Here is Fast Friday Fitness - learn healthy floor-sitting, mobilize your pelvis, and use your core muscles and brains at the same time to move out of painful position to healthy comfortable sitting.
Here is a technique to identify if you sit in a way that is associated with lower back pain, and a technique to move out of unhealthful position:
1. Sit on the floor cross legged. 2. Notice your pelvis. Does it tilt backward at the top, so that the lower back rounds outward. This is too much tuck, demonstrated by my student Yash in photo 1 below:
3. Put your hands on the floor right behind your hips. Push against your hands to lift your back upright. Can you feel your hip tilt forward to upright position demonstrated in photo 2 below?
(In the photo above, hands are not behind the hip, to provide unobstructed view of the hip/pelvis corrected from tilted back to vertical)
Sit well and you can sit without back pain.
If your hip is too tight to move out of unhealthful tilted position, then it is likely that you are sitting with your back in painful rounded position.
If you are tight, or do not know how to move your pelvis while sitting, it is often easier to learn to mobilize your pelvis standing or lying down. The pelvic tilt is misused in therapy settings. It is mistakenly thought of as a strengthener or a back pain fix. The muscle work (to strengthen) is minimal. The idea is to learn *how* to move the pelvis so that you can voluntarily move to the needed position, then hold it.
Here is Friday Fast Fitness - how do abs help your back? Only when you use them to:
Abdominal muscles don't help your back by themselves. Support is not automatic. They don't fix your back pain by being stronger. Strengthening abdominal muscles doesn't make you hold neutral position (support you). Holding neutral strengthens your abs.
In the post Fast Fitness - Strengthen by Changing Your Plank Reader David from Belgium showed changing the plank from overarched lower spine to neutral spine. He pushes up from the floor into an arched position, then fixes it. Readers asked to see how to push up from the floor (or from the bottom of a pushup) with neutral spine.
David made us another video. Click the > arrow to see the first 20 seconds show holding neutral - green check mark. Next 15 seconds repeat the same push up, but with over-arched spine, marked with a red X. Then he corrects spine angle until the end - green check again. Can you see the difference? Can you do the difference?
Letting your lower spine cave inward (hyperextend) under your body weight means you are not using core muscles to prevent it. Hyper-extension, is also called hyperlordosis (too much lordosis) and swayback. Hyperlordosis bangs and abrades the joints, called facets, of the spine. Hyperlordosis can also pinch a disc that is already degenerating or bulging, making disc pain worse.
Get the T-shirt - Abs only support your back when you use them to. Shows ab use for carrying load on the back, in front, and standing.
--- Questions come in by hundreds. I'm bailing the ocean with a bucket. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
As kids become pre-teens, the slight normal inward curve of the lower spine often increases too much. Large degree of hyper-lordosis (swayback) is often written in medical textbooks as normal development, however, my physician colleagues who see patients at Children's hospitals report much back pain in these kids.
Teaching kids they don't have to ooze into any slouch that just happens, is part of regular training in manners, looking both ways before crossing the street, brushing teeth, and physical habits. Changing from overly-sagging inward at the lower spine to more neutral spine, stops much lower back pain in these populations.
Here is a charming, well-made video by reader James J., age 14, showing keeping stable in all planes and with a smile:
James' dad Paul J. says this is a fun reminder or a way to get kids interested in neutral spine. He wrote, "Plastic Man has a plastic shirt, so you won't be able to see the slight curve that is neutral lower spine. You can put a plastic man on your desk as a reminder."
Enjoy the video as a wonderful reader contribution, for a smile, and to keep going. The way to get strong enough for a plank or handstand or all you do, is to do them and keep good spirit.
--- Questions come in by hundreds. I'm bailing the ocean with a bucket. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
Fast Fitness - Straighten and Stretch Hip While Strengthening Core, Arms, Legs, and Balance
Friday, March 27, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - Increase strength and muscular endurance of your body working as a whole, and learn to keep neutral spine and good hip position against resistance.
From a pushup position, turn to the side, raising one arm overhead, holding legs and body straight.
Raise your top leg. Notice if you increase the inward curve of your lower back (overarch to hyperlordosis) and if you bring the leg forward - demonstrated in the upper photo.
Instead, hold straight. To feel position, practice against a wall - demonstrated in the lower photo. Bring the back of the raised leg against the wall. Press your lower back closer toward the wall instead of letting it overarch from the weight of your leg pulling the spine.
The idea is to use the wall as a guide to learn positioning, then use your muscles and sense of positioning to hold straight without the wall from then onward.
Read success stories of these methods and send your own. Questions come in by the hundreds. I make posts from selected ones. Before asking, see if your answers are already here by clicking labels under posts, links in posts, and archives at right.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right.
Fixed Injuries, Got Strong, With Functional Exercise - Real Life
Wednesday, March 04, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
This fun note and great story came in from Robert Davis:
" I have tried to find a way to contact you for a while now!
"I have a story I thought I would share and I am so glad I had found your books and website.
" I had injured myself via weight lifting in late October. I had felt the warning signs before this, however I ignored them and continued to train full out. The result was I had hurt my lower back very badly. The pain was unbearable.
