To help you recover and reduce the risk of you having recurrent problems, chiropractors at Back-in-Action will recommend specific self-help exercises, ergonomic advice and tips on performing daily activities.

Today’s sedentary lifestyle leaves us all at risk of a variety of tight and weak muscles and poor aerobic capacity which can predispose us injury and pain. As part of your rehabilitation programme we will help you discover what these areas of weakness are and suggest exercises for you to do, so you have less risk of injuring yourself during your daily activities. We’ll also emphasise things you can do to help your posture when you’re sitting, standing and lieing down.

For information on chiropractic rehabilitation please read on. If you want some self help exercises for an acute episode of low back pain please click here.

Physical Rehabilitation Advice

What Is Chiropractic Rehabilitation? Chiropractic Rehabilitation combines various approaches to help your body function in a healthy way and prevent recurrences or future injuries. It works in a similar way that regular brushing helps keep your teeth healthy. If exercise sounds dreary – think of it as body-play. Make it fun and enjoy!

Why Rehabilitation? Most people getting backache can have another 4 episodes within 1 year. Many other problems such as neck pain and headaches can reoccur frequently to. Such pain is usually caused by problems with the joints, muscles, ligaments and nervous system. Chiropractic treatment quickly increases your comfort levels, but it takes time to correct the underlying problems. Once your joints have normal movement and position and overall posture is starting to improve, it is possible to start an exercise programme.

The majority of people with back pain have weakness in certain muscle groups. Things like sedentary lifestyles or postural problems can cause this. Increasing the muscle strength and the nervous system control is vital to help improve things. People who are physically fit generally get less pain and recover faster if they do get problems. Correcting the de-conditioning is the key to prevention.

Benefits Of Chiropractic Rehabilitation

• Assists your recovery and prevents future problems.
• Keeps the body supple and makes it stronger.
• Improves co-ordination and balance to reduce re-injury.
• Improves your body posture and movements during work and leisure so helping prevent future damage.
• Optimises healing of damaged tissues.
• Increases fitness and overall health.
• Reduces pain and psychological stress.
• Makes you feel better.
• Gives you greater confidence.

What Does Chiropractic Rehabilitation Involve?

• Regular exercises for mobilisation and de-conditioning.
• A minimum of 10 stretching sessions per week.
• Stabilisation exercises 3-6 times per day.
• Strengthening  2-3 times per week.
• Aerobic activity 2-3 times per week minimum.
• Balance and co-ordination exercises.

How Are The Exercises Prescribed? Exercise prescription comes from the analysis of posture, muscle length, muscle strength, muscle speed and the balance and co-ordination of muscle activity.

Mobilisation Exercises Your exercise programme starts with mobilisation exercises during the first two weeks of treatment. Each exercise is limited to the pain free range of movement to minimise the risk of re-injury. Your chiropractic treatment helps to free the local stiffness in the joints. Regular mobilisation helps to maintain that movement. Mobilisation assists healing and reduces de-conditioning. Remember normal healthy movement, allows the joints and muscles to act like batteries which help keep the nervous system active and healthy. Mobilisation exercises are repeated 10-15 times, 3-4 times a day.

Stretching Exercises

As the joints and soft tissues start to heal well, gentle stretching exercises are introduced to relax tight muscles. Even though some of your pain may persist, a moderate increase in activity will not harm you and will actually allow further improvement. It takes about 2 months of regular stretching to free tight muscles and up to a year to stretch tight ligaments. These exercises start to challenge the pain barrier. When stretching the challenge should produce a slight pulling sensation. Stretches are performed with a moderate pull and held for 30-60 seconds. Muscles do not respond in the first 10-15 seconds or if pulled too hard. Pain after stretching probably means you’ve pulled too hard. Pain after stretching exercises may require ice therapy or modification of exercises. Activity specific programmes may be given.

Strengthening Exercises

Sedentary lifestyles and localised stiffness in joints causes weakness in muscles. Once the joints are positioned and moving well and tight muscles stretched, it is necessary to strengthen weak muscles to prevent re-occurrence and improve posture. Significant strengthening can be observed by exercising 2-3 times weekly for 2-3 months and maintained after that by weekly training. Again strengthening exercises can lead to achiness caused by fatigue. Type of strength exercises vary depending on particular muscle group and function but involve different ratios of repetitions and sustained contraction. As your body strength improves the exercises are gradually progressed.

