Sunday, March 20, 2011

Back Recovery/Strengthing Routine

This is what I've been doing to help my back, one portion coming entirely from yoga classes back when and the other from physical therapy (PT; some are yoga poses as well). I originally did the PT routine twice a day, slowly building to what I describe below. Any sharp pain or numbness while on my way there meant a pose that was skipped or reduced. I mention some of the earlier motions I did here and there while noting the ones I'm currently doing with ***. NOTE: I'm neither a physical therapist nor a yoga instructor... so I'd go to one of them if you really want a professional approach to this. This is just what *I* do:

PHYSICAL THERAPY ROUTINE - 5-15 MINUTES

1st Part - ON THE BACK, with a pillow under the head.

1. Lie flat on back, with legs flat to floor and slightly parted, arms loose at sides, and head elevated on a pillow. Take 10 very relaxed and deep breaths.

*** 2. Still on the back, lift the knees over a pillow or perhaps up to 60degrees to the floor. This is a subtle one, where I tilt the pelvis to feel it flatten against the floor, holding this for several seconds, then releasing. Do this 10 times. Over time, this will feel like flexing an engaged band of muscle. This is the one pose I wish I knew better how to explain as my physical therapist had to have her fingers under my lower back while doing it at first to teach me the feeling of what was being worked. She lightly pressed that band of muscle to let me know when I was doing it correctly. Another exercise I sometimes do here is the same timing and pattern as above but instead of tilting the pelvis I contract the muscles as if trying to hold back peeing. (Kegel)



*** 3. Still on the back, with the knees still bent but now sliding the feet even closer to the butt, pick up one foot and put its outer ankle on the other leg's knee. Roll the knee that's in the air slowly toward the ground while trying to keep the back level (having arms splayed outward helps this a lot). Count 30, then bring the knee back up and switch to do the other side. A harder/different version of this is to do the same with the ankle on the knee, but now you grab the hamstring of the planted foot leg and try to bring it toward your chest. Another version is to put your hands on top of your knees to push away as you use your stomach/leg strength to try pull the planted foot leg toward your chest in a resitance exercise. If these are brutal, consider doing instead some easier motions, like heel sliding one foot at a time all the way out and then back before doing the other, or marching your feet by lifting one foot up a ways and replanting it before doing the other.



*** 4. From the same initial position as #3, slowly roll the knees together toward the ground on one side, then the other, like windshield wipers. Try to keep the back level. Do 10 of these.


*** 5. Also in the same initial position as #3, this time simultaneously allow both knees to fall toward the ground to their sides and then back together again, like a butterfly. Do 10 of these slowly.

*** 6. With the calves still at 90degrees from the floor, and arms straight alongside the body on the floor, lift up the torso and butt to form a bridge - where the body is in a plank or flat alignment from the knees to the neck. Do this 10 times, going up and down slowly. Curling the spine in the process of doing this is a nice next level to take it to. After those 10 reps, another nice add is to again push up into the bridge position and then marching the legs dramatically in the air for 10 reps. In general, the bridge is a good "reset" which gives the back a break.

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*** 7. On the back, with the knees in an open butterly, lift the feet in the air to grab their outsides with the hands and extend the legs/feet upward and hold for a 30 count. This is sometimes called Happy Baby pose.

8. [NO GRAPHIC YET] Something I sometimes do at this point is an exercise for the stomach muscles. An easy one to do while still on the back is to move the legs in the air, like riding a bicycle. The lower the legs are to the floor, the harder this is. A significantly more difficult exercise to do is to place a pillow between your ankles while lying completely flat on the floor and with your arms stretched upward above the head. Swing the outstretched legs and arms slowly into the air toward each other, exchanging the pillow, then bring them down to the ground again still in a long outstretched position. Then repeat this pillow pass in the other direction to make 1 rep complete. Do this 10 times. It's tougher than it sounds...

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(***) 9. Moving to where there is a wall corner that is exterior, first use one side of the corner and then the other in lying on your back with one buttcheek placed against the wall to allow its leg to splay flat up the wall as the other leg lies flat on the floor and along the other side of the corner. It may take some time before the leg going up the wall can be flat against it - but that's the object of this position, ultimately. For back injuries, this might be the worst one of all to do of all my stretches/exercises. Take it slow and don't push against pain/nerve freakouts. A balled towel can be placed under the lower spine, if necessary. Hold this position for a 30 count, then twist the ankle 90degrees in one direction for another 30 count before switching to have it twisted in the other direction for another 30 count. Finally, roll the foot at the ankle for 10 reps of clockwise and then counterclockwise circles. Move to the other side of this wall corner to do the other leg similarly. If this is too hard, first try to just have both legs be up the wall in parallel and slowly work toward the legs flattening against the wall before moving on to the one leg up-one leg down position.

2nd Part - On Hands and knees.

