Comparative Back Pain Programs

Although there are several back pain books on the market and numerous physical therapy programs, The O'Connor Technique (tm) is not just another back pain methodology filled with various exercises that no one can realistically be expected to do when in the throes of a back pain episode or for that matter maintained daily for the rest of one's life.

It differs substantially from any other previously described program in that it advances an entirely novel method of back pain management. The major difference between The O'Connor Technique (tm) and conventional, traditional, exercise therapy is that this technique doesn't simply hand out a number of instructions that are assumed to be helpful without giving a rational, specific, physiological and anatomical justification. In my opinion, the back and neck exercises advocated by pre-existing literature and prescribed by most physicians as "physical therapy" have no true direction or sense to them because among other failings, they are not diagnosis-specific nor do they consider the physical realities of the individual. Doctors prescribing them, today, attempt to "sell" the impossible "one remedy that cures all". While ignoring the necessity for specificity, upon which they so often pride themselves when dismissing any therapy which originates outside of academia, they, in essence, commit the same fault for which they so often criticize alternative therapists. If you don't believe this, ask the doctor who has prescribed physical therapy for your back pain exactly what mechanical principle he/she is relying upon and what specific instructions he/she is giving to the physical therapist relevant to your particular back pain. Then, compare that answer to the explanation you would get if you sought the same answers from this treatment of the subject. My bet is that you will find a much more cogent and sensible rationale in this material's prescription.

That is not to say that some physical therapy programs don't have successful outcomes. In fact, this method is a "physical therapy;" and it would be absurd to argue that physical therapy has no benefits. However, just as throwing virgins into volcanoes had been shown to effectively stop the Polynesian lava flows, so too, the exercise programs of the past tell you to do certain things that from time to time appear to be effective. If they are practicing the current state-of-the-art, their "effectiveness" is more likely the consequence of random chance and probability than directed, intelligent, common sense effort. After reading this website, I can pretty much guarantee that the reader will agree with me.

It makes very little sense when a disc is "out" to commit the same, identical, movement (under the auspices of an exercise) that put it "out" in the first place, even in small increments. Unless of course, they wish to verify the principles of homeopathy in which a small amount of poison that produces given symptoms is a means of curing a disease with the same symptoms. I don't think so. I think that even a little damage repeated many times cannot be expected to lead to consistent improvement.

One patient, I recall, described a series of neck exercises that she ritualistically performed every morning which seemed to make her functional yet did not even approach what could be looked upon as relief. They consisted of sequential side-to-side and rotatory movements of the neck. She was suffering from an off-center disc to the left in the C2-C3 level. So, every time she tilted her head to the right, she actually aggravated the problem. The relief she did seem to get was only because her ritual ended with a twisting movement after a left-sided flexion. Had she not coincidentally or by unconscious trial and error finished with that physical set of forces she would have received only pain for her effort. In her case, it only gave a modicum of relief which was to say she was in pain most of the time. When she began applying The O'Connor Technique (tm) she immediately, that is, the next day, began appreciating what it was like to live without pain again.

The O'Connor Technique (tm) relies upon a few basic, easily understood, principles, within the parameters of which any spinal activity can be evaluated as favorable or unfavorable. For instance, this method does not allow intentional WEIGHT-BEARING FLEXION of the spine at the painful site. For the Lower Thoracic and Lumbar spine pain sufferer, that eliminates any type of sit-up type exercise often advocated in other back pain management programs and literature wherein a supposition is made that increasing abdominal tone is essential to the restoration of a normal spine.

Take, for instance, the Williams exercises designed by the same-named orthopedist, repeatedly recommended through the years by countless doctors, and still in wide-spread use since at least 1974 for low back pain.(27) They would have the back pain sufferer repeatedly engage in WEIGHT-BEARING FLEXION of the spine which causes a disc condition to actually get worse. I've yet to figure out how they ever gained popularity in the medical profession. I suspect they were and are still offered as a "something" in place of the alternative "nothing." They apparently are statistically tantamount to ignoring the problem because the patients tend to eventually get better whether they are practiced or not. Nevertheless, they were and seemingly are still one of the standards of practice, since they continually and repeatedly are recommended in the current literature as well as by many primary care physicians, orthopedists, back pain educators, and physical therapists. Chiropractors rarely offer them because if anything worked at home, it might serve to keep patients out of their offices--they are seldom given to cutting their own economic throats. Besides, Williams exercises have never been proven to be effective.(28),(29) In a limited regard, as it pertains to extension exercises, I would contend that The O'Connor Technique (tm) can be seen to be consistent with some components of most other back pain exercise programs. Exercise, in and of itself, is not bad; but it becomes maladaptive when it is not rationally based.

