Yoga for Lower Back Pain

To understand how stretching can improve or aggravate disc problems, let’s look at how a disc works and how it gets damaged. Intervertebral discs function as shock absorbers, cushioning the brain from jarring as we walk, run, and jump. Each disc consists of two parts: the inner disc, the nucleus pulposus, made of a shock-absorbing gel-like substance, and the annulus fibrosis, the rings of ligament that surround and support the center.

A normal lumbar spine has a mild curve forward, and in this position, weight is evenly distributed throughout each disc. During toe-touching, the lower back flexes, losing its normal curve, and more weight is put on the front of the discs. The gel-like centers get pushed backward, into the now stretching support ligaments. While this can happen during forward bending even if a person tends to have excessive lumbar curve (“swayback”), it is especially problematic if the spine has lost the normal curve and become flattened.

With repetition, or if great force is applied as in heavy lifting, the ligaments weaken and may “bulge” like a bubble in the wall of a tire. Or the ligaments may tear, allowing the gel-like inner disc to leak out, resulting in a herniated disc. The bulging or herniated disc may cause lower back pain or, if it is pressing on an adjacent nerve, pain can be referred into the hip and leg. Bulging and herniated discs may be treated conservatively, with physical therapy, exercise, and other noninvasive treatments, but a badly herniated disc is a serious medical problem which may require surgery and a lengthy recovery period.

While heavy lifting is a well-known cause of back injuries, disc damage is just as frequently caused by the smaller but repetitious forward-bending movements we make during daily activities at work and at home. For most of us, half of our body weight is above the waist. Just as a child “weighs more” as he or she slides away from the center to sit at the end of a teeter-totter, our own upper body weight exerts greater force at the disc as we bend farther forward. This tremendous force on the disc, added to the strain on the supporting ligaments, sets the stage for damage.

In our society, opportunities abound for repetitive forward bending: child care, yardwork, housework, shopping. Even sedentary work may exert strain on the lower back; for example, someone bending and twisting from a sitting position to lift a heavy object out of a bottom desk drawer. The greater the weight being lifted (and the weight of one’s own body), the greater the pressure on the disc.

Forward bending activities, especially combined with lifting, are also the most common cause of back “strain.” While much less serious than disc injuries, back strain is responsible for most of our lower back pain, including the Monday morning ache after weekend gardening.

Lower Back Pain Relief Yoga Sequence


1. Supine Hamstring Stretch


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Lying on your back, bend your right knee into your chest and place a strap or rolled-up towel around the ball of your foot. Straighten your leg toward the ceiling. Press out through both heels. If the lower back feels strained, bend the left knee and place the foot on the ground.Hold for 3-5 minutes and then switch to the left let for 3-5 minutes.


2. Two-Knee Twist


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Lying on your back, bend your knees into your chest and bring your arms out at a T. As you exhale lower your knees to ground on the right. Keep both shoulders pressing down firmly. If the left shoulder lifts, lower your knees further away from the right arm. Hold for 1-2 minutes each side.


3. Sphinx


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Lying on your stomach, prop yourself up on your forearms. Align your elbows directly under your shoulders. Press firmly through your palms and the tops of your feet. Press your pubic bone forward. You will feel sensations in your lower back, but breathe through it. You are allowing blood flow into the lower back for healing.Hold for 1-3 minutes.


4A. Pigeon


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From all-fours, bring your right knee behind your right wrist with your lower leg at a diagonal toward your left hip. Square off your hips toward the ground. Bend forward. Widen the elbows and place one hand on top of the other as a pillow for your forehead. Hold 2-3 minutes and then switch to the left side for 2-3 minutes.


If pigeon pose bothers your knees, then do Thread the Needle.


4B. Thread the Needle


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Lying on your back, bend both knees with the feet flat on the ground. Bend the right knee like a figure four, with the outer left ankle to the right thigh. Lift the left foot into the air, bringing the left calf parallel to the ground. Thread your right hand between the opening of the legs and interlace your hands behind your left thigh. Hold 2-3 minutes and then repeat on the other side.


5. Legs Up the Wall


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Scoot your buttocks all the way into the wall and swing your feet up the wall. This pose is excellent for relaxing the muscles of the lower back and drains stagnant fluid from the feet and ankles. Do this pose after a challenging workout and always after traveling by plane.Hold for 5-10 minutes.




1. “This sequence is very safe for people with lower-back issues and can help to alleviate pain when done regularly,” says Jean Koerner who has been teaching yoga for 20 years and is currently an instructor at ISHTA Yoga in New York City. ISHTA is a Sanskrit word for “personalized practice,” and this routine is customized for back-pain sufferers.



