Earlier this summer I flew out to California to be interviewed about back pain on The Holistic Success Show. I had a wonderful time meeting Dr. Puff, Elizabeth, and the crew. They really made me feel at home. Feel free to check out Episode 38 if you’d like to hear me speak about back pain. Feel free to contact me with your thoughts!

Sciatic pain is almost as ubiquitous as back pain in our culture. As with most chronic pain conditions, I’ve found sciatic pain to be a problem in people’s habits such as sitting or sleeping postures as well as anatomical issues such as tight muscles in the front of the pelvis or weak muscles in the back of the pelvis.

Let’s look at the anatomical players first. The sciatic nerve originates in the lumbar spine as nerve roots exiting the spine then coming together to form the sciatic nerve which passes through the back of the pelvis and continues down the leg. Often the pelvis can become tilted forward (anterior pelvic tilt), backward (posterior pelvic tilt), or rotated so that one of the pelvic bones is tilted forward while the other is not. The vast majority of sciatic pain I treat results from either an anteriorly tilted pelvis or one that is rotated.

This happens when the muscles in the front of the pelvis become symmetrically tight as with an anterior pelvic tilt or they can become asymmetrically tight creating a rotated pelvis. Correcting this tightness goes a long way toward correcting sciatic pain.

Pelvic Asymmetry Copyright Boone Publishing, LLC. 2009

Usually people with these issues also present with weakened or poorly performing gluteal muscles (the rear-end muscles). These usually turn off as a result of poor standing posture or walking mechanics. Turning these muscles on while walking or running, together with stretching the muscles in the front of the pelvis help restore normal pelvic mechanics which then restores normal spinal mechanics. The spine responds to the pelvis because both are linked so closely together. Fixing the pelvis will help fix the spine.

Let’s look at sitting and sleeping postures that relate to sciatic pain now. When sitting, most often I find the knees are resting too low in relationship to the hips or the legs are too close together. This creates an anterior pelvic tilt and consequent spinal extension (arching) which can create sciatic pain. Another problem would be sitting asymmetrically so one leg is loaded more than the other. This can create a rotated pelvis also contributing to asymmetrical stress to the spinal nerve roots.

Standing habits involve locking out the knees and allowing one or both leg bones (femurs) to rotate inward too much. Both of these habits also create varying degrees of anterior pelvic tilt either symmetrical or asymmetrical.

Typically people with sciatic pain sleep on their sides which allows spinal sidebending and rotation to occur. Sleeping presents one of the hardest stresses on the spine because you are in this position for 6-9 hours each night. This can cause damage if care isn’t taken to pay attention to your body. Often what I find helpful is folding a bath towel lengthwise and placing it under the waist. This removes sidebending and rotation stresses to the spine regardless of which side you are lying on. Consequently it helps sciatic pain.

These tips and others can be found in my book, Fixing You: Back Pain.

I recently saw a woman who had a history of sharp stabbing back pain for about 40 years. I performed my evaluation and gave her the exercises to correct the issues I found. She felt relief but still had occasional stabbing pain. I asked her when this happened and she told me it was after sitting in a chair or getting up from bed. So I evaluated her sitting and lying habits and made a few changes. Today she told me her pain was 98% gone–in one week.

To me this highlights the importance of addressing how you do things as much as what you do. She happened to have a hypermobile spine which made it difficult for her to stabilize well. She was out of touch with her body and couldn’t connect with her abdominals to stabilize the pelvis or spine. So focusing on habits such as how she stood up, sat down, slept, and worked at her desk was where we were really going to make a difference quickly. She was amazed.

This was deeply satisfying to me because she came to me a couple years ago with back pain and I wasn’t able to make a big difference in her pain. Now I know why. I didn’t focus on the things she did 99% of the day and instead focused on anatomical problems I found. This was a good lesson for both of us!

I just had a fun interview with Ruhe Fitness who is doing an audio series about back pain.  You can check it out at this link if you’re interested.

http://ruhefitness.audioacrobat.com/download/RickOlderman-FixingYou_net.mp3

I’ve had several emails from people who have purchased my book on back pain. They’ve written me to say they have identified the cause of their pain and are just beginning to fix themselves. This alone has been a huge weight lifted from their shoulders after hearing multitudes of diagnoses and theories from specialists. This makes me very excited because once you understand the cause of your pain, you can take the necessary steps to fix it. I’ve outlined how to understand the causes of back pain and these steps in my book. I’ve made it as simple as possible.

I feel like a parent witnessing my kids take their first unsure steps! Yes, there will be some wobbling and mistakes but if they stick with it and think about the underlying causes of their pain, they’ll be not only walking but running before you know it! It’s very exciting and satisfying to know I am making a difference in these people’s lives whom I’ve never met.

I wish I could be there to guide them personally and make sure they do all the right things. In a way, I can. I just had my first Skype session with someone who purchased my book. It went quite well. Better than I expected. Ideally though, I hope readers feel they can go it themselves. I think it’s important to understand that everyone has all the tools within them to fix their back pain.

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.

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!

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).

Figure 1. Rotated Pelvis

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.

I think we are all thoroughly confused now with all the advice on back pain bombarding us every day!

So you’re going to figure out why you have pain right now. It’ll take 60 seconds. Really. Get out your watch and time yourself while performing this very simple back pain test.