Training Phase	Weights    –    Core Stability	Sets	Repetitions
1st 1-2 weeks	Light     –   Easy	2-3	15-20
Weeks 3-5	Heavier     –    Moderate	3	8-12
Weeks 6-8	Heaviest   –    Complex	5	4-6

Strengthening exercises may also be given to improve specific home, work or leisure activities. It is advised that strengthening exercises are done when the body is more supple at the end of the day and that you don’t stretch immediately prior (within 1 hour) to strengthening.

Co-ordination & Balance Exercises

Adaptation after injury requires that muscles are retrained to work together well. In order to protect the joints, muscles need increased co-ordination, increased speed of activation and improved programming. It is about nervous system control. Working on balance helps further improve stability and increase body awareness, which helps prevent re-injury. Exercising for fifteen minutes a day quickly shows good improvements. These exercises are only introduced once dysfunction has normalised, otherwise training is on faulty movements and is training in the pathology.

Aerobic Exercises

Aerobic exercise is crucial for improving overall fitness particularly cardio-vascular and lung function. Aerobic exercise can help boost mood. Moderate to strong aerobic exercise can increase bone density, burn fat and release painkillers. You’ll be encouraged to perform at least 3 half-hour sessions per week. Though aerobic exercise is not strictly necessary to improve spinal pain, it is essential for overall health.

Functional Neurological Exercises

Various parts of the brain and nervous system have a strong influence over muscle tone and control. A chiropractor trained in functional neurology, assesses which part of the nervous system are not functioning ideally and prescribes exercises and other advice to help strengthen the weak areas and relax over-functioning areas. It is based on the principle of use-it-or-lose-it but don’t abuse it.

Will Exercising Cause Any Problems?

Recent studies show that sitting puts more stress on the discs than running. Walking and mild daily activities should not even worsen disc herniations. In fact one study showed that 92% of people with severe problems, selected to have an operation on a lumbar disc problem could return to work through ‘aggressive’ exercise intervention alone such as stretching and strengthening. However we would strongly suggest you receive professional guidance. Exercise programmes have also been shown to be very useful in those continuing to have problems after back surgery.

The recommendation is: even though some pain may continue, increasing activity sensibly will not produce harm. As function returns to the body then pain will reduce.

Can Exercise Help With Arthritis? Exercise is safe for many conditions and mild-moderate exercise can have benefits for forms of arthritis such as Osteoarthritis, Rheumatoid Arthritis and Ankylosing Spondylitis. Again we would recommend professional advice and not to overdo it during a flare up.

Core Stability Programme. Do I Need Extra Equipment? When you progress to the more advanced strengthening and balance exercise programmes, accessory products such as exercise balls, wobble boards and elastic tubing are useful. A mini-trampoline can also be very beneficial. Springs on the trampoline need to be 15-18cm ideally. Less than 7cm are not good enough.

General Guidance About Frequency Of Exercise The more you are able to stick with your exercise programme the fewer treatments you will need, the quicker you will recover and the less likely it is that you will have a re-occurrence of your problem. Also remember rest and recovery after exercise is at least as important as doing the actual exercises.

Exercise Prescription For Minimum Good Health

	Improvement Training	Maintenance Programme
Mobilisation	15-20 times per week	10 times per week
Stretching	15 times per week	10 times per week
Strengthening	2-3 times per week	1 time per week
Co-ordination	15 minutes per day	No known research
Aerobic	30 mins 3 times weekly	30 mins 3 times weekly

The above chart is a general guide. Certain specific conditions may need specialised programmes. For example diabetics benefit from 20 minutes aerobic exercise daily.

I Haven’t Got Time – Implementation Strategies Initially the normal strategy for most people is to fit the exercises in at specific times because they are motivated by pain and the desire to recover. As you get better the pressures of life take over and the exercises may drop off. You start to fall back into the old habits which may have caused the problem in the first place.

