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!