" Sitting hurt. Getting up and walking hurt. To top all this off, I was so adamant that one's "back" health is determined by how well you can stretch forward bending! So this became a discouraging struggle as the more I tested that, the worse I hurt! I had many bad habits besides that and will go into that in a moment.
" I kept training "thru" the pain and bad movement thru to about November 24th. I kept aggravating the area thru bad habits (while doing these exercises. Arched back, rounding etc). I finally went to the doctor and he just made me do some simple movements and the typical straight leg lift. He had decided for now that it was not something all that bad and said that we would do a MRI (or was it CAT scan?) if it did not get better.
I struggled for the next few weeks as I was told to simply rest. I realize the fallacy in this because "just taking it easy" had lead to muscle weakness. It was now a double edged sword by Christmas. I hurt in my back, but when I tried to exercise it it was so weak it hurt more.
I finally ran across your website just after Christmas and before the new year. I started to play around with the ideas at first. I was still stuck though on "better" meant no more pain bending forward. So for a week or two more I played back and forth with these ideas.
" Finally around the 15th or so after the new year I decided "what the heck" I will order some of your books. They seemed more promising then anything I had looked at and I realized in an "aha" moment that it was a form of exercise, which I so very much craved at the time as I simply love to exercise. This "resting" was driving me nuts..
I was watching a show on TV one night on beaches and shell collecting of all things and the biggest "aha" came to me in the form of a little girl. I watched adults picking things up and they bend right over without thought. This went on for a while. Then I saw a child pick up shells. She squatted every time! I said to myself "jeez these books are absolutely right, I am basing everything on bad habits!"..
" I immediately started becoming aware of everything I did during and after exercise. I took your book "fix your own pain" and have almost memorized every chapter and decided if I am going to do this I am going to balance my whole body.
" So after weeks of this (trial and error). I slowly got better. Things I learned along the way are this.. Bending over to pick stuff up is not healthy nor is it natural (that child in the show!).. I learned even after doing weight training for 2 years that my legs were still not as strong as I thought. I learned I had developed bad leg positions from unhealthy squatting (on the knee joints instead of behind). I had further learned that I was holding my feet outward and I think this had come from doing leg pressed with feet slightly out to try to target certain areas.
" I learned to strengthen my core much more effectively and better thru the ab revolution and fix your own pain. I was a 500 crunch type person. I am no longer doing sit ups crunches or whatnot. The stuff in your ab revolution is much more difficult to do and healthier.
I learned to strengthen my body thru its own weight, destroying the myth that you need "weights" for gains as I found these exercises to be just as challenging, if not more in some cases because of the added balance and flexibility required.
" I am now sitting here writing this and I tell you that compared to the initial injury and repeated re-injury (doing the same exercises with bad habits) to now, I am close to 100 percent.
" The funny thing is, I no longer have the desire to go back to weight training, which is odd because that was my life! I have discovered a whole new world of fitness with body weight alone. I am trying more challenging things by the day and I have realized that this is actually more fun the weight training for health and I am getting the same, and often better results (since I am not a body builder, just love exercise and looking fit). I had gone and bought a few things like pull up bars and planche devices and am currently working on mastering some very difficult moves that require body strength alone, but at the same time a mindful awareness of how I am doing it by using your techniques (keeping the back straight with slight tilt etc, no arching).
" It is fun working up to one arm pull-ups in good form. Jeez, to think you could bench press close to 300 a few months ago but doing a few of these exercises in your book were hard! I was surprised I could not do very many pull ups or hold these planks and whatnot.. I am set on a new adventure and I love it because it feels so "free" and balancing. I don't have to spend a huge fee to go to the gym. My gym is my body and functional movement.
" Thank you for your knowledge. Having my back back (sorry for that funny saying!) is great. I intend to keep it healthy now and have begun the correction process of all my body, all the way to my feet!
" I don't look at my injury as a mistake anymore. I look at it as a life changing experience and a chance to explore more functional and fun ways of living. I have passed this site and your books on (not my personal copies!) to a lot of friends into fitness. Some are already reporting healing knees and what not and even re-considering how they live and workout!
" PS I have also changed to a Vegan diet just to see what happens. I was very intrigued by the 72 year old body builder who is vegan.
"You are a godsend. Robert Davis"
Great work Mr. Davis! Robert has been sending me many insightful updates with photos, to be posted with his ongoing success stories. His next story starts here: Cardiovascular Cleanup.
Junk food can be vegan and vegetarian with unhealthful additives, dyes, refined processed sugar and flour. Click the label "Nutrition" under this post for all posts on how to get healthy fun sports food and Healthier Fitness by clicking the label "Green Fitness."
Weightlifting and Weightbearing With Lower Spine Overarching (Sticking out too much in back) Compresses Vertebral Facet Joints:
Read success stories of these methods and send in your own. Questions come in by the hundreds. I make posts from selected ones. Before asking, see if your answers are already here by clicking labels under posts, links in posts, and archives at right.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right.
Here is Friday Fast Fitness - learn how to use your abdominal muscles for what they need to do in real life - hold your spine in neutral position, even against resistance:
Lie flat, face up. Legs out straight, as if standing up. Hold a weight a few inches above the floor with arms outstretched, elbows by your ears.
Lift the weight a few inches up and down, using your abdominal muscles to prevent your ribs from lifting up and to keep your back from leaving neutral position.
