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Introduction

• Some of the pain clinic exercises require you to use a piece of Thera-Band for muscle strengthening. If required you can buy it from Physio Med. I would suggest red for the upper limb exercises, and green for the lower limb exercises. Depending on your physical capabilities, you may need to go higher or lower in the range.
• The purpose of these exercises is to stretch muscles which are shortened and in spasm, and to strengthen muscles which are weak.
• What makes a happy muscle - a happy muscle is one that is supple, strong, and emotionally calm (good descending inhibition). An unhappy muscle is one that is shortened, weak, and emotionally distressed (poor descending inhibition). You may ask "How do I stay emotionally calm in the presence of severe pain ?". My answer would be that you should learn as much about the cause of the pain as possible, and try to develop a set of beliefs that are simple and have some basis in science. Try to avoid distressing adjectives, superstitious ideas about the pain, and dangerous labels like "crumbling discs", "spinal arthritis". Hopefully this website will help you to this end.
• If you are in the middle of an acute pain episode, then all of these exercises can be attempted in an attempt to produce pain relief, but need to be done gently, and without excessive force. Severe pain means you have over done it, and you need to be more gentle. If you are experiencing just a little pulling feeling or mild pain, then that's about just right. On one hand you have to listen to your body so that you don't over do things, and on the other, you don't have to be frightened of it. Remember it's just muscle pain and it won't kill you. Gentle exercises such as these are very unlikely to cause harm. As the pain and spasm begins to ease, you can gently increase the length of time you spend stretching, and how far you push the stretch.
• I would suggest that you take the duvet off your bed and use the bed as a comfortable exercise mat. If you have an exercise mat then that would be fine also.
• Muscles relax when warm, and contract when cold. I would therefore suggest soaking in a hot bath before stretching, particularly during an acute attack.
• If you have acute sciatica with severe pain in the leg down to the foot, I would advise having treatment for the sciatica, before starting on this programme. The stretches on this page also apply to those with non-nerve root sciatica. Look at exercises for sciatica also.
• Those who have chronic back pain should pace themselves, not being too impatient at the start. Set yourself a small goal and take your time getting there. You cannot undo several years of back pain in five minutes. Starting too vigorously is likely to increase the muscle spasm not reduce it. If you haven't done it for years, then it is bound to hurt a little at the beginning. Have courage and don't be frightened. Stretching regularly plus general aerobic exercise like swimming and walking is the key to success. It may take you months or years to achieve some of the movements on this page. Muscle Energy Techniques may be more suitable for this group of sufferers. Some people may have to accept that they cannot achieve the full stretch, but even 50% achievement is better than nothing !!
• Those with severe heart and breathing problems should consult their own doctor before starting.
• These exercises should be safe for those with osteoporosis, but if you have any doubts please consult your own doctor.
• Think about trying the Pain Gone Pen - a simple low-cost non-drug self-help pain device for home use.

Muscle Energy Technique

• Muscle Energy Technique (MET) was invented by a USA osteopath, it is also known as Post Isometric Relaxation (PIR).
• It is basically an electro-physiological trick to encourage muscles to relax more quickly. You contract the muscle that you want to stretch against a fixed resistance for 5 seconds in one direction, and then gently stretch it in the opposite direction during the first 3 seconds after the contraction has stopped. 
• The initial muscle contraction is known as an isometric contraction i.e. making the muscle work whilst it is kept at a fixed length. It appears that because of the way that agonist/antagonist pairs of muscles are connected to the dorsal horn of the spinal cord, a muscle can readily relax during the 3 second window just after a 5 second isometric contraction. Once you understand the basic principles of the technique, you can figure out how to stretch any muscle in the body !!
• You can also incorporate breathing into MET to aid muscle relaxation. Try to follow the sequence below:-
  1. Gently stretch the muscle in question to the point where it begins to pull - this is the initial barrier point.
  2. Take a big breath in and hold it (don't let it escape).
  3. Whilst remaining at the barrier point, contract the muscle you want to stretch against a fixed resistance for FIVE seconds in one direction, at about 25% of maximum effort. You don't get any extra benefit by being macho - 25% is the best, not 100%. 
  4. Quickly let your breath go with your mouth open (not slowly through pursed lips), and during the next THREE seconds gently stretch the muscle a little further in the opposite direction until you feel a gentle pull again - this is the new barrier point. You must not force the muscle to stretch, as this will cause it to contract rather than relax.
  5. Hold this new barrier point and start again at no.2, going round the loop several times.
• At the end of a 5 minute session you should find that the muscle has considerably lengthened, that it feels looser, and with a greater range of active and passive movement.
• It is common to find in an agonist/antagonist pair of muscles, that one muscle is over-developed, supple and strong, with the other muscle being under-developed, weak and short e.g. strong supple quadriceps in the front of the thigh with weak short hamstrings in the back of the thigh. For proper muscle balance it is worth stretching and strengthening the weak short one.
• For a practical demonstration of MET look at the MET stretch in Flexion (Lying).