3 Moves to Beat Back Pain Now!

One of the most common questions I hear as a PT is “I have back pain, so what should I do about it?” What I realize now is that there’s a lot of confusion about this and most other diagnoses.

The bottom line is that if there was one solution to back pain (or any other pain), it would have been discovered long ago and we’d be done with understanding how the body works. To my knowledge there is no single solution. This is because the body is complex, we all lead unique lives, have singular genetics, and different emotional experiences which makes for lots of variety and therefore potential causes for back pain.

This even holds true for diagnoses such as a bulging disc. I think what people need to understand is what most diagnoses are really telling you is the name of the tissue that’s complaining–nothing more. Usually the culprits lie elsewhere.

To give you an idea of what I mean, I was recently asked by an exercise instructor what might cause knee pain in her client. Well there are many potential causes of knee pain: flat or high-arched feet, tight calf muscles, poor walking patterns, rotated thigh bones, poor gluteal (butt) muscle function, a tilted pelvis, tight hip flexors, tight hamstrings, structural problems such as ligament tears, or simply poor movement habits. Notice almost all of these had nothing to do directly with the knee. By the time I got through with this list, the instructor’s eyes were glazed over (I’m sure you feel the same!). And that’s just knee pain, a fairly simple joint in the body. Just think what more complicated areas must be going through!

So diagnoses like back pain, SI joint pain, cervical/neck pain, back strain, bulging discs, hip bursitis, tennis elbow, tension headaches, migraines, sciatica, plantar fasciitis, ITB syndrome, or patellofemoral syndrome really mean very little. Basically you’re being told which tissue is hurting. Instead what we really need is a diagnosis that tells us how or why something is painful.

Part of all this confusion is that healthcare providers often fall into the trap of focusing only on the tissue that hurts. After all, your doctor said, “You’ve got a disc bulge” not “You’ve got a flat foot that is rotating your knee and thigh inward, which is dropping down that side of your pelvis and turning off your gluteal muscles, which is creating excessive arching on that side of your spine, which is causing you to have back pain”.  In my experience the second explanation is the more accurate diagnosis, not to mention one that we can actually work with.

I don’t really expect other health care professionals like doctors or massage therapists to know these root causes though as that isn’t really their specialty. But it is the job of a physical therapist.

Magazines and other sources don’t help much either by trying to narrow down the solution to cute or catchy bite-sized pieces: 3 Moves to Beat Your Back Pain Now!, The Tennis Elbow Cure!, 5 Reasons Chocolate is Great for Your Headaches! and other types of articles (Did the title of this article make you look?). These give readers the impression that their solutions must be just as simple. Sometimes they are–but not often.

Can you imagine stuffing all those causes for knee pain into one article? Remember journalists for magazines or newspapers or even most bloggers are not healthcare professionals. Their job is to write an interesting article—not fix people’s pain. There’s a big difference.

A simple search on the internet shows that there are a lot of people writing about pain– these writers, however have become the gateway to your understanding of your own issues. Unfortunately many of these people don’t really have any experience helping others with pain. Therefore the answers most people are getting are usually a bit skewed.

Because understanding why pain is happening can be complicated (or at least not summed up in 250 words or less) the real reasons pain happens, never get much press. I can attest that it’s very difficult for me to get my message out to the public, mostly because it’s not simple or sexy enough (let’s face it, both of the people reading this blog might be struggling to even finish it—sorry Mom and Dad, I’ll try to make the next one shorter). It makes me think there must be others who have good answers for chronic pain but they either aren’t writers, can’t catch the ear of the media, or they can’t convey their information in a creative, concise magazine article.

I wrote my back pain book and my other books in the most concise and effective way I could. In them, you’ll find most of the roots to your own pain. One of my goals with all my books is to help you understand how your body works so you can fix it. Once you understand this, you’ll be able to manage your body and eliminate pain forever. I encourage others who have consistent success to write their books as well.

That’s my two cents. I sincerely hope you find solutions to your pain. I truly believe they are available if you look in the right places (hint: begin with my books!) and ask the right questions.

Fixing You: Back Pain Video Preview

Hi All,

I thought I’d put this little video together for those of you interested in moving through my book more quickly. Basically there are two tests that are pivotal in your understanding of your back pain. This video explains where to find them in the book and what they are. If you understand how these two tests are working on your body, you’ll have a HUGE understanding of how to fix your pain.