Next, inhale, draw your knees into your chest, and as you exhale, lower your knees to the right, keeping them at hip level.



 Lie on your back with your knees bent, feet flat on the floor, hip-width apart and 4 to 6 inches away from your sit bones. Open the arms out to the sides, even with your shoulders, palms facing up. Then lift your hips and shift them over 4 inches to the left, setting yourself off center.



 Lie on your back with your feet flat on floor, palms facing down. Lift your hips and torso off the floor, pressing into your palms and feet. Then interlace your hands under your hips and press your shoulders and upper arms into the floor, lifting your hips higher toward the ceiling. As your breastbone rises toward your chin, move your chin back a little away from your chest. Hold for six to eight breaths. Then lower yourself slowly rolling down from the top of your spine to your tailbone. Rest for four breaths before repeating.


5. Extended side angle pose

Stand with your feet about 4 feet apart and raise your arms out to your sides, shoulder height, with your palms facing down. Turn your left foot and leg out 90 degrees to the left and your right foot in about 15 to 30 degrees. Inhale, and as you exhale bend your left knee up to 90 degrees, keeping your knee stacked over your heel. Place the top of your left forearm on your left thigh and roll your chest open toward the ceiling. Raise your right hand straight up and turn your head to look at it. Hold for five breaths. Then carefully come out of the pose and repeat on the opposite side.


6.Warrior II pose

 Stand with your feet about 4 feet apart and raise your arms out to the sides at shoulder height, palms facing down. Then turn your left foot and leg 90 degrees out to the left and your right foot in about 15 to 30 degrees. Inhale, and as you exhale bend your left knee up to 90 degrees, keeping your knee stacked over your heel. To further protect your knee, center it over the middle of your foot, so it’s pointing over your second and third toes. Then turn your face to the left and gaze out over your left hand. Hold for five breaths before straightening up and repeating on the opposite side.



From down dog, keep the hands planted on the floor, but walk the feet towards the hands. Hold for 5 breaths. 
2. Then, start at the tailbone and move to standing by rolling up the back vertebrae by vertebrae. Keep the feet pressing into the floor and come to a standing position with feet hip-distance apart and pointing forward.



From down dog, lower your hips so your body is in a high pushup position with your hips connecting the straight line between your shoulders and ankles (i.e., not drooping toward the floor). Engage your abdominals and hold for five breaths. Then lift the hips back into down dog and hold for five breaths. Next move inhale into plank and exhale back to down dog, repeating five times to warm up your shoulders.



From all fours, curl your toes under. Inhale, and as you exhale, push your hands into the floor, lift your knees, and lift your hips back and up. Push the tops of your thighs back so your body looks like an inverted “V.” Keep knees bent if needed to keep your spine long and straight. Hold for 1 minute.



Exhale and point your toes. Round through your lower back, pressing your palms into the floor and tilt the top of your head down, releasing the tension from the upper back and neck. Repeat for six full breaths.


11.CAT- COW POSE ( A )

Begin on all fours with your hands under your shoulders and knees under your hips. Inhale and curl your toes under. Tilt your pelvis toward the ceiling, turning your sit bones up, draw the shoulder blades down the back, open through the chest and look a little forward keeping the neck curve long.



Lie comfortably on your back on the floor with your arms separated at a 45-degree angle from your body, palms facing up. Let your legs rest as wide apart as feels comfortable. And allow your feet to relax and roll open. Then release all tension from every part of your body. Place a bolster or large cushion under your thighs or knees if you have any discomfort in your lower back in this pose. Stay here for 5 minutes (set an alarm clock if you need to).


Enjoy ! 


Photos courtesy of Shutterstock and Women´s Health ( http://www.womenshealthmag.com/ )




Tendinosis – a chronic degeneration of the tendon caused by repeated microtears. This is not an inflammatory condition,and may not respond well to an anti-inflammatory protocol ( ITP).

Tendinosis is a degeneration of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly.


Swelling in a region of micro damage or partial tear may be detected visually or by touch. Increased water content and disorganized collagen matrix in tendon lesions may be detected byultrasonography or magnetic resonance imaging.

Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms.


Tendons are very slow to heal if injured. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendon. Recurrence of injury in the damaged region of tendon is common.

