Pain Relief Solutions
How To Do The BackBlock
'How to Do the BackBlock' or Spinal Decompression Exercises
Using a BackBlock for the treatment of back problems is the brainchild of Sarah Key, the renowned Sydney physiotherapist, founder and director of Sarah Key Global (Australia) Pty Ltd., with an international reputation for fixing bad backs. Based on the traditional yoga block, Sarah Key's BackBlock is designed to help back pain patients treat themselves
It is important to know how to use the BackBlock to get the best from it. The 'pressure change therapy' regime of the BackBlock is very potent. It must be done for the right amount of time and the following exercises at the right rhythm and rate. You can't afford to do your own thing and leave any of the steps out, or you will not get all the benefit.
The 3 Steps of Using The BackBlock in the 'Pressure Change Therapy' Regime
Doing the 3-step 'BackBlock' regime involves pulling the vertebrae apart and pushing them together again to to circulate discal fluids. The alternating pressures push and pull fresh nutrients and waste products in and out of the discs. They also do other, less obvious things, such as stimulating the healing processes at a cellular level and teasing out tight muscles and ligaments.
Below is 'How to Do the Back Block' in 3 easy steps. Don’t worry about getting it all off pat right away. When your Back Block arrives, you'll find it has instructions written all over it!
Step 1. Using the BackBlock for 60 Seconds
Begin by lying on your back on the floor. With your knees bent, lift your bottom and slide the Block on its flat side under your sacrum, that hard flat bone at the base of the spine with the two dimples either side. Usually you have to move it around to get it positioned just right – and make sure you fuss around to do this. Remember my words: where it’s most comfortable is where it should be.
Step 1a. Position the block under your bottom, not your lower back
From here, calmly straighten out both legs one at a time by sliding each heel out along the floor, and then relax (the most important bit!). Don’t lift your legs off the floor to straighten them. Don’t try to keep both heels together; get the feeling of your legs rolling out like two heavy tree trunks as you completely let everything go.
You will feel a sensation of agreeable discomfort in your lower back and across the front of both hips; more so as you relax and let go. And don’t be alarmed if you feel the familiar pain you have long complained of. If you search in the recesses of your mind midst all the anxiety of ‘is this right’ you will recognise a shriller potted version – almost a sweet pain version - of your familiar pain going right to the nub of things.
Step 1b. Lying draped backwards for 60 seconds
The action of lying backwards passively over the Back Block, gently opens out the lower back, just like pulling out a concertina. Of all the myriad movements you have performed in your life, you have probably never done this! And how old are you? And I hope you see it as remarkable that all you do is lie there while gravity does all the work. It separates the jammed lower vertebrae and takes you out of your habitual stoop. It is a brilliant combination, and really - so simple.
Step 2. The Knees Rocking
Funny to say, but this second step - rocking the knees to your chest – is almost an art form if done well. Done properly, it makes all the difference in the world. It is not a bounce, or a tug or a stretch; it is really a gentle, persuasive pumping action that also teases out tight muscles and ligaments. It makes such a difference to the results if you are doing it right.
You can rock your knees by holding behind your knees or on top of each knee, which may be better for letting the legs go wide, around your belly.
The rate the body ‘likes’ most is slightly faster than1 Hz (or one cycle per second). After all, this is the rhythm babies like, if you are rocking them to sleep in their carriage. It’s a calming, less is more, te-tump te-tump rhythm, as you rock your knees through a small range with your legs wide and ankles crossed (and if you’re doing it right – you’re almost fighting right now to keep awake!) This, I believe, is when you’re really getting things done, as you can feel cog-by-cog your spine and muscles let go and your back soften and relax. This is what you’re looking for.
Step 3. The Reverse Curl Ups
Fifteen knees to chin for every 60 seconds on the Block
It is imperative always to follow the Back Block with the low abdominal exercise of reverse curl ups. After rocking the knees first, to remove the cast-ness of your back, and make it easier to hump your back around the other way, you should go straight to these. If you fail to do the prescribed number (or worse still none at all) your back will feel stiff and sore over the next few days. Reverse curls and the BackBlock should always be balanced, otherwise the benefit is reduced.
