Understanding Lower Back Pain & Sciatica - McKenzie Institute® , Dr. Yoav Suprun

all right hi welcome everyone thank you for joining me my name is Joe of super une physical therapist started my career in New York City in 1995 after serving in the Israeli Air Force for four years moved to New York and started my career as a personal trainer anyone knows how long it might have taken me to become a trainer in America in 1995 about yeah I read the book I memorized it passed the test and I was a certified personal trainer and got a bunch of clients in a gym in New York City and unfortunately I injured a bunch of them not intentionally didn't know that some of the stretches or some of the exercises I'm doing with them we're actually not appropriate for them I read a bunch of books read some magazines thought I knew how to train people but unfortunately I would get once in a while a phone call you know after what we did now my back pain is actually acting up and I'm feeling it down my leg at times I would get a phone call I'm sitting on my sofa and it's very hard for me to get up or times where I would hear I'm trying to turn my neck after a workout and I can't turn my neck and I stretch those clients when they were in pain as a trainer that's what I thought will be appropriate when you are in pain we tend to stretch lower back pain and sciatica is now a culprit it's a problem across the world not only in the United States we are seeing more and more people coming to our clinics complaining of back pain as well as sciatica sciatica is nerve pain that starts in the back but you actually feel it down the leg it feels as if you need to stretch that it feels as if you need to do something to alleviate your leg symptoms but actually the pain is not from your leg most of the time it's coming from your spine so I operate two clinics in Miami Beach and I see people who have been through traditional physical therapy car practic they may have had injections they may have had MRIs they were told all kinds of things on their back and often we find that about 75% of the patients that we see within a couple of sessions if you find the right direction and the right exercise for that person within a couple of session that person can fix themselves he or she can get real resolution of the problem not only that they can prevent it from happening again okay so we're going to talk about some of the misconceptions about lower back pain and sciatica 10% of this country right now either have back pain or sciatica one half of all working individuals at me to having lower back pain every year it is now it used to be the second most common reason to see the doctor now it became the primary reason we have heard many things in the past 20 years what one should do for example we heard you should strengthen your core so a lot of people did core strength a lot of people joined all kind of Pilates and yoga classes hoping to strengthen their core we see a spike of back pain and sciatica with people that try to strengthen their core you can be chiseled ripped six-pack if you don't know how to sit your core doesn't hold you here there is not an exercise for the core that will hold you up here not one that exists in the world you have to know how to sit in order for your spine to be in the right alignment if you are very strong and you strengthen your core for months or even years and you hired a trainer you took a class to strengthen your core but you see it like so in front of a computer or you slouch on your sofa eventually you may develop back pain or sciatica what does it mean most back pain cases are mechanical mechanical means something moves out of place there's days that it's in place and those days you walk you feel fine you drive your leg doesn't bother you and the day where it moves in the wrong direction all of a sudden it's hard for you to bend it's hard for you to get dressed you're walking in your leg feel funny after sitting you maybe lying in bed and all of a sudden your leg starts talking to you and you flip to the other side and the pain goes away it comes and goes it moves mechanical means something moves in your back it's not as a result often it's not a result of arthritic changes it's not as a result of getting old it's not as a result of having a weak core it's a result of something that moves and on days that it moves in the wrong direction it radiates down your leg on the days that it's in place you feel fine we spend a lot of money each year and we can get this country out of debt if we know how to prevent back pain if the public knows how to prevent back pains that my hope in seeing you is to teach you how to evaluate and treat it on your own to know what it means when your back is about to go out we can save this country a lot of money experts estimated as much as 80% of the public will experience back pain at some point in their life so let's take a look at the spine we have a spine right here so this is the spine you're looking at yourself now from behind this is your right buttock this is your left buttock when you look at the spine from a profile you see there are certain curvatures in the spine it looks like an S the spine as we age loses that s curvature often and it becomes more of a C hence you see a lot of people as they age are actually a little stuck here whether