Keep your lower back close to the floor. This is the key to making this into an effective and functional abdominal retraining exercise. Also prevent the weight from touching the floor (don't drop baby on head).
This video was made by David from Belgium with his baby Aiko, born one year ago today, Feb 27th 2008. Happy Birthday Aiko!
Click the arrow to run. If the video does not load, here is the URL: http://www.youtube.com/watch?v=8k4zDwce7bE
Watch how David bends well with heels down and upright body to pick up baby Aiko, and gets up again without using hands.
Press your lower back toward the floor and feel your abdominal muscles working strongly. The point of this retraining drill is to have fun learning to hold your spine stable against resistance, learn how to reduce an overly large lower back arch using the floor as a guide, then transfer that knowledge to standing and lifting overhead. This is how your abs are supposed to work in daily life when standing - to prevent the spine from overarching (overextending backward).
For more on using neutral spine in real life see the third expanded edition of The Ab Revolution™.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Partner 1 (white uniform) does biceps curls and other lifts using partner 2's weight.
Partner 2 uses core and whole body strength and endurance to hold straight positioning. Partner 2 can face up, down or sideways, in each case using appropriate muscles to maintain straight position. Breathe normally.
This Fast Fitness can be done with willing friends, children, pets, and furniture.
Partner 1 uses core and abdominal muscles to stand with neutral spine rather than leaning backward, and whole body strength to support weight of partner 2.
It is a myth that you must lean back to offset a carried load. You get intense and functional abdominal muscle workout by using them to pull you forward to neutral standing position.
I once used this exercise of holding straight horizontal position (partner 2's part) while helping out a friend who is a stage magician. I filled in for his absent assistant for the floating lady illusion. I was too tall for the apparatus. It usually holds your body out flat using struts reaching from head to thigh. It reached only to my midback. I wound up holding my weight myself, from hips to feet - high above the stage - while trying to look hypnotized. More on this, someday, in another post.
I make posts from fun mail. Before asking more questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Try fun stuff, then contribute! Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy. ---
Fast Friday - Functional Oblique Abdominal Muscle Practice - Holding Straight
Friday, February 06, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - use your oblique abdominal muscles functionally - to hold yourself straight against resistance:
Stretch out on the floor. Turn to the side, standing on one hand and one foot
Hold straight as long as you can. Don't sag. Feel how to hold yourself straight and relaxed.
For more, raise the top leg. Keep body straight, instead of bending forward at the hip. Don't increase the inward curve at the lower spine when you raise the leg. Keep neutral spine.
Photo is of one of my students, Dr. Hanley Owen, a physician from Fairbanks Alaska, who took a workshop with me at the Wilderness Medical Society meeting 2008. Check my web site CLASS page for workshops this summer - DrBookspan.com/classes.
Instead of curling forward and sideways to exercise abdominal muscles, this drill retrains oblique abdominal the way you need them in real life - to keep you straight instead of slouching to the front or side when carrying shoulder bags and other loads, including yourself.
---
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Subscribe to The Fitness Fixer e-mailed to you. Click "updates via e-mail" - (trumpet icon).
Fast Fitness - How Abdominal Muscles Prevent Hyperlordosis When Carrying
Friday, January 09, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - How to use your abdominal muscles to maintain neutral spine when carrying babies, and other things held and carried.
When you hold loads in front, notice if you lean your upper body backward - right-hand photo marked with red X. Leaning backward from the waist increases lumbar lordosis (hyperlordosis) which pinches the lower spine, causing aching after long standing.
Instead, stand upright - middle and left photo. The muscles that pull your spine forward to straight position against the load are your abdominal muscles. Upper spine angle will be a little more upright than pictured (center).
It is a myth that you must lean back to offset a carried load. You get a free abdominal muscle workout and increase abdominal muscles endurance by using them (not tightening) to change from painful to healthful standing position. Breathe normally.
David from Belgium is pictured at left. David has made many contributions to Fitness Fixer through photos, movies, success stories fixing his own pain and of his yoga students, translated many of my articles into Dutch, and has developed a healthier yoga style which he premiered at a world yoga congress last year
He did all this during the time he and wife (pictured center and right above) were expecting their first baby, arriving early last February. Thank you David and family from all of us.
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
Vertebral Artery Compression, Dizziness, Discs, and the Forward Head
Tuesday, December 02, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
I received an e-mail from Serbia. Miroslav had suffered eight years of dizziness from compression of the vasculature and nerves of his neck. Then he found how to prevent the bad position called "forward head" using my methods. Miroslav had previously read various sources promoting the often-repeated bad advice to bend the neck forward as a the way to make space for the nerves that exit the back of spine. A little knowledge is a dangerous thing. That kind of forward bending is not a healthy way over the long term.
Bending the spine forward pinches vertebrae closer in front and farther apart in back, creating unequal pressure that over time, wedges and squeezes discs rearward and outward, like squeezing a tube of toothpaste. A disc nearly always bulges (herniates/moves/slips/migrates/extrudes) toward the back of the spine out the enlarged space, from years of the bad posture of sitting and standing with a rounded/bent forward spine.
Sitting and standing straight would make more space for the nerves without the herniating force. Miroslav also had a forward head as a regular posture, also called "straightening the cervical lordosis." He had been flexing his neck (bending forward) trying to fix his various numbness and pain, and wound up compressing verves, blood vessels and other structures.
