After being in a cast or on crutches rehab is mostly about re-developing strength and flexibility. Muscles atrophy with disuse and ligaments tighten up.

With low back and neck injuries muscle strength is generally not the main problem. So my rehab exercises are not totally about building up your back muscles.

With backs and necks the biggest problem is with imbalance and a lack of coordination in the muscles. Many back problems ultimately start with poor posture or an over-use situation. This creates an imbalance in the muscles where some are shortened and tight while the opposing ones are weak and stretched. The classic is the “crossed syndrome” in the neck:

With a slouching posture your head starts to jut forward and tilt back, no longer sitting squarely on your torso. To hold your head there the muscles down the back of your neck work overtime and get short and tight. Thus the muscles along the front of your neck have to stretch out making them weak. That slouch also curls your shoulders forward, making your chest muscles short and tight. As your shoulder blades draw upward with the curled shoulders the muscles halfway down your back, which anchor the shoulder blades down, must stretch and thus get weak.

This imbalance puts stress on the joints and discs at the base of your neck and one day you sneeze and POW, an injury.

The rehab for that should be all about re-developing the balance between the muscles affected by your slouch. Stretch and massage the tight ones and strengthen the weak ones. It has to be specific.

Sometimes the exercises seem pretty easy because we aren’t trying to “bulk up” the muscles. We just want to re-set the tone.

In the low back especially, exercises are aimed at teaching the muscles to stabilize the spine. There is a similar “crossed syndrome” there developing from a lazy posture. Chronically tight low back muscles are notoriously bad at stabilizing sudden movements. When I harp on the need for “core strength” I really am thinking “core muscle coordination”. Again, my rehab protocols are not difficult, but must be done correctly to re-train those core muscles to stabilize properly.

So please, do your exercises regularly, and do them right. Those easy exercises, if done right, can prevent significant pain down the road.