Less is More

For this blog, I wanted to talk about less is more in the context of rehab exercises and treatment in the office. It took me a long time from when I got out of school to now to develop the approach of not trying to throw everything at a problem right off the bat.

I wanted to talk about this for a variety of reasons. First, from a nervous system standpoint, too much all at once can be an overload. As a provider, we want to use all the tools in our tool box and it is difficult to step back from that and try to do what is best for the nervous system at that time. This is especially difficult for patients when it does not “feel” like much is being done. 

Different Scenarios To Better Explain Less Is More

If someone comes into my office who is having an acute flare up where they cannot get down on the table easily or cannot lie face down, I ask myself what I can do for them. If they cannot tolerate a lot of pressure, you can make it worse if you let the brain feel like it is having even more insult to the area with an aggressive technique.

I had a patient come in once with severe pain down her leg and in the lower back and she was not able to lie in her stomach. When you go to a chiropractor, you think of lying on your stomach and getting adjusted. So, what can you do without lying on your stomach at the chiropractor? Quite a bit! I was able to perform an exam. I had her lie on her back and worked with simple breath work to stabilize her core and provide some natural support for her low back.  I gave her simple exercises to do at home and treated her regularly. She did have a large disc herniation in her low back and did NOT end up needing surgery.  She was able to return to all of her activities in time.  

From a rehab standpoint, I know that getting the right intra abdominal control is the first key step in helping to support around a herniated disc. Core control evokes an image of sit ups and planks, but it starts with breath and integrating your diaphragm, which is the lid to your core.  For the above patient, we did breath work for 20 minutes and then we did some light stimulation around the diaphragm and around the low back musculature wall while she was seated. You do not want to use a super deep pressure that is going to make the patient resist the pressure and tighten up.

Pain takes the same pathway up to your brain as light touch and because of that I do a light and soft stroke with the rock blade, a metal tool that we use in the office that can help with overriding the pain signal. Once they are out of the office, I will have them do something similar with a paint brush or any type of brush that can put a soft touch to the area just to give the brain a little rest from the pain signals and have something different to view. I also have them continue doing the breath work.

The little baby steps to getting you some relief and being able to do any kind of rehab type exercises are the keys to feeling better. It is difficult to jump into rehab exercises when you cannot even move to get into the position. It also does not help you to do an exercise if you are going to cause more pain and your brain will sense even more distress. That will make it lock more things up around it and cause you less mobility.

It is also great to keep in mind that if it is a one-sided pain, it’s beneficial to work on the good side as well. Giving brain input to the good side will positively affect the other side that has pain. It is a more comfortable way to work the aggravated and painful area. 

For example, I worked on a patient with excruciating pain on one side in her neck that she woke up with randomly.   We started working on her while seated because she had terrible pain lying down. I then used cupping to help bring increased blood flow to the area to try to dissipate some of the inflammation. I did this because a lot of times when you have something acute like that where there is a lot of inflammation around the area.  It is key to keep blood and lymph fluid moving. Stagnant lymph is a key factor of inflammation.  Increased blood flow  helps to deliver more oxygen.  

Later, I followed it up with super light trigger point therapy. This is when the concept that light pressure can be just as effective as the deep pressure that people associate with getting the knots out comes in.  I also followed it up with some rock tape that was cut in strips to help even more with the facilitation to get the inflammation to subside.

Once you get to the pain-free mobility point, that is where you can strengthen, figure out where the weak spots are, what caused the problem, and how to avoid that problem from happening again. Most likely, the problem did not happen for no reason. Once you are out of the acute flare-up and you are all set and ready to introduce movement and strengthening, you will see the why behind the problem. Some patients will only want to get out of pain and not take the next step of knowing how to prevent it from happening again. If this is the case, you have to meet your patient where they are at and not push for the next step. The best you can tell them is to see you again if the same thing happens in the future or if it gets worse.

Why Less Is More

Oftentimes, less can be better. This is difficult as a practitioner because we want people to feel better immediately. I have been out of school since 2007 and it has taken years to trust the process, do less, and trust that it will be the better thing.

The same thing goes with the pelvic floor and diastasis recti stuff that I do. Jumping right into strengthening before you learn how to fully relax your pelvic floor will not help you. With diastasis, there is that very fine line of building the proper intra abdominal pressure and overdoing the core work to make your situation worse. It’s really all about being gracious with yourself and finding the right amount for you. This is a key part in any type of rehab exercises because you need to find the amount that is just enough for you to make progress but not let you backslide.

It takes practice and trial and error, but do not get discouraged. People are often used to the more is more approach and they have a difficult time shifting their mindset, but I guarantee that it will be more beneficial for you in the long run.

If you have any questions, you can drop it in the comment section or you send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

You can also check my TikTok account as I use the platform to educate viewers about movement, chiropractic education, yoga, pregnancy, and more! 

Thank you for listening and see you next week!