Flexion Intolerance Low Back Pain Rehab Profession And My Overall Rehab Thought Process


Born in Hong Kong and raised in beautiful British Columbia, Dr. Li. obtained his Bachelor of Human Kinetics from the University of British Columbia. He went on pursuing his Doctor of Chiropractic degree at New York Chiropractic College. While practicing as a chiropractic physician in New Jersey, he continued to follow his passion of learning and completed post-graduate degree program in functional rehabilitation. He is only the one of three Diplomate of American Chiropractic Rehabilitation Board in the state of Washington, with the other one being the current Seahawks chiropractor and his mentor, Dr Jim Kurtz.


Dr. Li 0:01 

This video is made to demonstrate how I will take someone with low back pain in the early phase of rehab. So, flexion intolerance low back pain is a common case seen in our clinic. And the main thing we want to teach them is a good hip hinge. So, there can be a variety of ways, we usually start off with putting tapes on their back so they can really feel any flexion movement or movements in the low back. Then, from there, we use the tape as a guide to teach them how to hip hinge. So, maybe the kneeling hip hinge

[Inaudible 0:40] from their treatment bench, or kneeling position like this. Then from progressions to… Or, from there, progression to rocking hip hinge, singular hip hinge afterward.

Then we can get what we call a DNS, sometimes, movement at half kneeling, so to see if we can get them to have a clean hip hinge. Getting up from the kneeling to half kneeling. Then, from there, with support, they’re going to come up and step up. In other ways, the approach we have is from Gray Cook's FMS. So, we always start from the ground first. So, a lot of ground-based exercise, and then the usual from stable to more unstable, or unsupported exercise. So, just a general stream of how we do things. And, of course, in the context of the low back pain case, so after they can do the movement pattern right, then we start to increase the loading. And, in this case, my favorite one is to teach them how to do some sort of deadlift.

That's usually how we go by things. While there are a lot of ways to get the same things done, the general mindset I have for cases decrease any neurological symptoms. And when I say neuro symptoms, in addition to loss of reflexes, sensations, or muscle weakness. Then the next one is any nerve tension, per se, as of neurodynamic or Michael Shacklock's work. So, neuro tensions, and then, from here, we're going to play out any joints or muscle dysfunctions. When we say joint, do they really have a restricted movement? So, for low back case, I want to see, okay, do they really have a mid back, or joint, or the hip joint movement instability, or really just cannot move at that joint because of the tight joint or whatever reason that cause the tightness?

That's when the manual work comes in. And then, from there, we clear the neuro joint muscles, we go on to addressing the movement pattern. Now, the movement pattern, you will see that always goes back to all this because we’re trying to always install proper movement. But, in the meantime, we want to make sure they don't really have any interference that makes all the issues react that can also change the movement pattern. So, that's my thought process. Then afterward, the last phase of that is the loading part.

And that's what I like about training, they really use a lot of weight or repetitions,

[Inaudible 3:25] intensity. Really trying to make a physiological change in that patient so that we can get the tissues capacity up or tolerance up, whatever we want to call them, but they will be ready for life. And then, of course, with the other end, we have any more physical demand for our recreation athletes. That's where more sport-specific training comes in. And that’s the part I try to expand my clinic to work on if we can do more of this part. But, for now, hopefully, that gave you a more guideline of what my thought process is.

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