Login to view Shoulder & Elbow Pain videosCan Back Pain be Helped Using Pilates & Yoga?
February 23, 2010
Back pain, like other areas of chronic pain in the body, is really the result of poor movement habits. These movement habits though, are often accompanied by anatomical and biomechanical problems feeding, and fed by, these movement habits. This creates a cycle of chronic pain that needs to be broken at these three levels.
If you talk to enough people (or visit enough websites), you'll find someone who swears by Pilates or Yoga as the end-all-be-all solution for their chronic pain. And rightly so. These disciplines take the body through positions and movements that it normally wouldn't go through. This is what has helped those with chronic back pain. I'm a big believer in these two disciplines and any others that responsibly help people feel and understand their bodies movement habits or functional deficits.
What you don't hear about, are those others who were not helped or even made worse by their experiences with these disciplines. Yes, there are many. So, how is it that the same movement philosophy, and even the same instructor, can be the cure for one person and not the other? The answer lies in a lack of understanding of functional anatomy as it relates to movement and chronic pain.
Ultimately many practitioners have only a general idea of how the body moves or how specific muscles work. But they don't understand how that movement, or lack of it, exactly relates to chronic back pain (or pain elsewhere in the body). So typically you are taken through a series of moves that are exactly right for your problem and others that are exactly wrong for your problem. In the case of back pain, most pain can be boiled down to either excessive arching (extension) of the lower spine or by excessive flatness (flexion) of the lumbar spine. I've posted a 1-minute test on YouTube to help you figure this out. Of course there are varying degrees of these problems and reasons contributing to them but you'll get the idea using this simple test.
If you look at a typical Yoga or Pilates repertoire, you'll notice that about half the exercises involve stretching the spine into extension while the other half stretch it into flexion. So by the end of your session, you will have done the perfect exercises for your back pain--and the wrong exercises as well. That's why so many receive temporary relief of their pain but it always returns.
In addition to being a physical therapist, I'm a Pilates instructor myself and am not picking on these disciplines. They can truly be just what the doctor ordered--if the doctor understands exactly what your problem is. Many do not, however. Fortunately understanding the roots of your pain are quite simple. Once you know why your back hurts, you can hone your workouts to focus on those exercises or poses that directly correct these issues and avoid those that contribute to it. Finding an instructor that understands these root causes can be a beautiful experience of letting go of pain and fear of movement and reclaiming your life.
Back Pain and Walking
February 14, 2010
I've been working on an upcoming book, Fixing You: Foot & Ankle Pain, and have been experimenting with a new approach to fixing foot problems. The interesting thing is, since I've been trying this new approach to walking, my pelvis has not become rotated, resulting in no back pain. Before, I've always been able to prevent or fix my back pain with the techniques from my book, Fixing You: Back Pain. But one thing I hadn't been able to do is identify the habit that is continually causing my pelvis to become rotated, contributing to recurrence of my back pain. Now I think I'm on to it! This is an unexpected benefit I hadn't counted on. Of course, we all know that everything in the body is connected but we don't know yet, the best way to use these connections to reduce pain. I think, in the course of applying a new understanding of our foot and lower leg anatomy, that I've figured out a way to reduce chronic pelvic rotation which is often at the root of pelvic pain, sciatica, SI joint, and back pain.
This was reinforced when I asked one of my clients with a perpetually rotated pelvis and a history of back and sciatic pain to try this new walking technique. He also has hip pain due to arthritis that has gradually become worse over the years of his pounding sports. Additionally he has knee pain on the same side. We've been able to fix all these aches and pains but I have not been able to get him to fix his walking pattern which is contributing to the recurrence of these problems. Immediately upon fixing his gait (walking) pattern his leg and pelvis corrected themselves without his even thinking about it! He also reported his hip pain had vanished! We both looked at each other stunned.
I'm still experimenting with this and working out the nuances for different foot types but I'm excited at what I'm finding. Finally, I think I might be getting to the bottom of a more complete approach to fixing ailments from head to toes, beginning with the toes!
How Do You Heal Sciatic Pain?
January 22, 2010
Sciatic pain (sciatica) can be disabling and extend all the way down to the toes if left untreated. Many suffer from this chronic pain condition but few find relief. Understanding the root causes of this chronic pain will help you fix it.
First it’s important to understand that the sciatic nerve is composed of nerve roots exiting the low back (lumbar spine). These roots come together to form one big sciatic nerve that runs down the back of the leg, feeding leg muscles. So, most often the cause of sciatic pain is from these nerve roots getting pinched in some way. The most common reason for this pinching is due to the lumbar spine being arched (extended) too much. What I mean by this is that our spines have natural curves and the inward curve of the lower back can become excessive. This pinches nerve roots exiting the lumbar spine. I believe this excessive arching also leads to bulging disks which can also pinch the nerve roots.
Many people with sciatica find relief by bending forward, which flattens out the lumbar spine. They’ll also report that this feels like a great stretch for their low back and relieves their chronic pain. If this is the case for you then you have, what I call, an extension problem where your spine is too arched and needs to be flattened out a bit. Flattening the lumbar spine will take the pressure off the nerve roots of the sciatic nerve.