I hope it helps!

What is the Link Between Emotional Stress and Chronic Pain? – 5 Tips to Help Minimize Stress!

ElephantonBackThese days instead of a monkey on our backs – it’s more like an elephant! Emotional stress is all around us. We hear it all the time, “I’m so stressed out – my neck is killing me!” or “My in-laws are in town and my back is acting up again!”. But how does this really happen? How does emotion or stress create pain? While we don’t have the complete picture on how this happens, a piece of the puzzle may be the fascia.

Fascia is like a web of tissue in our bodies that surrounds and binds together our muscles, tendons, bones and just about every other structure. Fascia tends to have patterns to it, like highways, that connect say our feet to our head. It’s made up of a type of cell called fibroblasts. There is a certain type of fibroblast, called myofibroblasts, that are laid down in areas of more wear and tear in our bodies. One well-known concentration of myofibroblasts is in the fascia of the lower back area called the thoracolumbar fascia.

Myofibroblasts can contract (myo- relates to muscle) – just like a muscle. Their contraction however is a direct response to chemicals circulating in our bodies as opposed to nerve signals causing them to contract, as is the case with muscles. One of these molecules is called Transforming Growth Factor-β1 (TGF-β1) and is secreted by our immune system.

A trigger for the release of TGF-β1 is activation of the sympathetic nervous system (SNS)—our fight or flight nervous system . Its role is to help us deal with threats, whether physical or emotional. In prehistoric times this system helped us fight off saber-toothed tigers and other predators but now we have different, more long-lasting threats like working at a hostile job or meeting an important deadline. Our SNS then kicks in for much longer periods of time. There are a host of internal processes that occur as a result of SNS activation that affect every major system in our bodies.

Once we are threatened or under stress, our SNS becomes stimulated, causing the release of TGF-β1 which then triggers myofibroblasts to contract. Remember myofibroblasts are laid down in areas of mechanical stress (joints, the spine, etc) so those areas will be most prone to this type of contraction. The back and neck are potential areas of great mechanical stress for a variety of reasons and so these may contain higher concentrations of myofibroblasts than other areas of the body. This would make them more prone to fascial contraction due to stress.

There are a few different ways then we can approach this problem of emotionally created pain. One is to remove the stressors from our lives. This is always good to work on however new stressors will continue to present themselves. We can also change our reactions to stressors so they don’t cause our SNS to engage so easily. Here are 5 techniques to help modify your behavior:

1. Practice Deep Breathing. Studies show that just focusing on the breath for 5 minutes can change your reaction or attitude.

2. Learn EFT (Emotional Freedom Techniques), also known as tapping. This combination of psychology and acupressure points can give you relief from pain – physical or emotional -sometimes within just minutes.

3. Meditation. Take up a daily meditation practice. Just 15 minutes a day can make a huge different in how you navigate through your day.

4. Practice Yoga. Since yoga combines breathing, movement and some meditative aspects a daily practice can have a profound effect on the SNS.

5. Try Tai Chi. Tai Chi involves slow, gentle movements, deep breathing, and meditation – all excellent ways to lower your stress level and the release of TGF-β1.

Another approach is to fix the areas of mechanical stress. That way there are fewer areas to activate. This is where I come in as a physical therapist and where my books can help. I think the best approach is to work on both fronts. It’s not likely we’ll ever completely remove emotional stressors from our lives nor is it likely we’ll remove all mechanical stressors. But if we can reduce both even just a little then we have a great opportunity to live a pain free life that isn’t at the whims of our emotions.

The Mystery of a Cyclist’s Knee Pain

Sam came into the clinic with complaints of stabbing knee and hip pain. He was a cyclist who liked to put in around 150 miles each week. In Colorado we have a cycling event called Ride the Rockies which is a series of challenging long days of cycling through the mountains, and he wanted to do it this year—except his hip and knee pain were excruciating after about an hour of riding.

Sam’s evaluation revealed both of his femurs were retroverted. This means his thigh bones were rotated outward. His gluteal strength and timing were good and he didn’t have a tracking problem with the head of his femur in the hip socket. So I simply asked him to stand his normal way, which he did with feet pointing forward. I asked him to assess any tension in his lower extremities. Because this was his normal way of standing, he didn’t detect any unusual stress. Then I asked him to turn his feet outward a few degrees and stand there for 30 seconds.

