Hello, hello everyone!
I wanted to check in with you about an issue that’s come up many times in my emails with readers recently. This time, it’s about an exercise not to do.
What I’m talking about, specifically, is back extension. This is the term that refers to when you’re bending your spine backwards.
Back extension can be a component of several different exercises, including something called McKenzie exercises.
The first exercise in this video, the “press-up,” shows what I’m talking about:
Basically, you’re bending your spine backwards. This motion is meant to gently nudge a herniated disc back into the proper position.
However… I’ve had about five different people email me now and say the McKenzie exercises make their SI joints worse.
Now, let me back up. Why are so many SIJ patients are being prescribed McKenzie exercises?
I think it’s because the symptoms of a herniated disc and SI joint dysfunction can be very similar. I think it’s possible that a doctor might send a patient to PT, not necessarily being sure which condition the patient has, or thinking there’s a possibility they might have both.
And then the PT follows a treatment plan, thinking that perhaps if the McKenzie exercises help, then that must mean the patient did have a herniated disc.
However, I haven’t been surprised to hear SIJ patients not liking these exercises, because back extension is something I’ve learned to avoid myself.
I actually never tried the McKenzie exercises personally, but I used to try to do a similar exercise involving back extension, often called the cat-camel stretch. Many of you may have been prescribed this stretch as well.
Here’s an example– the part at 0:13 is back extension:
Now, I don’t want to say anything negative about someone else’s video– the cat-camel is a legitimate exercise to prescribe to many patients with back pain, and this video does a great job of demonstrating it properly. (I wouldn’t link to it otherwise! Same for the video above).
However, I’ve always found this motion to change the alignment of my SI joints. Because think about it: when you extend your spine, you are moving the sacrum. After all, it’s the base of the spine.
But your hip bones aren’t necessarily going to follow along– especially if you’re using your legs to hold yourself up, as in this video.
The SI joint, you may remember, is the place where the hip bones and the sacrum meet.
So when you deliberately change the positioning of the sacrum, you’re automatically changing the alignment of the joint.
Again, everyone is different.
Maybe some people won’t have this problem. But for me personally, I’ve come to avoid anything that deliberately moves the sacrum.
It’s even one of the problems I’ve had with massage therapy, and why I stopped letting anyone except for my one trusted massage therapist go anywhere near my SI joints. If they used too much force, even if it was on my upper back, somehow it would alter the alignment of my SI joints.
I once had a different massage therapist once try out a specific technique that was supposed to do something to realign the sacrum. She said it was something she had learned as part of craniosacral therapy (which, in general, I believe can be helpful).
But she put her hand under my sacrum and gently moved it around… and it was really painful. I did not feel better when I got up. So that was the first and last time I ever tried anything like that.
So in a nutshell… be very cautious about anything that can change your alignment!
A lot of the time, I have found, less can be more. (That’s the whole principle behind why I came to prefer MET over chiropractic adjustments).
This was somewhat of a long and rambly post, but I hope you were able to follow along!
If your PT is prescribing you exercises that involve back extension, be sure you ask why. Does the PT think you have a herniated disc? What is his or her rational for thinking that, versus SI joint dysfunction?
And if you find McKenzie exercises make your SI joints worse, don’t be afraid to say you can’t do them! You have me and a bunch of other readers who’ve all experienced the same thing!
Okay, that’s all for now.
As always, if you have any questions, feel free to leave a comment below or email me at firstname.lastname@example.org.