You might recall in our last episode, Adam shared the very intimate details of his lifelong struggle with lower back pain and how he’s conquering it by combing slow motion, high-intensity strength training with a positive attitude. Here in episode 24, we get into some of the psychological aspects of a negative diagnosis, such as a lower back problem, and how that diagnosis alone can prolong an illness or injury.
Conversely, we’ll share some interesting data that supports the notion that a simple attitude adjustment can change the course of your rehabilitation towards a faster recovery. Dr. Louis Fierro who is a chiropractor and works with the InForm Fitness Active Rehabilitation program joins Adam Zickerman to offer up his suggestions and solutions for those experiencing back pain.
Below is a link to the book Adam mentioned in this episode: Foundation: Redefine You Core, Conquer Back Pain, and Move with Confidence: http://bit.ly/FoundationRedefineYourCore
A Rational Approach to the Treatment of Low Back Pain by Brian W. Nelson, MD http://www.medxonline.com/pdf/rationalapproachtotreatment.pdf
Louis: People get diagnosed, and then they go into this sick syndrome if you will as Adam
described and their anxiety levels go through the roof. They’re told to take [Inaudible] and
medication and immobilize, rest, don’t actively engage and really here at InForm Fitness, it’s the opposite. The patients are clients with the clients and taught to enthusiastically actively engage in not only an exercise program of high intensity, but a healthy lifestyle.
Tim: InForm Nation, good to have you back with us here on the InForm Nation podcast. 20
minutes with New York Times bestselling author, Adam Zickerman, and friends. I’m Tim
Edwards with the InBound Podcasting Network and a client of InForm Fitness. You just heard the voice of Dr. Louis Fierro, he’s a chiropractor who works with Adam in the InForm Fitness Active Rehabilitation program. Now in this episode, Dr. Lou as he’s affectionally called, will offer up his suggestions and solutions for those experiencing back pain, much like Adam has. You might recall on the last episode, Adam shared the very intimate details of his lifelong struggle with lower back pain, and how he’s conquering it by combing slow motion, high intensity strength training with his attitude. Here on episode 24, we get into some of the psychological aspects of a negative diagnoses such as a back problem, and how that alone can prolong an illness or injury. Conversely, we’ll share some interesting data that supports the notion that a simple attitude adjustment can change the course of your rehabilitation towards a faster recovery. Joined as always by Sheila Melody, the co-owner and general manager of the Burbank location, and Mike Rogers, the general manager of the Manhattan location. Here is the founder of InForm Fitness, Adam Zickerman.
Adam: I read this article a couple of years ago which really resonated with me, written by some doctors that treat lower back problems, non surgically, the way we’re actually doing it here and the way we recommend people do it, but it’s not just a physical program of exercise that he was talking about. There was another aspect about people getting better, and that was the mental side of it which I found really interesting. For years and years and years, people kept telling me you’ve got to do something about your back. Every so often you’re getting these spasms, you’ve got to get some MRIs and some interventions, like surgical type of interventions. At the very least, get injections into the facets of your spine, all these techniques that I was very resistant to because in my mind, my back problem was a temporary thing that I had to solve. I didn’t really believe that I had a back problem, I thought that there were some muscular things that weren’t being dealt with and putting me into spasm, it wasn’t a structural thing with my back, I was convinced of that, and therefore I never accepted the fact that I was somebody with back problems. Obviously when I had a spasm I had to accept the fact that I had a back problem, but the chronic pain that came and went from a one to a four, back to a one, I was just saying I need to do something in a nonsurgical way, I just haven’t figured it out yet, and then the article talked about that. He was saying that a lot of patients, they fall into this sick role when they’re told they have a back problem and it becomes a self-fulfilling prophecy and now they have a back
problem, and they just accept the fact that they have this back problem, and there’s a huge
psychological component to this. I realized that one of the reasons why I wasn’t debilitated long term is because I never accepted the fact that I had this back problem and it’s because of that nonacceptance if you will that I am where I am right now, but my attitude towards this whole thing is what I’m saying is what got me through this and there are a lot of people that kind of feel when they have a back problem, that’s it and you rely on these surgical methodologies because there’s no other way to fix it. Even though they have MRIs that are less remarkable than mine, so Dr. Lou Fierro, chiropractor that works out of our studio here in Manhattan and is involved in our active rehabilitation program and uses some of our equipment to help patients, is here with us today and I want him to talk about this idea that people play this sick role when all of a sudden they’re told by a doctor that they have a back problem. Do you find that to be true?
