TweetIs Gravity Getting You Down?

Sunday, 07 March 2010 16:08

Dr. Anthony H Close
Level 14, Suite C
120 The Terrace
Wellington CBD, 6011

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Is gravity getting you down? A large majority of the patients I see clinically for lower back pain are losing a war between themselves and the pull of earth. In so much as, many patients are deficient in two or more of the following areas:

1. Pushing
2. Pulling
3. Squatting/Lifting
4. Balance

Considering these movements make up all of our moving life, it's sad to see sedentary lifestyles causing years of disability, pain, and loss of time from loved ones. It's easy for one to become easily discouraged due to immobility, pain, disability, and separation from loved ones. This discouragement leads to a downward spiral away from health and emotional well being. Once the person passes the point of no return, they have in essence, "let themselves go." This is probably one of the most heartbreaking situations for me to encounter both clinically and personally. At this point the person no longer cares about their body, their mind or even their health and well being. It is a time of dissociation of who they think they are and who they really are. Because of this, potential is lost.

Once potential is lost, discouragement sets it. Once discouragement sets in, fear takes hold and once fear takes hold, hope is extinguished. Without hope what do we have to gain? Weight, pain, sickness, illness, suffering, and the list continues on. What is even worse is at this stage negotiation begins, regarding budgets and spending for health. Money is allocated into foods that kill, products that kill, and material things that will never prolong the person's life. In many cases, these products shorten the person's lifespan by adding to their sedentary actions! Why are we making excuses not to peruse proper health? Is it the media, movies, television, or people we know?

How about yourself? How about internal conflict both mentally, physically, and spiritually. You make the choices that affect your own personal world. You choose not to stand, not to be active, and not to eat properly. People very often choose death and not life. Once they free themselves from the fact that no one else is in charge except them, it empowers the person to make appropriate decisions such as living right. Then and only then can they push through the barrier of dissolution and disease.

One of the best ways for a person to begin recovery and a movement towards health is through setting goals and becoming organized. Lack of systems is the number two failure of business. What is number one? Improper communication tops the list as a cause of business failure. Improper communication with your own self causes a lack of organization, lack of systems, and low personal moral. Stop making excuses. Get into the groove. It's going to be hard at first. Nobody said it's easy but it's worth it. Remember that poor muscular resiliency, letting gravity win, poor joint health, and sedentary lifestyles lead to pain, dysfunction, immobility, disability, and eventually some form of hospitalization or medical treatment. The more you tread through a wheat field the more apparent the path becomes. Therefore, keep with it. Take you goals, take your plan and do it. Make short commitments at first and keep track of progress. As it becomes easier, extended it, push yourself and see what you can do with your new found power!

Here is a simple screen we use in the clinic for determining whether gravity is getting a patient down.
The AC Gravity Screen (ACGS):

The ACGS is centered around horizontal and vertical pressing and pulling, as well as, squatting and lifting. Basically everything you should be able to do against gravity/body-weight.

5 Press Ups (Full Body, even for girls)
5 Pull Ups (Wide Grip)
5 Inverted Rows
5 Hand Stand Press Ups (Against wall is fine)
5 Single Leg Box Squats (All the way down)

Sound hard? Then your probably not as fit as you should be. We grade each movement according to form and mechanics (poor, average, or immaculate). If the patient is unable to do five, then it's graded as a failure or impairment. We then begin to correct movement patterns according to the poor or mediocre form, followed by strengthening the impairments found. This works 99.9% of the time. In fact we find almost always, that if the patient is lacking in one area, there is sure to be pain or there has been pain around that joint complex. In other words, if they are unable to perform a horizontal pull they will almost always have issues in the glenohumeral or scapular thoracic areas. It doesn't take complex differentials to figure that out. Insert analogy here: You are only as strong as your weakest link.

Remember that proper progression is the key to all of this. If you jump into it, without proper progressions, expect for disappointment. If you become disappointed and the client becomes disappointed, then hope is lost and if you read the above you will understand the negative effect of losing hope. An example for regaining the single leg strength portion of the ACGS using progressions is as follows:

1. Back Bridging

a. Common Faults:

i. Hamstrings are contracting during extension (palpate the hamstrings)

ii. Rolling the spine (the yoga pitfall)

iii. Medial Knee Drift (see i.)

b. Common Corrections

i. Theraband Around Knees (Gluteal Facilitation)

ii. Make client place thumbs on hip joint (not hip crest) and keep a locked/neutral spine during descent.

iii. Place hands on sides of knees and make the client press into your hands in a lateral direction

c. Once the client has no faults then progress

2. Split Squatting with Rear Leg Elevated

3. Single Leg Squatting

4. Skaters Box Squat

5. Single Leg Box Squat (All the way down)

This is an example; you may have a better idea or method. Remember the words of Dr. McGill, "there is no single fitness god or guru." The main take a way point is build appropriate strength through appropriate progression.
Summary:

1. Loss of strength is a loss of life (physically, mentally, and emotionally)

2. Building strength against gravity impaired movements should precede all other strengthening regimens

3. Areas prone to injury are areas that are being "beat" by gravity

4. Progressions are pinnacle to proper performance and functionality

5. Don't lose hope; a person is never "too far gone." If you are gifted, you will be able to go in after them. However, don't waste time on people that are not "ripe" for change. It takes a few bad apples and experiences to figure out how to find the ripe ones, so don't be discouraged.

6. You are in charge of your choices. Your choices determine your path and your path determines your destination. Some people take the long way, some people take the short way, and many people get lost.

TweetQuestion for you, Prion. Have you ever rehabbed someone after a hip scope for FAI? Scope consisted of labral refixation, femoral oseatoplasty and acetabular rim trim. Had this done 7 months ago and am still experiencing problems along with possible nerve damage issues. Thanks