it's toward the cane or towards the Walker or they walk holding themselves in this position they used to be here and now the largest generation the history of the United States started to retire a couple of years ago they're called aa baby boomers and they're all saying listen I've strengthened my core I worked out I'd opened my chest and I'm still feeling that I'm not standing the way I used to stand look at mom dad grandma grandpa a lot of the people we know are ending up in this direction something occurs in the lower back over a lifetime that prevents the lower back to stay hollowed we are interested in keeping this if you can keep this lower back hollowed throughout your day there's a very good chance you will not experience back pain or sciatica so where can the pain come from good could be many many regions it could come from the vertebra it can come from the ligaments around your back it can come from the discs it can come from the nerve research shows it's very hard to pinpoint exactly what structure is the one that's causing you pain some of you have heard you you have a herniated disc or you may have osteoporosis and your bones are not as hot as a firm as they used to be you can see here this is a normal vertebra this is an osteoporotic vertebra it's more spongy more brittle causes of pain can come from many many regions however some of you told me before when we were talking outside you got an MRI and you have stenosis or you have herniated discs but at the same time when I asked you do you have good and bad days you said all of you said yeah there's days where it's there and days though it's not there so what happens to your stenosis or your herniated discs on the good days how come there's weeks where you feel fine and weeks where you're hurting this is an interesting phenomenon and it relates to the movement of the spine there is a wide distribution of nerves all around the spine starting around the early 90s some top researchers around the world have concluded that in Coos Leach Adele in 1991 published an interesting study the predominant not the only but the predominant source of back pain was the intervertebral discs and some of had MRIs and you're aware of it that it's coming from the disk and the source of sciatica this is the sciatic nerve the source of sciatica is a compressed nerve root something that chokes the nerve and when the nerve gets choked in your back you fill it down into the leg ah one lady here in the back said to me it's my scoliosis I was told it's my scoliosis and I asked her do you have good and bad day and you said yes there's days that my back doesn't hurt there's weeks that I feel fine how can your scoliosis be the cause of the problem if you have weeks where it doesn't bother you the scoliosis is still there so when I graduated NYU after injuring enough people as a trainer I am obviously I'm exaggerating but there was a bunch of people I couldn't fix didn't know what to do with them I decided to go to NYU and did my doctor and physical therapy and got great education there and went to study afterwards with this gentleman his name is Robin Mackenzie Mackenzie unfortunately passed away two years ago he lived his life in New Zealand and in 1956 he discovered a very interesting phenomena a patient will he called him mr. Smith came into him into his office limping he walks in with severe right leg pain and Robin says to mr. Smith mr. Smith why are you walking like this and mr. Smith said I had back pain on and off intermittent for weeks however three weeks ago sorry for years but three weeks ago I lifted something heavy and all of a sudden the back pain became leg pain and now my leg is hurting and I'm not feeling steady when I'm walk when I walk so Mackenzie says to mr. Smith please go to that room over there and lie on the stomach I'll be right there I'm going to examine you take your shirt off flounder stomach what Mackenzie didn't know is in that room the bed was left elevated his assistant did not take that piece of wood down so mr. Smith goes and lies in a position called extension McKenzie walks into the room we finish up with another patient he walks into the room and he see the patient lies down bend backwards that was considered the worst thing you can do for someone who has back pain he looks at mr. Smith and ah mr. Smith how are you feeling says to him my leg pain is gone what do you mean it's gone it's gone get up gets up not in my leg the pain moved out of my leg back to where it used to be in the center of my back so McKenzie was very intrigued by that phenomena how can the pain move what we know right now and what research is supporting and you are welcome to look at it online Google the phenomena of centralization of back pain every neurosurgeon knows about it if you have back pain that becomes leg pain you are getting progressively worse if you have leg pain that becomes back pain you're getting better meaning if you came to take a class Zumba class Pilates class yoga class p90x TRX spinning whatever it is and you started the class with leg pain and you left the class and now your back is hurting you are actually moving in the right direction for your back something is moving your back in the right direction the opposite is also true you started a class or you did an activity and it was hurting your