Often I have cases come into my practice where they stand out as a good example of what appropriate progression can accomplish. Also, frequently I get people asking me: what do you do with people? What is your secret to helping people get pain free and strong? I thought this case might be a good example of both and allow me to share some of the principles that have brought me success with people like Chris D. While this is an extreme example of a case, it might help give you insight as to what proper progression and intention can accomplish.
Chris started working with me ten weeks ago. He came to me through a referral described as a “back problem”, which I quickly found out was a bit of a loose description. I can’t obviously share what his scans MRI revealed but needless to say they were detailed and he had a lot of spinal issues stemming from a long career as a contractor. The biggest problem with our initial assessment was a pretty glaring one:
Chris couldn’t sit down. He couldn’t sleep for more than about an hour without waking. He couldn’t work without constant pain in his neck and shoulders and legs. Even driving his car was an exercise in pain management. Due to the pain in his neck, upper back, shoulders, lower back and legs after just sitting in my office for five minutes he was uncomfortable enough to have to stand up. No matter what I tried to do in order to check movements through his upper and lower body he was in pain, and it would flare up at the slightest bit of movement or force. Even isometrics, which is usually the most minimally irritating to most people was really irritating to Chris. I’ll share later what we have found out during the course of his treatment but needless to say it was a very daunting task.
For only the second time in my training career (and you can read about the first HERE) I was faced with a situation where I wasn’t 100% sure if I could help. Chris expressed that his previous physio experience left him feeling better, but of course things came back once he stopped because he didn’t have strategies to keep helping himself after he was done. This is all too common – physio can help to an extent, but then it takes getting stronger to really complete the rehabilitation process.
Initially Chris decided to give me a two week period to see if what I was doing would help a bit. Here’s a layout of how our first movement session worked (I keep notes on everything I do with every client so this is directly out of my notes):
- Priorities: Mobilize upper neck C5/6/7, upper trap, R side shoulder blade, strengthen L side upper quadrant. Standing mobility in L side hip com/glute com/lower back, strength in R side glute/hip coms and ankle on R side. (this was all based on what I could assess)
Release therapy was done on his upper trap areas on both sides to bring blood flow into the area and expose him to self myofascial release that we could do on his own with a ball. There are varying sizes of these and we used the largest one in order to have the largest surface area and the least access to deep tissue. Chris could not stretch conventionally because any movement would cause his pain to flare.
We started with a manual two legged hip hinging movement with about 20-30 degrees of hip and knee flexion (with a base for support that was 30 inches high as a guide) for control and teaching how to use his pelvis. My initial goal was to work on getting him sitting down (to help with work and being at home), then lying down (to help with sleep). We did some R side isometric engagement (while standing) for his glute and hamstring. We did some standing brace work to teach his inner unit how to engage properly and worked on his walking gait. One major discovery we did right away was that if he flexed his L shoulder 20 degrees forward while walking his pain diminished significantly through his neck and upper back.
After 35 minutes we had to stop because Chris was getting major irritation in his shoulders and neck.
Using proper microprogression and trial and error Chris was able to sit down in his car so that he could drive to his father’s place 1 hour away for Father’s Day in June, about five weeks after we started. His sleep was still an issue and his shoulders and neck would still get irritated quite easily, but through constant self therapy and working on movement patterns we had established on his own, things started to improve. Chris started to experience periods of time without neck/shoulder pain. Through more trial and error we found that if Chris rotated his shoulder blades a certain way he experienced relief. Being mindful of all of these things kept him encouraged and improving.
His lower back and legs started to improve significantly and we introduced compound movements. After the eight week point we discovered that his thoracic spine was likely twisted and began to work on that aspect, which helped quite a bit. Chris discovered that when driving (which he could do at all previously and now could do for extended periods) if he consciously kept his shoulder blades even he could eliminate pain in his neck. By now Chris could squat (with load), split squat, flex his shoulders almost to 90 degrees and even hold his spine against rotational torque.
After ten weeks Chris could deadlift 60 pounds with perfect form. I have a video of it but Chris asked that he remain relatively anonymous.
He has been getting proper nights’ sleep and been able to do more driving for work. He has been able to do work around his home that would have caused serious problems three months ago. Here’s a layout of our most recent workout:
- Alpha Ball warmup – mobility in rotator cuffs (both sides), one legged balance and thoracic spine mobility. Blood flow increase to VL/IT Band fascial line on R side (since doing more with his legs he started to experience some weakness through this area on his R side).
- Dead Lifts starting at 50 lbs and increasing to 60 (he holds the bar in external rotation because his shoulder is able to maintain in that position) for up to 9 repetitions.
- Lying position shoulder flexion with 3 lbs load on both sides maintaining position above 20 degrees from floor (through various positions we found that he is able to use front delt/pec/serratus in this position)
- Single Legged Leg press at 90 lbs of load (does not affect his lower back or hip complex any more)
- Eccentric loaded row in an incline position (I would have to take a picture of this for you to understand but think about lowering through a chest press focusing on the negative portion only)
Chris had made phenomenal progress over his time so far seeing me for only two hours per week. He also does a lot of work on his own, which is what I expect from my clients. He is aware of what he needs to do (and not do) and every time he comes in we have some new insight into a movement pattern that he experienced and we are able to build on that. One thing I constantly express to him is how I love the fact that he wants to understand what is going on and focuses constantly on moving properly. Chris has invested in his recovery, which is vital to any progress you want to make physically. It doesn’t happen slowly, it happens with careful application and time.
So here’s a good example of how a properly progressed strength program can help someone that has been in chronic pain for a long period of time. Many people walk around in situations that can easily be diminished or resolved through a properly progressed program with lots of intention and appropriateness. I’m hoping that Chris will continue to improve. One of our major goals was achieved last week when he actually slept properly, something he couldn’t remember doing for a very long time. These little things can make a huge difference to someone’s quality of life.
If you have any comments or questions about what I have been doing/have done with Chris please simply ask and I will share it (with his permission of course). Also, if you have any people who you think could benefit from the type of treatment Chris has gone through feel free to let me know.
Until next time – keep moving!