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Webinar with Dr. Cobb


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Brain-Based Fall Prevention & Preparation.


How To Deal With SI Pain (Takes 3 Minutes!)

Video Highlights

• A Key Missing Movement in Most Spinal Issues
• Precision Isometric Strength Training
• How Different Isometric Approaches Impact the Nervous System

Hi, I’m Dr. Eric Cobb of Z Health Performance, and we’re beginning a quick series on kind of my high payoff drills for back issues. Week by week, we’re gonna be looking at the pelvis, the low back, the mid back, and the neck. And we’re gonna be focusing specifically on recovering one movement that makes a huge difference for most people.

If you are new to Z Health, we are a brain-based education company. We specialize in working with doctors, coaches, and therapists from around the world. So if you enjoy neurology and you enjoy this kind of information, make sure to subscribe. Alright, here we go.

Spine issues. Super common. We all know that. And what do we do about it? Well, there are so many different possibilities when it comes to dealing with low back issues or spinal issues of any kind. But one thing that is very common is a loss of one specific motion. What you will generally find is anyone who’s suffering from neck pain, midback pain, low back pain or pelvis issues, if you test them, they will lack the ability to comfortably laterally bend. Alright, side bend.

Now, whether that’s a neck, a mid-back, low back, or pelvis side bend, that is one of the motions that whenever we’re working with someone, we focus on recovering. In many cases, you will find people doing a lot of mobility work, right? A lot of mobilizations trying to recover lateral bending, and that’s great, but I want to do something super high payoff and relatively simple, which is isometric strength training. Isometrics, when done appropriately, are incredibly useful for improving movement. Whether that seems strange or not, because you’re not really moving, what you are doing is you are increasing muscular activity, which is the precursor to the joint motion that is typically lost.
The second thing about isometrics is that they are fabulous for pain. So if you have someone with a right sacroiliac joint issue or right hip issue or lumbar issue, whatever it is, an appropriately chosen and performed isometric exercise can make all the difference.

So here’s what we’re going to talk about very quickly. How do we use isometrics for pain? There are a couple different things that we need to think about. Number one, what position or what length does the muscle need to be in? Number two, how hard do we contract the muscle? And number three, how long do we hold the contraction?

Alright, so here are the basics. Whenever we dig into the neurology research of isometric exercise, what we find is that isometric contractions for a muscle done in a shortened length will increase neural activity within that muscle.

If the muscle is lengthened, we will typically see better changes in strength and hypertrophy. But for our purposes, specifically talking about movement disorders and pain, right now for our purposes, we’re gonna focus on doing isometrics typically with a shortened muscle length. And I’m gonna show you what that looks like for each area of the body. So we’re gonna do a shortened muscle length.

The next thing we want to know is how hard do we contract? Well, the research again shows that a contraction, an isometric contraction of 30 to 40% of your maximum is most ideal. We don’t need to do 50, we don’t need to do 60, we don’t need to do a hundred. We want to do 30 to 40% of your maximum.

So it’s not that uncomfortable. You’re not straining very hard. But that’s then coupled with how long do we hold it, the duration, and this is where it gets super interesting. Most people who have done isometrics in the past have heard, Hey, you do an isometric for six seconds or eight seconds, or whatever. For pain, what is showing up regularly in the research is that long contractions are better. And by long contractions, I mean up to five minutes. Whenever we compare one minute to three minutes to five minutes, there is a doubling of pain relief as the time goes up. So in general, when we are working on the spine, we’re gonna try to do a shortened muscle length. We’re going to do a contraction of 30 to 40% of your maximum, and we’re gonna try to hold that for up to five minutes. In most cases, I have people start with one minute. ’cause once you get to 2, 3, 4, 5, it starts to get pretty hard. So with that in mind, we’re gonna focus on the pelvis today.

For the pelvis, very simple idea. The pelvis needs to have the capacity to laterally bend. What that looks like is kind of a hula hoop motion or a, you know, little Friday night dance move. I don’t know what you wanna call it, but basically the right side of the pelvis needs to be able to elevate while the left side goes down, right? And we just need to be able to reverse that. If let’s say you’re having pain on the right side, we don’t know if you need to work on contracting up or lengthening on that side. That’s something that you’re gonna have to test. Once you know whether you’re gonna work on the right side or the left side, just by doing a little bit of testing, I’m gonna show you the exercise I want you to focus on.

For this. You’re gonna need something to stand on. I just have a couple of books to make this seem like I’m at my house. If you don’t have a convenient step stool or stairs in your house, grab a couple of books that you don’t care about. That’s the important part. And your first exercise is gonna be pretty simple. What you’re going to do is you’re gonna stand, if you need to hold onto something for balance, do that. We’re gonna get into a nice kind of comfortable posture, and we’re gonna begin by letting the free leg drop all the way to the ground. And now we’re going to lift the pelvis up. All right? And I just want you to practice that a couple of times and make sure that you can feel the contraction. So now as we lift up and we hold, we’re now into that shortened muscle length. For many people, just trying to hold this for one to two minutes is sufficient. This may for you achieve that 30 to 40% of your maximum load. That would be the exercise. It’s very simple. You start this, you test, you see how your back’s feeling, test the motions that are painful for you, you get up into position, you figure out the movement, and you just lift the hip. Hold it for, let’s say, 30 seconds or so. Get down and retest. If you improve, fantastic. We’re gonna then repeat that and make sure that we’re going for that 2, 3, 4, 5 minute hold. If you have to take a break in the middle, that’s fine.

Now, let’s assume, however, you’re more conditioned, you’re a little bit stronger. What do we do now? Well, we’re gonna now need to add some tension to this. The easiest way to do that is with a strap of some kind. I have down here a what’s called a forearm forklift, which is a strange, you know name, but it’s from Home Depot. It’s for moving furniture. So it’s just a nylon strap. It’s got this nice little padded loop down here, and I have it underneath the books. So all that I would then have to do to add a little bit of load to this is take this strap, slip it over my foot, and I apologize for showing you the wonderfully bald head there.

And now I’m gonna go back up into position, and if I need to, I can bend my knee a little bit, and now I’m going to again, elevate the pelvis. I’m still trying to get into that shortened position, but now I am able to pull harder because I have the strap providing some resistance.

Now, obviously that’s a little bit more complicated of a setup. You don’t have to do that in the beginning. As I said, for many people, especially if you’re deconditioned or having pain, just the weight of your leg will be enough. But this is an amazingly powerful drill, even though it looks simple because it’s combining a lot of stuff that we’ve learned about neurology and isometrics and pain, all into one exercise, that will take you two to three minutes. Give it a shot. Hope it works well for you, and we’ll see you again soon.

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