Dr. Jolie Bookspan & the debate on flexion

Discussions relating to Lower Back Pain.

Dr. Jolie Bookspan & the debate on flexion

Postby Lee » Fri Apr 17, 2009 7:04 am

Hi All,

I just finished Bookspan's "Fix Your Own Pain - Without Drugs or Surgery" and she basically prescribes that for herniated discs (of which I have 2, L4/L5 & L5/S1) all flexion should be avoided. She is particularly negative on stomache crunches. Her method of reducing back pain seems to focus almost entirely on the exercise Dean call's "the Swim", which she believes will unload pressure on the lumbar discs adequately enough to allow for all healing. She also recommends doing planks to strengthen the core, but is adament that crunches and sit ups should be avoided.

It's difficult to make sense of the differing views on flexion. My physiatrist prescribed all sorts of flexion exercises, while Mckenzie seems to believe they should be done on a limited basis, and only after the pain has "centralized". Bookspan seems to believe don't do them at all. What is the answer? The RYB method seems to be the most inter-disciplinary of them all, combining both flexion and extension in equal doses at the same time. Any thoughts would be appreciated.

Best,
Lee
Lee
 
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Postby randolph 2 » Fri Apr 17, 2009 8:56 am

Hi Lee

I'd like to weigh in on the flexion controversy. Mostly anecdotal evidence here, based on lots of practice and limited understanding of exercise physiology.

Herniated L5/S1 9/05 (after doing weighted squat improperly ... essentially turning a helpful exercise into a risky flexion exercise). Used NSAIDs/ Dean's pain book recommendations for pain control the first half year, and RYB plus some other stretches and core strenghtening exercises to rehab successfully.

My take on the major task we undertake, when healing from a herniated lower disc, is we're trying to strengthen the core muscles around the spine so these muscles, and NOT the spine and discs, take most of the stress burden of physical movement. Abs are half the core, so it would seem that SOMETHING of a flexing nature must be done to strenghten them (the rationale of exercise is that we're trying to prepare our body for the inevitable, uncontrollable stresses of life on our body by gradually increasing the controlled loads we place on it with exercising ... right?). My major challenge in choosing which flexion exercises to do was finding something that would strengthen the abs WITHOUT threatening overload on the spine and discs. Situps and the butterfly swim stroke, e.g., don't work for me: too much stress on the back. Lots of crunches, weighted lunges, planks, a variety of forward stretches, work for me: only 1 relapse 4 months after initial injury (again, improperly done flexion exercise - chopping wood). I attribute the success of my present core strenghtening program to diligent mindfulness of maintaining a neutral spine during exercising, and not doing those that threaten even a momentary overload on the spine (like the butterfly stroke).

My best guess is that Dr. Bookspan's carte blanche prohibition of flexion exercises comes from her belief and/or experience that most of her patients just can't gauge for themselves which exercises they shouldn't do to prevent re-injury to the discs. Certainly, you're not going to injure your disc from an improperly done flexion exercise IF you don't do any. But for me, the benefit of strengthening the ab muscle complex is worth the risk and extra work of monitoring carefully which exercises I can and cannot do, making sure I don't flex improperly, and alternating flexion exercises with extending ones. It takes some practice, which Dr. Bookspan probably assumes correctly places some of her patients at unacceptable risk (major goofs, like my wood chopping, are certainly painful and slow recovery time) so it's probably wise for some folks to just avoid the risk altogether. Personally, I think it just comes down to carefully assessing risks vs. benefits ... like we do, hopefully, before doing anything in life.

Randolph
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