Rehab of dysfunctional hips eliminates low back pain

April 15, 2021
Dr. Tyler Ideus

Jay is a 42-year-old male who came to the clinic with recent onset of low back pain. Low back pain wasn’t something new to him as he had done a lot of squats growing up and had worked in construction ever since graduating college. 

In the past, when he would irritate his back the pain would go away within a week or so. However, in this instance, he said the pain had been persistent for about a month, and it was getting to the point where it was having a negative affect on his ability to work.

Oftentimes I hear people say pain isn’t “normal.” However, with more than 80% of the adult population experiencing low back pain at some point, I argue that having some back pain at some point in life is pretty normal. I always assure people that often it is nothing to worry about as long as we are smart about it. What I do think is abnormal is long-lasting, persistent pain that doesn’t seem to be helped with normal “home remedies.”

It was my opinion that in Jay’s case it was time to start digging a little deeper, and it was smart for him to make an appointment.

One of my mentors would always say that he has never seen a case of low back pain without dysfunctional hips. I couldn’t agree more. My evaluation of Jay — which included squats, lunges and active and passive ranges of motion — led me to the obvious conclusion of hip dysfunction.

Jay’s treatment consisted of:

1. Hip mobility exercises to address tightness
2. Decompression therapy of the lumbar spine to open up the spine and benefit the health of intervertebral disc
3. Body awareness exercises, so he could feel when he was in good positions versus bad positions while doing physical labor

Thankfully, Jay’s case was not a difficult one, and it was easily resolved in a few sessions. 

When evaluated correctly, a majority of low back pain cases can be resolved much like Jay’s — quickly and with minimal care.

Defining true “rehab” — individualization is key

April 12, 2021
Dr. Tyler Ideus

One of our guiding principles here at LPSM is that people have the ability to care for themselves through education and, at times, with short-term, hands-on conservative care.

With this in mind, I’ve felt quite compelled recently to share how I define “rehab,” or “performance rehabilitation.” I’ve noticed these terms becoming more trendy marketing terms rather than technical terms, and I think it needs to be addressed.

So, what is “rehab?” And, as an educated consumer of health care, how do you know you are getting quality, comprehensive rehab that will truly help you reach your goals?

True “rehab” is much more than an exercise anyone can look up on YouTube or read from a sheet and do on their own. 

In true rehab, individualization is key. 

The exercises themselves, the grouping of exercises, the level of the exercises and how they are performed all need to be unique to each person’s issues, tissue characteristics, body type and body awareness. 

To expand a bit specifically when it comes to characteristics of soft tissues, someone may have very strong, robust connective tissue that allows them to get away with more stress on their muscles – perhaps they can compensate in the weight room or throw more pitches. However, if you’re someone with less robust tissue healing characteristics, you have to be far more diligent about not only your rehab, but also your technique, programming and recovery.

All of this absolutely needs to be considered in designing a true rehab program. Guidance about how to increase, or “level-up,” the difficulty of the exercises should also be considered throughout the rehabilitation process.

Your rehabilitation program should also be challenging, rewarding and demonstrate at least some improvement over the course of a few days to weeks.

As Alaetra, an LPSM patient, recently shared regarding her rehab with me: “They weren’t just the stationary [exercises] like every person usually gives you.”

To accomplish all of this, we must start with a very thorough evaluation. 

As an example, when it comes to rehab for low back pain, the following should be considered in the evaluation:

• Joint/skeletal structure
• How the brain decides to coordinate muscle activity
• Daily demands such as work postures or sports techniques

Given the outcomes of each of these, prescribed exercises may address the following, each at different levels, frequency and reps:

• Body awareness (feel what is right versus what wrong is)
• Tissue tolerances
• Workload capacity
• Connective tissue structure
• Balancing asymmetries

Beyond the evaluation and the exercise program, to know if you are receiving quality rehab, you can consider how you are being educated within your experience. If you and your therapist cannot clearly explain if your exercise is therapeutic-based, stability-based or performance-based and what it does from a brain, muscle, connective tissue and joint standpoint, it is NOT specific and would not fit the term “rehab.” Instead, it will be considered generic exercises.