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*** 1. Start with yoga's Cobra pose: This means first lying on your belly, then planting your palms to the floor with straightened arms and pulling up your torso to look up. The beginner version of this to at first just be on your elbows; the advanced version is to pull/slide just that much more of your chest through your arms. Make sure the back and butt are relaxed. Count 20 or 30. While in belly-to-floor position, another pose you can do is to fully lie on your belly with your calves up and 90degrees to the floor while allowing your calves to splay back and forward like windshield wipers.

*** 2. Pull up to being on your hands and knees, with both your arms and thighs perpendicular to the floor and your torso. Now do yoga's CatCow alternation, arching your back slowly between convex and concave positions. Do 10 of these pairs of arches slowly. The depth of the arching will get better over time.

*** 3. Back to the hands and knees position, this time rotate your hips to first one side and then the other as you lower your hips toward the floor back and forth like an upside down pendulum. Do 10 of these pairs of vertical hip drops slowly.

*** 4. Again back to the hands and knees position, now swivel your hips back and forth on the other plane, mentally/physically trying to bring a hip toward/under the armpit on the same side before swinging the hip to the other side and doing the same. Do 10 of these horizontal hip swivels.

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*** 5. Here I often do a child's pose, like #5 of the Evening Route.

*** 6. Back to hands and knees, at the same time lift one leg and its opposing arm to level and parallel to the floor/torso while looking straight forward, slowly extending then switching to the alternate pairing of leg and arm. Slowly do these with control 10 times for each side (alternating between sides). This can be upped by moving the palms on the floor further from the knees. Balance will come with practice.

3rd Part - Still on the floor, a couple of twists

1. In what I call the half-swastika [NO GRAPHIC YET], sit on the floor and flatten first one leg to the floor in an L-shape before doing the same with the other. The two Ls will be at 90degree angles to each other (thus the look from above and the name) while you plant your palms on the ground, one between the legs and one outside while the torso is upright and you look forward. Hold for a 30 count before switching to the other side.

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2. This one is called the pigeon pose, where, with your belly toward the ground, you swing one leg up so that it lies on the ground and its calf is perpendicular (as much as is possible) to the torso while the other leg is long in alignment with the body - and whose knee and toe both touch the ground. Place your palms onto the ground above the bent leg and look forward and count 30. Up this pose by doing 10 reps or more, where you lower your face to the ground (kissing it, essentially) before returning to the up position. When in the up position, clench the butt cheek of the leg that is long, releasing it when going down for the floor kiss. Another, easier, version of the pigeon is to do it standing in front of a bed. In this one you bend one leg, placing its calf against the bed's edge while leaning into it and stretching that leg's buttcheek.


OTHER THINGS...

1. Sitting is the source of a lot of back problems, so the less sitting you do in the first place the better. If you are sitting for 45-60 unbroken minutes at a time, a great idea is to get up if only for a moment. Maybe this means (while driving) stopping the car and getting out to just break the sitting pattern. Even if this means doing nothing more than merely standing up, or perhaps walking in a small circle, it helps. Lots of activites we sit for can instead be done lying down, particularly reading, surfing the internet, watching TV/movies... so that's a good habit to adopt. While sitting, meanwhile, you want to feel your weight being fully supported by your sit bones, not from leaning back and using your lower back. Better still, sit a bit forward in a chair while letting one knee drop below the other, sometimes changing which knee is a little down from the other. This lowers back pressure as well.

2. Walking is good for the back, engaging all kinds of muscles in the back naturally. Walk more!

3. A good release for the back is to approach the edge of a sturdy desk/table/counter. There, twist the arms backward so that your palms can grasp the table's edge and support your body's weight as you allow your lower body to go limp (with the tops of the feet dragging on the floor somewhere behind you). This can be something of a relaxing reset for the back while relaxing the lower spine and any built-up pressure there.


POSES FROM MY YOGA ROUTINE - I USUALLY ONLY DO 15-20 MINUTES WORTH

My morning routine uses traditional yoga poses to elongate and twist the body while contributing some more strengthing of the core stomach muscles which are so key to back issues in the long run. What follows is what I'm doing right now, but in the future some of these poses might get swapped with others that work the same areas while adding variety and perhaps more complexity/challenge. One of the key things to me has been to try and keep this to something like a 15min session so that mentally I don't come to dread it as an undertaking. The idea is to keep this daily, short and sweet.

1. Lie flat on back, with legs flat to floor and slightly parted, arms loose at sides, and head elevated on a pillow. Take 10 very relaxed and deep breaths.

2. Still on the back, lift the knees over a pillow or perhaps up to 60degrees to the floor. This is a subtle one, where I tilt the pelvis to feel it flatten against the floor, holding this for several seconds, then releasing. Do this 10 times. Over time, this will feel like flexing an engaged band of muscle. This is the one pose I wish I knew better how to explain as my physical therapist had to have her fingers under my lower back while doing it at first to teach me the feeling of what was being worked. She lightly pressed that band of muscle to let me know when I was doing it correctly. Another exercise I sometimes do here is the same timing and pattern as above but instead of tilting the pelvis I contract the muscles as if trying to hold back peeing. (Kegel)

3. Standing, with feel slightly apart and perpendicular to the floor, I droop over to do a classic forward bend. The neck and head hang loosely, as do the arms at first. This pose is held for 60 seconds, slowly elongating while doing it via pulling the hands to the floor upon exhalations. The thigh muscles should rotate outward and there should be even weight distribution between the heel and the forward pads of the feet on each side. The knees are not locked. Ultimately work toward having the knuckles grazing on the floor and then even having the palms touching and splayed on the floor.