Miroslav wrote in one of his blog posts that he was practicing Alexander technique for the previous few weeks, "as specified in Richard Brennan's book /head up and forward." After getting worse and trying various doctors and cures, Miroslav found my web site. He wrote:
"Dear Dr Bookspan, "I have found Your articles online and they have been extremely helpful. I just wanted to say that I appreciate Your work immensely. Few last articles I wrote on http://cvelee.blogspot.com/2008/11/quick-solutions.html regarding my problem and how You have helped me. If You have time, you can catch a glimpse of them. "With respects, "Miroslav Cvetinov"
Here is the post from his blog:
"Q u i c k s o l u t i o n s
"I am strong opponent to quick solutions to many of our everyday problem, whether money or health related. In such manner, I didn't expect my dizziness to disappear over night without trace.
"I had it since 2000. So 8 years before, they did everything necessary to rule out other diseases : EEG, Dopler, Blink reflexes, Evoked potentials... everything clean.
"In 2007. dizziness worsened so neurologist sent me to do endocranium MRI/MRA. Totally clean: no lesions whether white MS or atherosclerotic, balanced blood flow...
"2008. I have found article from Dr Jolie Bookspan, describing forward head posture and neurological deficits. I did have extremely straightened cervical lordosis, so I qualify for FHP. I started practicing healthy head postures : head back and FLEXION.
"I always thought that neck flexion was the key to healthy disc, because it opens neuroforamen, and that that degree of neck flexion wasn't possible without FHP. But, guys, I am physics scientist, I do not know how did it miss me : head-neck system has 5 degrees of freedom. I could pull it back, yet keep healthy degree of flexion. Just think of extending back of the neck while shortening front portion of it. That compulsive strengthening of SCM muscles I did, didn't do me any good, but...
"Anyway, MY TREMENDOUS DIZZINESS DISAPPEARED IN A MOMENT!! MOMENT, not day, not week, immediately. How? I do not know! I do not care! Thanks Dr Jolie.
"I can look over my shoulder while walking now. Easily without dizziness, loss of balance and lightheadedness. This it totally new.
"I have to give credit to 2 doctors more: 1. Dear ENT Vukoja Novak - he was the first one out of many doctors to tell me that if I consider it real, organic disease and not anxiety/panic related, I should check out carotid arteries on Doppler and cervical spine on roentgen. Latter revealed disk degeneration and straightened lordosis. He was the first to point to the spine. 2. Dr Mijanović - While doing EMG, he told me that tongue is clear except huge amount of hyperexcitability and asked me to check out something serious and real. I suggested left arm, with disesthesia running in C6 dermatome. He asked me about dizziness, I told him " I do have it, a lot of it, but dear doctor, I have panic disorder and somatoform disorder. It is due to this.". After poked me with a needle in left deltoid he immediately said "I can assure you, your dizziness are due to your spine."
"So, now I know. Not that it was spine, it can be cured in a moment:)"
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
How Much Inward Curve Space Should There Be In The Lower Back?
Wednesday, November 19, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Reader Carina asked a good question on the post Prevent Back Surgery about how much space there should be in the lower back inward curve. Comments were not accepted by the Blogger software for several weeks, and I could not reply in the comments. Her question is so good, it was chosen for this Fitness Fixer post.
Carina writes:
"Hello Jolie, "Your information is so wonderful. Thanks for this stuff it's priceless.
I have been using the wall trick during the day when my back hurts (How to Feel Change to Neutral Spine). Wow it feels great. Only thing I can't STAY and walk like this. My knees are STUCK bent (or I go back to the big arch). I'd seriously look very odd walking around with bent knees. So here are my questions
"1) How much of my hand should go through when I am standing against the wall??? When I stand at the wall and do it naturally I can stick my whole arm to my elbow behind the arch.
"2) Besides these links you provided from a previous question Fast Fitness - Quick Relaxing Hip and http://windowsxp-privacy.net/?id=198760105 " (Note - the above link didn't come through in Carina's comment; I don't know which it is.)
"is there anything that helps me walk in neutral spine and not looking silly? "Thanks for caring about our backs, Carina"
Carina, great work. You have found that simply changing spinal angle (wall "trick") to reduce overarching works right away to reduce cause of pain. Next, here is how to retrain neutral spine into a normal natural stance:
1) Don't worry about "How much hand fits." It doesn't indicate amount of overarching. Lower spinal angle is what matters. Body proportions change the distance from wall - independent of spinal angle.
If you have too much tilt to the pelvis or you lean the upper body backward, lower spinal angle increases. To reduce an arch that is large, press the lower back closer to the wall.
The post Neutral Spine or Not? shows how to tell if your hip (pelvis) is tilted or straight, and/or if overarching (hyperlordosis/swayback) is coming from the upper body (leaning back). The wall maneuver shows you how to reduce the overarch. Don't press flat against the wall or you'll round like a beetle :-)
While standing at the wall, see if you can do a small "crunch" movement without rounding your upper body forward, to reduce the overly large arch. Movement is just from the hip and mid-torso. Hopefully, you will feel that you easily move the body without bending your knees. That should produce reduced lower back arch. Send some photos if you like and I will take a look.