Another indication of quality is the credentials of the provider. Given the current rate of scientific research output, technologies being created and innovative options being pushed forward each year, continuing education is a must.

How I’ve laid all of this out should demonstrate the other guiding principles here at LPSM:

• “Health care” is helping people truly understand their issue at the root cause, how they got there and educating them about how to correct it.
• The systems of the body can never be separated — one system affects all systems.

Learn more about my overall philosophy at http://sportsmedlincoln.com/drtylerideus/.

The Amateur Garden

This ravine, the middle one of the grove's three, is about a hundred feet wide. When I first began to venture the human touch in it, it afforded no open spot level enough to hold a camp-stool. From the lawn above to the river road below, the distance is three hundred and thirty feet, and the fall, of fifty-five feet, is mostly at the upper end, which is therefore too steep, as well as too full of varied undergrowth, for any going but climbing. In the next ravine on its left there was a clear, cold spring and in the one on its right ran a natural rivulet that trickled even in August; but this middle ravine was dry or merely moist.

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Here let me say to any who would try an amateur landscape art on their own acre at the edge of a growing town, that the town's growth tends steadily to diminish the amount of their landscape's natural water supply by catching on street pavements and scores and hundreds of roofs, lawns and walks, and carrying away in sewers, the rain and melting snows which for ages filtered slowly through the soil. Small wonder, I think, that, when in the square quarter-mile between my acre and Elm Street fifty-three dwellings and three short streets took the place of an old farm, my grove, by sheer water famine, lost several of its giant pines. Wonder to me is that the harm seems at length to have ceased.

But about that ravine: one day the nature of its growth and soil, especially its alders, elders, and willows and a show of clay and gravel, forced on my notice the likelihood that here, too, had once been a spring, if no more.

I scratched at its head with a stick and out came an imprisoned rill like a recollected word from the scratched head of a schoolboy. Happily the spot was just at the bottom of the impassably steep fall of ground next the edge of the lawn and was almost in the centre of those four acres—one of sward, three of woods—which I proposed to hold under more or less discipline, leaving the rest—a wooded strip running up the river shore—wholly wild, as college girls, for example, would count wildness. In both parts the wealth of foliage on timber and underbrush almost everywhere shut the river out of view from the lawn and kept the eye restless for a glint, if no more, of water. And so there I thought at once to give myself what I had all my life most absurdly wished for, a fish-pool. I had never been able to look upon an aquarium and keep the tenth Commandment. I had never caught a fish without wanting to take it home and legally adopt it into the family—a tendency which once led my son to say, "Yes, he would be pleased to go fishing with me if I would only fish in a sportsmanlike manner." What a beautifully marked fish is the sun-perch! Once, in boyhood, I kept six of those "pumpkin-seed" in a cistern, and my smile has never been the same since I lost them—one of my war losses.

I resolved to impound the waters of my spring in the ravine and keep fish at last—without salt—to my heart's content. Yet I remembered certain restraining precepts: first, that law of art which condemns incongruity—requires everything to be in keeping with its natural surroundings—and which therefore, for one thing, makes an American garden the best possible sort of garden to have in America; second,[Pg 16] that twin art law, against inutility, which demands that everything in an artistic scheme serve the use it pretends to serve; third, a precept of Colonel Waring's: "Don't fool with running water if you haven't money to fool away"; and, fourth, that best of all gardening rules—look before you leap.

However, on second thought, and tenth, and twentieth, one thought a day for twenty days, I found that if water was to be impounded anywhere on my acre here was the strategic point. Down this ravine, as I have said, was the lawn's one good glimpse of the river, and a kindred gleam intervening would tend, in effect, to draw those farther waters in under the trees and into the picture.