“How does that feel?” I asked.

“Like I’m standing like a duck,” he said.

After about 30 seconds, I then asked him to turn his feet back to normal. “Which feels more comfortable to you? More relaxed?” I asked.

“Wow, standing like a duck is much more comfortable!” he exclaimed.

“Your job is to start standing and walking with your toes turned out a few degrees,” I said. “And when you’re riding your bike, let the knees drift away from the frame of the bike about a ¼-1/2 inch to accommodate the shape of your femurs,”

Cycling is a sport where you must have great leg strength and the typical cycling position is to bring the knees toward the frame of the bike to reduce wind resistance. I explained how the shape of his thigh bones dictated that he shouldn’t bring his knees in quite so severely as it impinged both his knee and hip joints.

Sam came in for his second visit completely painfree and astonished. He had anticipated months of rehab to strengthen his leg muscles more. Sam was already strong as a bull and strength wasn’t his problem. It was knowledge of his body that he needed to guide his training.

I want to point out here that Sam originally thought of his improved standing posture as “standing like a duck”. This is a judgment based on our cultural or societal norms and values of standing and walking with the feet pointed forward. These judgments or rules however are based on the misunderstanding that all bodies are built the same. Perhaps keep that in mind while working through your issues and you may find that old lessons or tried-and-true rules you’ve had, no longer apply to your goals of being painfree and healthy.

Back Pain and Standing Habits

If you’ve read my back pain book, you’ll know that I blame our movement habits for a lot of chronic back pain. Recently I saw a woman for back pain that had been on and off for a few years but for the past few months had not abated. She had more pain standing or walking than sitting.

As she stood there in front of me during our evaluation, it was pretty clear to me what the problem was: she had a spine with excessive low back curve and her pelvis tilted forward. There’s a picture of someone with a lordotic spine in my back pain book on page 58.

One of the biggest habits that magnifies this lordotic problem is locking the knees. By this I mean the knees are completely straightened and pushed backward. It’s a very common habit especially as we age because it helps save energy. Instead of using our leg muscles to hold us up, we use our joints. The consequence of this habit though is that it tilts the pelvis forward in those with lordotic postures. This then causes the spine to arch more, which is what causes back pain in this type of posture.

If you think you have this problem, try this little test yourself.

  • Stand normally and sense any back discomfort.
  • Now unlock your knees, bending them very slightly. Feel the difference in your back and stand there for 30 seconds.
  • After 30 seconds, lock the knees again and feel your back.

Which feels more comfortable or relaxed for your back–locked knees or unlocked? Just about everyone feels immediate back pain relief when unlocking their knees.FIGURE 5-8 This habit was so strong in my patient that I decided to tape the backs of her knees (see picture) so they didn’t lock backward. This simple intervention disrupted her pelvic tilting and consequent back arching. Just from changing this habit alone, she was 90% better the next visit!

After her third visit she said, “I don’t understand, my back pain is gone but you haven’t given me any exercises to do at home. How is this possible?”  I explained that her pain was largely due to the way she used her body. She had made the necessary changes and that’s all she needed to continue to do. She just shook her head baffled by the concept. But she knew it was true because she had no more pain. In the interest of full disclosure, we did change one or two other movement habits causing her problems which sealed the deal.

If you found this helpful, there are likely other issues you can target to fix your pain. In addition to correcting habits such as standing, walking, sitting, bending etc, Fixing You: Back Pain also gives you exercises to correct tight or weak muscles that result from these habits. These exercises can be accessed for free on the Fixing You website.

Good luck and don’t lose hope! There is a solution to your pain!

Fixing You: Back Pain 2nd Edition is Here!

Wow, I can’t believe I’ve finally completed the 2nd edition of Fixing You: Back Pain! I’ve been working on it for 2 years now and there are so many changes, I wanted to devote a blog entry to talk about them.

Fixing You: Back Pain 2nd Edition will be offered at half-price, only $10, for a limited time as a thank you to my previous readers.