Lou: Absolutely, and you shared this article with me several months ago, and I thought the title said a lot [Inaudible: 00:05:10].
Adam: Brian Nelson, exactly.
Lou: A rational approach to the treatment of lower back pain, and after I read it, I said this is
really a proactive approach and that’s the model we’ve always taken. Whether we had an elite level athlete, a professional athlete, a weekend warrior, the de-conditioned mother that’s caring for kids that have so much anxiety when they’re given an MRI and shown the results of a
herniation, and the reality is if we took 100% of the population and gave them an MRI,
specifically in the lumbar region, about 82% studies show, there would some shape or form of a degenerative change or a herniation between the ages of 22 and 65. Only about 30% of that
population has a subjective complaint to follow and mirror that objective finding, so people get diagnosed and then they get into this sick syndrome, if you will as Adam described, and their anxiety levels go through the roof. They’re told take [Inaudible: 00:06:02], take medication,
immobilize, rest, don’t actively engage, and really here at InForm Fitness, it’s the opposite. The patients are educated, the clients are taught to enthusiastically actively engage, not only in an
exercise program of high intensity, but a healthy lifestyle. Once they’re shown that I can BLT, bend, lift, and twist, and not exacerbate my condition, now I can walk up a flight of stairs. I can care for my children, I can be a good spouse. They just really decrease in their pain threshold, and inflammation in their body, because there have been studies to show that inflammation is not only caused by poor diet, overactive activities, but by stress levels. Cortisol —
Adam: Lack of sleep.
Lou: Side effects of medication, so I don’t know the exact date that I first met Adam, but once I really saw the program that they were doing here, I kind of had to look twice at it and I realized wow, he’s onto something. He’s onto something more than most medical doctors have doing for the last twenty-five years.
Tim: He’s the guru, I keep telling you.
Lou: I think as recently as last week in [Inaudible: 00:07:56], I said Adam you’ve got to come in here, I’ve got a patient that actually had a three level laminectomy and she’s got rotational scoliosis in her back, and she has had nagging, nagging pain. I cannot remember [Inaudible: 00:08:13] may be the medication she’s on, but without that medication, it’s hard for her to function. I said you know what, we’re going to throw her on the MedEx machine here, lumbar extension machine. This is after I did a little bit of what I call white knuckling, trigger point release into one of her spinal muscles that was contracted. Put her on that machine, she stood up, and she said I’m pain free. Holy crap, I’m pain free.
Adam: It’s like one of those evangelists that touch you.
Lou: I said to her listen, marching orders are go leave now, live your life, don’t do anything out of the ordinary, and she says I’m going to see my trainer tonight that’s going to come to my house. I said you never told me you had a home trainer, what do you do with the trainer? She started demonstrating rotational chops, high force activities, high load activities, high back torque, loading the spine in ways that really aren’t necessary. So she said do you mind talking to my trainer, I said not a problem. So I spoke to her and I have a patient the person and trainer may listen to this podcast, which is all cool but anyway. I spoke to the trainer, and I said let’s just remove certain of those BLTs for right now, no bent over single arm rows and just keep it very linear, very static if you will. She was feeling good and I didn’t want to say don’t train at all because I didn’t want to impede on her lifestyle. She came back in today, and she had discomfort, and I said when did the discomfort start? She said from the time I left you guys all the way up until I had my training session, I was pain free, and then after my training session, it started to exacerbate again. I’m going to give a little bit of a time out, I don’t know how
comfortable I am giving this admission from her testimonial today because I don’t want to offend her trainer. Anyway we put her back on that machine today, and once again she felt phenomenal. So this machine, essentially what is allows someone to do that is in an active back spasm or even or has a neurological deficit from a disc compression, locks down the pelvis in such a way that when you actively extend, the only muscles being engaged and being recruited are the lumbar and rector, and even some of the deep spinal rotators have to engage in straight extension. So it allows for a term that I like to use, instead of traction it’s called decoaptation, where it’s a joint segment that’s being lengthened without cavitation of the joint.