The Power Of One

For no monarchy is so absolute, but it is circumscribed with laws; but when the executive power is in the law-makers, there is no further check upon them; and the people must suffer without a remedy, because they are oppressed by their representatives. If I must serve, the number of my masters, who were born my equals, would but add to the ignominy of my bondage. The nature of our government, above all others, is exactly suited both to the situation of our country, and the temper of the natives; an island being more proper for commerce and for defence, than for extending its dominions on the Continent; for what the valour of its inhabitants might gain, by reason of its remoteness, and the casualties of the seas, it could not so easily preserve: And, therefore, neither the arbitrary power of One, in a monarchy, nor of Many, in a commonwealth, could make us greater than we are.

It is true, that vaster and more frequent taxes might be gathered, when the consent of the people was not asked or needed; but this were only by conquering abroad, to be poor at home; and the examples of our neighbours teach us, that they are not always the happiest subjects, whose kings extend their dominions farthest. Since therefore we cannot win by an offensive war, at least, a land war, the model of our government seems naturally contrived for the defensive part; and the consent of a people is easily obtained to contribute to that power which must protect it. Felices nimium, bona si sua norint, Angligenae! And yet there are not wanting malcontents among us, who, surfeiting themselves on too much happiness, would persuade the people that they might be happier by a change. It was indeed the policy of their old forefather, when himself was fallen from the station of glory, to seduce mankind into the same rebellion with him, by telling him he might yet be freer than he was; that is more free than his nature would allow, or, if I may so say, than God could make him. We have already all the liberty which freeborn subjects can enjoy, and all beyond it is but licence.

But if it be liberty of conscience which they pretend, the moderation of our church is such, that its practice extends not to the severity of persecution; and its discipline is withal so easy, that it allows more freedom to dissenters than any of the sects would allow to it. In the meantime, what right can be pretended by these men to attempt innovation in church or state?

– John Dryden

Who made them the trustees, or to speak a little nearer their own language, the keepers of the liberty of England? If their call be extraordinary, let them convince us by working miracles; for ordinary vocation they can have none, to disturb the government under which they were born, and which protects them. He who has often changed his party, and always has made his interest the rule of it, gives little evidence of his sincerity for the public good; it is manifest he changes but for himself, and takes the people for tools to work his fortune. Yet the experience of all ages might let him know, that they who trouble the waters first, have seldom the benefit of the fishing; as they who began the late rebellion enjoyed not the fruit of their undertaking, but were crushed themselves by the usurpation of their own instrument.

Neither is it enough for them to answer, that they only intend a reformation of the government, but not the subversion of it: on such pretence all insurrections have been founded; it is striking at the root of power, which is obedience. Every remonstrance of private men has the seed of treason in it; and discourses, which are couched in ambiguous terms, are therefore the more dangerous, because they do all the mischief of open sedition, yet are safe from the punishment of the laws. These, my lord, are considerations, which I should not pass so lightly over, had I room to manage them as they deserve; for no man can be so inconsiderable in a nation, as not to have a share in the welfare of it; and if he be a true Englishman, he must at the same time be fired with indignation, and revenge himself as he can on the disturbers of his country. And to whom could I more fitly apply myself than to your lordship, who have not only an inborn, but an hereditary loyalty? The memorable constancy and sufferings of your father, almost to the ruin of his estate, for the royal cause, were an earnest of that which such a parent and such an institution would produce in the person of a son.

But so unhappy an occasion of manifesting your own zeal, in suffering for his present majesty, the providence of God, and the prudence of your administration, will, I hope, prevent; that, as your father's fortune waited on the unhappiness of his sovereign, so your own may participate of the better fate which attends his son. The relation which you have by alliance to the noble family of your lady, serves to confirm to you both this happy augury. For what can deserve a greater place in the English chronicle, than the loyalty and courage, the actions and death, of the general of an army, fighting for his prince and country? The honour and gallantry of the Earl of Lindsey is so illustrious a subject, that it is fit to adorn an heroic poem; for he was the protomartyr of the cause, and the type of his unfortunate royal master.