The Cutting Edge: Lumbar Spine Rehab

The age of electricity began in 1882 and fueled the second Industrial Revolution.  The ability to produce more goods faster, shaped the outcomes of major world events such as World War I & II.  Consider that only England, Germany, France and the U.S. has completed the industrial revolution at this time. Our ability to produce mass quantities of weapons, uniforms, supplies, and food was significant in this era.  History buffs know there are many examples of how German technology was superior to US/British technology at this time, however we all know the outcome. In short, during this period quantity trumped quality.

As this has carried forward we see widespread  examples of how this concept of quantity over quality has gone wrong.  Quantity over quality  has corrupted society.  We are saturated in low quality abundance.

• Calories over nutritional content.
• White bread everywhere vs. whole grains.
• American cheese food vs. actual cheese.
• Processed, packaged foods full of preservatives.
• ALL LEAD TO: Obesity & disease

• Exercise fads, the quick easy, this is for everyone approach.
• 3 sets of 10 mentality.
• Lift more weight.
• Add balance challenges to anything.
• No pain, no gain mantra.
• LEADS TO:  hypertrophy, compensatory pattern, accumulation of stress/strain, failure to meet goals, frustration, injury,…… inactivity.  (Stronger, but no healthier.)

We now know that quality of exercise is more important than quantity.  The same holds true in nutrition, quality foods (whole foods, organic foods) are more valuable than quantity.
Systems have been developed to access quality of movement.  Functional assessment or evaluation of movement quality have been around for some time and were championed by Vladamir Janda.

• Janda & Prague School teachings including Dynamic Neuromuscular Stability.
• FMS /SFMA
• Liebenson’s Mag 7

These methods are not always used as we rely on traditional orthopedic testing (which has it’s place in examination, but also has it’s limitations) and diagnostic imaging.  Imaging such as x-ray, MRI, CT also has it’s utility, but is frequently over utilized and often muddles the clinical picture as it does not show function or pain.  Evaluation of structural change has poor correlation to pain and function, it can be misleading.  To combine the concepts, below are some examples of imaging (flouroscopy) during poor quality and then high quality movement patterns.  After watching them which is more important, the # of repetitions you do, or the quality of the repetitions?  Would you prefer 3 sets of 10 with bad form? Or one set of 4 with good form?

Abduction of the shoulder, first with a shrugged, decentrated, elevated scapula; then repeated with proper packing/stabilization.

original posting @ http://irontamerblog.com/packing-the-shoulder/

Which shoulder exercise would you like to see in your patients?  In your own exercise?

The days of quantity have passed.  The emphasis needs to return to QUALITY.   Once we achieve quality, quantities of quality exercise can be used to increase capacity.