4. Downward dog pose, 60 seconds. I find for spacing that I like to get in the pushup or standard plank position, then push the butt up into the air. The leg muscles will rotate outward, as will the shoulders - as if trying to get the shoulder blades to touch each other. The head should hang limply and the heels might not necessarily be on the floor at first.

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5. Here I do a child's pose on the floor as a brief rest, first getting into a kneeling position, then slightly parting the knees before settling the butt on the heels. I palm-walk or slide my hands on the mat away from the rest of the body until fully extended as the head hangs limply or rests on the floor as I again rotate the shoulders outward as if the shoulder blades are going to touch each other. Alternately, an easier version is to have the arms to the sides limp with the hands resting on the ground past the butt.



6. Planks. I first go briefly into forward plank, or the upper pushup position on hands and toes, then roll to one side to let one inner ankle rest on the other for a side plank. The chest and stomach should face forward as I raise one arm up to the ceiling and turn my head to face its flattened palm. The body should be straight, not sagging. This plank is often seen as difficult and can be worked up to, for example first resting on the forearm instead of the hand or just facing forward and perhaps having the upper hand on the hip with the elbow in the air. Hold for 60 seconds (eventually - it's hard!), then roll through the forward plank to do a side plank on the other side for 60. Then I roll back into a forward plank which I hold for 60. This forward plank I sometimes change a bit and make more demanding, by perhaps alternating legs that I move to a side and then back to the center again 10 times each. Same thing with the arms. Sometimes I do the forward plank before the side planks and eliminate a child's pose.

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7. Repeat 5.



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8. Standing again, I spread my legs very wide with both feet forward. For this item, I go through several poses where the feet don't move at all, starting with three upright ones where I'm first facing forward with a vertical torso and having my arms down at my sides and gripping my upper inner hamstring muscles right next to the butt. The shoulders are rolled backward, as in the other poses. Count to 20, then move the arms up and out to a level position and count another 20. Then move the arms to straight upward with palms facing each other [NO GRAPHIC ABOVE YET!] and count another 20. For these first three 20-counts, there can be a tendency for the butt muscles to clench - which you want to consciously release if that happens. Now I bend my torso forward for the last two stances, first planting my palms on the ground (or on blocks at first) in front of me to make an upside down U arch. Lift the head to gaze forward and rotate the hips back. The weight should be even between hands and feet; palms are directly in front of shoulders. Hold this for 20 (eventually 60), then move the palms (if possible) to be as much below the body as possible and let the head hang limply and hold for 20-60. Again, the weight should be even between hands and feet, and now you will try to bring your elbows toward each other so that the arms are parallel. This last pose will likely feel much more strenuous than the others, and it may take some time before the palms make their way to being under the body. Over time, the arms will hopefully come to bend at a 90degree angle, the leg muscles won't quiver, and the head will touch the floor!

9. Standing on first one foot, then later the other, I do the eagle pose. This means curling one leg over the other so that the butt moves downward in the direction of being almost in a seated position. The top of the toes of the leg curling over the other will press under the other leg's calf muscle. The arms similarly will be twisted around each other to make a 90degree angle with palms clasped. NOTE: The arm that is below will be on the same side as the leg that is curling over the other. Gaze forward and into the distance, with forearms straight up and upper arms horizontal, counting 60. Switch sides.

10. Triangle pose, which was easily the hardest of the bunch for me for a good while - and shot a lot of pain down the leg which didn't even let me attempt it for a good while! Again stand with the legs apart - but not maximally so, by any means - and turn one foot to be in complete alignment with the body as the other only turns 45degrees in the same direction. Putting the arm for the 45degree foot up horizontally and the other arm straight up, rotate this 90degree arm formation along with the torso to move down and away from the 45 degree foot. Rotate until the 45degree leg's arm is now the one that is straight up. As for the now-lower hand, at first I only put it on the knee, but then I slowly start working it down over the top of the shin and then down and over the top of the ankle (or more) as I count to 60. Leg muscles are rotated outward as I twist my head to face the palm of the hand reaching toward the ceiling. There will be a good twist in the sides on this one, and it might take a bit to get the balance down. It's important to remember to calmly breathe and, should the butt cheek you are leaning over start to clench, release it.



11. If I'm in the mood, sometimes I fold up my mat and place it near a wall to do a headstand on it. I do this first with my feet straight up in the air, counting 60, then I let the legs drop away from each other to the sides while "pulling" the leg out through the heel, again counting 60.


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