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.

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?

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.

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