Physical therapy, rest, and gradual return to the activity in which tendinosis was experienced is a common therapy. There is evidence to suggest that tendinosis is not an inflammatory disorder; anti-inflammatory drugs are not an effective treatment,and inflammation is not the cause of this type of tendon dysfunction.There is a variety of treatment options, but more research is necessary to determine their effectiveness. Initial recovery is usually within 2 to 3 months, and full recovery usually within 3 to 6 months. About 80% of patients will fully recover within 12 months. If the conservative therapy doesn’t work, then surgery can be an option. This surgery consists of the excision of abnormal tissue. Time required to recover from surgery is about 4 to 6 months.

Treatment and self-care recommendations for tendinosis include:

  • rest (  With repetitive work tasks, the patient is recommended to take a break for one minute every 15 minutes and a five-minute break every 20–30 minutes.This reduction isn’t much considering its role in preventing long-term pain and disability. Some people will need to rest even more than this at the start of treatment. The patient should be advised to stay aware of their body as it heals. If the activity they are engaging in is causing pain, then they are probably doing too much.)
  • adjust ergonomics and biomechanics( example: a person that types a lot on the computer should find a neutral position for their wrists to rest while typing)
  • use appropriate support ( bracing,taping)
  • strech and keep moving though conservatively ( Lightly stretching and moving the affected area through its natural range of motion while minimizing pain will prevent shortening of the related muscles (preserving active range of motion and flexibility). It can also increase circulation, thereby assisting the healing process. Stretching can also elongate the muscle-tendon unit, reducing the tension placed on the tendon during activity, thereby reducing the chemical changes that cause degeneration)
  • apply ice (  Ice causes vasoconstriction and is thought to address the abnormal neovascularization of the tendon tissue. Clinical experience indicates that icing is helpful for tendinopathies even though the reason why it works is not yet fully understood. Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon)
  • eccentric strenghtening ( An eccentric strengthening regimen done 1–2 times daily for 12 weeks has been clinically proven to be a very successful treatment for tendinosis, especially when the exercises are performed slowly. Eccentric strengthening is “lengthening a muscle while it is loaded and contracting. For example, lengthening one’s bicep while holding a dumb-bell in one’s hand would stimulate eccentric contraction. Eccentric strengthening might also help to reduce ground substance and tendon volume (swelling/thickening). It can be helpful to consult with a physical therapist to maximize the benefit of strengthening exercises and to minimize the possibility of re-injury.)
  • masssage (  Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied to the tendon serves to stimulate fibroblast activity and generate new collagen.)
  • nutrition (  Vitamin C, manganese, and zinc are all important for the synthesis of collagen production.Vitamin B6 and Vitamin E have also been linked to tendon health. Patients might benefit from talking with their primary health care provider or a nutrition specialist to be sure their intake of these nutrients is sufficient )

While the cellular damage is unlikely to be reversed completely, these treatments and self-care recommendations can increase the strength of the tendon by stopping the cycle of injury, introducing healthy collagen into the area, addressing unhealthy vascular changes, and decreasing the over-abundance of ground substance. Proper treatment of tendinosis should eliminate or significantly decrease pain, increase range of motion, increase strength, and return the patient to pain-free, normal daily activities.

Tendinosis causes tissue changes that make the tendon more prone to injury, so it is important that the patient continue to take care of the compromised tendon once the initial phase of treatment is complete. Ongoing massage, stretching, strength training, and warming up before starting work or exercise can help to prevent re-injury and keep the tissue as healthy as possible.








Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.

Tendinitis (also tendonitis), meaning inflammation of a tendon, is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment.

The term tendinitis should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation. Generally tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting the Achilles tendon), or patellar tendinitis (jumper’s knee, affecting the patellar tendon).


Types of Tendinitis :

Tendinitis injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers or elbows, swimmers in their shoulders.Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping, while Patellar tendinitis is a common among basketball and volleyball players owing to the amount of jumping and landing.

Diagnosis :

Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms. If the symptoms of tendinitis last for several months or longer it is probably tendinosis.


  • pain,but often ubsides when tendon is warmed-up and returns when cooled down
  • swelling
  • warm to the touch
  • decreased motion
  • decreased function
  • crepitus – grating or cracking sound caused by the inflamed tendon struggling to move through its covering

Causes : 

  • overuse ( gradual onset of syptoms )
  • acute ( symptoms lasting less than two weeks )
  • sub acute ( symptoms lasting two to six weeks )
  • chronic ( symptoms lasting longer than six weeks )
  • repeated muscle contraction causing the tendon to slide over the bone


Treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs (NSAIDs), rest, and gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression and elevation are also frequently recommended.

