Abstract:
An integrated back pain and back health program incorporating proper posture to achieve joint realignment and muscle relaxation, proper breathing to achieve stress management and muscle relaxation, and an exercise program focused on the muscles of the back, neck, shoulders, abdomen and hips to achieve muscle and joint flexibility and strengthening. By providing instruction on maintaining proper posture, the protocol offers back pain sufferers relief from the stress caused by muscles involuntarily attempting to realign and/or stabilize misaligned joints. The breathing techniques used in the protocol aid in muscle relaxation and, together with proper posture, maximize the benefits of the exercises performed in the procedure. The exercises in the protocol stretch and strengthen the muscles that are commonly implicated in the occurrence of back pain, release spasm in those muscles, and reset those muscles to normal tonus.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority based on provisional patent application Ser. No. 60/224,066, filed Aug. 9, 2000. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to a method for relieving back pain and improving back health. More particularly, the invention relates to a back pain and back health protocol selectively incorporating various exercise protocols designed to promote proper posture and breathing and to stretch and strengthen the muscles of the back, neck, shoulders, abdomen, and hips. 
     BACKGROUND OF THE INVENTION 
     Back pain is a problem for a significant number of people. Numerous causes can lead to pain in the back. One common source of back pain is the normal human preference for using muscles on one side of the body. A right-handed person, for example, tends to use the right hand, arm, and leg more often than the left, leading to increased muscle strength on the dominant side. This can create a bilateral strength imbalance and cause bilateral misalignment of the spine. Anterior/posterior strength imbalance and misalignment of the spine and other joints can either be caused by or result in poor posture. When the neck, shoulders, back, and/or hips are subjected to bilateral or anterior/posterior misalignment, chronic muscle contraction or muscle spasm can occur in an involuntary attempt to prevent further misalignment. A lack of exercise can also lead to weakness, low flexibility, and spasms in the muscles of the back, neck, shoulders, abdomen, and hips. In addition, stress can contribute to back problems. In stressful situations a ‘fight-or-flight’ response sometimes occurs leading to involuntary contraction of muscles and misalignment of joints in order to prepare for fighting or fleeing. If unrelieved, these muscle contractions and joint misalignments can eventually lead to muscle spasms and back pain. The prevalence of back problems can thus be attributed to any one of, or any combination of, bilateral dominance, poor posture, inactivity, and the skeleto-neuro-muscular response to mismanaged stress. 
     Traditional treatments for back pain do not adequately address the causes of back pain and/or do not provide the back pain sufferer with a long-term plan for improving and maintaining back health and preventing back pain. Physical therapy tends to be symptom-based. It has the capability to offer temporary relief from excessive muscle contraction (i.e., muscle spasm) but typically does not offer the back pain sufferer instruction in the exercise protocols, posture models, breathing methods, and stress management techniques that can provide long-term relief from back pain. Chiropractic therapy has the capability to realign joints but, as is the case with physical therapy, clients are typically not taught proper posture, proper breathing techniques, or proper exercise habits. Without adequate education, clients of both physical therapy and chiropractic therapy tend to return to the habits that caused their back problems. Analgesic and muscle relaxant drug therapies can provide temporary relief from back pain but do not address the causes of the pain. 
     The present invention offers an improvement over traditional back pain prevention and treatment protocols by addressing the causes of back pain such as stress, poor posture, and poor muscle tone and by providing the back pain sufferer with the education needed to carry out a long-term program for improving back health and preventing future back pain. 
     SUMMARY OF THE INVENTION 
     The present invention, hereafter generally referred to as the Back Pain/Back Health Protocol, relates to an integrated back pain relief and strengthening program comprising: joint realignment and muscle relaxation through proper posture; stress management and muscle relaxation through proper breathing; and muscle stretching and strengthening through an exercise program focused on the muscles of the back, neck, shoulders, abdomen, and hips. By providing instruction on maintaining proper posture, the Back Pain/Back Health Protocol offers back pain sufferers relief from the stress caused by muscles involuntarily contracting and spasming in an attempt to realign and/or stabilize misaligned joints. The breathing techniques used in the Back Pain/Back Health Protocol aid in muscle relaxation and, together with proper posture, maximize the benefits of the exercises performed in the procedure. The exercises in the Back Pain/Back Health Protocol are designed to stretch and strengthen the muscles that are commonly implicated in the occurrence of back pain. The combination of proper posture, proper breathing, and muscle stretching and strengthening exercises prevents the occurrence of back pain and provides back pain sufferers a unique and effective means of attaining long-term relief from back pain. 