1. If you’re familiar with the 1st edition, I think the first big change is a departure from the category of Rotation Problems in favor of Sidebending Problems. “What’s the big deal?” Fig12_Sidebendingyou might ask. Well it’s a very big deal because I believe the sidebending issues are creating the rotation problems. It kind of works like this, when the spine is in a neutral position, sidebending to one side creates rotation to the opposite direction. So if the spine is sidebending to the left, it rotates to the right. The first edition of Fixing You: Back Pain identified these issues as rotation problems however it’s very difficult to correct a rotation issue. Now I believe that is because the driver of the rotation problem is actually a sidebending problem. And these are much easier to fix as you’ll see in the second edition. I think the sidebending issues are the main culprits in creating unilateral back pain or sciatic pain. This has been a significant tool in the correction of asymmetry in the pelvis and lumbar spine.

2.These past few years I’ve looked more into fascia and have included more information about the role of fascia in chronic pain. I’ve uncovered some research that connects fascial contraction to our sympathetic nervous system response (our fight-or-flight or stress response). I’ve completely re-written the first section, Mindful Healing, to include how our brain, stress, fascia, and habits come together to create chronic contraction patterns. I think you’ll find it interesting and useful. To this end, I’ve included a worksheet in the Appendix of the book to help you identify and quantify stress in your life. This can go a long way to relieving chronic pain due to the connection between the stress and fascial contraction.

3. Hanna Somatics techniques have been introduced. I have spent 3 years studying Hanna Somatics, which has become a very important approach in my clinic when working with chronic pain patients or those with recurring injuries. I’ve “somaticized” some of my exercises to reflect this learning. I’ve also created separate audio and video somatics lessons to help people reduce tension and pain throughout their bodies. These can be found at www.FixingYouBooks.com.

4. Re-shot all videos of exercises and tests in the book! There are now many more exercises as well as tests in this book to help you more precisely understand and fix your pain. The videos look great, offering more detail, and I think they will be VERY helpful in taking your solutions to the next level.

5. Lots more images! There are over 145 pictures and images in this book (69 in the first 2 sections and 76 in the 3rd section of corrective exercises) as compared to the 1st edition which had 58 (23 in the first 2 sections and 35 in the 3rd section of corrective exercises). Part of the reason this revision has taken so long is waiting for the new images and figuring out how to fit them into the book. I actually had to go to an 8×10 layout, which I think you’ll find easier to read.

6. I have more recommendations about how to change sitting, standing, walking and bending habits that seem to be at the root of a lot of people’s pain. Overall the 2nd edition is now 177 pages while the first edition was only 123. This is such as substantial increase in size, I have to list it as a completely new book!

7. Read a chapter for free! I’m offering Chapter 3: The Basics free if you’d like to check it out first or send it to a friend who might need some help. This chapter talks about things that happen in the background that set us up for back pain. I think you’ll find it useful.

I hope Fixing You: Back Pain 2nd edition helps even more of you fix your pain. Thank you all for your patience and support as I put this together. Please feel free to leave a review on Amazon as I must start all over again with the reviews since this is considered a new book. Thank you and let me hear your stories!

Patient Story: From Wheelchair to Pain Free in 5 Visits

I recently saw a woman who had such crippling back and sciatic pain that she had to use a wheelchair to go to church and couldn’t stand. This was building for several months and she finally sought help.


Muscle imbalances in the legs can feed issues up above.

What I found during our exam was one side of the pelvis higher than the other, contracted hip flexor muscles, one side of her rib cage was lower than the other, a walking pattern that promoted hyperextending knees and a very strong heel strike, a thigh bone that rotated in too far at foot strike, two flat feet and ankles that collapsed too. She was kind of like the picture to the right– her body was all askew. She was very tense so that when I touched or moved her, she jumped or couldn’t allow me to really move her passively.

She was very scared because her quality of life had diminished significantly and she was on the verge of tears. Her work involved a large amount of stress and she just seemed to absorb it right into her body. She was a very caring person but took on too much of other peoples’ concerns. She doubted she could ever return to her old life.

After 5 visits she was a completely different woman. No wheelchair, she smiled more and was more relaxed while walking. She could bend down to the floor without any pain and could sit or stand for long periods of time with no pain at all. In summary, she was the picture of health and confidence with no pain whatsoever.

How did she do it? As with all our patients at the clinic, we focus on decreasing tension and improving how people do things like sitting, standing, walking etc. She had downloaded my audio Somatics Movement Lessons (Hanna Somatics) and practiced those every day which began to unlock her body. There are 8 gentle lessons in this audio download, targeting different parts of the body.