Many of the exercises we give you are similar to brushing your teeth. They need to be a natural part of life not an occasional luxury. The best approach is to fit the exercises in with things you do regularly each day. Do the exercises before getting up or when going to bed. Link them to brushing your teeth, making a cup of tea or travelling. Fit them in to the work routine or during breaks. Some sitting exercises are best done at least every 30 minutes. Set an alarm or watch the clock. Make a game of them with the kids. Try introducing more walking during the day – park your car or get off the bus further from your destination. Take stairs as often as possible. Another useful strategy is to join a few exercise classes or a gym. Please ask your chiropractor for exercise variations you can introduce more easily and local classes they recommend..

What’s The Optimal Level Of Activity For Normal Human Health? Compared to most of our ancestors, our lifestyle today is movement deficient. Using studies of surviving modern hunter-gatherer, it is possible to gather insights in to the way of life of our ancestors. The average activity was found to be 1-2 hours of aerobic activity daily and 2-3 episodes of intense physical activity alternating with rest days per week. Our genes evolved expecting this as normal. Exercise can be thought of like diet – our cells need exercise like they need food.  Choosing not to exercise, quite bluntly, is choosing to commit suicide slowly. Our genes today are pretty much identical to our ancestors and we need the same level of exercise.

Optimal Body-Play Programme For Normal Human Health

Is There A Maximum Amount Of Exercise I Should Do? You should build your exercise programme up gradually – increasing it slightly every fortnight. Recent studies have shown that 9 hours a week moderate walking is beneficial for the brain and there was no further improvement beyond this. Some preliminary studies have shown that people exercising extremely intensively for more than 16 hours a week may start to show deficits in brain function.

What Else Could I Do?

To help with motivation it helps for some people to join an exercise class or a gym. We would recommend exercise classes such as Yoga, Tai Chi, Pilates, Core Stability  etc.

Type of Exercise	Training
Mobilisation	2-5 times per day
Spinal Range of Movement	2-5 times per day
Balance	3-5 minutes per day
Co-ordination	3-5 times per day
‘YWTL’Postural Muscle Strengthening	3-5 times per day3-5 times per day
Stretching	2-3 times per day
Core Stability	3-5 times per week
Strengthening	2-3 times per week
Speed & Power	2-3 times per week
Aerobic	1-2 hours daily

Why Aerobic Exercise?

The importance of aerobic exercise for general wellbeing cannot be over emphasised. If you don’t use it you lose it.  “Aerobic” literally means “with oxygen,” and refers to moderate exercise sustained over a period of time. If exercise becomes too intense it becomes “anaerobic” or “without oxygen,” and can only be sustained for short periods.

The benefits of aerobic exercise can include:

• Increased feeling of wellbeing.
• Increased endurance.
• Increased fitness of the heart.
• Stronger muscles controlling breathing and increased capacity of the lungs.
• Improved efficiency of oxygen uptake by the lungs into the body.
• Increased number of red blood cells.
• Increased networks of blood vessels and improved circulation.
• Improved health of cells.
• Better strength and flexibility of muscles.
• Weight loss.
• Can help stabilise blood sugar levels in diabetics.
• Better balance of nervous system.
• Reduces the effects of stress.
• Improved sleep.
• Effective against depression.
• Power reserve.
• Increased energy.

Aerobic exercise limits are governed by heart rate. When exercising aerobically we burn fat as fuel. Studies have shown that people on high fat diets who exercise aerobically are healthier than those on low fat diets and don’t exercise. A combination of healthy diet and healthy exercise creates wellbeing.

A combination of aerobic exercise and calorie reduction is a really effective way to reduce weight. Reducing calories by itself makes it progressively more difficult to lose weight as the body automatically lowers its metabolic rate after a few days of low calories. A diet and exercise combination helps you to re-programme your body to store less fat whilst maintaining a faster metabolic rate.