The biggest reason a spine becomes too arched is because the pelvis tilts forward forcing the spine to arch more. Muscles in front of the pelvis are often responsible for this. These muscles can be tighter on one side than the other creating a rotated pelvis which then contributes to a rotated spine and pinches the sciatic nerve roots even more (Figure 1. Rotated Pelvis. Copyright Boone Publishing, 2009).
[caption id="attachment_178" align="alignleft" width="182" caption="Figure 1. Rotated Pelvis"][/caption]
Fixing sciatic pain is not only about reducing the curve in your back or your tilted pelvis. It’s about changing the habits that are creating these problems. For instance, one habit that contributes to a rotated pelvis is weight shifting onto a straight leg while the other leg is bent and rotated inward. This is partially responsible for tightening key muscles that asymmetrically pull one side of the pelvis forward creating a rotated pelvis. This then creates a rotated spine or excessive spinal extension on one side of the spine which pinches nerve roots.
If you can do fix habits like this, while correcting the underlying muscle tightness or weakness contributing to your chronic pain, then you’ll fix your sciatica, back pain, neck pain, hip pain, knee pain, headaches, tennis elbow, shoulder pain or any other chronic pain for good. Regarding sciatic and back pain, solutions to these problems can be found in my book, Fixing You: Back Pain.
Who to Trust When Making Medical Decisions?
January 20, 2010
I use a little feature called Google Alerts to help me track chronic pain information on the web I'm interested in. I have a setting for "neck pain", "headaches", and "back pain". It's always good to keep up with what's being said out there, which, I'm sorry to say isn't much. I'm thankful that I can discern between what is meaningful and what is often just a recycling of old ideas. Judging by the comments of people reading these articles and blogs, I realize that the average consumer has no real way to understand what is good information and what is bad.
If you have no knowledge of anatomy, biomechanics, and physiology, how can you be expected to make an intelligent decision as to whether to see one practitioner over another to help you with chronic pain? Or try one product or another, not to mention undergoing surgery. Unfortunately it often comes down to word of mouth but even that isn't very reliable because the practitioner being referred to, may have just set up that person to come in on a monthly basis forever to keep their pain at bay. I see plenty of people who have been to see "experts" and are left with no lasting answers and their bank account more than a little depleted.
Even when I say that you can trust my books because I lay out the specific anatomy and biomechanics involved with particular injuries, you really can't. I've heard fitness or health care practitioners explain anatomical or biomechanical concepts completely wrong and people buy it because it "sounds" right. Well, on what basis do you as a consumer decide that something "sounds" right?
I'm afraid I don't really have an answer for you. I suppose that is why I'm writing these blogs--to help give you, the consumer, some intelligent background so you can make the best choices for you. So here's where I'm coming from:
One of my basic tenets regarding chronic pain is that our bodies are not designed to be in pain. They are perfect working machines. In my experience, doing something right for the body pays instant dividends regarding eliminating chronic pain. Most of my clients instantly feel better after one or two exercises because we've restored proper function. This inspires my clients then to fix themselves. Most people feel significantly better in two or three treatments as a result.
The same goes for using my books. After testing yourself and performing the exercises, you will feel significantly better very quickly. You can read my testimonials if you're not convinced.
I determine my success by how few times I need to meet with a client. If I'm doing my job right, then they won't need to see me again--ever. As one doctor I treated for neck and back pain stated, "You're not much of a businessman then, are you?", I replied, "But I can sleep at night."
Conversely there are practitioners whose goals are to see you as often as possible and for as long as possible. Yes your pain may temporarily reduce after seeing them but are they really fixing you if you need to keep coming back? Would you be happy with this set-up if it was your car? Continually returning to tweak it again and again? No, of course not. Do you then, think your car is built better than your body? I'm here to say your body is perfect. It just needs a little help to get back on track and you're off and running again.
So the next time you're looking for information about how to fix your chronic pain, ask yourself, "Does this person (or product) require that I visit them (or use it) perpetually? That's one hint that maybe they are geared more toward temporarily easing your pain rather than fixing the source of the problem.
A 20-second Test for Neck Pain & Headaches
January 13, 2010
Most headaches and neck pain are due to the shoulder blades sitting too low on the trunk. There are muscles attaching from the shoulder blade directly to the first four neck vertebrae and skull. When the shoulders sit too low, these muscles then pull on the neck bones and skull causing neck pain and headaches. This is explained in my book, Fixing You: Neck Pain & Headaches.
Here's a quick, simple test to see if this is the case with you. If you're having right-sided neck pain or headaches, raise your right hand and place it flat on top of your head for 20 seconds. Make sure your head doesn't side-bend or rotate to achieve this. If your pain diminished after this test, then your scapula may be sitting too low causing your discomfort. This is easily correctable. This is also the culprit in diagnoses such as thoracic outlet syndrome and carpal tunnel syndrome or with symptoms of pain or numbness down one arm.
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