I’ve had two patients referred to me recently with difficult neck and shoulder pain issues. Their complaints were of the typical pain distribution–from the base of the skull down the neck to the shoulder blade and across the top of the shoulder as well as pain in the front of their shoulders. MRIs and X-Rays were negative for disc or other pathologies. They had been through several specialists and felt no relief other than with steroids and Vicodin.

After examining both women, I found they had very similar problems in that the shoulder blades were sitting too low on the trunk (Figure 1.).

Figure 1. Depressed Right Shoulder Blade (Copyright Boone Publishing. 2009)

Also the  humeral head was sitting too far forward in the shoulder socket (Figure 2) causing pain in the front of the shoulder. I taped both the humeral head and the shoulder blades in a corrected position and their pain was eliminated–until the tape was taken off a few days later. This told me my diagnosis was correct. But how could I get them to hold these corrected positions on their own? Our attempts at specific corrective strengthening only met with irritation of their pain.

Figure 2. Humeral Anterior Glide (Copyright Boone Publishing. 2010)

Because the shoulder blades’ position on the trunk is partially determined by ribcage orientation, I revisited this aspect of their pain and found that by elevating their rib cages, pain was eliminated. This did two things: 1. it reduced the anterior tilting of the shoulder blade and, 2. activated key scapular positioning muscles that were deficient. The other maneuver I discovered to be of great help was asking them to place their painful side’s hand on the opposite shoulder. This elevated the painful shoulder blade and posteriorly  glided (pushed back) the humeral head into a corrected position in the shoulder socket. Both felt about 80-99% relief from their symptoms during the following week.

Both are now able to begin their strengthening program without pain. If  irritation does occur, they know exactly how to eliminate it, finally giving them a means to control their own pain.

Both of these women had one more issue in common. They were self-conscious of their breast size and therefore slouched  their shoulders. Over time, I believe this established the environment for these mechanical issues to become painful. Both commented that upon fixing their posture, they felt they were sticking their chests out too much, drawing attention to themselves. They clearly saw the mechanical connection, however, as their pain returned after resuming their slouched postures (Figure 3). Ultimately they needed to come to terms about their personal issues of drawing attention to themselves in order to be better.

Figure 3. Posture & Shoulder Blade Position (Copyright Boone Publishing. 2010)

This reinforces to me that, although my point of view focuses more on the mechanical causes of chronic pain, there are also significant emotional or psychological causes. I believe often there exists a combination of dietary, musculoskeletal, and psychological issues that contribute to chronic pain. There are probably others as well. Each person’s pain is a function of a different combination of these issues. My training is in understanding the musculoskeletal aspects of pain but occasionally I bump into someone with more psychological issues instead.

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.

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 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.

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.

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?

One of the toughest aspects when talking with someone with chronic pain is feeling their sense of defeat and doubt. The hardest part of helping people with chronic pain is getting them to believe they can still heal their pain. Fear is a big obstacle here. Fear of being let down, fear of hurting themselves, fear of spending a lot of money on another dead end, and fear of getting hopes up only to be dashed– again. All of this contributes to doubt that anyone can really help them. After all, haven’t they visited the best specialists in their fields?

I don’t blame people with chronic pain one bit for their doubts. So many doctors, specialists, therapists, and other practitioners haven’t been able to help them–why should I be any different? They’ve been in pain for so long, it must be permanent–mustn’t it? If there was something new under the sun, surely the word would have gotten out by now–wouldn’t it?

Besides, there was an X-Ray or MRI with a disk bulge, herniated disk, spinal stenosis, degenerated disk, arthritis, or any number of other diagnoses that showed exactly why they have pain. There’s a physical thing causing their pain–they actually saw it!

But is that structural issue really causing their pain? If that was the case, why didn’t surgery help? Why did the pain pop up somewhere else after the surgery? Could it be that the same issue that caused that structural problem is also causing their pain? Could it be that the structural problem seen on the MRI or X-Ray is separate from the issue that is causing the pain? Could it be that the structural problems are instead a symptom of the underlying roots of their pain, borne out in a physical form?

I believe the roots of back, neck, or other types of pain are usually separate from these diagnoses. I believe these root causes create these diagnoses. Here’s why. If these problems were really the source of people’s pain then I shouldn’t be able to make anyone painfree because I’m not a surgeon. How could I possibly help someone with spinal stenosis without correcting the spinal stenosis? The same goes for disk bulges, degenerated disks or any of the other diagnoses mentioned above.

But they do become painfree. They are able to resume their normal life again. In fact they are able to do much more than they could because they are armed with knowledge of their condition and what makes it worse or better. They have the tools to fix themselves instead of being dependent upon me to fix them. Everyone has the ability to fix themselves. The only thing they’re missing is the knowledge to do so.

That’s where my books come in. You are now closer than you’ve ever been to fixing your chronic pain. I know this sounds presumptuous but it is true. My books will teach you to understand your pain from an anatomical, biomechanical, and movement-based perspective. Though it may sound difficult, it is all quite simple. Don’t worry, I won’t overwhelm you with boring technical jargon. I’ll explain it just as I’m explaining this to you now. Besides, I have video clips on the Fixing You website of all the exercises in my books to make sure you get it right. And I am always here to help.

Those of you with years of chronic pain, believe you can be fixed. Know that the answers exist to eliminate your pain. Instead of relying on someone else, rely on yourself. My books will give you the tools to do so.  Suspend your doubts for just a little while. If you have reached this website then you are closer than you’ve ever been to fixing your pain–for good. You can do it!