INTRODUCTION
In this 21st century of economic crisis and increasing natural disasters a healthy back is extremely important. Opti-stretch provides valuable information for both those with back pain reoccurring more than once in the same location and to athletic individuals with little or no back pain.

Opti-stretch is goal oriented. For those with a history of back pain, first perform the screening exam. If risk factors are detected, proceed to Level 1 of the Opti-stretch challenge.

For athletic individuals and Dr. Moms, simply read the knowledge base and see if it may contain helpful information in your individual goals for you or your child.


REOCCURING BACK PAIN. HOW IS IT DEFINED?
Reoccurring back pain is pain that occurs in the same location more than once. Back pain that occurs once and doesn't reoccur for another 5 years is generally not a problem. However, back pain reoccurring in the exact same location 3 or 4 times a year is a significant problem for many individuals.

A major breakthrough is the ability to assign a level to your back pain and objectively compare it with others. For any given incident of back strain, the level of pain is valuable. However, a more important indicator is amount of time it takes for the pain to disappear and for the individual to return to normal activity.

Using a Degree 1 to 4 system is simple but also valuable for research. Think of it as classifying a burn. There 1st, 2nd, and 3rd degree. Clinically there is a 4th degree burn (requiring deep tissue debridement).


Table 1: Simplified Back Strain Classification

• *Pain severity in Degrees 1st  and 3rd  can be highly variable.
• Time to Healing is when the individual feels like the strain has completely resolved.
• Using this system, it is easy to assign a level to your type of back pain and very useful for comparison.

Incapacity:  Another important distinction is whether there is any incapacity after healing.  Most commonly after a 4th Degree strain an individual will say that their back never felt the same again.  Many "religiously avoid lifting heavy objects" or if they do lift heavy objects they are "continually aware of body position while lifting so as not to strain the back again".
"No incapacity" suggests the individual can comfortably lift an object off the ground 1.0 to 1.5 times their own ideal body weight,

4th Degree: Is of particular interest.
For the first 5 days the pain is so severe and unrelenting that if you have ever experienced it, you will remember it. The severity of pain is very similar to having a broken bone. Classic descriptions are that "it takes an extra 10 minutes just to put on my shoes". "Once I find a semi-comfortable position, I have to think twice whether it is even worth getting up to go to the bathroom." Only 1 in 100 individuals to 1 in 300 will experience this type of strain. It only occurs in the low back. The pain encompasses the entire low back at first. After 2-4 weeks of healing, the pain then gradually localizes over the left or right posterior superior iliac spine (boney prominence 3 fingerbreadths from the middle of the spine at the level of the belt-line [see home page figure 1]). Many report that a simple twisting motion can cause this type of strain. Commonly the individual will describe that their "back never felt the same" after the first occurrence. After several strains, many self impose a strict limitation on their lifting of heavy objects and certain other activities. Doing this, they find they can go for prolonged time periods without another strain. Given that activity is "a spice of life", this tremendously negative effect on the quality of life is a needless tragedy for many. Until they regain their healthy strain-resistant back they sometimes don't even realize how much of life they were missing. Opti-stretch was specifically designed for this type of individual.

General Back Health Classification:

1. Healthy ("good back"). No significant back pain in the past 5 years.
2. Possible problem back. Even one incidence of 3rd Degree or definitely a 4th Degree.
3. Problematic ("bad back"). Any incapacitations or more than 2 reoccurrences of any level per year.

Comparing back pain problems: Usually in 5 year increments.

A classic example for a 4th Degree "bad back":

1. Before Opti-stretch. During the last 20 years. 4th degree strains approx. 5 times, 3rd degree approx. several dozen of times, 2nd degree and 1st degree approx. several hundred of times. General back health during this time was considered "problematic with significant incapacitations".
2. After completing Opti-stretch. During the last 5 years. 2nd degree without any incapacity approx. 3 times, and 1st degree approx. couple dozen times. General back health is now considered as "healthy".

How to remedy the problem?
Stretching, if properly performed, has proven to be an extremely valuable tool for assessing reoccurring muscle strain problems. Many complex anatomic and physiologic properties of muscles have simplified by Opti-stretch to offer a effective program.

It is important to understand certain basic concepts of safe and effective stretching techniques prior to attempting the Opti-stretch program.
A major goal is to utilize stretching to determine whether muscles are healthy or whether some type of chronic injury is present. Traditional medicine teaches that following strain, muscles will heal to 100%. This does apply to peripheral muscles. However, in the core muscles where both stronger and weaker muscle groups performsimilar functions, the weaker muscles in certain body types can remain in a state of chronic injury for decades. These muscle groups are extremely susceptible to reinjury thus causing reoccurring strain problems. If present, they are essentially asymptomatic (unless directly assessed). The term "asymptomatic chronically injured muscles" (ACIMS) has been coined.
Not only the primarily injured muscles display the properties of ACIMS but so do other more remote muscle groups which have presumably gone into a partial spasm state to preserve the essential functional capacity of the body. These secondary ACIMS must be corrected before primary ACIMS can be completely returned to health.