back when you are beginning that last and now 45 minutes or an hour at the end of the class your back feels fine but your leg feels funny when you're driving home that class may have injured you and that's something we're trying to instill in them to the American public which is a very important phenomena I did not know as a trainer location of pain where it should hurt is paramount do not fear pain when I see you individually in the clinic after this talk I'm going to move you around to see if I can change your pain location if we can get the pain out of your leg into the back it is heavily documented to be a good thing and you have a good prognosis you we can get better and the goal in the assessment after we after we meet is to try to see if we can change your pain and we can change your mechanics and I'll talk about mechanics in a little bit should you go get an MRI if you have back pain and we now know that after all those years of people having MRIs we have a group in Tallahassee Florida that convinced Blue Cross Blue Shield to look at it Blue Cross Blue Shield of Tallahassee Florida dr. Nance even vests and the chief medical officer of Blue Cross Blue Shield in Tallahassee Florida over time so an interesting phenomenon issues interesting change 65 out of 100 adults without any back pain have abnormalities such as authorises and bulging discs meaning if you take a thousand people right now over the age of 65 you throw them into an MRI machine you will probably get major changes in their back and they may not be symptomatic meaning the patient does not have pain although the MRI may show that they have major changes such as arthritic changes bulging disc herniated discs Fassett arthrosis whatever it is but that person may not have pain which means these images make early clinical correlation problematic and can lead to inaccurate association between chronic asymptomatic findings and acute pain just because it's on an MRI doesn't mean that you have to be in pain so for us to understand you we need to move you to see if we can change your pain unless there's a serious symptoms on uncontrolled bowel and bladder these imaging studies are not recommended unless after a couple of weeks up to six weeks the pain is still severe not improving the older you are the greater the chances that your back x-rays or MRIs will show that you have something there that may not be the reason to your pain the take-home message ladies and gentlemen is you do not want to go under any procedures x-rays MRIs medication injection or surgery for sure not surgery unless you saw a mechanical therapist that can move you around we as Mackenzie or MDT therapist mechanical diagnosis and therapy that's what we do when we see you I listen to your history I move you around to try to see if we can get your pain out of your leg into your back and abolish it from your back the pain should recede back and disappear from your back research have shown that the mackenzie procedures for assessing patients with low back pain was found to be more accurate than an MRI in differentiating disco genic or non disco genic pain as well as contained from non contained discs what does it mean contained versus non contain discs here we have the model of virtu vertebra and a disc between them this is the spinal cord these are the nerve roots when someone has a bulging disc the disc starts to move towards the nerve it starts with back pain and often it moves on to the nerve and the further it squeezes or chokes the nerve the further down the leg you will feel your symptoms as the pain moves back up often we find that that bulge actually is receding back towards the center that was Mackenzie's model the hypothesis that he developed in the 50s something must have moved when mr. Smith lay there in extension and the pain came out of his leg back into the back a contained disc means this is still intact her herniated disc means this jelly that in the disk has squirted out when it squirts out often people start to have severe neurological that's what's a herniated disc is severe neurological symptoms down below their knee you may have a foot drop you may have difficulty walking severe burning sensation whether it's in the neck down the arm with weakness or in the back down the leg what we're looking is for what we call a directional preference a directional preference means you're moving your spine in a direction that puts your joints in your back back into place once those joints are back into place a lot of the time the pain gets better and I'll give you an example some of you have felt it or you know someone that exhibits this behavior you sit in the car or you sit in a movie theater you sit in a restaurant you get up and the first couple of steps you feel bad a core leg pain as you continue to move the buttock of back pain disappears and it goes away and all of a sudden as you walk you feel nothing that means you're actually moving in a direction that your spine needs that's a directional preference we're going to find in the assessment the movement for your spine that you will duplicate a couple of times during the day to put you back in that direction to see if we can vanish your symptoms out of your legs back into the back and teach you how to prevent it from happening again some of you have gotten MRI and we talked