Eliminating Your Pain: Finding Your CONTROL – ALT – DELETE

When your computer locks up, what do you do?  The CONTROL – ALT – DELETE key combo is probably your go-to plan to put your computer back in business.  How cool would it be if you could quickly fix your body when unexpectedly pain locks you up?

I’m here to tell you that you can do just that!

Unwelcome Guests

We all get them so it shouldn’t come as a surprise to any of us.  Their disguises may vary while their locations tend to be a bit more consistent.  Meanwhile, they are rarely welcome and we never quite know when they plan on leaving.

Who are these mystery intruders?  They have many name such as aches, stiffness, joint catching, shooting pain, throbbing, spasms, stabbing tendon pain and/or deep-bone pain.  Do any of those different forms of pain sound all too familiar?

Onset of Pain

Some of these mild to moderate pains, although not enjoyable by any means, can be justified based on your history.  An old injury or surgery can add merit to why a joint is stiff or why a muscle is not as strong as its counterpart on the  other side of your body.

But what about the sudden stabbing pain in the front of the shoulder when you reach into the frig to grab the milk or when your kneecap catches as you bend down to pick up your shoes?  An injury is almost understandable when it occurs while you lift a heavy weight or run hard up a hill but “…how can I hurt my damn back just sitting at my desk?!”  Those are the pains that frustrate us; athletes and non-athletes alike.

Injury vs Pain

If you have a legitimate injury, get it checked out by a sports doctor, physical therapist or certified athletic trainer.  These quick fixes I’m about to tell you about don’t pertain to serious injuries.  If you’re dealing with a mild to moderate pain, as noted above, you may be able to eliminated it quickly and effectively.

Delving into a deep sports medicine diagnosing injury lesson is well beyond the scope of this article.  Keeping it simple: If your pain started without involving an accident of any sort, a significant change in your activity level and/or is not accompanied by swelling/redness and/or an increased warmth in the area of pain, you might be able to promptly improve your symptoms.

If you have any questions or concerns about your symptoms, see your doctor ASAP and get a firm handle on your injury.


When my shoulders hurt, somewhat common after many bike crashes, falls and a shoulder surgery, my Go To Fix-It move is: Pushups.  90% of my shoulder throbbing, stabbing and impingement pain will disappear after a quick set of 25 pushups.  I’m literally smiling as I type this because I love pushups!  They are my shoulder CONTROL – ALT – DELETE solution.

I personally have six (6) of these body pain eliminating routines in my personal toolbox which are awesome quick-fixes for my many orthopedic ailments.  They take no more than 5 minutes to complete and they keep me very active, almost pain-free and, as my wife will agree with, much easier to live with.

My question to you: What are your CONTROL – ALT – DELETE’s?

Tips to Finding Your CONTROL – ALT – DELETE’s

Go With What Works – what have you done in the past that helped you with this type of pain with this joint/body part?  Start with what has worked in the past and work on modifying your technique to improve it’s effectiveness and prolong its benefits.

Stop Looking for the Why – When in pain, the WHY is far less important than the HOW.  Eliminate your pain now and worry about your selfie-in-pain FB picture later.

Bilateral Movements – Your body likes balance.  Doing bilateral (both sides of your body) movements like twists, double arm stretches, bike riding, arm circles and crunches are typically the best moves to start with.

Slow Movements & Deep Breaths – Unless you’re a chiropractor, keep all you movements slow and methodical.  Slow and deep breathing relaxes your body and allows you to listen to the message your body is sending to you, be them good or bad.  Remember, you’re trying to “reset” your body to be balanced and pain-free so allowing for ample time in these new positions is crucial.

Posture, Posture, Posture – Poor posture is a very common source of pain in adults.  Viewing front, side and back photos of you standing and sitting will quickly show visual cues to problem areas in your body.  Focus on stretching stronger/short muscles and strengthening weaker/longer muscles.  Head and neck posture is a common problem in our sit-friendly society.

Examples of Simple Pain Eliminating Solutions

Shoulder Pain – Pushups, door stretches, resisted external rotations, ice massage, thumb-up dumbbell side raises, pool water movements, and seated rows.

Low Back Pain – Crunches, hamstring stretches, laying on hard floor with pillows under knees, hip flexor stretches, bike riding, groin stretches, rolling tennis ball into front/side of hip, Yoga downdog stretches and double arm pull-up bar hangs.

Knee Pain – Roller on front/side of quads, quad stretches, controlled quad strengthening, ice massage, hamstring stretches, massaging and mobilizing kneecap, hip flexor stretches, wall sits, Yoga downdog stretches and bike riding.

Ankle Pain/Heel Pain – Yoga down dog stretches, barefoot walking on soft surfaces, arch & calf massage, ice massage, duck walks on grass on heels only, resisted ankle motion: outward and upward, eliminate shoes with moderate to high heels, picking up marbles/rocks with toes and a heel lift if legs are not equal length.

