A client came in last month asking why we would not just put him on the MedX machine on day one. He had read about the strength gains, he wanted the numbers, and he wanted them fast. That is a reasonable instinct. It is also backwards. Manual therapy has to come first, and understanding why changes how you think about the whole treatment sequence.
Here is the misconception I want to overturn early: MedX spinal strengthening is not a starting point. It is a finishing move. The muscle you are trying to load has to be able to fire correctly and move through a clean range before loading it does any good. Skip that step and you are not strengthening the spine. You are reinforcing whatever dysfunction is already sitting in the tissue.
What Manual Therapy Actually Prepares
Manual and muscular therapy is not a warmup lap before the real work. It has a specific mechanical job: it releases guarded, shortened, or adhered tissue so that the joint underneath it can move through its actual available range. A lumbar spine that is locked down by a hypertonic erector or a fibrotic thoracolumbar fascia is not going to extend cleanly on a MedX unit no matter how carefully you dial in the resistance. The machine measures force output. It does not know or care whether that force is coming from a properly recruited multifidus or from a client compensating through the lats and hip flexors because the deep stabilizers are locked up. This pattern often traces back to why a tight psoas keeps your low back and pelvis stuck, one of the more common sources of guarding we see before any strengthening work begins.
This is where San Juan's 2005 finding becomes relevant, not as a footnote but as a mechanism. Multifidus EMG activity was 51% greater with pelvic stabilization in place. Stabilization changes which muscle actually does the work. Manual therapy is doing something adjacent to that job before the client ever sits down on equipment: it is clearing the noise so the right muscle group is available to be trained in the first place.
Skip the manual work and you can still generate a strength number on a machine. You just will not know what tissue produced it.
Why the Reverse Order Fails Mechanically
Send an untreated client straight to spinal strengthening and one of two things happens. Either the guarded tissue blocks range of motion so severely that the exercise never loads the target muscle at all, or the body finds a compensation pattern and the "strength gain" you see on the readout is really a stronger compensation. Neither outcome fixes the original problem. The second one is worse, because it can mask the problem long enough for a client to feel confident doing more, loading a pattern that was never sound. This is part of why core workouts alone do not fix back pain, the tissue underneath the compensation was never addressed.
Graves' 1994 data is instructive here for a different reason than it is usually cited. Isolated lumbar strength improved only with pelvic stabilization, up 23.5% versus a loss of 1.2% without it. Stabilization was the variable that made the training effect real. Manual therapy is an earlier link in that same chain. Before you can stabilize a segment for isolated training, you often have to release what is holding it in a fixed, compensated position to begin with. Try to stabilize a segment that cannot move correctly and you are stabilizing a distortion.
Sequencing is not a philosophical preference. It is a mechanical requirement. Load before mobility work does not build a stronger spine. It builds a stronger version of the problem.
What Sequencing Looks Like in Practice
In my own clinical model, manual and muscular therapy comes first, addressing the soft tissue restriction and joint mobility deficits that block clean movement. Traction or spinal decompression can be layered in for clients whose presentation involves disc-related compression, creating space before we ask the segment to work under load. Only after that groundwork is in does MedX spinal strengthening enter the plan, part of why MedX spinal strengthening works when it is applied in the right order, and even then it starts at a controlled, measured resistance, not maximum effort.
This is not a slower path to the same destination. It is the only path that gets you to a genuine destination. A client who strengthens a clean movement pattern is building something durable. A client who strengthens a compensation is building something that will eventually need to be undone, usually with more time and more discomfort than doing it in order would have cost the first time.
Most people have never trained the muscles that actually support the spine.
You can. MedX isolates and strengthens the deep spinal extensors that conventional exercise can't reach.
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The Uncomfortable Part Clients Do Not Want to Hear
Clients want to skip to the strengthening phase because it feels like progress. Grip the handles, push against resistance, watch a number go up. Manual therapy feels less dramatic by comparison. No dial, no printout. But the number on a MedX readout is only meaningful if the tissue producing it has been prepared to move correctly first.
Pollock's 1989 study is the one people quote when they want a big number: 102% increase in lumbar extensor strength at zero degrees over ten weeks, training once a week. That is a real, verified figure, and it is worth understanding what it actually measured, healthy subjects building strength, not injured patients resolving pain. It says nothing about sequencing. It says nothing about what happens when you load tissue that has not been cleared first. The number is real. The context clients want to attach to it usually is not.
Order is not a formality here. It is the difference between training a spine and training a problem.
You don't have to live with this. Backs and necks can get stronger, pain can ease, and the body is more capable of recovery than most people are told. This blog is here to give you honest, practical information about what actually helps. As we learn more, we'll keep sharing what works. If something here spoke to you, that's a good reason to reach out and start the first conversation.
Trent Shuford, LMT, Cert. MedX Tech.