Physical therapyOccupational therapy, orthotics or braces may also be useful. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks.

Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term.

  • correct the cause
  • cryotherapy ( usually after activity )
  • heat therapy ( prior activity )
  • anti-inflammatory medication
  • iontophoresis
  • ultrasound
  • electrical muscle stimulation
  • massage to improve the blood flow
  • streching and ROM( range of motion) exercises
  • muscle strenghtening including proprioceptive and kinesthetic exercises
  • support with atheltic tape
  • cortisone injections
  • rest
  • gradual return to activity
  • in worst case : surgery

The goals of treatment for tendinitis are to restore movement to the joint without pain and to maintain strength in surrounding muscles while giving the tissues time to heal. Adequate rest is crucial.  Returning too soon to the activity that caused the injury can lead to chronic tendinitis or torn tendons.

As an immediate treatment for tendinitis, doctors and physical therapists recommend the RICE program: rest, ice, compression, and elevation of the injured tendon. They may also suggest aspirin, ibuprofen, or other anti-inflammatory drugs to help inflammation and pain. Ultrasound and whirlpool treatments are useful for relaxing muscles and tendons, improving circulation, and promoting healing. Occasionally, your doctor may discuss injecting corticosteroids (a stronger anti-inflammatory drug) around the tendon.

A physical therapist can propose an exercise plan that rests the tendon while strengthening nearby muscle groups and maintaining overall muscle tone. Only gradually will you begin to exercise the tendon itself. Your program may also include “eccentric” exercises, in which you gradually strengthen the muscle while stretching, stopping at the first sign of pain. You may also work into easy stretching exercises, done several times a day.

Surgery may be necessary to release or repair the involved tendon in chronic cases that don’t respond to other interventions.


How can I prevent Tendinitis ?

Include warm-up and cool-down exercises and stretches in your exercise routine. As a general rule, a good warm-up is five minutes for every 30 minutes of planned exercise. So, one hour on the treadmill or elliptical trainer should be preceded by 10 minutes of warm-up. Vary your exercises and gently stretch all the muscles and tendons you are planning to exercise.

Overly ambitious exercise in an attempt to lose weight rapidly also can lead to tendinitis.




Inflammation is the body’s attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens – and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body’s response to it.

The word inflammation comes from the Latin “inflammo”, meaning “I set alight, I ignite”.

Inflammation is part of the body’s immune response. Initially, it is beneficial when, for example, your knee sustains a blow and tissues need care and protection. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating. More inflammation is created in response to the existing inflammation.

According to Medilexicon’s medical dictionaryInflammation is:

“A fundamental pathologic process consisting of a dynamic complex of histologically apparent cytologic changes, cellular infiltration, and mediator release that occurs in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent, including the local reactions and resulting morphologic changes; the destruction or removal of the injurious material; and the responses that lead to repair and healing.

The so-called cardinal signs of inflammation are rubor, redness; calor, heat (or warmth); tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present.”

The suffix ¨ – itis ¨ refers to inflamation. Examples : appendicitis, tendinitis,tonsillitis.

Inflamation is not a pathological condition in itself, but rather the body´s reaction to tissue damage.The inflammatory cells remove debris and draw healing cells to the injury site. However, if irritiation continues,the process becomes detrimental and the inflammation becomes a chronic debilitating condition.

Symptoms : 

  • pain
  • swelling
  • skin warmth
  • redness

Inflammation helps wound to heal 

Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body’s attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation – the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal.

Difference between acute and chronic inflammation

Acute inflammation – starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.

Examples of diseases, conditions, and situations which can result in acute inflammation include: acutebronchitis, infected ingrown toenailsore throat from a cold or flu, a scratch/cut on the skin, exercise (especially intense training), acute appendicitis, acute dermatitis, acute tonsillitis, acute infective meningitis, acute sinusitis, or a blow.

Chronic inflammation – this means long-term inflammation, which can last for several months and even years. It can result from:

  • Failure to eliminate whatever was causing an acute inflammation
  • An autoimmune response to a self antigen – the immune system attacks healthy tissue, mistaking it (them) for harmful pathogens.
  • A chronic irritant of low intensity that persists

Examples of diseases and conditions with chronic inflammation include: asthma, chronic peptic ulcer,tuberculosisrheumatoid arthritis, chronic periodontitis, ulcerative colitis and Crohn’s disease, chronic sinusitis, and chronic active hepatitis (there are many more).