Adam: So for those of you that don’t speak science, what he’s saying here is that by fixing the hips in place and by doing a back extension but pushing yourself back, you’re actually opening up the spaces of the vertebrae which gives you relief.
Lou: On the note, it also gives kind of a self massage into those spinal segments. The only time — I’m starting to question some of the traditional medical research, the only time where they say don’t put a patient into extension is if they have facet arthrosis or facet arthritis, degeneration of the joints. Lately I’ve kind of taken Adam’s approach a little bit and said I’m going to test this, and I’m put a patient or two on there with facet arthrossi as diagnosed by a radiologist and confirmed by a surgeon, and they came out of it feeling better. So it goes back to my principle of motion is great joint lotion, and if we can actively engage a patient, not passively. The difference there is passively is the therapist is moving the patient, actively is them moving themselves and us assisting as a coach, making sure they’re in the bio mechanical correct position. They feel better, not only from a physiological point of view, but from an emotional and social wellbeing. I can do this, I can exercise. Guess what, we do that for two or three sessions and then we move them to a leg press. As you mentioned earlier, I don’t remember who said that they were struggling with it but then you just altered your position and you were pain free.
Adam: The leg press actually — I don’t want to give the leg press a bad name, the leg press is actually very good for the lower back because it’s strengthening your hip extensors which are your glutes. Those primary moves are also very important to work, matter of fact one of my mentors, Rob Francis told me that it’s very important. Once you start doing some lower back extensions and you’re starting to feel that relief, that it’s important to start doing some of the major hip movements like leg press.
Mike: Dr. Lou you can add onto this. There are probably some times, like if you wanted to do a leg press, there may be some conditions or just a status that a person is in, a client is in, where they’re just not ready to perform a certain movement pattern and I guess the low back machine can prepare you for a leg press, or manual therapy of some kind. Is that what’s necessary sometimes?
Lou: Absolutely. Even when we had the patient in today, she was saying that she was getting some burn in her quads while doing the back extension.
Adam: There’s some static contraction in there.
Lou: Exactly, but it’s just a progression physiologically but it’s also a progression mentally where hey, I just did that pain free. Not only pain free, I’m not in pain anymore therefore I’m
going to do something else, and there have been many times where I’ve had a patient that’s
gotten acute lower back exacerbation. We get them through the back extension pain free, and you say you know what, you’re going to do one of the safe chest presses here. I’m going to add that in, what does that have to do with their back? Maybe not a lot but everything to do with their psychological profile about themselves, and years ago, I’m trying to remember the first time. I don’t think I’ve ever shared this with Adam, but he actually probably knew. In 2002, I had opened up a rehab facility as part of my practice, and around that time I had a really bad, acute lower back condition and it was in the summer, and mine came — it was actually on a tractor. I was cutting my lawn, and the tractor went into an old kind of stump hole, it went down, I went up, and we met somewhere in the middle. It created an avulsion fracture on my left hip, and some secondary lower back issues. I went to see a doctor and they said take an epidural, have these pills, I didn’t want to do that. I wanted to let my body heal, and I was in such excruciating back pain one morning that I said I’m going to get up and do some deep knee bends, and I did and it immediately increased my range of motion. So I started testing on patients, I started having patients who had acute lower back pain doing kind of wall squats if you will. We were loading the muscles, strengthening and opening up the spinal segments, and now that I really think about it, probably as Adam just said, it had a lot to do with the mental approach of them actually being able to exercise. After being told immobilize, bed rest, don’t do anything and I was doing the
opposite. Fast forward to now, I’ve met Adam and he’s created this circuit where I look at
InForm Fitness and in my mind, people ask me how to describe it and I say it’s probably one of the hardest forms of exercise that I’ve ever come across, while being the safest form of exercise.
