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.

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.

During my seminars, I’m often questioned by people about how my approach to fixing back pain will help them. After all, they have a herniated disk, spinal stenosis, bulging disk, spondylolisthesis (insert your diagnosis here). In my experience these diagnoses are actually signs of the causes of back pain, not the causes themselves. A large portion of people with bulging disks don’t experience any pain, so the bulging disk isn’t necessarily the culprit. It’s what is causing the bulging disk that we should be concerned about.

Let’s forget for a while all the anatomy of the spine. Forget about the names of nerves, disks, muscles etc and let’s just think about how the spine has to function. It has to be able to bend forward or flex as in when we bend down to pick something up. It needs to straighten back up or extend. It needs to sidebend as when we are sitting at a desk and reach into a drawer. And it needs to rotate such as when we play sports like tennis, swimming, baseball or just about any other sport there is. Postural control falls along the continuum of these motions or functions.

That’s four things but we’re going to narrow that down to three because sidebending and rotation occur together. So really we need to make sure that our spine flexes, extends and rotates correctly. This lies at the heart of how I treat back pain. Correcting clients’ control of these motions, including the woman from the first post, is how I fix pain.

There is something called Wolff’s Law which says that bones react to stresses placed on them. The corollary to this is Davis’ Law which addresses how soft tissue responds to stresses placed on them. Regardless of whose law you are discussing, the body’s tissues respond to abnormal forces placed on them or to the lack of forces placed on them.

So, if our spines are not moving correctly, these stresses are placed on the bones and tissues. Eventually these can cause some of the diagnoses mentioned at the beginning of this post. Rather than treat the tissue that is hurting, I focus on the movements or function of the system in question. When corrected, pain goes away. It would be nice to know if the actual disk bulges go away too but I do not have access to that type of research and so have to suffice with eliminating the pain.

In my next post, I’ll discuss the mental aspect to fixing your pain. If you have any comments or questions, please feel free to write.

Rick Olderman MS, PT, CPT

My name is Rick Olderman. I am a physical therapist, personal trainer and Pilates instructor working in Denver, CO. I’ve worked with countless patients and clients with back pain and wanted to share some observations which help me treat pain more efficiently and effectively. I’ll also cover weight training, cardio and Pilates concepts.

Currently I’m working with a woman with severe spinal stenosis (narrowing of the spinal canal), spondylolisthesis (small spinal fracture) and an extra lumbar vertebra. She has been in pain for more than a decade, has been to specialists, therapists, accupuncturists, Pilates instructors -you name it. In three sessions her pain was 75% relieved and now rarely returns. We are just beginning on a weight training program and she’s eating it up!

It didn’t always work out this way. Often it was hit or miss whether I could help my back clients. However now I’m just over 90% successful in eliminating back pain these last few years. There’s no weird technique involved, instead I apply my understanding of anatomy,biomechanics and function to help people. In fact I rarely do any hands-on work aside from assessments. My approach is to teach people to fix themselves, thereby ensuring the fix will be longer lasting than by passive means such as adjustments or manipulations.

In the next posts (this is the first blog I’ve ever done), I’ll go into more detail as to how I look at the body and treat it as well as how I apply that to Pilates and weight training. I’ll be curious whether anyone actually reads this so if you are, please drop me a line and let me know. If there is something you’d like to discuss specifically (including other topics or injuries of the body), let me know that too and I’ll try to help you with it.

Thanks,

Rick