Key Point to Remember

Your body does not want to be in pain.  Your objective for this endeavor is to put your symptomatic body part(s) in a position which is pain-free and strong to allow your body and mind to reprogram all your associated muscles, tendons, joint capsules and fascia to maintain this “happy place” allowing you to move with less resistance and less pain. Period.

I know this concept sounds very different from the all too common; “medicate to reduce pain” philosophy.  Personally, my physical therapy motto is simple:  Trust your body to know what it needs to do its job!

Being active and healthy is NOT a passive process.   There’s no better time than now to get busy eliminating your pain so you can get busy living.

The Slipping Back Problem of Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The lumbar spine accepts a majority of the weight bearing stress. Because of this important role, it the most susceptible level of the spine for this type of an injury. Learn how to stand up straight against Spondylolisthesis.

Understanding Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The term was coined from its Greek root words, spondylo + listhesis which means “vertebra” and “to slip”, respectively. Hence, the particular description of this injury when one of the spine bones slips forward over the one below causing a mechanically motivated inflammation involving the surrounding bone, capsule, ligaments and nerves resulting in pain and limitations.

The lumbar spine accepts a majority of the weight bearing stress.  Because of this important role, it the most susceptible level of the spine for this type of an injury. There are two major causes of this disorder observed in a specific group of people.

For younger adults, slipping of the 5th lumbar vertebra occurs because the vertbraes of the spine tend to sit in a forward direction over the sacrum.  Meanwhile gravity applies a force which increases this forward slippage of the vertebral body.  Another factor is the type of sporting event.  Activities that increase the extension of the lower back can easily result in a stress fracture of the bony ring of the lumbar spine.  When this fracture present with no slippage, it is referred to as spondylolysis.

Signs & Symptoms of Spondylolisthesis

  • Low back pain and tenderness which increases with lumbar extension or twisting.
  • Pain and stiffness which can involve the buttocks area.
  • Tight feeling in the hamstrings region or weakness on the thigh and/or leg.
  • Walking accompanied by  a back and forth shifting shuffle pattern.
  • Slowed lower extremity reflexes.
  • With serious cases, difficulty controlling bowel and bladder functions.
  • Sudden weakness and poor voluntary control of abdomen muscles.

Professional Treatment for Spondylolisthesis

  • Rest on a firm surface in a non-weight bearing position, which completely eliminates the symptoms.  This is usually most effective in a supine (face-up) or side lying positions with pillows placed behind the knees.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • A core stability program targeting your functional abdominal strength and endurance along with enhancing trunk and pelvis control.
  • Always avoid all positions and activities that increase lumbar hyperextension, the #1 enemy of spondylolysis and spondylolisthesis of the low back.
  • Wearing a low back brace or corsets may be a smart option for players with a weak core and/or pain with prolonged sitting.
  • Rehabilitation therapy is recommended to minimize activities causing extension pressures at the lumbar vertebrae and to build up your muscles promoting an antilordotic posture.
  • An optional form of treatment for chronic suffers is an epidural steroid injection (ESI).  ESIs is a potent anti-inflammatory injection which helps to reduce pain and swelling. This type of treatment is only considered with advanced cases or when physical therapy is not completely effective.
  • In severe cases where the lumbar slip is causing abnormal walking patterns, loss of control in bowel or bladder function, or simply a worsening condition, surgery may be required. Surgical procedures may include laminectomy, posterior fusion with instrumentation or posterior lumbar interbody fusion.
  • Employing updated physical therapy modalities are also provided to decrease pain and reduce swelling. Treatments of heat, cold, ultrasound, and electrical stimulation may be used to reduce pain, enhance painfree motion and minimize muscle spasm.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What part of my spinal vertebrae is responsible for my pain and limitations?
  2. How important is my core strength to my recovery?
  3. What condition would require wearing a rigid back brace?
  4. Do you think I will eventually need surgery to fix my spondylolisthesis?
  5. When I’m painfree, what preventive steps I should take to avoid a recurrence of this injury?

Elite Sports Medicine Tips from Mike Ryan

  • Go to the core of the problem: Exercises such as planks, pelvic tilt and crunches focus on strengthening core core muscles.
  • Prevention is always the better alternative: A pre-existing bilateral spondylolysis can easily develop into spondylolisthesis.
  • Aim for the right angle: Keeping the spine healthy requires consitent changes in posture.  Movement helps the spine promote circulation and reduce muscle fatigue. Sitting for a prolonged period eventually will make a even a healthy low back unhappy.
  • Get ahead of your game: As you make progress, progressively advance into functional strengthening exercises that get your core, trunk and lower extremity ready to get back in the game!

Bulging Disc of the Low Back

Understanding a Lumbar Spine Bulging Disc

It seems that most non-medical people understand more about their computers and smart phones than they know about their good old friendly back.  With that being said, it demonstrates the irony of this information gap when statistics show that 80% of us will suffer from low back pain sometime in our lifetime!