    
    
     DESCRIPTION OF THE DRAWINGS 
     The invention, together with further advantages thereof, can be more fully understood by reference to the following drawings in which: 
     FIG. 1 is a schematic of the alpha posture. 
     FIGS. 2A and 2B are a flow chart depicting the elements of the breathing reset protocol. 
     FIG. 3 is a schematic of a variation of the breathing reset protocol. 
     FIGS. 4A and 4B are schematics of an external hip rotation exercise protocol. 
     FIGS. 5A and 5B are schematics of a variation of the external hip rotation exercise protocol. 
     FIGS. 6A and 6B are schematics of another variation of the external hip rotation exercise protocol. 
     FIGS. 7A and 7B are schematics of an internal hip rotation exercise protocol. 
     FIGS. 8A and 8B are schematics of a variation of the internal hip rotation exercise protocol. 
     FIG. 9A and 9B are schematics of another variation of the internal hip rotation exercise protocol. 
     FIGS. 10A and 10B are schematics of a ‘knee-to-armpit’ exercise protocol. 
     FIGS. 11A and 11B are schematics of a variation of the ‘knee-to-armpit’ exercise protocol. 
     FIGS. 12A and 12B are schematics of a ‘bow-and-arrow’ exercise protocol. 
     FIGS. 13A and 13B are schematics of a variation of the ‘bow-and-arrow’ exercise protocol. 
     FIGS. 14A and 14B are schematics of a ‘push down’ exercise protocol. 
     FIGS. 15A,  15 B, and  15 C are schematics of a ‘three way abdominal crunch’ exercise protocol. 
     FIGS. 16A,  16 B, and  16 C are schematics of a ‘kneeling arm and leg raise’ exercise protocol and variations thereof. 
     FIGS. 17A,  17 B, and  17 C are schematics of other variations of the ‘kneeling arm and leg raise’ exercise protocol. 
    
    
     DETAILED DESCRIPTION 
     The present invention, hereafter referred to as the Back Pain/Back Health Protocol, relates to a method for preventing and relieving back pain through the use of a combination of proper posture, a breathing protocol, and a set of exercise protocols for increasing strength and flexibility in the muscles of the back, neck, shoulders, abdomen, and hips. The preferred posture used in the Back Pain/Back Health Protocol is known as the ‘alpha posture’, an anatomically optimal, gravity-neutral position in which the joints are aligned properly. As shown in FIG. 1, in the alpha posture the neck  110  is straight and extended upward, the chin  120  is tucked in slightly, the head  130  is directly above a line connecting the shoulders  140 , the shoulders  140  are depressed toward the floor and retracted toward the back of the body to align at right angles to the sides of the head  130 , the thoracic  150  and lumbar  160  portions of the spine are extended upward so that anatomically optimal curvatures are maintained, the pelvis  170  is rotated to the rear of the body so that the proper interface with the sacroiliac joints is maintained, and the knees  180  are locked. The alpha posture promotes proper alignment of joints and thus prevents the muscular contractions or spasms that may occur involuntarily to realign and/or stabilize misaligned joints. 