Our infections, wounds and any damage to tissue would never health without inflammation – tissue would become more and more damaged and the body, or any organism, would eventually perish.

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

What happens during acute inflammation?

Within a few seconds or minutes after tissue is injured, acute inflammation starts to occur. The damage may be a physical one, or might be caused by an immune response.

Three main processes occur before and during acute inflammation:

    • Arterioles, small branches of arteries that lead to capillaries that supply blood to the damaged region dilate, resulting in increased blood flow
    • The capillaries become more permeable, so fluid and blood proteins can move into interstitial spaces (spaces between cells).
  • Neutrophils, and possibly some macrophages migrate out of the capillaries and venules (small veins that go from a capillary to a vein) and move into interstitial spaces. A neutrophil is a type of granulocyte (white blood cell), it is filled with tiny sacs which contain enzymes that digest microorganisms. Macrophages are also a type of white blood cells that ingests foreign material.

When our skin is scratched (and the skin is not broken), one may see a pale red line. Soon the area around that scratch goes red, this is because the arterioles have dilated and the capillaries have filled up with blood and become more permeable, allowing fluid and blood proteins to move into the space between tissues.

Edema – the area then swells as further fluid builds up in the interstitial spaces.

The five cardinal signs of acute inflammation – “PRISH”

  • Pain – the inflamed area is likely to be painful, especially when touched. Chemicals that stimulate nerve endings are released, making the area much more sensitive.
  • Redness – this is because the capillaries are filled up with more blood than usual
  • Immobility – there may be some loss of function
  • Swelling – caused by an accumulation of fluid
  • Heat – as with the reason for the redness, more blood in the affected area makes it feel hot to the touch

The five classical signs of inflammation:

Although Latin terms are still used widely in Western medicine, local language terms, such as English, are taking over. PRISH is a more modern acronym which refers to the signs of inflammation. The traditional Latin based terms have been around for two thousand years:

  • Dolor – Latin term for “pain”
  • Calor – Latin term for “heat”
  • Rubor – which in Latin means “redness”
  • Tumor – a Latin term for “swelling”
  • Functio laesa – which in Latin means “injured function”, which can also mean loss of function

Acute and chronic inflammation compared

The lists below show the difference between chronic and acute inflammation regarding the causative agents, which major cells are involved, features regarding onset, duration, and outcomes:

Acute Inflammation

  • Causative agents – harmful bacteria or injury to tissue
  • Major cells involved – mainly neutrophils, basophils (in the inflammatory response), and eosinophils (response to parasites and worms), and mononuclear cells (macrophages, monocytes)
  • Primary mediators – eicosanoids, vasoactive amines
  • Onset (when does the inflammation start) – straight away
  • Duration – short-lived, only a few days
  • Outcomes – the inflammation either gets better (resolution), develops into an abscess, or becomes a chronic inflammation

Chronic inflammation

  • Causative agent – non-degradable pathogens that cause persistent inflammation, infection with some types of viruses, persistent foreign bodies, overactive immune system reactions
  • Major cells involved – Macrophages, lymphocytes, plasma cells (these three are mononuclear cells), and fibroblasts
  • Primary mediators – reactive oxygen species, hydrolytic enzymes, IFN-γ and other cytokines, growth factors
  • Duration – from several months to years
  • Outcomes – the destruction of tissue, thickening and scarring of connective tissue (fibrosis), death of cells or tissues (necrosis)

Inflammation Treatment Protocol ( ITP):

The following is a general treatment protocol for most inflammatory conditions.The ITP can reduce the extent of inflammation and its unwanted effects.

Not all aspects of the ITP are needed or recommended for every situation!

  1. correct the cause
  2. cryotherapy ( usually after activity )
  3. heat therapy ( usually prior to activity )
  4. anti- inflammatory medication ( OTC or prescription strenght )
  5. iontophoresis
  6. electrical muscle stimulation
  7. ultrasound
  8. massage techniques to improve blood flow
  9. streching and ROM exercises
  10. muscle strenghtening,including proprioceptive and kinesthetic exercises
  11. support with athletic tape
  12. cortisone injections
  13. rest
  14. gradual return to activity
  15. surgery


Source :    Medical News Today 

NESTA certified Sports Injury Specialist


Nerve Injuries

Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly, and a loss of feeling in the injured area.


Nerves are part of the “electrical wiring” system that carries messages between the brain and the rest of the body. Motor nerves carry messages between the brain and muscles to make the body move. Sensory nerves carry messages between the brain and different parts of the body to signal pain, pressure, and temperature.