The material in this audio download includes:

Lesson 1: Back Movements (approximately 35 minutes)

Lesson 2: Front Movements (approximately 30 minutes)

Lesson 3: Waist Movements (approximately 26 minutes)

Lesson 4: Rotation Movements (approximately 25 minutes)

Lesson 5: Hip Movements (approximately 27 minutes)

Lesson 6: Neck Movements (approximately 50 minutes)

Lesson 7: Breathing (approximately 27 minutes)

Lesson 8: Walking (approximately 32 minutes)


As a bonus, they help decrease the sympathetic nervous system level while increasing the level of the parasympathetic nervous system–great when you want to reduce the effects of stress on your body!

In the clinic I used similar techniques to more specifically release patterns of contraction in her body. We combined this with a better way of walking, sitting, and bending over. You can see an example of this in my post: I Don’t like Doing My Physical Therapy Exercises!. In addition, I merely told her she’s carrying too much stress from her work and she needed to distance herself from it and protect herself.

I think the moral of the story is no matter how bad it may seem, trust that there is a solution to your pain. You must keep trying–there is an answer!

Many of these issues are addressed in my book Fixing You: Back Pain (2nd ed) available on Amazon soon.

I Don’t Like Doing My Physical Therapy Exercises!

I just got off the phone with a friend of mine whose husband is having back pain. She said, “When he does his exercises, he feels great. When he doesn’t, he doesn’t”. This brings up a big beef for people seeing a physical therapist–they don’t want to do exercises for the rest of their life to keep their pain at bay. I don’t blame them.

I heard from one of my other patients that a PT told him long ago that only 30% of their patients get better because people don’t do their exercises. Only 30%! That’s crazy!

Gosh, why are so many people not doing their exercises? Well first of all, I don’t know –I rarely hear this complaint at my clinic. But I have an idea. I think the problem is that the exercises most people receive don’t meaningfully apply to their lives. They’re probably exercises that people have to stop to do in a special place and require a lot of time time to do them. “We’re busy, we don’t have time for exercises!” is what many of you are probably thinking. Rightfully so.

So why don’t I run into this problem at my clinic? Well I think it’s because I focus on pain-causing movements rather than weak or tight muscles. We identify the movements that are painful, understand the muscular issues and/or biomechanics behind the problem and integrate those fixes back into a better way of doing things. So what I recommend to people is more about improving how they do things like walking, bending, sitting, and sleeping. That way the changes are part of their lifestyles and require little to no extra time out of their days to do them. They just require some attention and thoughtfulness.

The video below shows what I’m talking about. If I’ve determined someone’s butt muscles are weak or not participating enough, I can teach them to integrate those muscles into activities like stair climbing. This is especially helpful if they’re complaining about knee, hip, or back pain when climbing stairs! Check it out, this is one of the videos from my revised back pain book due out soon (I hope!).


This is also why most of my patients’ pain doesn’t return, because they’ve fixed the behaviors that caused it in the first place. There’s a lot of education that goes on in my clinic and by the time my patients leave, they know exactly why they have pain, exactly what to do to correct it, and how to apply those behaviors to new activities. I want them to understand their bodies and brains just as well as I do. That way they don’t need to see me once a month or even once a year. They can just fix themselves! Isn’t that what it’s all about?


Jason Dufner’s Neck Pain

Jason Dufner, a big golf fan favorite, had to pull out of the PGA Championship this year due to neck pain. It appears he has a couple of bulging discs. Apparently he’s tried everything but hasn’t seen any relief. So what could be the cause of Jason’s disc bulges and neck pain?

Figure 1. Scapular muscles

Figure 1. Scapular muscles

Well to lay a little groundwork, the neck region is unique in the body in that it’s strongly influenced by a system that doesn’t really have a bony attachment to it. What I mean by this is that everywhere else in the body, bones stack on top of bones which help those bones stay in alignment. The neck, however, is a little different. While it’s true the neck bones (cervical vertebrae) stack on top of each other, there is a major player affecting it that doesn’t even attach to it from a bony standpoint–the shoulder.

The shoulder girdle (including the collarbone and shoulder blade) are kind of a floating system on the upper body. Unlike every other movement system, this one is held in place almost exclusively by muscles. Two of those muscles, the levator scapula and the trapezius, attach directly to the head and neck (Figure 1).