     The breathing technique used in the Back Pain/Back Health Protocol is known as the breathing reset method. One of the goals of breathing reset is to aid the exerciser in eliminating a submissive, non-alpha posture and attaining the alpha posture. FIGS. 2A and 2B are a flow chart depicting the rationale, procedures, and effects of the breathing reset method as applied to the transformation from the submissive to the alpha posture. Boxes  205 ,  210 , and  215  in FIG. 2A describe the neuro-muscular and psycho-neural elements of the submissive posture. As shown in box  205 , the postural, neuro-muscular effects of assuming a submissive posture are a compressed abdominal space, a shallow hyperventilatory breathing pattern, and breathing focused on the middle to upper chest and thoracic area. Box  210  describes the neuro-muscular effects of a submissive posture on target muscles. In a submissive posture, a ‘fight-or-flight’ state of readiness is assumed resulting in contraction of the calf, shoulder, and neck muscles and the muscles used in breathing. As box  215  shows, the ‘fight-or-flight’ status involves a psycho-neural as well as a neuro-muscular response. The neuro-muscular and psycho-neural elements of the submissive posture can result in habitual, involuntary muscle contraction, or muscle spasm, as shown in box  220 . The breathing reset method, box  230 , can eliminate the negative effects of a submissive posture and allow the exerciser to attain and maintain alpha posture. 
     In the continuation of the breathing reset method flowchart in FIG. 2B, breathing reset, box  230 , is initiated with stretching, box  240 , and/or contraction, box  250 , as needed to return spasmed muscles to their normal status. The neuro-muscular and psycho-neural effects of the breathing reset method are shown in Figures  255 ,  260 , and  265 . The postural, neuro-muscular results, box  255 , are an opening of the abdominal space to an optimum dimension and a slower, fuller, more energy-efficient, abdomen-based breathing. Box  260  describes the breathing reset method as applied to target muscles, as described more fully below. Box  265  describes the psycho-neural image used in the breathing reset method. As shown in Figure 270, the alpha posture and its related neuro-muscular and psycho-neural elements enable the exerciser to regain voluntary control over muscles and aid in maintenance of normal muscle tone. 
     In a preferred mode of performing breathing reset, the alpha posture as described above is generally assumed as a first step. The alpha posture maximizes the volume of the abdominal space and encourages the use of abdominal-based rather than thoracic-based breathing. That is, inhalation and exhalation are achieved predominantly through expansion and contraction of the abdomen rather than the rib cage. Ventilation is optimized and less energy is expended per breath in abdominal-based breathing as opposed to thoracic-based breathing. The user of the breathing reset method next forms a mental image in which the body is hollow except for a target muscle-joint complex. Upon exhalation of a physical breath, using abdominal-based breathing, the user imagines an internal breath passing from the top of the head, through the target muscle-joint complex, and then out of the body through the arms or legs, as indicated in box  260 . When stretching exercises are performed without the breathing reset method, a significant pain response is elicited early in the range of motion at which point the exerciser&#39;s survival reflex is triggered, the breath is stopped and held, and any further stretch is heavily inhibited. The mental image used in the breathing reset method accentuates muscle stretching and relaxes muscle spasms by overriding the instinctive, protective inhibition against muscle stretching, particularly stretching of muscle which is in spasm (i.e., involuntarily contracted). Box  265  references this release of the protective reflex. When the breathing reset method is focused on the muscle joint complex targeted by an exercise, maximal relaxation, strengthening, and stretching of muscles can be achieved in the performance of the exercise. 
     In a variation of the breathing reset method, shown in FIG. 3, the neck  305  and shoulder  310  areas are taken as the target muscle-joint complex and a partner  320  assists in achieving relaxation of the target area by depressing the shoulders  310  of the user  330 . The partner  320  stands behind the user  330 , if the user  330  is seated in a chair, or kneels behind the user  330  if the user  330  is seated on the floor. In either case, the waist  325  of the partner  320  is near the level of the shoulders  310  of the user  330 . As the user  330  performs the breathing reset method described above, the partner  320  places his or her hands  340  on the shoulders  310  of the user  330  and exerts a slight downward pressure. In another variation of the breathing reset method the user  330  can, in addition to the steps just described, imagine depressing the elbows  350  or the fingers into the ground. Both of these variations serve as aids in achieving maximal relaxation and depression of the shoulders  310  thereby releasing muscle spasm and returning the target musclejoint complex to its normal tonal and anatomical status. 