What Is A good Example Of Aerobic Exercise? At lower heart rates:

• Swimming
• Running
• Rowing
• Hiking
• Dancing
• Bicycling
• Skating
• Cross country skiing

The Significance Of Heart Rate A man who exercises regularly will have a resting heart rate of about 60 beats per minute or less. A de-conditioned man will have a resting heart rate of 80 or more. Even at complete rest a non-exercising man forces his heart to beat nearly 30,000 times more every day of his life. Healthy hearts peak out a 190 beats per minute or less without strain whilst poorly conditioned hearts may go as high as 220 beats or more during exhaustive activity, which is dangerously high.

How Do I Exercise Aerobically Optimally? Ideally an aerobic exercise programme should include a 12-15 minute warm up, a minimum of 20 minutes exercise and a 12 minute cool down. The warm up is essential to mobilise your body to burn fats and oils. If you go straight into exercise to intense for your system you burn sugar. This gives the sugar roller coaster effect going from extremes of high blood sugar to low blood sugar. The heart is designed to work optimally when it burns fat. Overweight people tend to burn more sugar. Thin people tend to burn more oil.

How Do I Pace Myself To Perform Optimally? Maximum Heart Rate = 220 – (your age)

Your maximum heart rate 220 -_____ = ______ Example: if you are 40 years old then your Maximum Heart Rate = 220 – 40 = 180 Never exceed this rate!

Aerobic Heart Rate is the rate you need to exercise at after you have warmed up for 12-15 minutes. Your aerobic capacity is 70% of your maximum capacity.

Aerobic Heart Rate = 180 – (your age) = 180 – _____ = ______ Example: if you are 40 years old then your Aerobic Heart Rate = 180 – 40 = 140. If you are recovering from an illness or are on medication subtract an additional 10 points from your score. If you have not exercised before, are recovering from an injury, or if you often get colds, flu or allergies, subtract a further 5 points. If you have been exercising for more than 2 years and making progress without injury or illness add 5 points.

Your Aerobic Heart Rate Range is +5 and –5 of your Aerobic Heart Rate.

To work out your Warm-up/ Cool Down Range: Your Maximum Warm Up = Maximum Heart Rate x 0.6 = _____ Your Minimum Warm Up = Maximum Heart Rate x 0.5 = _____

How Often Do I Need To Exercise? A minimum of 40 minutes 3 times a week is recommended. Ideally every day for 1-2 hours – you can include in this all the walking up and down stairs you do, gardening and the stroll to the shop. Research has shown that if you exercise consistently over a 12-month period, you will form this positive addiction for a lifetime.

What If I’m Limited For Time? If your programme is limited to 12 to 20 minutes a day of activity, the exercise must be vigorous enough to produce a sustained optimum heart rate. If the exercise is not vigorous enough to produce a sustained heart rate, but is still demanding oxygen, the exercise must be continued longer than 20 minutes. The total period of time depends on the oxygen consumed. Examples:

• Running one mile in less than 8 minutes.
• Swimming 24 laps (600 yds) in less than 15 minutes.
• Cycling 5 miles in less than 20 minutes.
• Stationary cycling for a total of 12½ minutes.
• Squash/ badminton  playing for 35 minutes.

No Pain – No Gain? Pain is usually a signal that you are doing something wrong in most cases. Your goal is to exercise for a longer period of time but in an enjoyable way. If you exercise at 70% of your heart rate, you can exercise ‘forever’, and won’t feel stressed. Afterwards you don’t feel stiff, you don’t even feel tired – it’s an incredible feeling!

Should I Do Warm  Up or Warm Down Exercises?

It is generally recommended you do some gentle mobilisation or range of movement exercises to prepare yourself for aerobic exercise. Recent studies suggest that stretching immediately before other exercises may not be a good idea. They have shown that stretching can weaken a muscle for up to an hour.

A regular stretching programme is a good idea. Theoretically balanced muscle tone should reduce injuries and increase efficiency of movement. Studies have shown that stretching more than 10 times a week will stretch tight muscles within 2 months. This is assuming that the stress that initially caused the muscle to tighten up has been removed. Ligaments take a year to fully stretch.

What is my Optimal Water Intake?

Your body is 60% water. Water is required as to maintain body temperature, transport waste products, lubricate joints and body maintenance. When sedentary we need to drink about 1.2 litres a day. This increases to 3.5 litres for exercising 60-90 minutes.