If the exercise program doesn't insure that no further damage is done by the process, then it is counter-productive. The absurdity of any exercise prescription given to an acutely injured back patient is made manifest any time that the doctor cannot accurately diagnose the lesion and insure that the exercises will not increase the damage. In the case of extension versus flexion exercises, a certain percentage of patients will get relief with either method owing to the varied disease states encountered by chance and probability; however, simply because a quantifiable number of people get relief doesn't justify increasing the pain of a probably larger percentage of those in whom a given exercise is decidedly inappropriate.

The test of any medical therapy is that it proves to be safe and effective. The currently available exercise regimens prescribed in other programs for low back pain, in part, can be seen as effective if they contain extensor strengthening components, but cannot be considered safe if they include WEIGHT-BEARING FLEXION.

The closest analogy I can draw to what is being given to back patients today with most physical therapy prescriptions is the same as if a patient were to walk into a doctor's office stating that he had a "blood pressure problem" and having the doctor offer two different pills. One pill makes the blood pressure go up and the other brings it down. The doctor then plays an "eenie-meenie-miney-moe" game and randomly gives the patient one of the pills. A higher understanding and logic tells us that most people are going to need the pill that brings down the blood pressure, and about fifty percent of the time the doctor will be "right." Unfortunately, an equal percentage of patients will not only be not helped but even harmed, by the wrong pill.

Certainly, after the pill takes effect, determining whether the patient's blood pressure goes up or down will offer some measure of information as to whether the truly correct decision was made; but that policy necessitates that the answer comes only after the prescription is administered and its expense and consequence is felt. In the context of a back pain exercise prescription, the incorrect choice is felt in both the patient's increase in pain and the nonproductive dent in his wallet. This method is predicated upon the assumption that these are two consequences that most people would rather do without if there is a better way of proceeding.

I would hope that most intelligent patients would argue the inadequacy of the analogy from the perspective that the doctor should have most certainly first measured the patient's blood pressure to determine the true nature of the problem before initiating a prescription. In the context of back pain, the doctor would, similarly, have been expected to first determine the precise nature of the back pain's origin before writing his prescription. However, one must understand that the principle means a doctor has of correctly diagnosing a disc problem (in the absence of applying The O'Connor Technique's (tm) methods to determine if the back pain's origin is discogenic) is with an objective measurable imaging study. Those have been deemed too expensive by the current "back pain intelligentsia" in the absence of clinically obvious nerve damage; and, even when they show a disc bulge, the artificially erudite clinicians will most likely quote a study that claims such a finding is present in too many supposedly asymptomatic people to be the source of the pain. So, the "eenie-meenie" game is played with exercise prescriptions because there is usually a failure to diagnose the disc as the source. Then, currently acceptable exercise regimens are prescribed without the knowledge necessary to logically presume how, or if, they will be successful.

I refuse to play that game. This website gives the readers explicit means by which to determine for themselves what logic-motivated type of movements or exercise program should be employed and the physiological time an exercise program can begin based upon mechanical reality.

I would argue that the currently advocated exercise regimens are one of the major reasons why our present back care management strategy is in such obvious disarray. Williams' and McKenzie's exercises have had years to competently address the problem and reduce back pain; yet they still leave the back pain sufferer today with the same statistically dismal chance for relief as they had for years in the past. One reason is simple: They often actually reproduce the forces that caused the injury and ask the sufferer to repeatedly perform them.

Too, they usually are prescribed in a progressively increasing and complex series so as to give the illusion of scientific accuracy; when in actual practice, if you are not the ideal candidate, the more you do, the worse you will get. Like so many of my patients, I tried them before I developed my alternative. I, too, abandoned them because they hurt too much and seemed to make me worse.