2) Next, you need to make it possible and comfortable:
Check how you are standing. Don't try to touch the back of the legs to the wall. Just heels, backside, upper back, back of head.
Thank you for already checking the other links and finding the relaxing-hip-stretch. I couldn't tell which other stretch you wrote, but most stretches that lengthen a tight front hip can help. One that is functional for daily bending that you need to do anyway is Hip Stretch While You Strengthen Legs.
Hope to hear more about your successes. Send photos and I can post your continuing success in Readers Inspiring Stories.
---
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
Which Stretch Stops Back Pain by Making Neutral Spine Possible?
Monday, November 10, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
What can you do if you're too tight to stand and move in neutral spine? A common lower back pain occurs after long standing, walking, and upright activity. The most common cause is exaggerated inward curve in the lower spine - a bad posture called hyperlordosis or overarching which pinches the joints called facets and the surrounding soft tissue. An obvious treatment is to simply stop the cause, and restore neutral spine.
Which specific stretches relieve the tight muscles that make neutral spine difficult?
Usually the tight muscles are in the front of the hip (anterior hip muscles) called hip flexors. Several specific easy stretches restore resting length to the front hip. Several of my patients and readers find that posterior hip stretches also help quickly. Liz first wrote in with her success story, How a Reader Stopped Recurring Pain, Got Stronger, and Said Aha!
Liz continues her story:
"Dear Dr Bookspan, "Just a few days ago I checked back to read your blog…since I posted my "Short history" which turned out to not be so short. I was particularly trying to share one thing that had happened to me, for which I couldn't find any specific help until I read your blog, which was back pain after bike riding.
"Even short walks hurt my back before I discovered your work, let alone the way my back felt after a bike ride, a future of pain, getting fat and depressed from lack of activity.
(trouble persists with getting photos to load - Liz' photo should be here and hopefully will soon)
"I thought I'd send at least one photo of me on my bike (I think I have mastered the dorky cyclist look) after a 12 km ride home from work and 12 kms to work that morning. If it hadn't been for you I would not have been able to do this, I would have not experienced the joy it gives me to use my muscles, feel my body doing what it was meant to do.
"I like being able to look after myself and not rely on an external source, like a chiropractor, to keep me well. Whenever I take out your book (Fix Your Own Pain) to refer to, my husband says, 'oh oh, what's wrong?' Mostly now it's just to refresh my memory of an exercise or principle you have written or to check I'm not doing something terrible to my knees. What a marvelous reference book it is.
"After I hurt my back during my first trial cycling to work, I read so many books and articles and web pages on back pain, and many on cycling and back pain. Mostly they were about pain caused by the racing position or impact injuries from bumps in the road. Then I read one of your blog entries where a readers/patient explained he had to give up cycling because of the pain he experienced in his lower back a while after he had been on a ride.
"This is what happened to me, in that blog you explained that a few specific stretches were useful for specific muscles. I checked many pictures of anatomy, which named the muscles that I seemed to be having trouble with, I went back to your book and read more about hips and how tight muscles in the hip area can cause lower back pain. It seems, sitting at a computer all day, then using my leg and hip muscles to propel myself up really steep hills was causing the muscles in my hips to tighten a great deal. That's why I tried your figure 4 stretch.
"It did precisely what I needed it to do, now if I don't do it regularly, I can feel my pelvis is tilting the wrong way, all by itself and my lower back starts to hurt. And when I lie on my back my front hip/pelvic bones (iliac crest) stick way out because of the extreme tilt. Then I do the lying figure 4 stretch and they go back into the right place. Now I know exactly what to do to end the pain and I wanted to make sure, should anyone be searching for help, that they will know there is an answer and your work is the source.
"Thank you for helping me find my joy." Liz.
Neutral spine is pictured at left. Too much inward curve (hyperlordosis) is pictured in the middle and right drawings. Abs are too long, lower spine is pinched in back.
Habitually keeping too much inward curve (hyperlordosis) shortens and tightens lower back muscles. Tight lower back muscles pull the back of the pelvis upward, tilting it outward in back and forward in front. The tight area feels normal when held shortened (hyperlordotic) and resists lengthening enough to stand in neutral spine. Stretching the lower back allows neutral spine to become possible and feel normal.
I wrote back to Liz asking if she was using anterior hip (hip flexor) stretches too and if she felt the posterior hip stretches working to let her restore straight hip instead of tilting forward.
Liz replied:
"Yes, being a mostly sitting worker I do the hip flexor (anterior front hip) stretch too, I'm sure it helps my ability to voluntarily keep my hips tilted correctly all the time, I can feel with my hands when they 'flatten'. I do this stretch everyday, sometimes twice a day and it's very helpful. I have on occasion skipped this stretch and only done the posterior hip stretch and I've found I have had no trouble achieving neutral spine. But I do it anyway, it's got to be good for me!
"This is my description of the reason I do the posterior hip stretch, mostly on my bike ride days (though it's so good for me, now I do it twice a day) - Even though I am tilting my hips voluntarily to the best of my ability, if I have not done the posterior hip stretch I feel a sharp pinching in my lower back, where the 'dimples' are, sometimes only one side sometimes both. I feel my front hip bones with my hands and can tell my pelvis is not correctly angled, I can't tilt it correctly any further without starting to use muscle force. Not the gentle neutral spine you describe.
