The vast majority of muscu-loskeletal problems (including,of course, neck and back prob-lems) may be said to be the re-sult of inefficient biomechanics,but so saying does not indicatespecific treatment directions. Tomove beyond a mere descriptionof the problem (even though'biomechanical' does have a nicescientific ring about it!) to atreatment of its cause(s) requiresthat some analytical process beused. As I have published else-where, one such specific and re-peatable process is the assess-ment of physical functions interms of insufficient flexibility orlack of strength. This relatively simple analysis yields specifictreatment recommendations:stretching exercises for areasthat testing reveals to be tight incomparison with what is'normal' for that client andstrengthening exercises for areasshown to be weak. This latterassessment will require an un-derstanding of which musclesneed to be activated and how strong they need to be in relationto other muscles.
Going beyond a 'condition'or 'problem'
There is a further considerationin recommending specificstretching and strengthening ex-ercises, and that is the notion of empowerment. Far too many practitioners---deliberately orinadvertently---disempoweredtheir clients. That is, from thevery first consultation, an atmos-phere can be created wherein thepractitioner and the client bothregard the client as the more-or-less passive recipient of thetreatment being practised. Inother words, the practitioner isput forward implicitly as thefount of wisdom, and the clientthe vessel. Apart from being pa-tronising, a great deal of recentresearch in medical anthropol-ogy suggests strongly that thelikelihood of successful resolu-tion of any problem is lessenedconsiderably if the client is notactively involved in his or hertreatment.
States of mind
So we might say that one couldhave a process reason for recom-mending stretching or strength-ening exercises (that your analy-sis has yielded an understandingof specific biomechanical prob-lems in the client's system) and apsychological reason. This latterreason is simply (and very im-portantly) the creation of an op-timistic state of mind in the cli-ent, and the passing on of spe-cific tools for the client to use toresolve his or the problem. Thisgives the control of the problemlargely to the client---in my view an essential first step up for full,permanent resolution of theproblem. Until the client takesresponsibility for his or her ownproblem, the problem is likely torecur regardless of how effectiveyour treatment is.
Integration of treatmentelements
If the practitioner embraces ananalytic protocol as, for example,outlined in the book
Overcomeneck & back pain
, the structuraland functional analysis will takeabout 30 minutes in total. As-suming a treatment hour, theremainder of the time can beused in the teaching what theanalysis reveals to be the mostlikely significant two or threeexercises. At a future consulta-tion, you will be able to concen-trate on whichever muscles theanalysis has revealed to be exces-sively tight, in addition to themassage process that you usually use. At the conclusion of themassage, spend 10 minutes re-viewing the previously-taughtexercises with the client. Experi-ence has shown that no matterhow well these exercises aretaught the first time, reviewingthem a week or a couple of weekslater will reveal practise errors;we are all human, after all, andclients (and practitioners) alterthe form of an exercise to makeit more comfortable, and oftenavoid the target area as a result.
Progressing the intensity of the exercises
I have found that once the painof the initial problem has re-ceded, it is usually necessary toteach some strengthening exer-cises in order that the client re-turned to full normal (or, desir-able) function. We might say that in order for rehabilitation tobe considered complete, the cli-ent must move
the pre-injury state of fitness that led tothe initial problem. In respect of neck pain, the anterior neck muscles usually need strength-ening. Any tendency to carry thehead forward of the ideal posi-tion will also need to be cor-rected, and this usually requiresthe strengthening of muscles inthe lower abdominal area. In ad-dition, it will be necessary tocheck the flexibility of the hipflexors,
,in particular. This isbecause the research has shownthat an anterior pelvic tilt can be
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