In the section discussing WEIGHT-BEARING FLEXION, the demonstrations why these type of exercises can be harmful are discussed and the specific exercises that should be avoided are described. Here, it is sufficient to say that those components of the McKenzie or Williams exercises that involve WEIGHT-BEARING FLEXION should not be done under any circumstances.

Also, unfortunately for the large population of back pain sufferers the McKenzie method is felt by some clinicians to be inadequate:

"To carry out the mechanical spinal assessment described by McKenzie requires considerable education and clinical experience; clinicians must learn the many variations and combinations of spinal movements that enable accurate assessment of a wide range of patients...Regardless of the type of onset, the well-trained clinician can identify the correct direction of end-range spinal bending that centralizes and abolishes the pain in the majority of patients."(30)

Figure 6 McKenzie exercise instructions that
injudiciously promote weight-bearing on the affected
disc.

The O'Connor Technique (tm) differs substantially from the McKenzie technique because, among other reasons, it does not require considerable education or clinical experience and can be performed by the average person rather than requiring a "well-trained clinician" because it is designed to address, in a comprehensible manner, the overwhelmingly most common cause of back pain--disc disease due to disc herniations. It can be easily understood by non-medically trained people because it is based upon a few principles that once understood can be applied to nearly every activity of daily living to prevent back pain; and, above all, costs nothing. Alternatively, one can always count on spending a lot of money if one must rely upon a clinician with "considerable education and clinical experience" as described above.

I feel the need to delineate that there are multiple distinctions of substantive significance between The O'Connor Technique (tm) and McKenzie's method. The first seems to come from McKenzie himself. Clinician's who have recently heard him speak(31) state that he argues against the distinction of having created any "McKenzie Technique" since the method relies upon the individualized creation of specific exercises for each different patient depending upon the patient's pain pattern. By that, it does not lend itself, by his own admission, to popular use by lay persons. It requires a complex series of tests administered by a clinician who designs specific exercises which require a great deal of sustained exacting activity.

I am compelled to also point out that McKenzie, in his book, advocates the practice of actual exercises, which to my mind are not absolutely necessary to relieve back pain. Of utmost negative significance, the McKenzie exercises ignore the resistance generated by the weight of the body part(s) above the lesion in designing the selective exercise. One may note that in each of the terminal components of the McKenzie exercises, (See Figures 5 & 6), the Lumbar disc units are bearing the weight of the body parts above them. This practice is antithetical to my understanding and recommendations because it can aggravate symptoms, increase pain, and lead to disc damage (extrusions) that otherwise wouldn't have occurred if practiced without proper insurance that the disc material is properly positioned before attempting them.

Figure 7 Flexion while weight-bearing serves to
aggravate pain and posterior displacement of disc
material

Figure 7A shows a particularly contraindicated exercise promoted by both Williams and McKenzie. The posture recommended by McKenzie in Figure 7B should, likewise, never be allowed, let alone advocated, in a patient with low back pain due to disc herniation. The reasoning for not performing these exercises and those shown in Figure 8 will become manifest later, but suffice it to say that anyone with disc disease practicing these exercises can expect to increase and prolong their discomfort.

No true exercise involving WEIGHT-BEARING FLEXION of the involved painful segment of the spine is recommended or allowed with The O'Connor Technique (tm). You see, prior "wisdom" a la Williams has drawn a connection between lax abdominal tone and back pain. Probably, this association arises from the recognition that a substantial percentage of back pain sufferers have "pot-bellies." Increasing abdominal tone (by performing sit-ups or sucking in the gut) has the effect of flexing and straightening the Lumbar spine. According to William's and much of the current philosophy, a straightening of the spine is the ideal to be sought in an attempt to "stabilize" it. Therefore, they conclude, strengthening and increasing the abdominal musculature's tone must improve the condition of the spine. I view their reasoning as faulty and this opinion is supported by studies which make it increasingly clear that Lumbar extensor strength is more important than abdominal muscle strength in patients with low back pain.(32),(33)

Instead, I am forced to argue the opposite! Keeping the spine "straight" may even predispose to greater harm. Biological systems do not always satisfy teleological argumentation because what appears to be the obviously logical conclusion to a set of understandings may turn out to be wrong. In biological systems, it is better to attempt to explain reality by starting with a known fact and using logic to explain the fact rather than the opposite mentation--trying to use logic to arrive at a biological fact. More often than not, this turns out to be an exercise in wishful thinking rather than science.