Lie down on your back on a firm surface. Straighten your legs out and stay there with them resting on the ground for 30 seconds. Don’t forget to time yourself! Now bend your knees with feet flat on the floor and stay there for 30 seconds. No cheating! Just 30 seconds no matter how good it feels! If there was no difference in your back pain then hug your knees to your chest for 30 seconds instead.

If your back felt better with the knees bent (which most people do) then your pain is the result of too much arching in your low back. Bending the knees and flexing the hips flattens the spine and reduces the arch. All you need to do is not allow the back to arch so much.

If your pain felt better with your legs straight, then your problem is due to too little arching in your low back. Straightening the knees creates more arch in the spine. All you need to do is make your back arch more.

Simple.

Sound too good to be true? It’s not. Back pain is due to a very basic problem of the lower spine either arching too much or too little.  It is this fundamental problem that is at the root of all back pain. “But, that’s too simple! It can’t be that easy!” you might say. It is–you just proved it to yourself.

“But, I have disk bulges, stenosis, degenerated disks (insert your diagnosis here)!” you might counter. Well, how do you think those problems got there? The body’s tissues respond to abnormal stresses placed on them. Excessive extension or flexion of the spine creates abnormal stress. A lot of it.

Don’t take my word for it though. You just did the test. Did your back actually feel better with your knees bent or straight? If your back could feel that good all the time, would you be happy? That’s all the proof you need to know that something is inherently right or wrong for you.

The trick is, getting your body to hold on to that good feeling. Turns out there are a few simple things you’ll have to do to make this relief last. First, you must remove the stresses pulling your spine into either too much extension or too much flexion.

Then you must strengthen the muscles responsible for maintaining this ideal position. Strengthening them without removing the stresses affecting the spine will not fix your pain. That is because the stresses pulling the spine into extension (or those creating too much flexion) are much more powerful than any strength program you could create. There’s just too much leverage acting on the spine.

Lastly you must identify the habits that are contributing to these first two issues and, therefore, pain. Luckily there is one neat little book that outlines all these principles–mine!  Fixing You: Back Pain will explain all of this to you in plain English including how to correct the stresses creating too much extension or flexion, the proper strengthening exercises and which movement habits are likely contributing to your pain. I also include free videos of all of the exercises in the book on the Fixing You website.

“Sounds like a lot of work,” you might be thinking. Wrong. Many of my clients are 50% better in just one treatment. It’s not uncommon to eliminate back pain altogether in two or three treatments.  Your body doesn’t have to be perfect, it just needs to be better than it is now.

In 60 seconds you’ve just learned the core of your problem. Don’t you think it’s worth it to take this a little bit further and see for yourself? I understand your doubt (see my blog, Chronic Pain & Chronic Doubt, just a few articles down from this one). Read my testimonials and you’ll see others who have been helped by this very simple way of approaching and treating the spine.

Whatever you decide, I truly wish you the best in your search for answers. I understand your pain and frustration. I work with people just like you all the time. They are better and you can be too.

Search any health or fitness magazine and you’ll see how important core strength is for back pain by virtue of the number of articles devoted to the subject. In fact, there are over 30,000 search hits each month about core strength on Google. Fitness instructors and medical professionals all espouse the benefits of core strength for chronic pain. Then why do we still have back pain? After all, many of you have been subjecting yourselves to endless abdominal exercises for years and still have that nagging pain. So, if it were a matter of just strengthening the core, we really shouldn’t be reading another word about back pain–but we do.

So, obviously core strengthening is not the key to fixing back pain–or at least how it is traditionally taught. Back pain stems from a functional problem with the pelvis and spine. Most back pain can be categorized into three root causes. All of these causes take into account the pelvis’s relationship to the spine.

What I mean by this is that, for various reasons, often the pelvis is tilted either forward, backward, or sideways. The spine then adjusts for these pelvic positions compensating in the opposite direction. For instance with an anterior pelvic tilt (where the pelvis is tilted forward), the spine will then compensate by bending backward or extending more to maintain an upright position. This increases lumbar lordosis (the inward curve of the lower spine) creating a spine that, more or less, becomes stuck in this position. During normal daily activities the spine moves maintaining this new posture.

This is the essence of why core strengthening doesn’t work, in and of itself, to fix back pain. Because the core is strengthened in a position that reinforces the original pelvic and spinal alignment causing pain. Don’t get me wrong, it’s possible to stumble upon the right way to strengthen the core and help relieve back pain. That is why you’ll read of so many people who were helped by one particular method or another. But remember, at least as many people have not been helped by it or have been made worse. You never read about those people.

When I look at yoga or Pilates exercises for back pain, they are usually taught in a series. If you look closely, half of the exercises in the series does one thing to the spine and half does the opposite. That is why they can sometimes be beneficial, because half the time you’ve happened to do the right thing for your spine. But that’s also why they don’t really help the spine, because half the time you’ve happened to do the wrong thing for your spine.

Probably more important than core strength is understanding how your daily activities are contributing to your back pain. After all, you spend far more time at your job than you do strengthening your core don’t you?

Now, I know a lot of you will think I’m just plugging my book here and I am–for the purpose of helping you understand exactly why you have back pain and what to do about it. The key to developing a core strengthening program that helps your back pain is to first understand why you have back pain. Sounds pretty obvious doesn’t it?