Adam: That sums it up pretty well.
Lou: It really does. Recently I had the pleasure of bringing in what I consider an elite level
athlete. Not a professional yet but an elite level athlete who just finished his two years of junior hockey and he’s going own to play at a high level one collegiate hockey. This guy is about as conditioned as anyone that I know. I had him do the protocol here, and he said that was by far the hardest twenty-five minutes of exercise I’ve ever done. I just don’t understand why it was only twenty-five because he was so mind conditioned that it has to an hour, or hour and a half. As
opposed to being able to get it done in what I call short duration, high intensity.
Mike: Real quick, we’ve had a few pro athletes here over the years and they’ve all made the same comment in regards to this strength training program, as opposed to any other strength training they’ve been a part of.
Adam: I want to bring it back to first of all, I want to summarize on kind of what we just said. So these passive modalities of back treatment, taking medication, inactivity, some of these things that physical therapists do on a passive level such as electric stem, heat packs, so the thing about those is they’re all well and good for acute situations but they’re not going to help an overall
situation for longterm. I think the takeaway from this is one, inactivity is not what you should be doing if you have some back problems. First of all, don’t accept your back problems, and know that most people, if they don’t have something really serious going on like a spinal tumor or some kind of neurological deficiency, you have to move that joint, but you have to do it safely. There are ways of doing it safely, I don’t want people just running out there now and just doing all this crazy stuff because they listened to this episode of our podcast and they just said move, so all of your sudden you’re doing all these crazy things like doing Crossfit or some of the things we were talking about with Lou’s patient. It has to be controlled, but this idea that you have to immobilize and not do anything, and be very, very careful, you have a back problem. That has not been working.
Lou: No, and on that point Adam, this article by Dr. Nelson does a great job about utilize the
science that’s there, utilize the diagnostic studies, the MRIs. If there’s a space occupying a spinal tumor, something that needs surgical intervention, you go for it, but what Adam is saying is very similar to this article is go through the correct markers and then actively engage and take an
active role in getting your body mobile.
Adam: The second thing besides just knowing that you should not be inactive just because you have a back problem, and not give up life, is doing some very specific things for your lower back. Dr. Lou is mentioning our program here, and we have some very special equipment. It does, it fixes the hips in place and allows somebody to go into a type of back extension that you cannot do without a machine like this, without something that can actually keep the hips fixed. So to plug InForm Fitness, we all have these machines in our gyms at InForm Fitness, so if you’re fortunate enough to be near to one of our locations, it’d be great to try one of these machines. These MedEx, lumbar extension machines. Having said that, and knowing that most people listening to this episode are not going to have access to these machines, all is not lost, and I want Mike, since he does a lot of work with people on these types of movements, I want Mike to talk about some of the things that you can do should you not have access to this type of machine.
Mike: It starts with a few mobility exercises, and they don’t take long at all to do, and the first thing I would recommend people to do is just to get down on all fours on a mat and get into a little child pose. You sit on your heels with your feet tucked underneath, and you tilt your body all the way over as if you’re bowing towards the sun. Just stay there for about twenty seconds or so, and for a lot of people who are dealing with acute pain or just some ordinary tightness, that often times gives some simple relief. After that, Adam mentioned before, pelvic tilts. They can be done from many different positions, from all fours once again to on your back, to standing up. Basically from an all fours position, you are doing what’s called an anterior pelvic tilt and a posterior pelvic tilt. The posterior sort of feels like you’re, while being on all fours, you arch your lower back up a little bit and you’re creating what feels like an ab crunch, and then the anterior tilt is when you do the exact opposite movement. After that, I usually guide people through doing another child’s pose for about twenty seconds, and then come back to all fours, and then a more extended version of what that last pose was which is cat cow, which is
recommended by every chiropractor and physical therapist. It’s a full tilt of spine, the whole
thoracic spine to the lumbar spine, and then a full arch as well. Followed by that a bird dog, so once again, being on all fours and where you extend your left arm forward in front of you, and then the opposing leg, the right leg back, and hold the position for ten to twenty seconds and then switch off. After that, some glute bridges, which are just lying on your back with your feet placed down on the mat, and your hips will come off the floor, and you just do some very, very light bridging off the floor and then coming back down to the floor. So these can all be demonstrated online, it’s a little difficult sometimes to say them without a visual, but it starts with simple stuff like that, and then a few more beyond that. I think if someone is dealing with some back tightness, it’s generally safe. Without any diagnosis, it’s probably safe to go down and give these little things a try. Obviously if you’re dealing with some acute pain while trying these very simple movements, then you definitely some advice from a professional.
