Physical therapist (P.T.) Jim Johnson's The Multifidus Back Pain Solution is a straight forward, educational and hope inspiring read that has been effective in helping me address my lower back and leg nerve pain.
For others who may be searching for a non-drug or non-surgical answer to back pain, I am sharing my experience in the hope of helping someone else.
Background:
Over the last year and half, I could not get any more than 3-4 hours sleep a night, because of back pain. I went through 3 new beds. Each new firm mattress I tried ended up after a month not being supportive enough for my sore back pain. My doctor recommended muscle relaxants, but that didn't help. So, I cranked up the sit-ups and attended an exercise class in addition to my normal tennis and occasional running. No pain, no gain. (Yes I am a slow learner). Then in exercise class my right knee went numb from a jumping exercise and I could not walk for a couple of minutes. Now I had back pain preventing me from sleeping. Sitting was becoming impossible without pain. My right knee would go numb going up stairs two at a time. My left leg had nerve pain shooting down my left thigh and part of my lower leg. And even after 4+ weeks staying off exercise to heal, none of these pains were going away.
So, the doctor ordered a series of tests and physical therapy for me. Ultrasound, electrical treatment and stretching for previous sports injuries always worked in the past. This time, physical therapy was a bust and some stretching my leg nerve pain. After getting an MRI of my back, the orthopedic doctor explained I have Grade 1 / 2 spondylolisthesis (i.e., your L5 vertebrate is slipping forward, because at some time in the past your bilateral pars or the hooks that hold each neighboring vertebrate in line in your back have broken off over time and the slippage is causing narrowing and severe impingement of the nerve root). You can take drugs and get a cortisone shoot to manage the pain, but there is nothing you can do. (The doctor was kind enough not to mention the screws in the vertebrae solution). Chiropractors and physical therapy are just feel good placeboes that can't help.
I am fifty and have lived a fairly healthy life. I won't take drugs to mask a problem and make it worse. Implying I have no future athletic mobility depressed me, and made me mad. This was just unfair and unacceptable.
Back pain help search:
So, I spent a lot of anxious weeks searching the internet for back pain solutions through Google scholar papers and university medical sites. I started reading and collecting randomized control trial studies similar to what P.T. Johnson describes in his book. During this searching it became apparent the British, Australians, French and Belgians believe in intensive physical therapy to address back pain and where successful in pursuing this route. It also became apparent surgical solutions may help some with improved back functionality, but some level of pain still remains.
My self-research progress was slow. I just kept reading and collecting studies, but not sure of what path to move out on. My first break thru was to read keeping a pillow between your knees in bed would relieve back and nerve pain. Pretty odd, but it only took one night and now I could sleep through the night. You can't believe what a relief and pleasure this was to sleep again! Next, I began using a lumbar support pillow to learn to sit up straight at work and at home which made sitting bearable over time. Then I told myself you need to keep exercising. So, I started walking for 50 minutes every morning before work. This was embarrassing at first for someone who has run all their life, but it seemed to relieve some of the leg nerve pain.
Eventually, I come upon Australian Professor Peter O'Sullivan's "Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain with Radiologic Diagnosis of Spondyloysis and Spondylolisthesis". This is where I began to realize a pattern in some of the back pain randomized control trail studies focusing on the multifidus back muscle and transversus abdomis muscles. However, the problem with most of the control studies is that they provide detailed randomized control trial statistics and control parameters, but scarce details on the actual physical exercise for these muscles. Fortunately, I was able to obtain a copy of one of Professor O'Sullivan's references, "Muscle Control pain control. What exercises would you prescribe" by C.A. Richardson and G.A. Jull which describe simple multifidus core muscle activation exercises similar to P.T. Johnson's exercise #6 in the on-all-fours position, lying on the stomach and standing positions. So, I began practicing these simple exercises and while continuing to build my anxious pile of internet papers and trying this or that exercise also. Still suffering from my no-pain, no-gain stupidity, I proceeded with searching the internet for multifidus and transversus abdomis exercises. Per chance, one multifus searches turned up P.T. Johnson's book. I read the Amazon reviews and surmised his exercise was similar to others I had stumbled upon elsewhere. However, one review was by a runner and he said he returned to marathons in 6 months. With my hope perked up from an athlete's perspective and being exhausted from internet searching and back muscle exercising, I bought the book.
