Pain Science is evolving.  The belief in the importance of core strength for reducing back pain is mainstream, and it will probably take 15 years or more for these new and more correct ideas to become mainstream.

“The popularity of core stability training is based on the following assumptions (taken directly from Lederman ¹):

• That certain muscles are more important for stabilisation of the spine, in particular transverses abdominis (TrA).
• That weak abdominal muscles lead to back pain.
• That strengthening abdominal or trunk muscles can reduce back pain.
• That there is a unique group of “core” muscles working independently of other 
trunk muscles.
• That a strong core will prevent injury.
• That there is a relationship between stability and back pain.

Admittedly, these assumptions pass the “it sounds right” test for someone who isn’t up to date with the pain literature. But “it sounds right” is far from a scientific basis and as a proponent of evidence based practice, I prefer to make clinical decisions based on the best available evidence. In the case of low back pain and core stability, we have a good deal of scientific evidence that we can consult for answers. The literature suggests the following (taken directly from Lederman ¹):

• Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation.
• The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote CS.
• Weak or dysfunctional abdominal muscles will not lead to back pain.
• Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.
• Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise.
• Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain.
• Any therapeutic influence is related to the exercise effects rather than CS issues.
• There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities.
• Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.

In short, the assumptions that core stability reasoning are built upon are no longer tenable. The evidence clearly demonstrates that core stability as a single solution to low back pain is no more than a reductionist fantasy. If a thorough review of the literature on the topic is desired, the reader is encouraged to read Lederman’s well referenced paper The Myth of Core Stability ¹.”

Source: http://ramseynijemfitness.com/2015/06/04/core-stability-winning-popularity-losing-science/

Inflammation is the natural response to damage.  When tissue is damaged, like when you’re breaking down muscle in a workout, you’ll get the “cardinal signs of inflammation” or S.H.A.R.P. (swelling, heat, altered function, redness and pain).  This is totally natural.  In fact, the body must undergo inflammatory processes in order to repair and get stronger.

Scenario A: Let’s say we do some exercises like dumbbell rows, ring rows etc. that break down some of your back muscles.  You’ll get an immediate inflammatory response after the workout, in those muscles, which might include pain.  Will icing the lats+rhomboids reduce inflammation?  Yes, it will, but we actually want inflammation at this point, for repair purposes.  Scenario B: It’s 2 or 3 days after our workout, and your back muscles are still sore.  The muscles have not fully healed.  The inflammatory and repair processes have not been adequate (or still need more time due to a large amount of tissue insult), due to any number of factors (age, nutrition, sleep, overtraining etc.).  Heat is what you would want in this situation, to actually promote blood flow to the muscles, thereby promoting healing + accelerating inflammation.  Cold/ice will actually suppress blood flow, and thereby slow the healing process.

So, when should ice/cold be used?  A. For acute pain, when you want relief from pain that comes along with inflammation.  B.  There is something referred to as “flushing” in which one will apply cold for a short duration, following by heat for a short duration, for multiple cycles – the theory being that it causes a net increase or “flushing” of blood within the area.  Otherwise, cold on it’s OWN, will simply reduce inflammation and blood flow.

It is very possible that tissue provocation therapies like Graston are actually exacerbating/increasing pain.

https://www.painscience.com/articles/tissue-provocation-therapies.php

Article published in the Toronto Star entitled “The death of the sit up”.  Based on the work of Stuart McGill of the University of Waterloo, a back biomechanics and injury researcher, the Canadian Armed Forces have dropped the sit-up from their fitness testing protocols, which has garnered the attention of the US Army.

I like McGill’s viewpoint on the relatively poor value of sit-ups in terms of promoting all-around health.  He states that while perhaps a useful exercise for the jujitsu athlete (which is true), the sit-up is not conducive, nor is it at all necessary, for all-around health promotion.

http://www.thestar.com/news/gta/2016/01/20/the-death-of-the-sit-up.html

Excellent article in the New York Times delineating the issues with the phenomenon of over-measuring in both education and healthcare.  Sometimes measurement is good, and sometimes it can be wasteful and counterproductive.

From the article: In medicine, for example, measuring the rates of certain hospital-acquired infections, has led to a greater emphasis on prevention and has most likely saved lives.  On the other hand, measuring whether doctors had documented that they provided discharge instructions to heart failure or asthma patients at the end of their hospital stay sounds good, but turns out to be an exercise in futile box-checking, and should be jettisoned.

 

Chronic pain = pain lasting 12+weeks

“A 2014 study conducted by a multidisciplinary team of researchers that included University of Luxembourg psychological scientist Fernand Anton provided converging evidence for the role of conditioning in pain experiences. Participants experienced a painful electric pulse to one foot while they simultaneously put one hand in a bucket of ice water, the bracing sensation of the ice water actively mitigating the pain of the shock. The researchers found that participants who heard a telephone ringtone while engaging in this active pain reduction strategy came to associate the ringtone with pain reduction; they subsequently reported significantly lower pain from the pulse when exposed only to the ringtone. The finding reinforces how learned associations can help people regulate pain.”

http://www.psychologicalscience.org/index.php/publications/observer/2015/november-15/relief.html

LLLT or Photomedicine consists of the use of low-intensity class 3b lasers and an array of high intensity LED lights at specific wavelengths to treat musculoskeletal injuries, chronic and degenerative conditions and to heal wounds.  It does so in a non-invasive, risk-free, and pain-free manner.

Tendinitis is the inflammation of the tendon and results from microtears occuring when the musculotendinous unit is acutely overloaded with a tensile force that supercedes the capacity of the tendon.  Tendinitis is a very common diagnosis, although was is thought to be tendinitis is most likely usually tendinosis.

Tendinosis is what occurs with frequent/unaddressed tendinitis.  It is a degeneration of the tendon’s collagen in response to chronic overuse without proper healing of the tendon.

Warming up decreases injuries.  In terms of stretching/flexibility, it is best to be in the “moderately flexible” category, for injury prevention, that is.