IMPORTANT:
Do not proceed with this regimen without the express approval of your treating medical practitioner or therapist. If in doubt, do not proceeed.
Do not use the BackBlock if you have suffered in the last 12 months from severe back or leg pain, pins and needles, numbness or muscle weakness, distributed bladder control, saddle anaesthesia, advanced osteoporosis, spinal metastases, or anxiety or mental depression, or if you are in late stages of pregnancy.
Why the BackBlock Works
It's almost impossible to have too much information about the BackBlock and getting the best out of it. Subtle adjustments and corrections make all the difference to it working optimally - even make all the difference between it being something to endure, and pure 'doing things' pleasure.
Discs lose 20% of their discal fluid throughout the day, with approximately 10% lost in the first 2 hours of sitting.
Lying back, passively draped backwards over the BackBlock is especially effective at stretching the front of the discs. You may have heard me say before that the annulus fibrosis, the stuff that makes the thick, multi-layered mesh walls of the discs, is the 'toughest' structure in the human body. At the front of the discs, the annulus is reinforced in its toughness by the super-strong 'anterior longitudinal ligament', the strongest spinal ligament. So it's not surprising that both have a habit of adaptively shortening if they remain 'un-stretched' for any period of time.
Apart from simply interrupting the 'disc squashing' pressures of sitting, the BackBlock is GREAT at pulling out long again these adaptively shortened structures. But, it means business - and it can feel quite dauntingly uncomfortable, especially the first few days.
Being on the BackBlock actually feels like what the body needs.
Strangely enough though, I believe it’s the very simple 'knees rocking' exercise that does some REAL heavy hitting in the PCT regime. I say this because it particularly addresses the much-traumatised back walls of the lumbar discs that have such a high maintenance load.
It seems such a simple exercise it’s hard to imagine you’re doing anything at all, but be comforted that you are. You will also see in the specific ‘spinal appeasing’ exercises that this exercise (together with spinal rolling) is the universal panacea in calming a spine that has gone into a painful crisis of lock-down mode.
Knees rocking gaps open the back of the vertebrae and makes it easier for fluid & nutrients to be drawn in through the back disc wall.
The knees rocking exercise, while compressing the front of the discs opens up the back and by creating a relative negative pressure, sucks fluid in through the back disc wall. In effect, this gives this part of the disc 'first use' of each fresh tide of nutrients coming in and provides the inside running on repairs and maintenance for this overworked part of the disc.
Unlike the front, the back of the disc wall (the posterior annulus) is very s-t-r-e-t-c-h-y. In fact, it stretches by up to 90% of its length, making it easier for the spinal segments to flare open at the back, so you can bend forward to tie up your shoelaces.
Very importantly, stretching the back wall of the disc also thins it, thus making what the scientists call a 'shortened diffusion pathway' for nutrients to cross. By this, they mean less of an obstruction or physical barrier for nutrients to squeeze through to keep the heart of the discs alive. In fact, the nucleus is always the first part of the disc to break down and it is precisely because of the difficulty of this critical journey.
Getting nutrients right in to the heart of the nucleus is greatly helped by the gentle pumping action of rocking the knees to help push and suck fluids through the disc.
At the same time, the back disc wall's extraordinary ability to stretch also widens out the dense capillary network of fine blood vessels contained in the posterior longitudinal ligament running down the back of the discs. This ligamant actually blends intimately with the fibres of the disc wall itself, and in a sort of piggy-backing way, lends its blood vessels to the disc wall to help it survive. In this way, the disc wall is able to cope better with its high maintenance load begot of bending.
Because remember the forces of destruction on the back of the discs by bending are great. They are under constant duress, both from the fibre tension caused by the stretching (with all the stooped postures and slumped sitting) and the pressure from within, caused by the liquid nucleus being squidged backwards. Both factors cause micro-damage as they 'ping' fibres of the posterior annulus at a regular rate. This means that all lumbar discs are pretty well in constant need of running repairs.
