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The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder, and Joint Pain

The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder, and Joint Pain

by Anthony B. Carey

"Anthony Carey hits the bull's-eye! Striving for a pain-free lifestyle is a goal we all want to achieve, and this book is a powerful tool to help you attain it."
—Bradford Stiles, M.D., Medical Director of California Sports & Industrial Medical Center

"Anthony Carey's unique approach to promote the proper function of the whole body in order to support


"Anthony Carey hits the bull's-eye! Striving for a pain-free lifestyle is a goal we all want to achieve, and this book is a powerful tool to help you attain it."
—Bradford Stiles, M.D., Medical Director of California Sports & Industrial Medical Center

"Anthony Carey's unique approach to promote the proper function of the whole body in order to support and heal the problematic area delivered the results that made me a lifetime believer. I continue to utilize Anthony's techniques to train and heal my body every day. I only wish I would have found his program earlier in my career."
—Erik Kramer, former NFL Quarterback

An innovative, therapeutic exercise program to stop the pain for good

If you're one of the millions who suffer from chronic back, neck, shoulder, and joint pain, all you can think about is relief. Now, exercise physiologist Anthony Carey presents a breakthrough whole-body approach to pain relief that will help your body function and heal the way it was designed to.

The Pain-Free Program shows you how to assess and treat the underlying cause of your pain rather than trying to simply fix your symptom area alone. Carey provides an individualized program for your specific body form, complete with customized exercise routines. This prescriptive guide:

• Addresses the full range of pain sources, outlining the typical "hot zones" where pain tends to occur and why

• Presents customized programs based on 6 major body forms identified by the author

• Features over 100 photographs and illustrations that demonstrate appropriate exercise positions, techniques, and modifications

• Reveals how you can prevent future injuries

The Pain-Free Program gives you the tools you need to get rid of the pain for good—and stay healthy for the rest of your life.

Editorial Reviews

Library Journal
We all know that exercise is good for us, but too much of a good thing-or the right thing done wrong-can lead to serious musculoskeletal problems. Carey, an exercise physiologist, and DiNubile, a sports medicine physician, have each written a book that will help people safely start, maintain, and build an exercise program. Both authors take philosophical approaches rooted in therapeutic modality, meaning that they prescribe exercises based on the interaction of the whole body. Carey believes that many musculoskeletal problems result from muscular length and strength imbalances. To correct these imbalances, he has developed the Function First program, which focuses on proper body alignment, kinesthetic awareness, and core body strength and stability. DiNubile, meanwhile, presents many of the same core body exercises as Carey; to boot, there is an extensive preexercise screening questionnaire and advice on aesthetics, weightlifting, diet, and seeking medical advice in case of injury. Both titles are well organized, include helpful illustrations, and impart advice that is in line with what trainers today are offering at many top health clubs. Both are highly recommended for public, consumer health, and human resource collections.-Howard Fuller, Stanford Health Lib., Palo Alto, CA Copyright 2005 Reed Business Information.

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Read an Excerpt

The Pain-Free Program

By Anthony B. Carey

John Wiley & Sons

ISBN: 0-471-68720-0

Chapter One

The Path to Pain

If you are reading this book, you are probably among the thousands of frustrated, angry people who are looking for help with their physical challenges and pain. According to the American Academy of Orthopedic Surgeons, for thirty-five million Americans-that's one in every seven-their movement is restricted by a musculoskeletal disorder, such as a broken bone, myofascial pain, arthritis, or a sports trauma. Pain sufferers are everywhere, from all walks of life and all ethnic backgrounds, socioeconomic levels, and ages. The common thread connecting these individuals is pain, either chronic (typically defined as pain that lasts longer than three months) or acute (pain that has more of a rapid onset to levels that often motivate a person to seek intervention).

Perhaps the pain you have is new. Maybe it's one more pain in a long list of pains that has prompted you to finally take action. Or maybe it's chronic pain that never went away or has disappeared, only to come back again. These scenarios often develop when chronic pain is improperly addressed over time. When this happens, the damage exceeds the body's level of tolerance, and the pain becomes acute. If intervention does not occur, disability or loss of function may result.