about it before in the breakout sessions and I was asked to show this here we have the spinal cord here are the intervertebral discs and this is what we call it bulging discs some radiologists may call it a herniated disc happy in the middle no problem starting to bulge with the green arrow is bulging even further and choking the nerve the more you choke the nerves in your back the further down the leg the sensation will be filled here we had a patient that was told that he needs surgery and after three months of a severe herniation we did another MRI and all of a sudden the symptoms that were there initially we're not there and the MRI has changed all we're saying is that there is a direction that you can move into and if you're a good candidate with 75% of you are your MRI can change if it's being done after the treatment so what's the hypothesis what's the model and again this is a model the MA shows the following here is the disk and here is the nucleus pulposus the nucleus pulposus is the center of the disk if you're looking at it it should be in the middle away from the nerve roots away from the spinal cord during the day we Bend a lot in this direction think about it you get out of bed you sit on your bed that's your first bending to get out of the bed to walk to the bathroom you bend again you prepare the toothpaste on the toothbrush you bend forward you brush your teeth for when you wash your face we shave we put makeup we get dressed we sit on the toilet we drive we hours in front of the computer then we're hours in front of the TV so we are constantly doing this to the spine we're taking it from the s and we move it towards the C and when you squeeze the vertebrae in the front that was Mackenzie's theory oh that is the theory behind the model when you squeeze the disc in the front and when the ligaments back here becomes slack as a result of sitting and slouching all day they become over flexible when you squeeze something in the front the jelly is going to migrate backwards it waits for you when you get up so the sensation you feel once you get up of that stiffness in the lower back is often associated with something that mechanically migrated backwards first couple of steps may hurt but actually as you walk some of you feel better because it moves back in you're starting to restore that s curvature here's the problem it migrates back goes back in migrates goes back in how many times you can bend the paperclip until it gives there's so many times one can do this until a fever forms a feature is the weak spot within the annulus would hold the disc in place and geli finds that direction and goes and prolapse into it now it's starting to migrate towards your nervous system towards your spinal cord or towards the nerve roots it can eventually extrude or even sequester which is a herniation if we don't treat it appropriately at the right time so that jelly can migrate in different direction can go directly back and go to the side more often than not it moves towards the side towards where the nerve roots are and when it squeezes onto the nerves or it sit close to the nerve you have those changing symptoms you sit in the car you squeeze it some more your leg is talking to you you get out of the car you walk around just like you mentioned to me before goes away comes and goes is one of the most common complaints good and bad days lots of variabilities so McKenzie realized is that occurs actually throughout the whole spine it occurs in the neck occurs in the lumbar spine here is the model two vertebrae just like we talked about before and the discs between them two vertebrae and a disc between them normal Anatomy in a bird's eye view that's which says cut here jelly should be in the middle the degeneration occurs in what we call a posterior lateral towards the back because all day long anyone can guesstimate how many times we've been forward on average 200,000 2,000 3,500 times a day average person anywhere between three to five thousand times a day you bend forward think of how many times you do it breakfast lunch dinner in your office in the car everything we do in our life mainly is bending forward so we start to push stuff backward it bulges backwards and some of you are scheduled for injection on a bulging disk now what you should do is get an assessment with us first because if we can find the direction that moves this back in you will not need an injection two of you mentioned to me at the beginning of the talk that after an injection you have no resolution of your symptoms why because you can inject this but unless you remove this mechanical obstruction back in the injection will help maybe for a couple of days to calm down the nerve but you have to take whatever using your nerve back in the best person to do it is you no one can do it better than you because you got to do it a couple of times a day and if you learn how to move in that direction you will be able to eliminate your leg or your back symptoms with time and get it back into place where it will not bug your nerve so eventually it sits on the nerve and it can herniate it can break through and that may be the next progression for your problem and we want to avoid that right so the disk model refer to radiating leg pain is caused by displace nuclear disc material mechanically stimulating