I’ve been experimenting with my theories about walking mechanics and chronic pain conditions such as plantar fasciitis, bunions, heel spurs, hammer toes etc. Although it has been simple to remove the pain of bunions through improved gait training, I haven’t yet been able to reduce the size of the bunions–until now (I think). The problem is I took pictures of my client’s bunions but mistakenly sent them to my trash. She believes (as well as I) they are reduced–dramatically. But I have no proof without those pictures!

The plantar fasciitis has been more difficult to treat. I can make the pain go away with my simple taping technique but getting people to actually alter their gait pattern consistently has been the problem. I’m now also experimenting with a simple knee taping technique to help change their gait mechanics even if they’re not thinking about it. This is an interesting mental leap for me as I generally haven’t considered the knee affecting the foot. Instead I’ve always thought of the foot affecting the knee. I think this should help though. We’ll see! I’m also understanding that, for those with chronic plantar fasciitis, the foot mechanics are in a “deep hole” of poor function and so taping right off the bat is the right way to go instead of just altering gait patterns.

Ultimately my theory is that we should not need foot orthoses to fix our foot mechanics given the proper guidance.  This, in light of the fact that I cast for foot orthoses, would be a major revelation in the industry. What I am learning, however, is that changing foot strike patterns on a regular basis is more difficult than I expected. For those unable (or unwilling)  to change their patterns, foot orthoses are a good choice–assuming they are casted correctly (which many are not).

Anyway, my experiments continue and I am heartened by my results!

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.

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.

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.

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!

I’ve recently read an interesting article in the NY Times about whether abdominal training actually contributes to back pain. There was no revolutionary information offered but I was amazed at the comments to the article. Many people swore certain abdominal exercises fixed their back pain while other claimed abdominal exercises made their back pain worse. Yet another group defended abdominal exercises as a strengthening must and yet others discussed how Pilates and Yoga are really where it’s at.

In my view, everyone is right and everyone is wrong. I say this because each person is speaking about their particular experience with particular exercises whether beneficial or not. But we get into trouble when we take our personal experiences and assume they should apply to the general population. We do this when we don’t fully understand what we are discussing–in this case biomechanics and pathomechanics.

The one unifying concept that I’ve found true regarding exercising and pain is that we must understand our personal biomechanical approach to each exercise to understand whether that exercise is beneficial or not. Not everyone will perform identical exercises identically. This is due to the history of each person’s experiences and how those experiences have formed movement habits predisposing them to certain injuries.

This is exactly why I am writing my books–to help people understand how their particular habits are causing pain and the simple remedies to correct them. This article confirms my belief that there is so much mis-information out there that noone really knows what to do. I’m very successful at what I do because I have studied, observed, experimented with and practice using biomechanics to correct chronic pain. While there seem to be endless muscles, bones, nerves and ligaments involved, the solutions to common problems are made simple and effective by understanding and correcting movement function as well as strength or range of motion issues leading to movement impairments. My books have distilled this information into very digestible bites. I hope they are helpful.

Leslie Fishbein, a community leader and business owner here in Denver, died about a year ago due to complications from a cortizone injection  she received  from a physician to relieve chronic back pain.

Recently Rodger MacFarlane, ex-director of The Gill Foundation, took his life due in part to debilitating back pain and a heart condition which did not allow him to enjoy his life.

We’ve all read the statistics that 8 out of 10 Americans will suffer from back pain in their lifetime or that currently more than 65 million Americans suffer from back pain. But the tragic stories above emphasize that, unlike a broken arm that eventually mends, back pain affects more than the tissues it irritates. It casts a cloud over most of the activities that give us joy and therefore can lead to depression and hopelessness if it is not solved. No one is immune from the potentially devastating effects of chronic pain.

I feel for all people who suffer from chronic pain. Each person has a story—often a fine line between managing pain and life-changing suffering. My experience has taught me however, that most chronic pain need not be chronic. It can be cured by correcting the underlying factors causing it. Yes it can be a mystery but not an unsolvable one.

As a physical therapist and author of several books for self-treatment of chronic pain conditions, I’ve seen many people with chronic pain become significantly better if not completely pain free by addressing the anatomy, biomechanics, and daily habits that contribute to their pain.

Don’t give up on the idea that your body is not meant to be in chronic pain. There are answers and I hope you will discover that they are contained in you.

I spoke with a woman over the phone in N. Carolina who has terrible back pain. I diagnosed her problem and she agreed with me. I then sent her several exercises to correct her pain. These were the same exercises that have worked for countless clients I’ve seen with similar problems. Unfortunately she isn’t experiencing pain relief from them.

When she emailed me she said that perhaps she has gone too long letting things go and so wouldn’t respond to the exercises. I completely disagree. Our bodies respond incredibly fast to the removal of harmful habits and initiating corrective exercises. I’ve seen people with back pain for 20 years have their pain significantly reduced in just one session–all from retraining the body to move and work as it should.

So, why didn’t this woman feel relief from her pain doing the same exercises everyone else has used to completely eliminate their pain? I think it has to do with her belief in herself. All too often, I see people who don’t believe they can be helped. There is something transferred from me to a client that instills belief that they can get better. People who don’t see me face to face aren’t able to absorb whatever that is.

Part of how I do this is that I test a client to see what hurts and when. For instance if it hurts to bend over, then we note at what point in the range it hurts and how much. Then I ask them to do a corrective exercise for a few repetitions. Afterward I ask them to re-test (bending over in this case) to see whether the pain is resolved. Almost always it is. That is when belief is kindled in their mind and they allow themselves to think their pain will stop. I think instilling belief in the client is a powerful aspect of healing.

Here is my problem though. I am writing a series of books to help people fix their chronic pain. I know the techniques work but will they work if I’m not there to help convince the reader they will work. If I’m not there, will belief in the probability they will be pain free take root in their minds? I don’t know. Somehow I want these books to engender this belief just as I do in clients I see face-to-face. How can I achieve this?

I have been writing a book detailing some very powerful self-treatment techniques I use to treat patients with chronic pain. It’s been an interesting venture because, in the process of writing the book, I now understand how my subconscious or intuition has been working to guide my treatments. This understanding, in turn, has helped guide my treatments.

Each chapter of the book addressed a different area of the body. For instance neck pain & headaches, shoulder pain, elbow pain, back pain, hip pain, knee pain, foot & ankle pain and back pain & sciatica during pregnancy. The feedback I’ve received is that the information was too technical for laypeople (who happen to be my audience). In the process of breaking the information down even more, each chapter has expanded to become its own book.

The title of the series will be Fixing You. The first book out will be Fixing You: Back Pain and will be followed by seven other books all to be published this year. It will be a busy year for me! My sincerest hope is that these books help the thousands of people out there living with chronic pain. So often with just a little attention to the right areas, pain will vanish. I hope the Fixing You series can guide people to pain-free lives.