There are four classic properties which ACIMS display referred to as "the 4-T's".

1. tight
2. tender
3. trigger points
4. shortened stretch-to-pain transition

"Tiene que llenar!

• Stretching in the warm-up phase

"Tiene que llenar!


Maintenance
The ultimate goal of Opti-stretch is to establish a level of activity which allows for maintaining all of the muscles of the back in a healthy state (i.e. rock climbing, triathlons, martial arts, etc.) Using the Opti-stretch screening program the health of the back can be checked initially every week for several months. If the muscles are remaining healthy the screening program needs to be performed at least once a month to ensure that no chronically injured muscles are starting to develop.
If an injury happens to occur, the Opti-stretch warm-up program can be utilized to help heal the injury as rapidly as possible. When the back has returned to normal, the screening program is performed to ensure the injury has healed completely.

Other important concepts

Flexibility
Many studies have shown that back pain occurs in about the same frequency for individuals who are extremely flexible and those who are not very flexible. Hyperflexible individuals with back pain exhibit similar asymmetry and (ACIMS) as other individuals with back pain.

Opti-stretch research has shown that expected relative flexibility can be estimated by assessing which joints are double-jointed (a.k.a. joint hyperflexibility or extensibility). Four groups exist: no doubled jointedness, 1st degree (thumb or finger), 2nd degree (elbow), 3rd degree (knee or hip) and 4th degree (spine). With increasing joint size double-jointedness the expected relative flexibility increases.

This is very valuable information when assessing and comparing individuals.

Seldom are these different levels of hyperflexibility see before 6 years of age.


Common Locations
These are the most common reoccurring muscle strain locations in 4000 individuals and where Opti-stretch has been demonstrated to be extremely helpful. A complete and detailed description is beyond the scope of this website. Only a brief introduction for reference purposes is presented. (A more detailed description is found in "Opti-stretch versus Recurrent Back Pain". There is a great deal of additional information which has not yet been published.)


Low Back
Button 1 shows the location of the most frequent and most incapacitating area of low back pain known. Remember, this location is after several weeks of healing. Acutely, the severe pain involves the entire low back area. There are 5 different types of this problem. Briefly, the most severe worst-of-the-worst strain problem known to man is right-sided ipsilateral (same side) asymptomatic chronically injured muscles (ACIMS). A less severe problem is left-sided ipsilateral ACIMS. Two other types are seen where contralateral (opposite side) ACIMS form. This constitutes a less severe form of the problem. A 5th type is reserved for the few individuals not fitting into the above mentioned types. The primary muscle strain involves the iliopsoas complex.
Button 3 is also a very common location for muscle strain of the erector spinae muscles. This is frequently seen in Level 1 form in blue collar labors experiencing a particularly demanding day working in a bend over position which they are not accustomed. Level 2 and 3 is commonly seen in "weekend warriors" and others with poorly conditioned erector spinae muscles.


Hip
Button 6 is a location frequently seen in females. It can be a serious problem and is analogous to the button 1 area in males. In its most acute form it can be mistaken for a hip bursitis.

Upper low back
Button 4 location is not extremely common. Frequently involves the quadratus lumborum muscle and\or multifidus musculature.

Upper back
Button 5 is the most common upper back problem area. It primarily involves the rhomboids which are difficult to stretch. Isometric exercises are important in returning the muscles to a healthy state. If low back ACIMS exist, these must be corrected first before any long term correction can be expected.

Neck and upper shoulders
Button 6 is the most common location of the shoulder and neck area. The levator scapulae and trapezius muscles are primarily involved. Two new stretches have been included in the Opti-stretch Upper Back Program for this area. Assessment and correction of low back ACIMS is again important.

Button 7 generally involves the rotational muscle of the neck. Again, for long term results, low back and upper back ACIMS must be corrected if present to achieve any long lasting results.

Program for Children - "Dr. Mom"

Basic Concepts why the Opti-stretch screening is a valuable tool for parents who are concerned about back pain in their children.

Flexibility
The human body is most flexible at birth. Flexibility decreases during the first year of life. Virtually all healthy 3 to 5 year olds have the same flexibility. This level of flexibility is also very common in adults who have no history of back pain (and no joint hyperflexibility). For this reason the level of flexibility at ages 3 to 5 has been determined the "gold standard of range-of-motion".

By age 6, hyperflexibility subtypes start to appear, as-well-as limitations of range-of-motion.