the pain sensitive annulus of the nerve root something moves out of place as long as the annulus as long as the envelope that holds the disc is in place and it's intact we will find repeated end range loading we will move you a lot in the clinic and you will duplicate one movement when we find that movement you will duplicate it when you are by yourself at home at the supermarket in the office and you will pull the pain out of the leg into the back you can return it on your own no one has to do it to you some of you have had many different therapies for your spine or your sciatica and you're saying it still comes it comes maybe it goes away for a couple of weeks and then returns you need to know when it's going to go out and we can teach you when it's going to go out on you so an interesting thing is to remember that bending forward actually squeezes the nucleus it squeezes the center backwards so activities that involve a lot of flexion a lot of that like gardening like cleaning may aggravate your symptoms but it doesn't mean you shouldn't do those if you know what to do before gardening and cleaning before doing the dishes before taking a long drive in the car where your leg starts bugging you or when you feel it what you do you'll be able to abolish those and that's what we're going to find a ballet show symptoms you'll be able to find those when we evaluate you so basically the majority not not only but the majority of sciatica comes as a result of a pinched nerve now a nerve can be pinched not as a result of a disc moving on it it could be a growth of a bone or a bone spur something that's not amenable to change with mechanical therapy however in a couple of visits we'll be able to tell you you don't need to come here there's a good chance you're a candidate for surgery but we will exhaust conservative care educating you in the process to figure out if your problem can change or not so here is a picture of the spine and one of the most common areas for this form of of a problem what we call it the arrangement is it around l4 l5 or l5 s1 and we see the different stages of disc bulge slasher knee Asian down here at the bottom and this here says a pinched nerve root and you can see when the disc moves towards the nerve root it starts to choke it when I would train people and they will tell me my pain is going down the leg in this fashion I used to roll them on a foam roller when stretch their IT band iliotibial band thinking that their pain is coming from their leg I never put 1+1 realizing that if we did squats if we did lunges if we did sumba if they did yoga Pilates or spinning you should be sore in both your legs if you have pain after activity or you're starting to have pain in your daily activity or daily life that's going down one leg and you're limping you are probably dealing unless someone hits you you're probably dealing with an angry nerve root that nerve root has to be freed from whatever is choking it if it squeezes on l5 nerve root a lot of the time you feel the pain from here going down the leg it may behave or look to you like a tight hamstring so when patients of mine will complain of it I would stretch them or teach them how to stretch their legs not realizing the source of the pain is not the leg it's coming from the lumbar spine or s1 nerve root definitely if you're coming with numbness or motor weakness you should know your problem is coming for sure from the lumbar spine very good chance it's coming from the lumbar spine if you felt it in the back first and now it's going down into your leg some of our patients are complaining of motor deficits difficult difficulty walking difficulty or starting to hit carpet some of you said to me I used to go up the stairs now one leg feels very weak when I go up the stairs if one leg is starting to behave in a very different fashion compared to the other leg there's a good chance your electricity to that leg is getting obstructed because something is bugging the nerve root in your lower back and that's the goal of our meeting together is to find out what can we do to change it and if it is changeable this may affect your motor ability reflexes you may have any sensation down your leg or into your foot such as numbness and tingling may you may feel it down into your hand numbness and tingling in the hand or weakness in the arm that if the nerve roots in the neck are involved and so yl BP lower back pain is such a big problem think about what you do all day long most of us sleep in some form of flexion we slouch a lot during the day we sit on the wrong sofas I have a lot of patients that by beautiful low deep sofas and use when you sit low and your knees go above your pelvis the period of time of you sitting you're actually over time hurting yourself if you find yourself getting up from the sofa and holding your back or getting out of the car and doing this you should know your back is starting to deranged the mechanics of your backs are moving in the wrong direction we make the bed we're in the car gardening cleaning sitting in front of the computer hours a day hundred thousand years ago we are hunters and gatherers what we did we woke up in the morning when to look for fruits vegetables and water we moved a lion chased us we ran away we saw a deer we chased it to kill it and bring the food to the camp