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.

Plantar fascitis or heel spur pain is a stubborn issue to get rid of.  Plantar fascitis’ classic symptom is a searing or tearing pain on the bottom of the foot when you first wake up and walk which then resolves after more walking. Anything with “-itis” after it simply means inflammation. So plantar fascitis is an inflammed plantar fascia. Like many medical labels, this term does not describe the underlying reasons for plantar fascitis. Hence you see all sorts of remedies out there which have little effect.

Typically heel pain presents as an exquisite tenderness on the heel when walking. It’s often referred to as heel spurs. Both diagnoses are somewhat related because of their anatomy. In order to get rid of these issues it’s important to understand why they occur.

The plantar fascia is  a broad fibrous tissue on the bottom of the foot, extending from the heel to the toes. Fascia isn’t like a muscle–it doesn’t contract on its own. It merely stretches slightly and then rebounds like a tough rubberband. Pointing blame at the plantar fascia is like yelling at the bowling ball that just dropped on your foot. It’s not the bowling ball’s fault, it’s your hand’s fault for letting it go. In plantar fascitis, the plantar fascia is just responding to abnormal stresses being placed on it.

The purpose of the plantar fascia is to assist with the spring-action of the foot. When you step on the foot it slightly flattens out. As your body passes over the foot, it springs back into shape with the help of the plantar fascia. Understanding this will help you visualize how to fix the problem.

There’s a multimillion dollar industry out there making products to stretch the plantar fascia. These products evolved because of the tearing feeling in the morning on the bottom of the foot during those first steps. Well, if there’s tearing, then the fascia must be too tight, right? Wrong. The plantar fascia merely returned to it’s normal length during the night and your foot excessively flattened out while walking which abruptly stretched the plantar fascia. Stretching the fascia during the night won’t correct the underlying problem–that of a collapsing foot.

Heel pain typically occurs near the insertion point of the planar fascia on the heel bone. I’ve found heel pain occurs in people with a history of plantar fascitis or that plantar fascitis follows heel pain. Both are caused, and helped, by the same thing.

So what’s at the bottom of these issues (so to speak)? The problem actually has to do with a third issue we haven’t mentioned yet. There is a muscle deep to the plantar fascia called the flexor digitorum brevis . This muscle runs from the heel bone to the toes and helps maintain the arch of the foot (see figure below). It supports the plantar fascia. When this muscle begins to fail, the foot flattens more than it should, stressing the plantar fascia and its insertion at the heel. Strengthening this muscle has fixed the majority of the plantar fascitis and heel pain patients I’ve seen.

Flexor digitorum brevis (Copyright 2009 Boone Publishing, LLC)

How to do this? It’s simple. Sit down with a towel under your foot. Now scrunch the towel with your toes keeping the heel down on the floor. Bunch it up under your arch and then spread it back out to start again. Repeat this 3 times. Perform this 5-10x per day for one week and you should feel a significant difference in your pain. You can also do this while standing, scrunching the toes up in your shoe. No one will even know you’re doing it.

The reason you need to do so many repetitions and sets is because each step you take, lengthens and weakens the flexor digitorum brevis muscle. You take many steps during the day so you’ll need to perform a lot of repetitions to counter that. After a week of this, your muscle should be on its way to restoring its normal length and tension.

This information and exercise can be found in my book, Fixing You: Foot & Ankle Pain. Let me know how it goes!

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?