Ignoring P.T. Johnson's advice at the beginning of his book, I immediately read the back exercise chapter and started exercising it. A week later I read the rest of the book. This is when I began to relax and have faith in pursuing this book's recommendations. P.T. Johnson references the same Professor O'Sullivan control trail I found and explains how his efforts are based on the randomized control trials accumulated over many years of research and practice of physical therapy in a hospital. In other words, here is a person knowledgeable in his field extracting from all the control studies, what I was struggling to understand, in simple terms, a understanding to back pain and what most can do to relieve that pain through specific exercises. Also, very important, P.T. Johnson's book educates the reader in understanding the back and its issues. For me, this helps provide belief that something is worth committing to.
Finally progress
After 4 weeks of P.T. Johnson's exercise, I am back and leg nerve pain free with minor back hip/buttucks area nerve pain at the end of the work day some times! This is after 1 ¼ years of lower back pain and 4 months of leg nerve pain. Now, the multifidus muscles on both sides of my lower back are like taught cables after the exercise. Also, now I don't need a pillow between my legs to sleep or a lumbar pillow for sitting, and have returned to competitive tennis. Note: I can still induce leg nerve pain by doing knee fall outs or sitting in slouchy positions, but it means I have to go out of my way to feel pain. A year from now is when I can give the best report, because it takes a while to build any muscle and really know if you are free and clear of an issue.
On my specific 3 day a week back exercise regimen, I do the following:
1. The simple multifidus activation exercises referenced by Richardson and Jull similar to P.T. Johnson's exercise #6 on the all fours position which P.T. Johnson recommends you do every day
2. P.T. Johnson's exercise #3 with the following caveat
do one exercise #3 set holding each leg out statically with the weight for 5-10 seconds and the other set with no delays to a dynamic beat. Why? The Belgian's L A Danneels, did a study, "Effects of three different training modalites on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain", on what exercise program it took to grow the multifidus as measured by a CT scan. Note: not that I am right, but that's what I am doing. If anyone can share an understanding of this it would be appreciated.
3. Sitting weighted ankle leg lifts
4. Lateral Dynamic Pillar Bridge exercises for each side to exercise the transverse abdomis muscles which horizontally wrap around the rib cage to give additional support to the back in conjunction with the vertical multifidus muscle support. Note: situps put a lot of undue compressive stresses on the backs and should be avoided if in pain or injured. (Reference: Professor Stuart McGill).
5. Walking 50 minutes each morning.
Based on my experience, I could have saved a lot of time and anxiety if I started reading P.T. Johnson's book first. I apologize for my long winded probably cathartic review, but I hope this provide a path of optimism and results for someone else suffering from back pain.
Jim Johnson stopped looking for causes of chronic back pain after researching the studies on the subject. Scientific studies don't support the common theories about what causes chronic back pain. Many people without pain live happily not knowing that they have back conditions usually treated with surgery.
Johnson also found that people with pain usually have weakened multifidus muscles. Those without pain usually don't. So, instead of looking for causes, Johnson recommends that patients initially work to strengthen their multifidus muscles. These muscles weave around your spine from your neck to your low back. Their location on your spine indicates their importance to your back health. Johnson describes three different exercises that target the multifidus. He lets the reader choose the one that they prefer to do.
Most physical therapists recommend multiple exercises for chronic back pain. That shotgun approach can be effective if followed. But patient compliance drops as programs get more complex. Johnson's program requires performing only one exercise. Yet most of his patients improve or completely relieve their chronic back pain without any other treatment.