now where are we all day here hours hours upon hours upon hours staring at a monitor spending time here without moving then someone will tell you strengthen your core and what is this motion very similar to all these motions so when I was a trainer I had everyone do core strengthening exercises not realizing yes I am strengthening their muscles but I'm actually doing what on their spine as they're doing crunches I'm flexing it even further and there would be times when after doing crunches I would lean on some of my clients and push their knees towards the chest and everyone loves that it feels good when someone hugs your knees to your chest but feels good and ladies and gentlemen this is a very difficult concept feels good doesn't mean it makes you good if hugging these two chairs which all of us love to do was the answer a lot of us will not be feeling lower back pain if hugging knees to chest or flexing our spine would be appropriate we will not be having issues after sitting slouched or sitting on low sofas so there's something going on mechanically now we talked before on the break about choice of activity if you sit for example all day in the office and you have back pain spinning may not be the right appropriate exercise for you you may want to choose not an activity where you're sitting again you may not want to sit on a recumbent bike if you have back pain or sciatica you probably want to figure out some activity whether it's elliptical whether it's walking see one of us first to figure out the right activity for you but there's a good chance that if you change your exercise your pain will move out of your leg back into the back and then it will disappear and then when we find your directional preference when we find your appropriate exercise your enjoyment of staying fit will skyrocket we're seeing so many people coming to our offices trying to hire a trainer trying to join a class and way the biggest spike is right now as we're coming towards the end of the year everyone has the new year's resolution I'm going to lose weight I'm going to join a class and then February my office is bombarded with I can't stay active I'm trying to stay active I'm trying to do something and it's again going down my leg oh it's in my back we need to figure out why we need to figure out what direction you need to be moving in McKenzie found an interesting phenomena if you see it slouched whether it's in the car or at home where you flatten your lower back you eliminate this hollow something occurs and the first structure that he noticed was the ligaments the ligaments connect bone to bone and there's a phenomenon called creep when you seat for prolonged period of time in a slouched posture he called it the silent killer when you sit here for prolonged period of time you elongate those ligaments in the back and now you're giving a clear way for the disc to move backwards so it's the prolonged sitting some of you say no all I did was I bent forward to take a piece of paper out of the fax machine or I was just putting make up and all of a sudden my back went out or I sneezed or I just lifted a bottle of orange juice out of the refrigerator my back went out well what were you doing before that how are you sitting how long were you sitting so we're going to teach you how to move your back in the right direction and what you might need to use when you're sitting to prevent the back from going out on you so bad sitting posture places the spine in flexion and is identical to the fully flexed standing posture some of you say when I see it I like to put a jacket in my lower back I go to the movie theater I always take a jacket with me or I take my person I put it there I feel better you guys that do that you realize something you like to have your back pushed in this direction and if that's the case we just need to promote more of those motions in that direction throughout the day and your problem will be resolved frequency of flexion from the moment we rise till we go to bed at night we are predominantly in flexed posture our life is forward we don't do things here we do things here we do things here about 3,500 times a day we move in this direction and we age in this direction so it's a choice to age up right or to age four just because you're aging doesn't mean you have to age forward so some of you asked me already before the talk what exercises are right for me I don't know the reason I don't know is because what's going to work for you may not work for you may not work for you I have to move you some of you every couple of months develop what we call a lateral shift that needs to be addressed with one exercise versus someone that comes and gets stuck in this direction which will require a different exercise so we do an assessment we're going to move you in multiple directions to find the one movement that will take your pain out of your leg into the back and from the back it should disappear and you will duplicate that exercise every two to three hours for a couple of days and the goal is for the leg not to talk to you the back may increase initially and the goal for it for the back to abolish afterwards it may be a partial correction component it may be an extension in lying exercise it may be flexion in lying exercise we won't know until we move you but if we find a direction