In the main course you’ll learn our rationale related to diagnosis and the AXB Functional Assessment. Briefly, one component of the Functional Assessment is movement intolerances. I believe this concept of establishing the aggravating movements and avoiding them was first published by New Zealand physio Robin McKenzie.
| Flexion Intolerant | Extension Intolerant |
| Worse when sitting | Worse when standing |
| Worse bending forwards | Worse bending backwards |
| Worse getting up from sitting |
But this only tells you the movements to avoid. It doesn’t tell you what you should do.
In essence, any movement that doesn’t aggravate the pain or underlying problem, is good.
Now, you will notice that very few of the relievers and none of the preventers involve stretching.
Why? Because the information I am giving you is based on evidence. It’s not culled from googling “exercises for low back pain”. The headline is….
There is no scientific evidence that stretching will prevent low back pain. It often feels good, but the benefits are very temporary. It just feels good. But it doesn’t do any lasting good. It can be a very short-term reliever.
Again, this is too large a topic to fit within this session, but the evidence is clear… It feels good, but there’s no lasting benefit, and for some people – approximately 40% of the people I see in the clinic, it is actually aggravating and perpetuating their problem. This is either because they have an instability in one or more of their lumbar joints, or they have a disc problem that they are stretching and aggravating; but because the perimeter of the disc has no direct nerve supply they don’t feel any pain at the time. But stretching the disc while it is healing delays and sometimes prevents healing entirely.
So, if stretching is out for some and not that helpful for others, what does that leave us with?
In a word… Movement.
Movement is absolutely essential to good health, including good healing. Movement (without pain) has many benefits:
- Improves the flow of arteriole blood, which aids healing
- Improves venous and lymphatic drainage, which reduces inflammation
- Blocks nociceptive input at the spinal cord level (see Main Course for details)
- Reassures your central nervous system that everything is OK
- Reduces the risk of neuromuscular weakening/inhibition, related to inactivity
- Boosts mood
The Golden Rule: Use it or Lose it, But Don’t Abuse it.
It is vitally important to strike the balance of maintaining movement, without aggravating the underlying condition. Pain is a good indicator if the client’s pain is less than 6 weeks old. However, the longer they have had pain, the poorer the relationship between pain and damage tends to be. This can make it difficult to judge. But any movement that doesn’t lead to more pain immediately, or the following day, is a good thing.
It is much much more important than the idea of having a “perfect posture”, or finding the one killer exercise. One of the major challenges with a movement class – particularly one such as yoga – is that your client is probably moving in all sorts of directions during a class. They may not feel any pain at the time (for a number of reasons, explored in the main course), but if they experience pain afterwards, we have no way of knowing which of the many movements they did may have contributed to this worsening of their pain.
This is why it is so important to establish directional intolerances, before undertaking any movement classes. AND then adapting the class to remove those movements, or adapting the movements, such that they don’t cause pain.
So, here are some good exercises for the different intolerances.
Flexion Intolerant (pain worse for bending forwards)
Extension Intolerant (pain worse for bending backwards)
The below exercises are always appropriate (unless they hurt!)
Wobble right 
Wobble left
I hope you get the idea? Avoid the direction that hurts, but otherwise movement is good… Use it or Lose it, But Don’t Abuse it.