Maybe it's a pain that you're tired of treating with medication. The medication may not be helping any more, or perhaps its side effectshave created their own problems. It could be a pain that you know is getting worse or will get worse if you don't do something about it.

You might not even experience "pain" per se, but you do have a muscular-related physical limitation that interferes with your daily activities, by causing difficulty in rising from a chair and sitting down, getting in and out of the car, or climbing up and down stairs. You might think that as long as you avoid a specific movement, you won't have any pain. Of course, little by little, you start adding to the list of activities to avoid until, finally, your life is restricted to a few, limited things you can do without pain.

Even a very active person can have similar problems. A small musculoskeletal imbalance or weakness can significantly limit an active individual's ability to perform at an optimum level. It can even result in your changing a favorite mode of exercise due to pain. No matter how hard you train or modify your technique, you can't seem to rise above the plateau. For example, at the third mile in a run your knee begins to hurt, or you can't play golf anymore because you will be laid up the next day with back pain. For the more elite athlete, an inability to cut, jump, balance, or accelerate as well with one side of the body greatly affects performance.

Peter, an up-and-coming triathlete, came to see me because he was unable to log the training miles from biking and running that he needed to improve his competition times. Sure, he could run ten miles and feel okay or bike thirty miles and feel pretty good, but as soon as he crossed those thresholds, his body began to break down, and the pain in his hip forced him to stop. Peter could swim without a problem, but that was only one third of what a triathlete needs to do. At the ten-mile run and the thirty-mile bike, Peter's body could no longer tolerate the stress that his training put on it. His mechanical deficiencies became magnified, and pain reared its ugly head. So, running or biking was not the problem; it was the way Peter ran and biked. The program we designed for him reeducated his body to move the way it was supposed to move, without the mechanical stress that it was so accustomed to. Peter is now competing at a level he never thought possible, and without pain. He is a winning example of how body mechanics must first be viewed from a macro level. Although he's a competitive athlete, Peter still had to begin with the fundamentals just like everyone else. If he hadn't started with the basics, his body would have resorted to its old familiar ways.

The Path to Pain

To help you understand what caused your present condition, I'd like to take you through what I term the "Path to Pain." Everyone's path is unique, but there is a sequence of events that's common to individuals whom I see in private practice. It isn't unique to the people who come to Function First; it happens to almost everyone. It's a series of events that, when traced back, often leads us to the underlying cause of an individual's pain. As you read, you'll begin to understand how this applies to you, and more than likely, to many people you know. You will not discover something extraordinary and unique; instead, you and your "healing team" (doctors, therapists, chiropractors, etc.) will begin to place emphasis on long-term rehabilitation and the prevention of future occurrences by looking beyond each symptom and seeking the underlying mechanical trigger.

In my opinion, the Path to Pain begins with muscle imbalance issues. A muscle imbalance is a discrepancy in length and strength between two opposing muscle groups. That is, muscles that oppose each other (pull in opposite directions) need to maintain a mutually beneficial relationship. They should have corresponding lengths and strengths that allow a joint to move equally and within its normal range of motion. A predictable pattern occurs with these muscle imbalances based on how our neurological system works. It's a dirty little trick that our bodies play on us. You see, when a muscle gets tight, it begins to demand more attention from our command center, the central nervous system (CNS). The tight muscle thus receives more of the information from the CNS, until it deprives the opposing muscle of its fair share of the information. This is equivalent to adding fuel to the fire. The shorter, tighter muscle continues to get even shorter and tighter. The opposing muscle now becomes long and weak as a result. Therefore, the situation perpetuates itself, if you do not recognize and act upon it. Ultimately, these muscle imbalances will result in altered or inappropriate movement patterns, which are precursors to many types of musculoskeletal injuries.