     In combination with the alpha posture, the breathing reset method promotes the relaxation of muscles that may be involuntarily contracted due to mismanaged stress and/or improper joint alignment. The combination of alpha posture and the breathing reset method also enhances the effects of the exercises described below. In each of the exercises, a specific musclejoint complex is stretched and/or contracted. When the breathing reset method is used during the performance of an exercise, the muscle-joint complex that is the focus of the exercise becomes the target muscle-joint complex of the breathing method. The overlaying of the breathing reset method on the exercises below allows a significantly higher degree of stretching and muscle spasm release/muscle tonus reset than the traditional method of performing the exercises alone could provide. 
     There are seven basic exercise protocols in the Back Pain/Back Health Protocol, four primarily intended to increase flexibility and three primarily intended to increase muscle strength. Variations exist for several of the exercise protocols. The overall goal of the strength and flexibility exercises is to relieve muscle spasms by resetting the muscles to their normal contraction (i.e., muscle tonus) status. It is preferable that the four stretching protocols be done as a group and that the three strength protocols be done as a group rather than selecting only certain stretching and certain strength exercises. This ensures that the upper/lower body core and posterior, anterior, and lateral body core and musculature are cumulatively targeted by a minimum number of exercises. The exercise protocols can be done in any sequence. 
     A typical sequence for performing one of the exercise protocols is to reach the point of maximum stretching during the exhalation phase of the breathing reset technique. While maintaining this position, two to three normal, involuntary breaths are taken. Another breath using the reset technique is then taken followed by two to three normal breaths. This sequence of a reset breath and two to three normal breaths, sometimes called ‘monitoring breaths’, is typically repeated two to four times for each exercise. Each reset breath will typically allow a greater extent of stretching to be attained and a ratcheting effect typically occurs whereby further stretching occurs with each sequence. The breathing reset method allows this greater degree of stretching by enabling an overriding of the instinctive, protective reflex encountered when stretching to full anatomic potential range of motion. As the user gains skill in the exercise protocol, the number of times the sequence of a reset breath and two to three monitoring breaths is repeated until maximum stretching is achieved typically decreases. Thus, a beginner may take three to four sequences to achieve maximum benefits, while an expert may require only one or two sequences. 
     Benefits for the protocols are also optimized when the alpha posture is maintained throughout the exercise protocols. However, some exercises require a position, such as a bending of the knees, that is not an element of the standing alpha posture. In these cases, it is preferable that all other elements of the alpha posture, as applied to the body core, be maintained to the extent possible. 
     One of the flexibility exercises in the Back Pain/Back Health Protocol, the external hip rotation protocol, is illustrated in FIGS. 4A and 4B. As shown in FIG. 4A, the exerciser  410  sits on a chair or other support platform and places the outer portion of the ankle  420  of one leg  430  (the target leg) on the upper portion of the knee  440  of the other leg  450  (the support leg) and exerts downward pressure on the target leg  430  with the hand  460  that is on the same side of the body as the target leg  430 . The knee  470  of the target leg  430  is pressed toward the floor as far as possible, as shown in FIG.  4 B. The external hip rotation exercise stretches the internal rotator muscles of the target hip  480 . In variations of this exercise, the exerciser  5   10  can be seated on the floor as illustrated in FIGS. 5A and 5B or the exerciser  610  can lie supine on the floor as illustrated in FIGS. 6A and 6B. If the exercise is done in a supine position, the knee  640  of the support leg  650  is bent so that the sole of the foot  690  of the support leg  650  is flat on the floor. 
     Another flexibility exercise is internal hip rotation as illustrated in FIGS. 7A and 7B. As shown in FIG. 7A, the exerciser  710  sits on a chair or other support platform and places the outer portion of the ankle  720  of the target leg  730  on the upper portion of the knee  740  of the support leg  750  as in the external hip rotation exercise. The exerciser  710  then exerts upward pressure on the target leg  730  with the hand  760  that is on the opposite side of the body as the target leg  730  so that the knee  770  of the target leg  730  is moved as far as possible toward the armpit  780  on the opposite side of the body, as shown in FIG.  7 B. The internal hip rotation exercise stretches the external rotator muscles of the target hip  790  as well as the gluteus medius, gluteus maximus, and quadratus lumborum. In variations of this exercise, the exerciser  810  can be seated on the floor as illustrated in FIGS. 8A and 8B or the exerciser  910  can lie supine on the floor as illustrated in FIGS. 9A and 9B. If the exercise is done in a supine position, the knee  940  of the support leg  950  is bent so that the sole of the foot  995  of the support leg  950  is flat on the floor. 