Human biological systems are complex, and simple logic doesn't always apply because there are many unrecognized variables that can modify the conclusions that would otherwise appear obvious. In this instance, I can prove for myself that certain exercises can be actually harmful for persons with disc disease. I know by viewing my CT scan that I have a herniated disc at the L5-S1 level to the right. When I do a sit-up or toe-touch as advocated in Figure 8, I get pain; and I can feel the disc material go "out" and pain radiates to the right hip/buttock region. I can get out of the pain with one of my MANEUVERS, and I can feel the disc material go back "in" followed immediately by pain relief. The pain is located at a site wholly consistent with what the CT scan indicates. My conclusion, based on enlightened observation, is that WEIGHT BEARING FLEXION exercises are pain-inducing due to their displacement of disc material.

There is an exceedingly small probability that all this can be explained by some other mechanism; however, I find that difficult to substantiate when I apply the same mechanical reasoning to the overwhelming majority of my patients with disc disease who get pain with sit-ups and toe-touches then, they find immediate and repeated relief with O'Connor Technique MANEUVERS. Thereby, these personal experimental observations and results become reproducible, constituting "scientific evidence." This experience solidifies in my mind that sit-ups are contraindicated. I happen to find this reasoning far superior to handing a patient a set of painful exercises and concluding that the patient is a malingerer if he or she doesn't practice them.

However, my experience has not yet had the opportunity to affect the many physicians and physical therapists, acting on faulty logic, from advocating these exercises; nor, when they are refused to be performed by patients who find them unnecessarily painful, from characterizing the patient's reluctance to engage in them as emanating from a lack of motivation. Too, if a patient refuses to exercise, then they assume that there must be something wrong with the patient. With their ego-logic, it is inconceivable that the sit-up component of their exercise regimen is in error because that is not what they have come to accept as a fact through their educations. You see, clinicians are didactically taught that the classic back pain exercises help people. They reason that they must have produced a beneficial or they wouldn't still be taught. Therefore, the illogic follows: because patients improved, they must have gotten better because of the exercises. They seem unable to modify their belief structures so as to accept as a fact that the patients get pain and could actually be hurt from that exercise. Rather, they rationalize a psychological component to explain the patients' behavior. I find that type of logic erroneous and unfair. It doesn't seem to dawn on them that the patients who did get better may have been getting better in spite of the exercise prescription; and, for those that were getting worse, it may have been because of them.

Also, as alluded to above, when lifting or squatting, the other programs make nearly universal recommendations to keep the back "straight." Realistically, when a person with a disc problem attempts to follow this advice, lifting is still painful because when squatting, in order to keep the body's center of gravity over the feet, the back naturally goes into flexion when the buttocks gets close to the heels and the hands get close to the ground. When a person attempts to keep simply a "straight" back while initiating the full squatting posture to lift, the thighs press against the abdomen forcing the Lumbar spine into a flexed position (especially if they have something more than a model's abdominal girth.)

The O'Connor Technique (tm) advocates employing a judicious EXTENSION prior to lifting and the locking of the involved area into an intentional EXTENSION posture during lifting so long as pain is not reproduced. If the pain is reproduced, then a series of specific MANEUVERS are taught to stop this pain so that the EXTENSIONS can be accomplished safely and intelligently. The justification for these deviations from the usual and historical advice will become apparent later, but suffice it to say: This is not just another "same old, same old, back pain instruction manual."

Article Contents:
You are not alone
The Pain
Contemporary Perspective on Back Pain
Historical Perspective of Back Pain
Science and Art
Alternative Therapeutic Modalities
Back Surgery
Comparative Programs
Not an Excercise Program
Dismissing the "Psychological" Contribution To Spinal Pain
Getting Better as a Process
Become your own Chiropractor
Hope

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