Muscle imbalances can be caused by many different things. The most easily recognized are those associated with habitual postures. For many people, the picture of a slouching teenager may come to mind. When left unaddressed, these postures become more ingrained in people's physical characteristics. Other examples of habitual postures are a tendency to always stand on one leg or to regularly shrug the shoulders in response to cold, fear, or tension. Women who were teenagers and young adults in the 1950s and 1960s were taught to tuck their buttocks under when they stood. Over time, this affects the position of the pelvis and the lower back. Habitual postures can also develop from psychological influences. Certain observable postures are often associated with depression and fatigue, others with stress and fear. A person who consistently experiences these emotions may reinforce these undesirable postures.

Another major cause of muscle imbalances is the work environment. If you do a lot of any one thing, your body will get stronger and more efficient at the mechanics it takes to complete that task. This can lead to tighter and stronger muscles associated with accomplishing that movement. This is true whether you use a computer or run a jackhammer every day. If you sit all day with your hands in front of you, certain muscles will likely develop tightness, while their antagonist muscles will develop weakness. The same principle applies if you always hold a particular work tool the same way or have to assume a specific stance on a regular basis (e.g., as a grocery checker).

Past injuries and surgeries can also cause muscle imbalances. Trauma to the body, be it from an accident or surgery, creates a response within the tissue. This includes the skin, the fascia, the blood vessels, the ligaments, the muscles, and the nerves. But we all knew this, right? You've experienced this if you fell and skinned your knee or your buttocks became bruised from a needle. For the sake of our discussion, however, the importance of this response to the tissue is how it affects the way we move. If there is a lack of movement in one part of the body, be it a muscle or a joint, the body will make up for it somewhere else. Let's say that you strained the hamstring muscle in the back of your left thigh. Strains come in different degrees of severity-from just a few torn muscle fibers to a complete tear, in which one side of the entire muscle is separated from the other side. So, let's say that your strain was pretty bad, and the skin above the muscle became discolored and bruised (this is due to bleeding of the damaged muscle fibers). As that tear heals, one part of the process is that the body places scar tissue in and over the region of the tear(s). Scar tissue does not have the same elastic properties that muscle has. This means that a muscle full of scar tissue does not lengthen or stretch the way a healthy one does. If left to heal on its own, that injured hamstring muscle will have less flexibility at the hip and the knee joints that it helps to move. The result is that even though the bruising has disappeared, the damage remains and can continue to impact the rest of your body.

Another way to develop muscle imbalances is through improper physical training-for example, how individuals work out in the gym, the way athletes train, and how a "weekend warrior" participates in his or her sport. The main difference between improper physical training and stressful activity in the work environment is the intensity of the former versus the duration of the latter. Work-related imbalances are often caused by repeating certain tasks and movements over a prolonged period of time. During physical training, muscle imbalances tend to develop as a result of overloading the muscles improperly-for example, a young man who spends most of his time in the gym training what I call the "mirror muscles." These are muscles that he sees in the mirror-the chest, the biceps, and the abdominals. Since he doesn't see the opposing muscles on the back side of his body, he doesn't give them the same attention. Although he may do this only two or three times a week, he is adding resistance to the body in the form of the weights he lifts. Therefore, he is making himself dysfunctionally stronger; although his toned muscles may look good, they in fact cause an overall negative impact on the body.

Another good example is a middle-aged woman who is an avid golfer. She loves to walk the course for exercise and never uses a cart. She may play only a few times a week or every two weeks, but because golf is a one-sided sport, she tends to develop detrimental muscle imbalances on one side of her body. Although she isn't working against resistance a way the weight lifter is, she has had to develop her body's muscular force to generate speed in the club to hit the ball. No matter how good a golfer she is, she would do this at least one hundred times each round, if her actual strokes plus practice swings were added up. In this example, it is the repetition of a single, one-sided movement that results in the stress.