A ring of tissue covers the nerve, protecting it just like the insulation surrounding an electrical cable. Nerves are composed of many fibers, called axons. These axons are separated into bundles within the nerve. The bundles are surrounded by tissue layers, just like the outer tissue layer that surrounds the nerve.



-range from minor nerve symptoms ( Grade 1 ) to paralysis (Grade 5 )

  • pain ( shooting,radiating,throbbing,stabbing,stinging…
  • burning or cold sensation
  • tingling
  • numbness that can radiate down a limb
  • muscle weakness
  • increased or decreased sensation
  • partial or complet paralysis

Causes :

  • contusion
  • compression
  • friction
  • over strech
  • laceration
  • broken bone that severs or compresses a nerve
  • decreased blood supply to the nerve
  • long term repeated activity ( chronic)

Treatment :

  • correct the cause
  • streching
  • ultrasound
  • analgesics
  • injections
  • surgery
  • rest


Several things can be done to keep up muscle activity and feeling while waiting for the nerve to heal.

  • Physical therapy will keep joints flexible. If the joints become stiff, they will not work, even after the muscles begin to work again.
  • If a sensory nerve has been injured, care must be taken not to burn or cut fingers because there is no feeling in the affected area.
  • With a nerve injury, the brain may need to be “re-educated.” After the nerve has recovered, sensory re-education may be needed to improve feeling to the hand or finger. The physician will recommend appropriate physical therapy based on the nature and location of the injury.

Factors that may affect results after nerve repair include age, the type of wound and nerve, and location of the injury. Although nerve injuries may create lasting problems, proper treatment helps patients return to more normal function.





Stress Fracture


stress fracture is one type of incomplete fracture in bones. It is caused by “unusual or repeated stress” and also heavy continuous weight on the ankle or leg.This is in contrast to other types of fractures, which are usually characterized by a solitary, severe impact.

It could be described as a very small sliver or crack in the bone; this is why it is sometimes dubbed “hairline fracture”. It typically occurs in weight-bearing bones, such as the tibia (bone of the lower leg), metatarsals (bones of the foot), and less commonly, the femur.

It is a common sports injury, and most cases are associated with athletics.


Stress fractures usually have only a few symptoms. A stress fracture could present as a generalized area of pain and tenderness associated with weight bearing. Usually when running, a stress fracture in the leg or foot will cause severe pain at the beginning of the run, moderate pain in the middle of the run, and severe pain at the end and after the run. After running it may just feel likeshin splints, but in a very concentrated area. Occasionally, darkening or bruising will be seen at the site.


-gradual onset-a dull ache which progresses to sharp pin point pain

phase 1 :  pain during activity

phase 2 : pain during and after activity

phase 3 : constant pain – even with the first steps in the morning before any activity

-point tenderness

-usually no swelling


-repeated overloading-overuse. The stress on the bone is not afforded sufficient time to recover between periods of use.

-poor physical condition

-overweight individuals

-poor diet-lack of calcium

-structural condition of the foot

-change of training habits

-surface change

-training too quickly; doing ¨ too much,too quickly¨

Bones are constantly attempting to remodel and repair themselves, especially during a sport where extraordinary stress is applied to the bone. Over time, if enough stress is placed on the bone that it exhausts the capacity of the bone to remodel, a weakened site—a stress fracture—on the bone may appear. The fracture does not appear suddenly. It occurs from repeated traumas, none of which is sufficient to cause a sudden break, but which, when added together, overwhelm the osteoblasts that remodel the bone.

Stress fractures commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task). They may also occur in Olympic-class athletes who do extraordinary quantities of high-impact exercise, in professional and amateur distance runners who run high weekly mileage, or in soldiers who march long distances.

Muscle fatigue can also play a role in the occurrence of stress fractures. In a runner, each stride normally exerts large forces at various points in the legs. Each shock—a rapid acceleration and energy transfer—must be absorbed. Both muscles and bones serve as shock absorbers. However, the muscles, usually those in the lower leg, become fatigued after running a long distance and lose their ability to absorb shock. As the bones now experience larger stresses, this increases the risk of fracture.

Previous stress fractures have been identified as a risk factor.


A stress fracture is best diagnosed after interview and examination by a physician. Investigations are not necessary to diagnose a stress fracture.

X-rays usually do not show any evidence of stress fractures, so a CT scanMRI, or 3-phase bone scan may be more effective in unclear cases.