"When I lie down and try to gently straighten my spine to neutral, I find I can't and my front hip bones stick out quite a bit. It feels like a muscle somewhere is holding on to my pelvic bone so firmly I can't move it without force. So then I do the posterior hip stretch on both sides for 30 seconds or more if it's feeling wonderful. Often I feel one side is far tighter than the other. Then I test again by lying straight, feeling my front hip bones with my hands and gently moving into neutral spine and I find they are nice and flat, and stay that way. Also the pinching pain goes quite rapidly. Occasionally the pain doesn't go away for a few hours, a hot bath helps. If this happens I do the posterior hip stretch a few times over an hour or two and that also helps. I expect this means I may have done a wee bit of damage to the soft tissue, amazing how the body heals.
"I have discovered that even on non-biking days, if I do this stretch regularly, I rarely feel any pain in my back at all. I'm not 100% certain if it's the combination of stretches that I do, including the hip flexor stretch, but I feel this one is critical for the correction of some kind of internal postural muscle, that is not behaving in a natural way, through some unconscious action of mine."
Usually, no special exercises are needed to have neutral spine. Worse, a common scenario is someone doing exercises then walking away with the spine still arched, never applying the exercise to real life. They become stronger people with the same bad posture - the exercise was not used for function. Instead, just stop the bad position and deliberately move your spine to neutral. However, when the area is too tight to move to neutral, here are stretches. The stretches don't change your voluntary posture, you do that. They just can make it possible:
First, Don't Tighten:
First make sure you don't tighten or clench abdominal or posterior hip and leg muscles. Tightening does not change posture, inhibits movement, and makes it hard to move to neutral spine.
Then, check if you just need a guide to help feel how to reduce the lower spine arch without pushing the hip forward, leaning back, or moving everything else:
If you find you are still too tight, stretch the front of the hip (anterior) and back (posterior):
Anterior Hip Stretches:
Until I make a post for this one, a relaxing start to stretch the front of the hip is to lie face up with knees bent and ankles crossed. Let knees separate to each side as far as comfortable. Keep lower legs next to each other, not one on top of the other. Do this without shoes, to fit your feet side by side without resting the lower leg on the foot. Experiment with pressing your lower back toward the floor. This stretches front and back at the same time, as needed for straighter standing. If this stretch is too much at first, start lying on your back with only one knee bent to the side, the other leg straight. Rest bottom of the foot of the bent leg at the knee of the straight leg.
A nice stretch over a bed or bench - Quick Relaxing Hip Stretch. If this one is too much, try it lying flat with a pillow under your hips. Gradually use a bigger pillow. Finally, lie with legs stretching down from the edge of the bed and no pillow.
A big stretch - Relaxing Hip, Leg, and Groin Stretch. If the Relaxing Hip, Leg, and Groin Stretch is too much to start with, do it face up instead of face down (see the first stretch above).
Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own.
Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
I have received urgent inquires from physicians and reporters after an ABC news report came out on surfer's myelopathy - lower body paralysis occurring shortly after surfing.
The main suspected mechanism is standing or lying for long periods with the lower back so overarched that it interferes with blood flow to the spine below it, causing a "stroke in the spine."
Overarching is a topic of my laboratory research as it relates to compression of soft tissue and the joints of the lower vertebrae leading to chronic mystery back pain.
Overarching the lower spine is an avoidable bad posture. It is simply and quickly changed by holding the pelvis level in what is commonly called neutral spine. Compression which impedes blood flow is a different, serious effect. Until I can post separately on it, to understand and avoid one main mechanism, check:
Holding neutral spine is not just an exercise to do then stop and return to overarching during life activity. Neutral spine is a healthy normal position to maintain comfortably, not rigidly, during ordinary activities and exercise. To see some of the issues of neutral spine, click:
Stop Lower Back Pain From Swimming and SCUBA Part II
Tuesday, June 24, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Yesterday's post explained the most common hidden cause of lower backache after swimming and scuba diving. Swimmers and divers who get this chronic pain are often misdiagnosed with SI (sacroiliac) joint dysfunction, arthritis, disc injury or various "catch-all" terms for back pain with unknown origin. Scans may show damage to the facet joints, which can occur from spinal overarching. Injections and surgeries and various anti-inflammatories are often prescribed. No shots, medicines, or surgeries are needed. You do not need physical therapy or strengthening programs. All you need to do is stop overarching and maintain neutral spine when walking, running, swimming, and diving. It is easy, and is a healthy and normal spine position. You do not tighten any muscles to do it. It is just learning a normal posture.
Check yourself to see if you stand in hyperlordosis:
Stand up and look sideways in a mirror. Your belt should be level, as in the left drawing of neutral spine. The side seam in dress or trousers should be vertical from leg to waist, as in left drawing, not tilted forward at the hip (middle drawing).
Back up slowly and gently into a wall. If your backside touches first, it may be an indicator that you lean forward at the hip. If your upper back touches first, it often is a good indicator that you lean the upper body backward (right drawing).
Stand with your back against a wall, with heels, hips, upper back and back of your head touching. There should be a small space between your lower back and the wall, but not a large space. Then raise both arms overhead to touch fingers to the wall behind you to simulate swimming with arms outstretched. See if the lumbar curve increases. You should be able to stand with the back of your head touching the wall without increasing your normal curve, and be able to raise your arms without increasing it.