The lower part of our lumbar spine has 5 strong and stabile bones called vertebra.  These vertebra stack on top of each other with intervertebral discs smartly located between each vertebra.  These lumbar disks have two functions:  Spacers and shock absorbers.

Each disc is thick and quite dense to protect the bones of the lower back while allowing for a very functional lumbar spine.  Inside each disk is a jelly-like nucleus called the nucleus pulposus with the very outer ring of the disc reinforced with the stabilizing structured called the annulus fibrosus.

When the lumbar spine is injured or put into a poor posture for a prolonged period of time, many things can happen to become the source of pain and limitation.  For the purpose of this article, let’s look at when the disc becomes the reason for someone having a bad back.  Unfortunately, a bulging disc is too commonly the reason for low back pain and managing a damaged disk may be one of the most important physical challenges that you face in your lifetime.

Bulging discs in the lumbar spine cause significant pain in the low back, buttocks area, groin and lower extremity.  Because of the complexity of the interactions with all the bones of the lumbar spine, disks of the spine, nerves of the spine and bones of the pelvis, the wide arrange of symptoms and treatments can greatly vary.

“Bad backs” can obviously be related to any part of the lower or middle back.  When the lumbar disk’s annulus fibrosus is damaged, the contents of the disk including the nucleus pulposus can be forced outward between the vertebra.  The spinal cord and its peripheral nerves that supply the trunk and lower extremity.  This bulging of the disc is the main reason for pressure on the nerves as they exit the lumbar spine and create nerve symptoms into the regions of the body that the nerve innervates.

Spinal stenosis (narrowing of the spinal canal), bone spurs, spondylolysis, spondylolisthesis and herniations of lumbar discs can be other medical factors that can contribute to Lumbago or low back pain.  A thorough exam by a medical physician is the best starting point for anyone with pain, numbness and/or weakness extending down an extremity from the spinal canal.

Signs & Symptoms of a “Bad Back”

  • Low back, buttock and/or lower extremity pain, numbness and/or weakness, which may be intermittent or constant.
  • May experience pain with standing after prolonged sitting or laying down.
  • May be associated with lateral shifting of the torso away from the painful side.  This is a postural compensation that known as listing.
  • In severe cases, abnormal knee and ankle reflexes can occur.

Professional Treatment for a Bulging Disc of the Lumbar Spine

  • Rest on a firm surface in a non-weight bearing position that completely eliminates the symptoms.  This is best done by lying in a supine (face-up) position with pillows placed behind the knees.
  • Ice bags placed on your back while lying supine or prone (face down) with a pillow placed under the stomach.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • Core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid positions that create low back pain commonly associated with spinal stenosis.
  • The application of heat in the form of a hot tub, heating pad or hot packs should be SLOWLY implemented only when the main symptom is “stiffness” or when there is a need to increase blood flow in the low back/hip area to “get things looser” for activities.  The introduction of heat too early or too aggressively will quickly worsen the symptoms and prolong the recovery time for a bulging disk.
  • Back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises while avoiding a kyphotic (slouched back position) curve of the low back which would assist in the posterior migration of the lumbar disc……not something that you want!
  • Some severe or chronic bulging discs may require an epidural injection from a physician

Questions a Pro Athlete Would Ask

A smart professional athlete with bad back who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do I need an MRI to rule out any other problems?
  2. Do you think I can manage this bulging disc with rehab without having surgery?
  3. With my bad back and knowing that I want to remain very active and healthy for a long time, what activities do I need to avoid/modify to accomplish this outcome?
  4. In your opinion, what three (3) factors (for example: flexibility, posture, body weight, severity of my injury, fitness level, activities, occupation, Ab strength, and attitude) are most important for me to focus on with my rehab?
  5. Who do you consider to be the expert low back and bulging disc rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips

  • It’s all in the Curve – Posture, posture, posture!  If you you’re your lumbar disk to stay in it’s happy place, focus on your posture.  If you maintain the “hollow curve” (lordotic curve) or sway back posture during all activities, the lumbar disc is naturally pressed forward and away from the nerves.
  • Flexibility Makes Your Back Sing – The looser the muscles are of the low back, hips and legs the less work the back has to do to do anything.  It’s that simple.
  • “I Threw My Back Out (fill in the blank)!” – Few people throw their back out lifting a car off their crazy cousin.  Most people damage a lumbar disk with innocent motions like picking up the newspaper or putting on a shoe.


  • Make a List – Anyone with a chronic bad back can tell you what helps and what hurts their back.  Do your homework and know the reasons before your back becomes chronic.  Make a list of:
    • What Makes my Back Better
    • What Makes my Back Worse?
  • When Will I be Painfree? – 80% of the population have low back pain sometime in their lives.  Bulging discs, low back strains, herniated discs, spondylo and ligament sprains are just a few examples of injuries that can cause low back pain.  Treating a lumbar bulging disc early and properly is just what the doctor ordered to keep you active and pain-free.