While many individuals with healthy backs and no history of back pain have significantly less range-of-motion than the "gold standard", Opti-stretch has determined that there is a minimum range-of-motion that needs to exist in order for an individual to both lift heavy objects and maintain a healthy back throughout life. (Details in the book "Opti-stretch Versus Recurrent Back Pain")


Injury
Most healthy children will have some type of bumps and bruises as they develop. The screening program is valuable in determining when the child or adolescent is ready for full activity.

Frequently we have encountered significant asymmetry in children who have suffered a fairly serious injury to that limb in the past. Knowledge of the range-of-motion prior to a serious accident will allow parents to determine if the injury has completely healed or whether the child needs to be reevaluated by their pediatrician. This allows optimum healing of any significant injury.


Assessing new activity regimens (i.e. martial arts)
Many activities such as martial arts, dance team, and others require a certain extreme range-of-motion. While this is generally regarded as healthy, it is important for parents to periodically assess that asymmetry is not developing in their child. If asymmetry is occurring, the risk of muscle strain and other injuries increase substantially.

Many studies on range-of-motion have determined that a certain amount of increased range-of motion is normal for overused dominant limbs (i.e. base-ball pitchers, kickers, carpenters, etc.). Rarely does this exceed 1 inch of range-of-motion increase. Also the non-dominant limb has a normal "stretch-to-pain" transition.

Program for Athletes

Warming up muscles!
The value of warming up muscle is quite controversial in the literature. First, the most important protection from muscle injury is having healthy strain resistant muscles to start with. Second, adrenaline significantly protects muscles from injury. This is why muscles are seldom injured during a true emergency activity. Third, as the body ages, the more important a good warm-up routine is. Therefore, learning routines while young is of significant value. Stretching is only one of many effective ways to warm up the muscles. Many team sports have a standard routine. At home, you can first perform the team standard routine and then the Opti-stretch warm-up afterwards to see whether all the muscles groups are sufficiently warmed up. Many have different warm-ups for different activities. As mentioned previously, the Opti-stretch warm-up can be used as a "gold standard" for comparing various routines. Depending on your body type you may need to incorporate a couple more warm-ups, especially if you have any non-correctable body asymmetries.

How long does a warm-up last?
This varies on age. For adolescents and adults under age 45 an "involuntary stretch" is adequate in the morning and lasts throughout the day until 2 hours or more of inactivity (i.e. a nap or prolonged car ride). If you are getting to an age where a 2 or more hour car ride makes you a little stiff, warm-ups before strenuous physical activity should strongly be considered.

Stretching exercise.
At last count, there are over 1,500 different stretches which have been published. There are approximately 656 muscles of the human body. I have reviewed over 150 different stretching programs (i.e. Yoga, Pilates, etc.). The stretches used by Opti-stretch (especially for the low back) have been carefully chosen for optimizing the warm-up of muscles required to lift heavy objects.

Overstressing the muscles?
Athletes can overstress muscles if their exercise routine is too demanding. This can lead to minor injury which can stall progress. You can periodically assess new routines by using a before-and-after comparison of either the Opti-stretch screening program or the Opti-stretch warm-up program. Significantly decreased ROM after an exercise routine may suggest too intense of routine. A more rapid improvement may be achieved by a more gradual increase in your routine intensity. Cooling down the muscles is highly recommended by many athletic trainers. The Opti-stretch warm-up routine is both valuable and can provide additional information regarding the work-out.

Assessing for muscle injury?
First sensation-of-stretch is a very valuable tool. If the 1st sensation has decreased, the chance of a significant injury has occurred. By pushing a strained muscle, the chance of a more serious strain occurring is increased dramatically. Everyone knows that if you move a muscle and you have pain, most likely an injury has occurred. What Opti-stretch has discovered is that even subtle shortening of the stretch-to-pain transition also indicates some type of injury has occurred.

Return to 100% activity following injury. When?
The 1st sensation of stretch has returned to normal and Opti-stretch warm-up shows symmetrical 2 inch increases in both sides of the body before engaging in 100% activity.

Deep muscle massage! How to give yourself one!
Deep muscle massage is a commonly employed by many professional athletes. This can be rather expensive for the average individual. By slowly and gently performing the Opti-stretch warm-up, you will achieve the same level of muscle relaxation and benefits for a fraction of the cost. Many find this a great stress reducer prior to bed.

Determining proper activity level!
Peak age of muscular performance is considered to be around ages 20-25. Your own individual optimal range-of-motion for your body type is generally at this age also. Many athletic individuals will continue this range-of-motion (ROM) into their 70's. Remember, optimum stretched ROM is different for different hyperflexibility body types.

Fountain of Youth
While there are many hallmarks of aging, a major indicator is range-of-motion. It always tends to decrease with advanced age. Above-average active individuals generally preserve an increased range-of-motion well into their 80's and 90's. "Spry" individuals at these ages tend to be more active and healthy. Studies in the literature suggest that increased range-of-motion at advanced ages decreases the incidence of falling and appears to be a good indicator of above average health.