The humble 'knees rocking' exercise I believe gives this much traumatised (and sensitive) back rim of the discs their best chance at repair. If you get the rate right in opening and closing the back of the discs, I believe you up the ante. Because if you do it in a way that is soporific, the muscles settle and let go more and you get a better influx and efflux of fluid.
[Image]: The rich blood capillary network 'loaned' to the back wall of the disc by the posterior longitudinal ligament helps this part with essential maintenance & repair.
General Points About Using a BackBlock
- Take time to find the position under the sacrum that's most comfortable
- There is a range up and down of several centimetres where it can go
- Remember 'where it's most comfortable is where it should be'
- Push one leg, then the other, out straight to relax back over the Block
- Never lift your legs high off the floor to straighten them
- When in position, say to yourself 'go heavy' to relax as much as possible
- Let the legs roll out (don't try to hold the ankles together)
- Don't be afraid to relax, although this will increase the sense of pulling
If you stay on the BackBlock too long it can be difficult getting off. Even so, there is always a murmur of discomfort as you lift your bottom to remove it. But if you have been there too long, what should be a small fleeting grab of pain becomes a full-blown crisis of getting cast. Although this usually does no harm in the long run, it can be unnerving and you (even subconsciously) may shy away from using the Back Block in future; it may not become your best friend.
Better to do shorter more fluent sessions, with one action melding into the next as you go into gentle, less-is-more knees rocking and then the reverse curl ups after each minute on the Block.
In Summary About the BackBlock
Even though it gets progressively less painful as you repeat each 3-step session on the Block, the structural changes take some time to reverse and improvement may not be immediate. Remember that discs have a slow metabolic rate and that they are slow to regenerate, just as they were slow to degenerate.
Over the first week or so the pain feels less heavy and dull and your back works better. A good sign is when the back feels 'lighter', as if you are no longer dragging an armour plated shell around with you. It feels less dense with movement, as if the segments are freer to move individually, and your hips swing when you walk. Especially in a prematurely ‘old’ and chronically stiff back, these changes and the easing of pain can feel nothing short of miraculous.
With more acute problems however, it is less straightforward. Where there is guarding from the muscle spasm, the BackBlock gives better results if it is taken more slowly, and if you have had a bad flare-up you should stop using it for several days (anything from three days to two weeks) until any newly acquired 'fragility' has dispersed.
Remember, it's normal for the back to feel a bit 'icky' when you start the BackBlock.
Even though you can get the same effect by using a stack of books, having a proper BackBlock is better because it can be more easily progressed through its various stages: from its lowest side, when the spine is particularly impacted, to the highest side when the spine is in its final stages of rehabilitation.
Apart from its stringent dimensions of the BackBlock, there's the added advantage of having the instruction plastered all over it. You need these as it's all too easy to forget. Having the proper BackBlock there also serves as a timely reminder as you spy it sitting in the corner by the TV. Just having it there makes you more likely to use it.
The blue BackBlock really comes into its own with travelling. All the carrying of heavy luggage, plus the long hours spent sitting and sleeping on unfamiliar beds means that you often need it most when you are away from home.
McKenzie Extensions in Prone Are No Substitute for the BackBlock
This exercise was validated by the New Zealander, Robin McKenzie, and as the hallmark procedure of the McKenzie Method, it has its rightful place in the annals of spinal treatment. It involves lying in prone and pushing the upper body back from the floor by straightening the arms. And though similar to the extension in supine provided by the BackBlock, it invokes a completely different set if dynamics.
I believe if the spinal segment is irritable - particularly the facet joints as the back of the spine - then extensions in prone will pinch the bones together and exacerbate the problem. And although the McKenzie extension procedure admirably stretches the hip flexor muscles and the very strong anterior longitudinal ligament at the front of the spine, it does not provide the gentle traction right through the lower back, nor the incremental backward glide of the lumbar segments to offset all the bending and static stooped postures we all endure throughout the day.
