What is the real story about back pain?

How many people do I see with back pain? Well, it is at least 80% of my practice. Back pain is the 3rd most common reason that people seek medical care in this country.

Clients tell me that they are doing their stretching exercises and their “core strengthening” regularly. They go to the gym and lift weights. They have stopped running, which they love, and the pain continues. What is going on?

Many come with a “diagnosis.” It is “arthritis,” spondylitis, spondylosis, degenerative disc disease, scoliosis, or more. And, no matter what the diagnosis, they all have the same pain. Pain in the right side, left side, middle, or all of the above. It often moves around. What’s going on?

Most have already been to the doctor, chiropractor, physical therapist, acupuncturist (I’m in California). Generally, they have been given the same feedback and treatment regimen. “Strengthen your core.” If this was working, I would not be seeing them. Often they are blamed for not doing it correctly by the professional they are seeing. What is going on?

Let’s explore. What is the core anyway? Does anybody know? The “core” muscles are the “(major) pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius.

Whew! That’s a lot of muscles to be holding at all times. How do you do that? How do you breathe and how do you walk, throw, reach, bend, jump, or step over a crack in the sidewalk?

In fact, the idea of “core” is an outdated concept based on a study by Paul Hodges (1991) which looked into the transverse abdominis activation and lower back pain (thank you Angela McMillan).

The spine is made up of 33 vertebrae, and 24 of them move. Joints called facet joints are on either side of each vertebra. And then, of course there are the ribs which form a joint with each vertebrae in the mid area of the spine. There are more joints that make up a functioning spine than I care to count right now. Joints are made to move and are not supposed to be held stiffly by muscles.

Apparently it is not common knowledge that back care needs to start with an exploration of all of these joints, or articulations, as they are called by the medical community.

We need to be able to move these joints if we want to feel better. The idea of “bracing” is misleading. We move in 3D. There are so many movements that we need to make all day long. Of course the muscles around the hip; psoas and hamstrings are working so much harder to move the braced body above that they get sore and “tight.” What do we do? We stretch the bejeebees out of them. Whew! There’s an ineffective cycle for you. And, your pain is still there. What’s going on.

Obviously new concepts in fitness take a while to trickle down to the average person. The “hold ‘em and stretch ‘em” approach has had the floor for over 20 years now. And what about pulling in the belly at all times? While perhaps considered sexy and fashionable in our culture, the health benefit is false. That does, however, keep the notion popular. Again, how do you breathe with your belly held in?

Our bodies are designed to move efficiently without us using much energy. We want fluid, graceful, effortless movement for our everyday activities. Simply put, there are just not a special group of core muscles. What happens in one part of our body affects the rest of the body.

Think about the energy you are using holding your muscles while trying to move. Muscles move us. They are not meant to hold us. We need adequate movement throughout the whole body so that we don’t stress any part of the body, not just the lumbar spine. All parts of our body, skeleton, muscles, “share the load.” Each joint and muscle is designed to allow options and variations in movement.

You can hold in your belly and whatever other muscles you like to look a certain way but don’t be fooled into thinking it will get rid of your pain. Why does your back still hurt after all the time and money you have already spent? That is what’s going on.

Do you want to learn how to move without pain and live the life you want? I want you to become the expert on you. Contact me for more information about my classes, workshops, and individual sessions.

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