day, you will probably feel some benefit from moving more. And if you’re an athlete and have been overtraining, maybe taking it easy for a few days would freshen you up and allow you to start your work again.
But if you’re moderately active, neither exercise nor rest will change the basic tone of your muscles, which is the key to changing posture and resisting injuries.
And that’s because up to 90% of muscle control is subconscious and relies purely on reflexes, leaving only 10% available to be improved by exercise.
Neurologists(3) have identified two types of muscle control.
Feed-forward (or proactive) control is the type we would normally associate with our muscles. It is used to produce the force needed to do a bench press or a squat. Such activities start with a thought and end with a movement, although the mechanisms that control the movement are incredibly complex.
Pro-active control is the system you use when you do exercises for your back or your neck or any other injuries. They are most commonly employed in training and rehabilitation schemes designed to increase muscle strength through controlled repetition of deliberate actions.
However, most injuries don’t occur doing a bench press or a push-up. They happen due to minor, but unexpected changes in direction, usually doing an activity or movement we have done hundreds of times before. Resisting these changes uses the second type of movement control which is feed-back or REACTIVE control. It uses a quite different set of processes than the PROACTIVE system.
If I drop a tennis ball and you reach out to catch it, your ability to work out the angle and velocity of the ball, where your hand needs to be and how to move it there would all be defined as proactive control. The reflex reaction of your biceps, triceps, flexor and extensor muscles from the stretch on their respective muscle spindles as you catch the ball would constitute reactive control.
Reactive control depends mostly reflexes, particularly the stretch reflex.
It is the reactive control stretch reflex that prevents your ankle from spraining if a rock gives way suddenly under your foot. The sudden stretch on muscles on the outside of your ankle will increase the firing from those muscles, directly stimulating the nerves in your spine increase their output, immediately counteracting the movement of the ankle and thereby preventing damage to the ligaments, bones and joints.
It is reactive muscle control that will tighten every shoulder muscle at the end of a throw to keep your arm attached to your trunk and it will stabilise your vertebrae when you bend over to pick up a lawn-mower.
Reactive muscle control prevents injury by constantly adapting muscle tone to the tension applied to the muscle. It thereby limits the amount of load transferred to surrounding tissues and because it uses spinal-level reflexes, it does so at speeds that could not be achieved with cortical processing.
Being a neurological mechanism, reactive muscle control is not related to the physical capacity of the muscle or the training of the individual. Good control can exist in a 50kg 83 year old woman just as easily as in a 25 yr old 80 kg body-builder. Both can also suffer from a faulty reactive mechanism.
Reactive stretch-reflex control is often found disrupted in patients with pain or injury.
Simon King, a Chiropractor with 20 years’ experience in teaching and practice has just published a book called Live Without Pain: A New Theory on What’s Wrong With You, and How to Fix It.
The book describes how thousands of patients have found the answer to their pain and injury problems when all conventional exercises and treatments hadn’t worked by such simple things as removing their earrings, changing a filling in their mouth or eating different foods, things that affect muscle tone in ways they could never imagine. Simon describes how everything we can sense, we sense through our nervous system, whose job it is to regulate our muscle tone and our sense of our body can be disrupted by many things we take for granted.
The book explains how to find out what things are affecting your muscle tone. Once you know the cause, it’s easy to cure the problem, and you can do it permanently; without drugs, exercise or surgery.
- Harts CC; Helmhout PH; de Bie RA; Staal JB A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial.Aust J Physiother. 2008; 54(1):23-31
- van Rijn RM et al. Supervised exercises for adults with acute lateral ankle sprain: a randomised controlled trial. Br J Gen Pract. 2007; 57(543):793-800
- Kandel ER, Schwartz and Jessell. Principles of Nerual Science, 4th edition 2000