The levator scapula is deep to the trapezius and much smaller. It runs from the shoulder blade up to the first four neck bones. Its job is to help elevate the scapula–just like its name implies. The trapezius runs from the shoulder blade and collarbone to the base of the skull and all the vertebrae down to about the low back area. It’s one of the prime movers and stabilizers of the shoulder blade.

Unfortunately there are some other big gorillas that mess with the shoulder girdle to throw it off. When this happens, stress is delivered to the neck and head creating excessive force and contributing to neck pain, headaches, disc bulges, strange head and face symptoms, as well as arm symptoms. About 99% of the neck pain and headaches I treat in the clinic are due to shoulder girdle dysfunction–regardless of whether there are bulges or degenerated discs, facet issues or other types of structural diagnoses. I write about these issues in my neck pain book.

If you think about it, this makes sense because what else could be straining the neck so much? Yes the head weighs about 12-15 pounds but Jason’s a young guy and with plenty of strength and good enough posture to hold his head in a relatively proper position. There really aren’t any other stressors.

Now think about the golf swing. It involves big arm and shoulder movements and the arm is given even more leverage against the neck by adding a long club moving at tremendous speeds (about 100-150 mph for pros). Given these loads, doesn’t it make sense that the levator scapula and trapezius muscles are wreaking havoc on Jason’s neck?

If I were to have an opportunity to help The Duf, I would begin with the shoulder girdle system, fixing the issues creating movement dysfunction. Once these are corrected, only then would I begin working with his neck directly. Otherwise those big arms and shoulders would just keep delivering their destruction. Good luck, Jason! Read my book or shoot me an email and I’d be happy to help!

Missy Franklin’s Back Pain

I’m so sorry to hear of Missy Franklin’s struggles with back pain. She’s a great person, athlete, and has inspired millions with her incredible skill at the 2012 Olympics. But swimming is normally an exercise that people are given to cure back pain not create it. So what could be the problem?

Well it’s important to understand that the site of most pain is like a crime scene. The painful joints or tissues are the victims while the culprits lurk outside the crime scene tape in the shadows. With regards to back pain, most pain is due to a problem with excessive arching of the spine. I call this an extension problem in my back pain book. Arching the spine creates compression of the discs and facet joints and, after repeated arching, the back muscles begin to accommodate this by remaining contracted as that’s what they’ve learned to do.

Figure 1. Pelvic Muscles Contribute to Back Pain

Figure 1. Pelvic Muscles Contribute to Back Pain

The culprits in this crime scene can be found in a few places. Some of them are the hip flexors which attach from the front of the pelvis to below the knee. When they are tight or overly contracted, they contribute to forward (anterior) tilting of the pelvis. The lower spine, being attached to the pelvis at the sacrum and being very good at arching (see graphic in Tiger Woods’ Back Pain), is then forced to arch to accommodate this pelvic position. Repeat this a few million times, as is the case while walking (or kicking of a swimmer’s legs) and disc degeneration, disc bulges, disc herniations, or facet issues ensue (Figure 1).

Another stressor creating an extension problem is tightness of the latissimus dorsi muscle. This muscle is very large and begins at the pelvis and lumbar spine running up to the shoulder blade and finally inserting onto the upper arm bone. If it’s tight or contracted, the back will arch to allow the arm to reach. Most people aren’t aware this is even happening. So when the arm is reaching overhead as in a shoulder press (or in swimming during any of the strokes) the back arches a little delivering more extension stress to the spine.

A third stressor is poor rear-end muscle, or gluteal, motor control (being able to control the turning on or off of a muscle). When the gluteal muscles aren’t being used well when bringing the leg back, others must make up for their slack. Usually these are the hamstrings and low back muscles. This very frequently comes into play with poor walking habits or, in the case of swimmers, poor kicking habits.

Lastly poor core (and specifically the external oblique muscles) control allows the spine to arch excessively. These muscles help guard against excessive extension of the low back. You can do a thousand sit-ups a day and still have weak external obliques though if you’re not specifically training them. And even if they are strong, they can’t offset the first three problems due to the leverage the arms and legs have over the core in acting on the spine.

So these would be the first places I’d look if I were to help Missy. I sure hope she recovers.