Adam: There’s a good book on the subject. There’s a lot of books on the subject, but a good one that I like, it’s well written and has great pictures, it’s called Foundation, subtitle Redefine Your Core, Conquer Back Pain, and Move With Confidence. I like the subtitle because we were just talking about moving with confidence, this confidence thing keeps coming up doesn’t it. It’s by Dr. Eric Goodman and Peter Park. Not Peter Parker. Foundation.
Tim: We’ll have links to that in the show notes as well.
Mike: I personally loved this book and there are a lot of different exercises. It gives a great
explanation of the anatomy of the low back, some of the common problems that can happen to the low back, and it goes into several different exercises but it revolves around one fundamental exercise which they call the founder, which is essentially a back extension, and they show you how to do it in that book.
Adam: So my final thoughts are, and the takeaway I’d like you to have and I mentioned this, is one, don’t accept your back pain, and use surgical methodology really as a last resort, and really try some of these — hire somebody or try some of these movements, therapies if you will, to help with this. Movement is so important, movement is really important, and I can tell you from my own experience that I’ve never thought of somebody who has back problems. I always thought of myself as somebody who had muscular problems in my lower back, and I think I might be right. What I’d like to do is come back to this in six months to a year, and let you know how I’m doing. I’m going to continue doing what I’ve been doing, and I’ll let you know because let me tell you something. If it doesn’t come back after another six months and I’ve been doing what I started doing six months ago, almost a year ago actually, and I don’t have these episodes going forward for the next six months or a year, I think my conclusion is going to be right because nothing else ever worked, short of doing surgical types of things which I’m not going to do. So stay tuned. The other thing that we’re going to be talking about on our next episode is the second thing I did which I feel contributed to a lot of the alleviation of my lower back problems, and that is my diet. That is what we’re going to be talking about in our next episode, the diet that I undertook in the last ninety days and how it’s changed me forever.
Tim: So there you have it. In next week’s episode as Adam just mentioned, we will be talking about a diet plan that Adam has been participating in for the last three months. A plan that Adam credits for assisting with successfully managing the lower back issues that he’s been dealing with for most of his life. Coming back in the next couple of weeks, we will be speaking with Gretchen Rubin. Gretchen’s books have sold more than two million copies in thirty different languages. She has a popular podcast of her own, it’s called Happier with Gretchen Rubin, and she’s also a client and has been for many years of InForm Fitness. Also on the way we have a terrific conversation with Dr. Martin Gaballa, author of The One Minute Workout. We will contrast and compare high intensity strength training with high intensity interval training. Looking forward to this one. Hey if you’d like to find an InForm Fitness location nearest you to give this workout a try for yourself, please visit informfitness.com. At this time of this recording we have locations in Manhattan, Port Washington, Denville, Burbank, Boulder, Leesburg, and Restin. If you are not near an InForm Fitness location, you can always pick up Adam’s book, Power of Ten, the Once a Week Slow Motion Revolution. Included in Adam’s book are several exercises that support this protocol that you can actually perform on your own. We’ll have a link to Adam’s book here in the show notes. For Sheila Melody, Mike Rogers, and Adam Zickerman, I’m Tim Edwards, with the InBound Podcasting Network.