For the entire month of May 2011, Dr. Boatman was laid up in bed due to his lumbar spinal stenosis. He has had several steroid injections throughout the years. Eventually, the injections were not alleviating his pain. As a medical doctor, Dr. Boatman knew he needed to handle his stenosis pain medically and holistically so he employed a physical therapist. The physical therapist immediately put him on a stability strength training exercise routine. This long term therapeutic approach usually ends up – more often than not – not getting rid of the problem but actually frustrating patients and only alleviating stenosis pain for a very short period of time. Dr. Boatman was no exception from this strength training experience. He was definitely aggravated and was actively seeking a different physical regimen that would help keep the pain at bay for a longer period of time and maybe even get rid of it.
The difference between Dynamic Fitness’ services and other health care professionals is that we take a comprehensive, evaluative approach. First, I assessed Dr. Boatman with the Selective Functional Movement Assessment. This assessment is a series of movement tests I use with clients who have pain with movement. The Selective Functional Movement Assessment discovers dysfunctional movement patterns, which point to musculoskeletal problems and injury prediction. If pain or improper movement is detected there is a breakout process (process of elimination) used to determine the dysfunctional system of body area causing the poor movement pattern and pain.
My qualitative analysis of his motion and structures helped point out the many physiological dysfunctions that were adversely affecting his lower back. The screen gave me the corrective strategies and measures necessary to decrease or alleviate Dr. Boatman’s back pain.
Dr. Boatman’s dysfunctional movements were being caused by myofacial tissue knots. Myofascial tissue is simply a substance that covers muscles. These tissue knots led to immobility and reduced stability. Significantly, Dr. Boatman’s muscles affected by the knots were the piriformis (a muscle located in the bottom) and gluteus medius (a muscle located above the hip bone). Those two then contributed to poor thoracic (middle back) rotation and his gluteus maximus’ inability to activate. Think of it this way: do you ever grab your lower back when it’s in pain or you cannot move your legs due to lower back pain? Well, this is more than likely not your back but your gluteus maximus (aka butt) causing the problems. This was Dr. Boatman. In fact his condition was so bad he could not move, stand or even sit in a wheelchair.
Additional factors that contributed to Dr. Boatman’s back pain were improper movement patterns brought on due to years of poor posture and arthritis. To top it all off, he adversely compensated for the pain with poor movement. Think of it when you bend at the waist instead of the knees because your knee hurts. Eventually, your back might start to hurt from bending at the waist.
My primary goals were to design an exercise and therapy program that would correct his current, compensatory movements that were contributing to his back pain.
First, I started with myofascial tissue knot release massage technique called Tiger Tail and manual therapy. After a couple of weeks Dr. Boatman started getting sustained pain relief. Once he established sustained pain relief we started working on important proper body weight movement patterns. It was important to make sure he could perform proper movement patterns without pain. Performing these movement patterns reestablished neuromuscular communication (brain to muscle) important to proper pain free physical motion. Our goal was also to reactivate muscles groups that had been shut down from chronic pain and movement compensation. Our therapeutic program focused aggressively on regaining middle back rotation. This initial therapeutic plan was designed to establish reactivation of the muscle groups that were not working.
By July 2011, we had reestablished proper movement patterns, significantly reduced pain and began an exercise program to work on stability.
Once we reestablished activation of his gluteus maximus and increased motion at his middle back we were able to start using weight resistant exercise with dumbbells and bands. I kept Dr. Boatman off of weight machines. Weight machines are very restrictive to proper motions, balance and stability. They more often than not promote poor body mechanics and negative movement patterns. The exercise plan progressions were designed to reinforce the muscle groups and movement patterns that were not initially working.
Within eight weeks of training, therapy, and exercise, Dr. Boatman was able to use a chainsaw and move logs pain free. He is currently getting stronger and everyday performing exercises and specific stretches from his program to help maintain the better quality of life.
“I have been retired for six years. I have a history of chronic back pain with episodes of acute episodes that requiring epidural anesthetic injections. Six years ago I became a “Gym Rat” hoping it would help my malady. I also thought I was in pretty good shape. A friend of mine convinced me that I should retain the services of his personal trainer Mr. Mark Croy. I discovered quickly that I was not in as good of shape as I thought. Mark has taken me to levels of fitness that I would have never have imagined that I could achieve. I have spent a great portion of my life practicing medicine and Mark’s depth of knowledge of anatomy and movement is better than anyone I know. Through his services I have lost weight, have become much stronger and have a great deal more energy for daily activities! Oh yes — Where Did The Back Pain Go?”