A stress fracture is so small that an X-ray can only detect the healing of the stress fracture ( the callus ) and not the fracture itself.It is better to take an initial X-ray as a baseline and a comparison X-ray 14 days later.

The most effective method of diagnosing a tress fracture is with a bone scan,where radioactive tracers are injected into the bloodstream and travel to the bone. If the bone absorbs the tracer,it will show as a ¨hot¨ spot and indicate a stress fracture. An MRI is also effective in showing bone abnormalities that X-ray fail to reveal.

If a stress fracture is suspected,it is recommended to stop the activity so the bony callus can form and begin to heal – usually 2 to 6 weeks,depending on the location of the fracture.

Stress fractures typically do no require casting,unless they are ignored and progress into a regular closed fracture.

A gradual return to activity is important.If activity is resumed too quickly,the stress fracture can return.

During recovery,corss training that does not put stress on the injury is recommended to maintain fitness levels.

If a stress fracture occurs in a weight-bearing bone, healing will be delayed or prevented by continuing to put weight on that limb. Most people don’t even know they have a hairline fracture until they hurt themselves again, then they have a broken bone. If left untreated, the broken bone can turn into an infection that can cause severe medical issues.

Rehabilitation usually includes muscle strength training to help dissipate the forces transmitted to the bones.

Bracing or casting the limb with a hard plastic boot or air cast may also prove beneficial by taking some stress off the stress fracture. An air cast has pre-inflated cells that put light pressure on the bone, which promotes healing by increasing blood flow to the area. This also reduces pain because of the pressure applied to the bone. If the stress fracture of the leg or foot is severe enough, crutches can help by removing stress from the bone.

With severe stress fractures, surgery may be needed for proper healing. The procedure may involve pinning the fracture site, and rehabilitation can take up to six months.


One method of avoiding stress fractures is to add more stress to the bones. Though this may seem counter-intuitive (because stress fractures are caused by too much stress on the bone), moderate stress applied to the bone in a controlled manner can strengthen the bone and make it less susceptible to a stress fracture. An easy way to do this is to follow the runner’s rule of increasing distance by no more than 10 percent per week. This allows the bones to adapt to the added stress so they are able to withstand greater stress in the future.

Strengthening exercises also help build muscle strength in the legs. Strengthening these muscles will prevent them from becoming fatigued quickly, allowing them to absorb the strain of running for longer periods of time. Key muscles that need strengthening with lower leg stress fractures are the calves and the shin muscles. Runners often suffer from overuse injuries or repetitive stress injuries. These include stress fractures, stress reactions, tendinitis, meniscal tears, ITB Friction syndrome, and exacerbation of pre-existing arthritis. Stress fractures, if not diagnosed and treated, can develop into complete fractures.

Depending on a variety of factors (including weight, running surface and shoe durability), runners should replace their shoes every 300–700 miles to allow adequate mid-sole cushioning. A change in running surfaces can also help prevent stress fractures. However, it is also argued that cushioning in shoes actually causes more stress by reducing the body’s natural shock-absorbing action, increasing the frequency of running injuries.

During exercise that applies more stress to the bones, it may help to increase calcium and vitamin D intake, depending on the individual. Also, it is important to monitor diet, because nutritionplays a vital role in bone development. Some individuals are at risk of osteoporosis, and depending on the country in which medical care is being supplied, there may be an osteoporosis screening program available.

A study released by Creighton University has shown Calcium and Vitamin D supplementation, even over a short period, can significantly reduce stress fractures in female military recruits. The study results were reported on February 11, 2007 at the 53rd annual Orthopaedic Research Society meeting at the San Diego Convention Center.





Lumbar Lordosis

Hi guys.

Sorry I haven´t been around for a while. I got a cold and I´m just starting to feel a bit better so i decided to post something 🙂

I saw that the most views  I have are for Lordosis ..so i thought you might like some more exercises and some info.


Lumbar Lordosis   is a condition where there is an increased inner curvature of the lumbar spine.Normally a human spine displays some amount of lordosis, but if it increases then it poses a problem for the individual. Lordosis is also known as “swayback.”

Anterior pelvic tilt is the major factor of lumbar lordosis. Due to increased curve of the lumbar spine, lower back puts more pressure on the entire back and this lead to poor movement of the back and lower back pain. It is necessary to keep the curve of the spine in their proper position.

The common factors for lumbar lordosis are tight hip flexors, weak core muscles, weak gluteal muscles, poor form during exercise, etc. The normal curve of the lumbar spine should be approx 30-35 degrees while standing.