that you should move in you should only do that specific exercise for a couple of days and not combine multiple exercises when I was training people I gave them a variety of stretches one knee to chest other knee to chest knee side to side pelvic raises core strengthening opposite arm and leg cat-cow a variety that some of you are smiling now because that's what you're doing in therapy and you still leave with your problem if I have a cut in the back of the knuckle what do I have to not do I shouldn't bend it because the cut will open there's only one direction I should move my cutting and that is this direction now what I should put a band-aid or should put is some kind of a splint and not bend it let it heal your body is amazing ladies and gentlemen in fixing itself you just need to give you the conditions to heal we made back pain so complicated we're often it's as simple as the cut on the knuckle is when you were a kid you knew that all I have to do is stop bugging it or mom told you keep the finger straight or put a little ice cream stick here tie something to it let it heal four or five days later mom took the band-aid off and now what do you have afterwards a scar or scab now it's going to hurt a little bit when you bend it until you restore that full range of motion we will find a point in time where your leg being become back pain and the back pain disappears and you will feel just slight stiffness in the lower back and then we'll start stretching your back in the opposite direction so the McKenzie method involves more than just exercises and when you come to the assessment with me you're welcome to bring your family members we have constantly family members who are coming to learn how to help each other there are times where I teach a mother or a spouse to apply some of the techniques so they can duplicate the care at home there is more to exercises there's room for therapists over pressure mobilization but we are a very safe method because we apply our hands on technique only after we moved you multiple times and we see that the direction you're moving into is the right direction the pain is coming out of your leg into the back if you plateau we help you push it a little further but most of you 70% of you can do it on your own just like you can brush your teeth no one comes and does it for you morning and evening you can brush you can floss you can move use mouthwash you don't need someone to do it on your own your back can be brushed and flossed with movement the best medicine ladies and gentlemen for your back is movement but the movement should be in the right direction then we will help you figure out what is the right exercise for you to stay healthy to stay fit go staying healthy and fit is paramount but you need to know which exercise is appropriate for you for example I spoke with a gentleman before who said to me he did leg press was a little too much 250 pounds could barely get off the leg press machine well maybe leg press is not appropriate for you think about it you are pushing a platform why not push mother earth and get up it's the same concept do you have to sit and stand for the rest of your life yes everything you're doing daily basis sitting on a toilet in the car you can push your mother earth and get up if that's easy for you we will find a load maybe dumbbells or a backpack filled with weight and you can strengthen yourself without necessarily going into a leg press machine we will find an appropriate exercise program for you that keeps you healthy and keeps you functional okay the most important functional exercise activity in the world functional is walking yes we got a walk followed by C to stand you gotta maintain these two activities as much as you can till the last day on the planet ability to walk ability to get up from a sofa from a chair without any restriction so to summarize lower back pain is a big epidemic most of it is caused by poor sitting posture and mechanical pain is very common mechanical pain can change some days it's there some days it's not we need to help you abolish it if you feel centralization within our first visit it's a very good thing has excellent research to support it movement is the best medicine to find a Mackenzie therapist around where you are some of you are leaving town today you can go to the McKenzie Institute website McKenzie Institute org or McKenzie MDT dot org mechanical diagnosis and therapy or just Google McKenzie USA you will find our clinicians in every city around the country and don't rely on someone to fix you learn to fix yourself you can do it we can teach you how thank you everyone for coming this was great hopefully we'll see you all very soon thank you

Channel: The McKenzie Institute, USA

Views: 2,590,367

Keywords: back pain, health, joint pain, McKenzie Institute International, McKenzie Institute USA, McKenzie Method, McKenzie Method of Mechanical Diagnosis and Therapy, MDT, neck pain, physical therapy, PT, rehabilitation, treatment, physical therapy training, lower extremities, lumbar therapy, advanced physical therapy, physical therapy lower extremities, physical therapy practice, webinar, Yoav Suprun, Sobe Spine, Florida, diagnosis, prognosis, intervention, examination, evaluation

Id: gsUE0CEz6g0

Length: 43min 28sec (2608 seconds)

Published: Tue Feb 09 2016