Rebuilding Milo

1. Back Pain: More Than Meets the MRI

Results on imaging show poor correlation to symptoms of pain.

MRI limitations. Relying solely on MRI scans for back pain diagnosis is flawed. Scans often reveal "abnormalities" like bulging discs that may not be the source of pain, as many asymptomatic individuals have similar findings.

Context is crucial. A skilled clinician must conduct a thorough examination to understand which specific movements, loads, and postures trigger pain. This context is essential for interpreting MRI results accurately.

Treat the person. The focus should be on restoring optimal movement through subtle improvements in strength, mobility, and coordination, rather than solely targeting anatomical abnormalities. This approach addresses the cause of pain and promotes long-term healing.

2. Decoding Back Injury Anatomy: Power = Force x Velocity

If you want your spine to move, you want to move it under minimal load.

Understanding the spine. The spine is a complex structure of vertebrae, discs, and facet joints, designed for movement within a "neutral" zone. Injuries often occur when the spine is loaded outside this zone.

Power equation. Spinal injuries often result from the equation Power = Force × Velocity. High force (heavy lifting) combined with high velocity (spinal movement) significantly increases injury risk.

Minimize spinal movement. To protect the spine, prioritize either minimal load with spinal movement (as in dance or golf) or heavy load with a locked, stable spine (as in powerlifting). This approach minimizes power generation at the spine and reduces injury risk.

3. Screening Your Back: Find Your Pain Trigger

There is always a reason for back pain.

Kinesiopathologic model. The key to fixing back pain lies in identifying the movement problems that led to the injury. This approach focuses on the "why" behind the pain, rather than solely treating the affected tissue.

Self-assessment. The screening process involves a detailed self-analysis of activities, movements, and postures that trigger pain, as well as those that can be performed without pain. This helps classify the injury as flexion intolerance, extension intolerance, rotation intolerance, or load intolerance.

Screening tests. Posture assessments, movement assessments (squats, RDLs), and load testing (weighted front raises, heel drops) provide further insights into individual pain triggers and movement dysfunctions. These tests help pinpoint specific postures, motions, and loads to avoid or modify.

4. Classifying Back Pain: Flexion, Extension, and Load Intolerance

During recovery, what you don’t do is often just as important as what you do do.

Movement diagnosis. Classifying back pain based on movement patterns (flexion, extension, rotation, load) is more useful than focusing solely on anatomical diagnoses. This approach guides treatment by addressing the specific triggers of pain.

General guidelines. Based on the movement diagnosis, specific guidelines are provided for activities like sleeping, sitting, standing, and lifting. These guidelines aim to minimize pain triggers and promote healing.

Individualized approach. It's crucial to remember that there is no one-size-fits-all approach to fixing back pain. Everyone responds differently, and the key is to identify and modify individual pain triggers.

5. Rebuilding Your Core: Stability is Key

It is the stiffness that is important for stability.

Core stability defined. Core stability refers to the ability to limit excessive or unwanted motion of the spine. It's achieved through the coordinated contraction of muscles surrounding the spine, creating stiffness.

Isometric exercises. Isometric exercises, which involve muscle contraction without joint movement, are superior to dynamic strengthening exercises for enhancing spinal stiffness and stability. These exercises improve muscular endurance and coordination.

The Big Three. The McGill Big Three exercises (curl-up, side plank, bird-dog) efficiently address all core muscles without placing excessive stress on the spine. These exercises enhance stability, muscular endurance, and coordination.

6. Bridging the Gap: From Rehab to Performance

Eliminating symptoms and building your body to become more resilient to injury requires a different and more active approach.

Three-stage approach. Resolving pain requires a three-stage approach: eliminating the cause of pain, addressing weak links, and rebuilding the body's capacity to handle high demands. This approach ensures long-term healing and injury prevention.

Hip hinge. Learning to move from the hips and keep the spine stable (a hip hinge) is essential for those with flexion intolerance. This movement pattern should be adopted for all daily activities, from picking up objects to performing barbell lifts.

Progressive loading. Rebuilding the body involves a gradual progression of exercises, starting with spine-friendly core stability work and progressing to exercises that challenge stability in multiple planes of motion. This approach ensures a safe and effective return to high-performance lifting.

7. Hip Pain: Anatomy and Individual Variations

The deeper the hip socket, the less the femur can move and rotate.

Hip joint complexity. The hip joint is a ball-and-socket joint with significant anatomical variations that influence movement and injury risk. These variations include the shape and orientation of the hip socket and the angle of the femur.

Anatomical assessments. Simple tests, such as assessing hip rotation range of motion and performing Craig's test, can provide insights into individual hip anatomy and potential movement limitations. These assessments help tailor training and rehabilitation programs.

Individualized technique. It's crucial to adapt lifting technique to individual hip anatomy. Forcing a specific technique without considering anatomical variations can lead to pain and injury.

8. Knee Pain: Beyond the Anatomy-Based Diagnosis

There is no one-size-fits-all approach when it comes to knee pain because there is no one universal movement that equally stresses all of the muscles that surround the spine.

Movement-based approach. Instead of focusing solely on anatomical diagnoses like patellofemoral pain syndrome, it's essential to identify the movement problems that contribute to knee pain. This approach allows for targeted and effective treatment.

Screening process. The screening process involves assessing movement patterns (squats, single-leg squats), mobility (ankle and hip), and load tolerance. This helps classify knee pain as a biomechanical dysfunction, mobility deficiency, stability deficiency, or load intolerance.

Rehabilitation strategies. Based on the classification, specific rehabilitation strategies are implemented, including mobility exercises, stability exercises, and load management techniques. This individualized approach ensures a comprehensive and effective recovery.

9. Shoulder Pain: Balancing Mobility and Stability

The shoulder is the most dynamic and intricate joint in the entire body.

Shoulder complexity. The shoulder is a highly mobile joint that requires a delicate balance of mobility and stability. Injuries often result from imbalances between prime movers and primary stabilizers, instability, or poor movement technique.

Screening process. The screening process involves assessing movement patterns, mobility (thoracic spine, lats, pecs), stability (rotator cuff strength), and technique. This helps identify the specific factors contributing to shoulder pain.

Rehabilitation strategies. Rehabilitation strategies include mobility exercises, strengthening exercises for the rotator cuff and scapular stabilizers, and movement re-education. This comprehensive approach aims to restore balance and function to the shoulder complex.

Last updated: April 23, 2025