     In another variation of the internal hip rotation exercise, the exerciser assumes the same seated, cross-legged starting position as shown in FIG.  7 A. Then, in addition to exerting upward pressure on the target leg  730 , as shown in FIG. 7B, the exerciser  710  also exerts inward pressure on the support leg  750  with the hand  765  that is on the opposite side of the body as the support leg  750  so that the knee  740  of the support leg  750  is moved as far as possible along a line parallel to a line connecting the hips, line H—H. 
     FIGS. 10A and 10B illustrate the knee-to-armpit exercise, another flexibility exercise. As shown in FIG. 10A, the exerciser  1010  lies in a supine position and bends the target leg  1020  at the hip  1030  and knee  1040  so that the lower leg  1050  of the target leg  1020  is generally perpendicular to the floor with the foot  1060  above the knee  1040 . Grasping the outside of the foot  1060  of the target leg  1020  with the hand  1070  that is on the same side of the body as the target leg  1020 , the exerciser  1010  pulls the target leg  1020  downward as far as possible toward the armpit  1080  that is on the same side of the body as the target leg  1020 , as shown in FIG.  10 B. The target muscles for the knee-to-armpit exercise are the hip extensors and the target joints are the hip and sacroiliac joints. In a variation of the knee-to-arrnpit exercise, both legs  1120  are target legs and are pulled downward simultaneously, as illustrated in FIGS. 11A and 11B. 
     Another flexibility exercise is the ‘bow-and-arrow’, or hip flexor extension, as illustrated in FIGS. 12A and 12B. As shown in FIG. 12A, the exerciser  1210  places the knee  1215  of the target leg  1220  on the floor, maintaining the thigh  1225  of the target leg  1220  generally perpendicular to the floor, and places the sole of the foot  1230  of the non-target leg  1235  flat on the floor, maintaining the lower leg  1240  of the non-target leg  1235  generally perpendicular to the floor and the thigh  1245  of the non-target leg  1235  generally parallel to the floor. An approximately 90-degree angle is maintained between the hips  1250  and the thigh  1245  of the non-target leg  1235  and the head  1255  is maintained above the knee  1215  of the target leg  1220 . The head  1255  and the knee  1215  of the target leg  1220  can be thought of as opposite ends of a bow and the knee  1260  of the non-target leg  1235  can be thought of as an arrow. The hips  1250  are then moved forward as far as possible in the direction of the knee  1260  of the non-target leg  1235 , as shown in FIG.  12 B. To achieve the maximum benefit from this exercise, the 90-degree angle between the hips  1250  and the thigh  1245  of the non-target leg  1235  should be maintained and the head  1255  should not move forward but should remain above the knee  1215  of the target leg  1220 . The target muscles for the bow-and-arrow exercise are the psoas and the quadriceps and the target joints are the hip joint and lumbar spine. 
     In a variation of the bow-and-arrow exercise, shown in FIGS. 13A and 13B, the exerciser  1310  lies on one side and places the arm  1320  that is in contact with the floor on the front side of the body, as shown in FIG.  13 A. The leg  1330  that is not in contact with the floor (the target leg) is bent at the hip  1340  and knee  1350  so that the exerciser  1310  can grasp the ankle  1360  of the target leg  1330  with the hand  1370  of the arm  1380  that is not in contact with the floor. The exerciser  1310  then pulls the target leg  1330  toward the rear side of the body as far as possible, as shown in FIG.  13 B. 