If you have a large space between lower back and the wall, try this:
If you can't figure how to do that, put your hands on your hips, thumbs facing the back, and roll your hip under so that your thumbs come downward in back.
Feel the large space between lower back and the wall become a smaller space.
Lower back pain that is caused by hyperlordosis should ease right away. Learn how to easily, gently do this while walking, running, swimming, or whatever you do. This is done without tightening or clenching any muscles.
Keep the good new neutral spine when you walk away from the wall, and all the time. Apply it to when you are swimming and scuba diving.
Muscle Use is Not Automatic The muscles that hold neutral spine are your abdominal muscles. They do not do this automatically, which is why strengthening programs do little to stop back pain. Someone may have strong abs but stand and swim in arched posture, with continuing lower back pain.
Heavy scuba tanks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem.
When you are standing up wearing tanks, straighten your body against the pull of the load and maintain neutral spine. Do not tighten your abs, just move your pelvis. If you notice yourself arching while wearing tanks, straighten your body as if starting to do a crunch but don't curl forward. Only straighten to neutral spine. Don't tuck so much that you lean back or push your hips forward.
No More Lower Back Pain From Overarching Transfer this neutral spine skill to your daily life for carrying gear, putting cargo up on racks, heavy packages on counters, and whenever you lift and reach. Use neutral spine when standing, walking, running, reaching overhead, swimming, and scuba diving.
Lifting and carrying heavy dive gear with good lifting mechanics is good and functional exercise. With bad lifting habits, it is a common and obvious cause of lower back pain in scuba divers. A second major cause of lower back pain after SCUBA and swimming is often overlooked and can occur after scuba diving and after swimming laps with no gear lifting.
Hyperlordosis When swimming or finning face down and horizontally through the water, many divers allow their lower back to increase in arch. They look like they are face down in a hammock - shown by the figurine below:
A small inward curve belongs in the lower back. When you allow the normal inward curve, (normal lordosis) to increase, it becomes hyperlordosis or overarching (swayback).
For most people, hyperlordosis is most common when upright, such as standing, walking, and running. Swimmers and divers who allow their back to overarch when swimming face down often notice the pain after swims and dives:
How Hyperlordosis Causes Lower Back Pain Hyperlordosis pinches the joints of the vertebrae called facets and the surrounding soft tissue. When swimming and diving in hyperlordosis, the fulcrum of the kick becomes the facets instead of the muscles of the abs and hip. When standing upright with a hyperlordotic lower spine instead of neutral spine, the weight of the upper body presses down on the overly pinched-backward lower back. Running in hyperlordosis causes more of the banging and pressing.
People with lower back pain from hyperlordosis usually feel they need to bend over forward, or sit, or raise one leg to relieve it. Often nothing shows up on x-rays and scans. Eventually, hyperlordosis can damage structures enough to show. Until then it just aches a great deal.
The cause of this kind of pain is often unrecognized and people may be told they have a condition called sacroiliac, or SI joint dysfunction, or nonspecific back pain, or other names.
Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine
Friday, June 13, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - quickly change your posture to change your luck on Friday the 13th. Hyperlordosis (swayback posture) seems to be unlucky - it causes lower back pain. You can do this in seconds to make a certain change to healthier spine for yoga or practicing the lunge. If you don't believe in luck, you're lucky. It's just good posture and simple anatomy.
Reader David from Belgium demonstrates in this 20 second movie that he made for us:
First ten seconds - he steps into a yoga pose called Warrior pose, but allows overly arched lower spine. He also demonstrates leaning more weight forward of center line, which is a different issue.
Note how the belt line tips downward in front and the lower spine overly curves inward - more than a normal curve.
At second 11 he levels the hip to bring the posture to neutral spine. Then he kindly demonstrates overarching when raising the arms further. Instead, hold neutral spine and raise the arms from the shoulder, not the lower back.
To prevent shoulder impingement when raising arms, keep shoulders down and back, don't just chin and neck forward, keep them gently in. A forward head posture compresses the rotator cuff when lifting arms. See Safer Overhead Military Press.
I never expected repeated requests to see how to do neutral spine in different activities. It is the same. Just apply the same neutral spine and that’s all. I thought one post would do it, but will post each activity readers ask about. I am aware that there are yoga and fitness places which teach to overarch the spine as part of the move. Teaching swayback does not seem to be as helpful as teaching neutral spine. Changing lunge and Warrior pose to neutral also improves the stretch to the front hip muscles of the back leg. Lucky.
Students Balances, Listens, Fixes Father's Back Pain
Tuesday, June 03, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
My student Ginger sent the photo at right taken on her recent camping trip. Don't try this at home. It takes balance training, concentration, and a few changes to standard back bend technique.
Ginger is distributing the stretch along the spine so that no one area is compressed at an unfavorable angle, and is contributing most of the leg extension from the hip, not lower spine. More safe back extension stretch and strengthening methods will come in future posts.
