Many patients who suffer from chronic pain, particularly in cases involving the lower back, do so because they have developed a condition I label “Bracing Deficiency”, in which the body’s network of bracing muscles no longer provides the underlying stability to move in the ways in which we’ve grown accustomed.
From early childhood into adulthood, body stability and coordination develop in a virtuous partnership; the uncoordinated child slowly becomes the stable, coordinated adult.
However, after an injury or sedentary period leads to the loss of strength and endurance in our bracing muscles [which, maddeningly, atrophy quicker than the action muscles that move us], we don’t go back to being uncoordinated to match our loss of stability. The coordination is still there, but its partner, bracing stability, has quietly left the building, leaving us in a state in which we move with the defined neuromuscular patterns developed over a lifetime, without the underlying bracing stability to safely do so.
The more pronounced the Bracing Deficiency, the more likely an immediate return to exercise will cause injury. Many of my pain patients come to me believing in a cycle of recovery in which they receive treatment for their pain then simply return to their routine. They remember a time when they were fit and feeling great, being “normal,” doing their thing. It’s all good, they insist. “I won’t be the person who goes back to the gym then two weeks later has to quit because I’ve re-injured myself.”
Then they have to suffer through my nagging reminders about the importance of bracing muscle strength and its impact on stability, a message which doesn’t keep pace with their vision of a seamless return to peak form. I concede that if they break an arm and have to go in a cast for six weeks then, sure, once the cast comes off they can get back to normal activities. But a quick recovery of this type isn’t in the works for areas of the body which require bracing/stabilization, which include the lower back, hips, feet, ankles, shoulders and neck.
A recovery from chronic trouble in these areas must begin with weeks to months of bracing muscle exercises to shore up the Bracing Deficiency to the point where your stability and movement patterns are more in line.
In this Bracing Series, we introduce exercises to strengthen select bracing muscles to ensure body stability as you move. While the exercises may strike you as basic–even trivial if you were expecting to sweat–they are essential to a full recovery without re-injury.
As demonstrated in the accompanying video, this fourth exercise strengthens a muscle in the calf called the soleus, which stabilizes the ankle and, to a lesser extent, the knee.
When performing this exercise, the key is to keep the knee bent, as a much stronger muscle in the calf [the gastrocnemius] will take over if you allow your leg to straighten.
Hold the raised position for twenty to thirty seconds on each leg. You multi-taskers can even do these while brushing your teeth if you like.