     One of the strength exercises in the Back Pain/Back Health Protocol, the push down, is illustrated in FIGS. 14A and 14B. In the starting position, shown in FIG. 14A, the exerciser  1410  lies on the back  1420 , places the soles of both feet  1430  flat on the floor, bends both knees  1440  to an approximately 45-degree angle, moves the shoulders  1450  upward toward the ears  1460 , maintains an approximately three to four inch space between the elbows  1470  and the torso, maintains the forearms  1480  perpendicular to the floor, and relaxes the wrists  1490 . The exerciser  1410  then lifts the shoulders  1450  and back  1420  as far as possible so that the elbows  1470  are the only part of the upper body in contact with the floor, as shown in FIG.  14 B. This position is maintained for approximately one to two seconds. The target muscles for the push down are the rear deltoids, the rhomboids, and the five rotator cuff muscles. 
     FIGS. 15A,  15 B, and  15 C illustrate the three-way abdominal crunch, another of the strength exercises. In the starting position of this exercise, shown in FIG. 15A, the exerciser  1510  lies on the back  1520 , folds the arms  1530  across the chest  1540 , and lifts the knees  1550  into a position higher than the hips  1560 . The soles of the feet  1570  can be placed flat on the floor as shown in FIG. 15A or the lower legs  1580  can be placed on a supporting surface. The exercise is done in three steps. In the first step, shown in FIG. 15B, the exerciser  1510  flexes the torso  1590  toward the knees  1550 , maintains that position for approximately one to two seconds, and returns to the starting position. In the second step, shown in FIG. 15C, the exerciser  1510  flexes the torso  1590  toward the knees  1550 , lifts one hip  1560  upward and toward the armpit  1595  on the same side of the body as the lifted hip  1560 , maintains that position for approximately one to two seconds, and returns to the starting position. The third step is identical to the second except that the opposite hip  1560  is lifted. The target muscles for the abdominal crunch are the quadratus lumborum, internal oblique, rectus, and transverse abdominus. In a variation, the abdominal crunch can be performed on an inclined or declined surface. 
     The kneeling arm and leg raise is another strength exercise. Several variations of this exercise are possible but the starting position for all the variations, shown in FIGS. 16A and 17A, is an all-fours position in which the hands  1610  and  1710 , knees  1620  and  1720 , and toes  1630  and  1730  are in contact with the floor, the elbows  1640  and  1740  are straight, and the arms  1650  and  1750  and thighs  1660  and  1760  are generally perpendicular to the floor. In one variation, illustrated in FIG. 16B, one leg  1670  is raised upward while maintaining its bent position so that the thigh  1660  is approximately parallel to the floor. Simultaneously, the bilaterally opposite arm  1650  is raised upward with the elbow  1640  at an approximately 90 degree angle and with the upper arm  1680  in a position near the ear  1690 . This position is maintained for approximately one to two seconds. Another variation, illustrated in FIG. 17B, is similar to the first except that the raised arm  1750  and leg  1770  are not bent but are, instead, extended forward and backward, respectively, as far as possible. In another variation, illustrated in FIG. 17C, the raised arm  1750  and leg  1770  are straightened but, instead of being extended forward and backward, are extended sideward at approximately 90 degree angles to the torso  1795 . Another variation, shown in FIG. 16C, allows the exerciser to decrease the angles to which the arms  1650  and legs  1670  are extended in order to make the exercise easier. Another technique to decrease the difficulty of the exercise is to lift only a leg  1670  or  1770  and not lift an arm  1650  or  1750  simultaneously. The target muscles for all the variations of the kneeling arm and leg raise are the hamstrings, gluteus medius, gluteus maximus, spinal erectors, quadratus lumborum, rear deltoid, trapezium, and rhomboids. The target joints are the sacroiliac, lumbar spine, thoracic spine, and cervical spine. 
     The descriptions of the alpha posture, the breathing reset method, and the exercises used in the Back Pain/Back Health Protocol are intended to convey the general principles used in those techniques. Those of skill in the art will recognize that variations in these methods will not diminish the effectiveness or uniqueness of the Back Pain/Back Health Protocol.