Ginger is a good student who makes good use of my classes. Last week, while visiting her parents, she was out walking with her father. She told me that her father said that his back hurt from the walking. She looked, and saw that her father was standing and walking with too much inward curve to the lower back - hyperlordosis (swayback). Standing with the lower spine overarched is a slouch that compresses the spine unevenly downward, pinching the joints and soft tissue at the back of the lower vertebrae. Overarching is a large hidden cause of lower back ache during walking and running. This slouch is not fixed in the bone, it is a posture that is easily corrected. It does not require strengthening the back or core muscles, just using the ones you have. In moments, Ginger showed her father what I taught in class - how to change a slouching overarch to neutral spine. Ginger's father said the ache disappeared right there, and that was all there was to it.
The article Innovation in Abdominal Muscles gives an overview, and the comments give a link to another post with a short movie showing the concept.
If you want a whole book showing the concept, several techniques to achieve and use neutral spine, and examples of use in all daily life, try the book The Ab Revolution™ Third edition expanded. Part I of the book shows daily use without needing any exercises. Part II shows how to exercise using neutral spine to get more exercise, healthier exercise, and use abdominal muscles functionally to stop unattractive and damaging overarching.
"Hello, I'm writing as someone who has incurred a training-related lower back injury and who has great interest in your words on hyperlordosis. I am hoping that you might shed some insight on how to achieve a neutral spine while doing "kettlebell swings." This is the exercise that has caused me back pain, and I would love to return to working out with kettlebells, but am not sure how to do so without creating too much lordosis. Any ideas? I appreciate any assistance you can provide and thank you for your contributions! Take care, Dan L"
Throughout history, people have lifted and swung weights of all kinds of shapes. Kettle bells (also called kettle balls and many other names) are usually ball-shaped weights with a handle. A variety of sizes is shown in the photo, above, along with a medicine ball for comparison.
Kettle bells were long used in various martial arts and cultural festivals and contests before being rediscovered for modern weight lifting. In general, you lift, swing, and move them to do various weight lifting exercises. Kettle bells are weights. Benefits of kettlebells are the same as lifting and swinging other kinds of weights.
The photo above shows injurious lower spine posture of the person lifting or swinging overhead, called overarching, swayback or hyperlordosis. His upper body tilts backward relative to the lower spine. There is too much inward curve, pinching and compressing the lower spine. You can even see this pinched fold in his lower back. This poor posture is a common cause of lower back pain. People who chronically over-arch this way often feel they need to bend over forward to make the pain stop. However, using neutral spine and not allowing the slouch while lifting overhead would stop the cause in the first place - right photo below.
Recent kettlebell devotees have made a small set of lifts, and limit swings to mostly vertical swings up and down between the legs. However, a wider range of movement and more function can be trained. Great benefits are possible using weights with handles for functional core stability training, as below.
The photos above, of injurious overarched spine position (left) and healthy neutral (right) while swinging a heavy medicine ball overhead, are from the book Healthy Martial Arts. My black belt student Christopher demonstrates. This is a similar motion as swinging kettle bells overhead by the handle.
In the left photo, Christopher demonstrates the hyperlordosis posture that compresses the lower spine and is a major cause of lower back pain. He allows the hip (pelvis) to tilt forward in front and out in back, and his upper body tilts backward relative to the lower spine. In the right photo, he reduces the overarching to neutral spine. The belt line changes from tipped downward in front to level.
Keep neutral spine when lifting and swinging kettlebells and any weight overhead (right photo). Prevent the slouch of leaning your upper body backward and tilting the pelvis (left photo). Leaning backward and allowing the hip to tilt are often mistakenly done to "balance the weight" and make the lift easier. Leaning the upper body back and tilting the pelvis are not necessary to balance a load - your own muscles can hold the load, and in fact, that is the point of lifting the weights.
Overarching increases the small normal small inward curve (normal small lordosis) to a large curve (hyperlordosis). Hyperlordosis increases compression on the joints (facets) and soft tissue of the lower spine. The same overarching is the hidden cause of back pain in women who lean back and/or tilt the hip trying to offset the load of a pregnancy - Back Pain in Pregnancy - and Why Men Can Get It. Leaning backward and overarching are not helpful adaptations as sometime thought, are not unavoidable, and are not limited to pregnant women. Overarching (hyperlordosis) is a common bad posture, and an often missed source of back pain. It can be easily prevented by using your muscles to hold neutral spine. The post Prevent Back Surgery shows photos of hyperlordosis compared to neutral spine during many activities.
Bending over forward to swing kettlebells between the legs is another exercise where injury and back pain frequently occur. Good squatting technique reduces the problem. Often weight lifters spend much time learning and debating good squat posture, then bend over (injurious bad bending) to pick up and put down their kettlebells.
Neutral spine while exercising with kettle bells is the same as neutral spine during anything else - just hold your spine position. Neutral spine is not done by tightening or clenching any muscles. It is done by moving your hip and lower spine the same way you move your arm to scratch your nose - without tightening, just moving it to where you want it. Holding neutral spine is the same as not slouching your shoulders or not letting your mouth hang open - a voluntary use of your own muscles - built-in exercise.
Keep breathing, Have fun. You can swing weights of any kind in any variety of ways, to be stronger and healthier, without injury.
Learn neutral spine swinging kettlebells, babies, and all other fun weightlifting:
(In the photo above, hands are not behind the hip, to provide unobstructed view of the hip/pelvis corrected from tilted back to vertical)