How to evaluate if you have lumbar lordosis :

Evaluate the space between the lumbar spine and the wall. When a person has an acceptable degree of lumbar lordosis, you should only be able to slide your fingers behind the lower back up to, and in line with the second or third knuckle of your hand (i.e., where the fingers meet the hand). If the space between the back and the wall is big enough for you to slide your whole hand or arm through, then the client has excessive lumbar lordosis. The greater the space is between the wall and the lower back, the more extreme the deviation or imbalance is.

If someone has a large gluteal complex and the tail bone is not in contact with the wall during the assessment, then you will need to make an allowance for the additional space. Use your best judgment to determine whether the lumbar curvature is excessive.

Lordosis Exercises

The selection of lordosis exercises are based on the imbalance and weakness of the muscle present in your spine. It is very important to address the particular muscle that directly correlates with increased lordosis.

Streches of Hip Flexor 

Due to tightness of hip flexor, the opposite groups of muscles (gluteal muscles) become weak and it affects the pelvic alignment. It is important to stretch your hip flexor in order to maintain proper alignment of pelvic and to avoid lumbar lordosis.
Hip flexor can be stretched manually in standing position, bend your knee and hold on to your ankle. When you pull your leg back, tilt your pelvic forward. Hold the stretch position for 25-30 seconds. Please refer to the image to see how this stretch is performed.

Stretches Of Hip Flexor For Lumbar Lordosis

Lower Back Muscle Streches

It is important to stretch your back muscle to free from lumbar lordosis. Lie down on the floor on your back, pull your knees slowly into your chest as shown in the image. Inhale with deep breath, when you are performing the exercise. Hold the position for 30-50 seconds.

Lower Back Muscle Stretches For Lumbar Lordosis

Abdominal Crunch

Abdominal muscles also play an important role to maintain your posture. Abdominal muscles strengthening exercises help in strengthening the spine and reducing the inward curve. Lie down on the floor facing the ceiling and put your feet on the floor. Tilt your pelvic back by pushing your lower back into the floor. Then lift your torso off the floor to 30 degrees angle, support your neck with your hands. And come back slowly to the starting position. Repeat this exercise 10 times.

Abdominal Crunch  For Lumbar Lordosis

Oblique Crunch

Lie down the floor on your back with knees bent and keep feet flat on the floor. Drop your legs to the left side slowly and let your knee rest near the floor. Keep your fingertips to the side of your head behind your ears. Push down your low back into the floor and hold. Then slowly curl up that both your shoulders lift off the floor a few inches. Hold the position for 5 second and return to the start position. Repeat this exercise for 10-15 times. Do the same on the other side.

Oblique Crunch For Lumbar Lordosis

Hip Extension In The Supine Position

Lay down your back on the floor facing your face upward with the flexion of knees. Keep your feet flat on the floor and apart from each other. Squeeze your gluteus and do slight posterior pelvic tilts to make your lower back flatten. Then lift your hip upward as much you can with squeezing of your gluteus muscles. Hold the position for 10-15 seconds and return to the starting position. Repeat 20 times a day.

               Hip Extension In The Supine Position For Lumbar Lordosis
Stability Ball-Bridge
 This exercise strengthens the gluteal muscles. Lie on your back with your calves draped over the ball. Start with a pelvic tilt and the squeeze your butt until a bridge position is obtained. When you roll down, try to feel that each vertebra is touching the floor. Your lower back should touch the floor before your pelvis. Make 12 repetitions daily.
Knees to Chest Stretch and Heel Slide
lie on your back with your knees bent and then lift both legs from the floor and draw the knees to your chest. After that, lower one heel to the floor. Keep the opposite knee close to your chest. Rotate the other heel along the floor until the leg is straight. Make 8 repetitions daily.
Other exercises for Hyperlodosis:

Tips To Help Prevention Of Lumbar Lordosis:

  • Keep your feet flat on the floor when sitting. Put a small wedge on your chair or adjust your chair to sit so that your knee should be slightly lower than your hip. Support your back lower curve because too much or too little of a curve can cause problems.
  • When standing, support your back by resting one leg higher on a step.
  • When standing, do not lock your knees straight.
  • Keep a flat pillow under your belly if you sleep on your stomach. Sleeping on your back is better with a pillow under your knees.
  • Do not wear high heel shoes, your posture will tend to fail. Always wear shoes that provide good support.
  • Maintain your buttock muscles and belly (abdominal) strong and firm.
  • See your physician if you have persistent or frequent back pain.



Sources:    http://www.epainassist.com/