A more specific guide for drinking is to drink 120 ml for every 20 minutes of exercise. Another way of looking at it is to weigh yourself before and after exercise. Every 1lb you have lost is equivalent to a water loss of 450 ml.

What About Sports Drinks And Other Supplements? Many sports drinks are too concentrated for optimal performance. Drinks with an osmolality over 300 mOsm will dehydrate the body. Ideally sports drinks should be 280 mOsm.  They rarely are. They are made concentrated so they taste good. Coca-cola for instance is 600 mOsm. You could dilute a sports drink down.

An alternatively way for you to replenish your cell salts is to make your own cocktail. For every 1 litre of water:

• 250 mg of Sodium Chloride (NaCl)  (1 teaspoon of normal table salt)
• 60-80 mg of Potassium Salt
• 60-80 mg of Calcium Salt
• 60-80 mg of Magnesium Salt

You could also add some B1 (Thiamine) and B6 (Pyridoxine).

L-Glutamine is a great supplement for athletes. It is the bodies secondary source of energy after glucose, without the challenges that glucose puts on the system. It also helps build up muscle mass and reduces the frequency or upper respiratory tract infections in athletes. 7-20g a day are beneficial. However a starting on a dose this high can cause headaches and loose stools. It is recommended that you start by taking 3 doses of 500mg a day for a week. Then increase the dose in the next week to 3 lots of 1g per day. The next week 3 lots of 2g per day etc. L-Glutamine can be taken with fruit juice or water but to maximise absorption L-glutamine should not be taken with other proteins.

Anti-Oxidants – particularly vitamins A, C, E and Selenium – are useful for tissue repair and reduced inflammation post exercise.

Muscle Cramps Muscle cramps can be a sign of vitamin or mineral deficiency. The most common are magnesium, potassium, vitamin E, B1 (Thiamine) and B6 (pyridoxine). Sodium – potassium imbalances are sometimes responsible and level of hydration should be considered. Caffeine drinks, diuretic drugs etc can deplete the body of magnesium and calcium which can cause tense muscles. Other than a chemical approach, correcting structural imbalances in the body posture and functional imbalances in the nervous system should be considered.

Over Exercise Over exercise is like any other stress and can:

• Reduce the effectiveness of your immune system.
• Increase risk of injury.
• May damage your nerve cells and reduce brain function.

Hunter-Gatherer Exercise Routine

(We found this article on the internet some time ago and liked it – thank you very much to the person who wrote it, we apologise at the moment for not being able to credit you.)

Hunter-gatherers do not lift weights, jog, or go to gyms. They do basically three things – hunt, gather, and walk long distances to find new places to hunt and gather. The routine below is designed to simulate the kinds of activity hunter-gatherers do. The routine is to be performed 3-5 times weekly, preferably outside. If you live close to nature, doing this routine in the woods or mountains is excellent. If you live in a city, stick to the other routines found on this page since exercising outside in the pollution of a city is apt to do your lungs more harm than good.

Nice long walk/hike at medium to top speed, with a weighted backpack if desired. (This simulates trekking to find a new camp from where to hunt and gather).

Sprints – 40 yds X 5, 100 yds X 5 (This simulates sprinting after a large mammal during the hunt – the distance you sprint is not as important as the sprint itself. This isn’t a jog or an easy run – you should be going your fastest, as if trying to run down a deer). For an even greater challenge, try sprinting up hills.

Walk carrying a sandbag or any other relatively heavy awkward object for as long as you can.(This simulates carrying meat back to camp after the hunt, or carrying a large basket of food while gathering).

Rock or sharp stick throwing – Find a small rock or a sharp stick, and practice your aim by throwing it at objects (preferably inanimate ones). To make this more challenging, try to hit the objects while on the run. (This simulates hunting).

Stretching – stretch your lower back, hamstrings, and calves. (No – hunter-gatherers do not stretch out, but since most of us spend our days sitting on chairs with our legs bent, our hamstrings and lower back tend to tighten up over the years).

Complement this routine with playful, fun activities such as swimming, dancing, and sports.