Johnson says most patients notice improvements within two weeks. If you don't improve within three months, try something else. He also acknowledges that his program is for chronic back pain: continuous or intermittent pain lasting for months. For acute pain, time heals better than any exercise program.
The book illustrates the exercises he recommends. Here is a basic description of them:
Johnson most highly recommends the "bird-dog" or opposite arm/leg extension. Start in an all-fours position on the floor. Raise one leg straight back and hold it up for a second, then lower. Alternate with the other leg. Work up to 20 repetitions with each leg or about two minutes of repetitions. Every other day or three times a week is enough. When that movement becomes easy, go to the next level by extending the opposite arm straight out while extending each leg. When that becomes easy, the final level is to add light weights to each arm and leg, depending upon your tolerance. Once you build up your strength, perform the exercise once a week to maintain it. You will find this exercise in many exercise books and on many websites. Alas, don't be alarmed that they all prescribe different "hold" times, number of repetitions, and other adjustments. Johnson explains why the pattern he describes should work fine for you.
The second exercise is commonly known as the prone or facedown extension. Lie on your stomach. Lift one leg straight up about 6 inches and hold for a second. Lower and repeat with the other leg. Work up to the same frequency and number of repetitions as the first exercise. When the exercise becomes easy, add light weights. Do this exercise if you can't do the first one.
The third exercise can be done sitting or standing. While exhaling, simply pull your stomach muscles in as tight as you can and hold them for a few seconds. Work up to 20 repetitions. This can be done daily. This exercise is for those unable to do one of the other two exercises.
Jim Johnson writes short convincing books. He presents simple self-care solutions. Do you want to avoid surgery, prescription drugs, supplements, pricey equipment, and complicated workout routines? Then try Jim Johnson's books for what ails you. If you have knee problems, look up his knee book on Amazon. He also has a book on treating your rotator cuff. Creating good health can sometimes be surprisingly simple.
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I am so excited when I see one of our members write such an informative book for the public. I read the book in one day. I too, am a physical therapist with a manual therapy background. I believe to the average "joe" this book will be helpful and encouraging. I would have liked "live" pictures, and more of a description of the multifidus. By strengthening the multifidus muscle, what movements does that help with and why? How does the spine become more stable by strengthening these muscles? These are questions I would have liked more specifically addressed. I glad he gave credit to Stanley Paris,PT,PH.D., whom has been advocating these exercises for over 10 years!
I think it's a good book for anyone not in the physical therapy profession as it answers most of the back pain questions.
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I had 2 herniated discs. Went through chiro, massage, p.t., cortisone injections....then i read this book and began following the exercises in it. The MacKenzie method DID NOT work for me, it only created more pain. This book was extremely helpful to me. Surprisingly, my massage therapist recommended it, not my physical therapist, orthopeadic, or chiropractor. I am fully healed without surgery and running marathons! I recommend this book to any average person who wants to have a better understanding of how to strengthen your back and core!
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I've had chronic back pain for years and have tried several modalities to treat the pain. I've also read several books on the subject and have tried different exercises. The Multifidus Back Pain Solution has fabulous medical research to back it up, simple exercises for people of all different strengths, and great common sense.
Most of the pain I have had in my back is gone. On the rare occasion that I do have pain, it is much less intense and doesn't last for as long. I have renewed hope and a rich life because I can move without fear.
Strenthening the multifidus is the way to go. I have checked out the spine journals where the author gets his information, and they are right on the mark.
The Chiropractor who wrote that the book is full of garbage should realize that the author is actually an advocate for chiropractic care along side the exercise program in the book.
I also don't see medical research as to the Chirpractor's claims to back them up.
Jim Johnson has clearly spent meticulous hours on organizing medical research, reading the spine journals, and seeing where commonalites exist within the data. I don't know too many practitioners who care that much to be so meticulous.
This book has allowed me to regain control of my back and not rely on outside help.
Buy this book and follow the program. It could just change your life like it has mine.
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