Another type of improper physical training that can negatively impact the body is walking or running asymmetrically. Your movements should be symmetrical, from left to right. Now, many professionals in my field would probably be quick to point out that very few, if any, humans are perfectly symmetrical in their gait. Yet when the trained eye can observe asymmetries without the use of high-tech recording equipment, it's obvious that damage is being done to your body with every step. Asymmetries in your gait reveal the effects of your postural misalignments and muscle imbalances. Walking is your posture in motion. Take a look at an older pair of your running or walking shoes and see whether the wear patterns are the same on both soles. If you see exaggerated wear on the inner sole or the outer heel, you may have a problem with an asymmetrical gait. This is just one way to see firsthand the uneven wear and tear to your body. In addition, notice whether you form calluses regularly on one area of a foot that you don't form on the other foot.

The last few contributing factors to muscle imbalances are those that you have very little control over. One such type consists of congenital factors. You are born with them-for instance, having one leg slightly longer than the other. This is a "true" leg-length discrepancy. I say "true," because many people have imbalances that make one leg appear longer than the other when it really is not. True leg-length discrepancy is one in which a bone or several bones are longer in one leg than in the other. This can create compensatory changes all throughout the body, as the individual adjusts to the uneven base.

Scoliosis can also (though not always) be a congenital musculoskeletal issue. Scoliosis refers to a lateral curvature of the spine. This is seen when the spine is viewed from the back. Muscles on either side of the spine that should be of the same length are instead drastically different from one side to the other. Scoliosis is also found with a leglength discrepancy, as a way for the body to compensate for the sideways tilting of the pelvis.

Other muscle imbalances develop indirectly as a result of neurological or neuromuscular disease. Examples of these would be imbalances due to stroke, Parkinson's disease, or fibromyalgia.

I'd like to make a very important point about congenital and disease-related imbalances: just because an individual wasn't directly responsible for the development of these imbalances doesn't mean that he or she is helpless to change them. To do this, we must stop the downward spiral by steering the body off the path of least resistance that it has traveled for so many years. We can accomplish this by working on getting the body as close as possible to an ideal alignment, using the exercises outlined in this book.

For example, let's look at the illustration of a woman in her early twenties who has congenital scoliosis (see figure 1). She believed that because she was born with it, she could do nothing about it and would just have to live with it. But by allowing the body to take the path of least resistance and giving in to the muscular forces acting on the scoliosis, the curves get worse and worse. In figure 2, we can see the same woman at fifty years of age. Although the curvature of her spin has deteriorated over the years, it isn't too late to begin the Function First program. The improvement in quality of life that one can experience by reversing the path of least resistance is worth every repetition of every last set of exercises.

How do you know whether you have muscle imbalances? A very effective way is to observe your static, relaxed posture. This, in itself, is not that easy for someone with an untrained eye, but in chapter 9 I'll provide you with examples of some of the more common postural faults that we regularly see. You can compare your stance with these examples in the mirror or let someone else inspect your posture and match your body to the closest example given.

The Story of Brian

Let us consider my client, Brian, who had a job loading and unloading furniture. He hurt his back because of muscular weakness throughout his core (hips, pelvis, and torso). Brian essentially stressed the muscles and the ligaments in his lower back because he wasn't strong enough to protect his spine against the outside force created by the weight of a piece of furniture. Brian's visit to the worker's compensation doctor resulted in orders to take two weeks off work, while using muscle relaxants and anti-inflammatories.

Returning for a follow-up visit two weeks later, Brian had only slightly improved symptomatically. The doctor then ordered an MRI (magnetic resonance imaging), a diagnostic tool that would determine whether any damage had occurred. It took about ten days to get an appointment and receive the MRI results. The MRI showed that Brian had a damaged disc between the vertebrae (bones) in his lower back. Depending on the extent of the damage and the philosophy and the ethics of the doctor, Brian's treatment could have gone several different ways.


Excerpted from The Pain-Free Program by Anthony B. Carey Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Meet the Author

ANTHONY B. CAREY, M.A., C.S.C.S., C.E.S., is the biomechanical consultant for Jazzercise International and is a continuing education provider for the American Council on Exercise, the National Strength and Conditioning Association, the American College of Sports Medicine, and the National Academy of Sports Medicine. He has successfully employed the exercise regimes described in this book for more than a decade through his company, Function First.

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