 all to help me start the end low back pain revolution. This is Think Tech Hawaii, and this is my seventh episode of Movement Matters. Movement Matters covers topics dealing with health and wellness of your body. If this is your first time joining us, I'm Christine Lenders. I've been a physical therapist for 23 years in California, New York, Connecticut, and now in Hawaii in a variety of settings, including sports, orthopedics, neuro, and even on-site corporate wellness platforms. I'm a board-certified orthopedic clinical specialist. I'm certified in Applied Functional Science and have my manual therapy certification. This show is designed to bring you the most cutting edge and effective treatment strategies so you can help your body perform better, decrease pain, and get back to doing the things you love. I have a very special episode for you today, where I'll be teaching you the evidence-based secret to core stabilization and anti-curve strategies for scoliosis. I began teaching to the community and to physical therapists on my biomechanical treatment approach to scoliosis in 2012. I presented successful case studies using my approach at physician rounds at the Hospital for Special Surgery in New York, prepared community education talks, and in 2016, I instructed a two-hour educational seminar on my approach at the National Physical Therapy Association's annual special section conference. I've also collaborated with a SHROT-certified physical therapist to teach physical therapists at a university a comprehensive approach to treating folks with scoliosis. First, let's take a look at my recently published article on the secret technique to eliminating low back pain in Image 1. This article is based on my soon-to-be-published book highlighting how to solve low back pain once and for all. The key is to learn to reactivate the transverse abdominis muscle in neutral spine, which we can see in our first video. It's important when you're learning to engage your transverse abdominis that you're in neutral spine, not with your back flat and not with your back super arched, but wherever it rests naturally on the table. The most important thing about finding your neutral spine is that you're not completely flat or completely swayed as I showed in the video. So it is best if you try to learn it on a firm surface. On a bed, you might collapse into the bed. And why this is important is because our low back has a natural backwards curve. So if you're flattening your back to the surface, that's reversing the curve of your low back. And the joints and the discs and the muscles don't perform optimally when they're not in that curve. So once you're able to perform this properly and you find your neutral spine, you'll need to train the TA, as I call it, which is the transversus abdominis, to work in real life situations like walking, as shown in our next video. Now that we've found our neutral spine, we're gonna pull our belly button into our spine to engage our transverse abdominis, not from the stomach, but from the belly button below and raise one foot, one inch. Put it down, keeping the belly button in. Raise the other foot, one inch. And put it down, making sure you keep your pelvis still. Okay, so that model did a great job of keeping her pelvis level. And that's one of the things I wanted to talk a little bit more about. When you have back pain or you injured your back or you've had knee or foot surgery or something that has made you walk a little bit funny for a while because you've had crutches or a boot or something like that, excuse me, you can throw your pelvis off a little bit and that throws off the firing of the deepest back muscles, the multifidus. When you pull your belly button in and you engage your transverse abdominis, you're forming a co-contraction with those deepest low back muscles, the multifidus, to give your low back spinal stability. So the model was able to keep her pelvis level when she was lifting one foot and then lifting the other. But oftentimes what I see in the clinic when people first learn to pull their belly button in neutral spine is that maybe they can lift one foot in their pelvis stays level, but then when they lift the other, their pelvis twists side to side, similar to if you had a bowl of water sitting on your pelvis while you're on your back and you lifted one foot, the bowl of water might dump off to the right. We don't want that. We want to train the transverse abdominis with the multifidus muscles to give you that anatomical girdle so that your pelvis stays level when you move your feet. And the reason why I do the moving the feet is I want to simulate walking because that's something that we do most. We get up and walk out the door. We walk to the kitchen. We walk to work. We walk to the water fountain. We walk to the bathroom. And so I want to make sure that we're training your anatomical girdle to work and keep your pelvis stable while you walk. So one of the reasons why folks suffer repeated episodes of low back pain is that even after one episode of low back pain, it was found that the multifidus muscles never regain function without specific retraining. This is cited in my article. Let's look at the next video. It's important for this exercise that you keep a pillow under your stomach. That way your low back is not extended too much by laying flat on the surface. It keeps you more in neutral. You're gonna pull your belly button inward and then lift one leg up just an inch or two. Put it down, keep your belly button in. Lift the other leg an inch or two. Okay, great. So this video shows an example of one way to start retraining the lumbar multifidus with the transor subdominus. And why I have people go face down is because it adds gravity to those muscles like you do when you would lift a weight or strengthen. That video that I just showed is very important as I mentioned in the video to put a pillow under your stomach so that your back is not too swayed so you don't get compression on the joints in your back. You wanna stay in neutral when you're engaging your transor subdominus and then exercising your multifidus. You want your anatomical girdle to be stabilizing your low back. Now in the next video, I'll show an easier way to do it that I found a couple years ago that is great at making those multifidus muscles fired together instead of one at a time sometimes when there's dysfunction, that's what will happen. So let's look at the next video. Another way to activate the multifidus without lifting the heavy lower leg is to pull your belly button in to engage them both symmetrically. Lift your arms just off the floor and then come down. So those two videos are great ways to retrain the lumbar multifidus muscles. What you wanna make sure is that you don't have any pain when you do it. You have to be pain free. You need to pull your belly button in first and be sure to engage your transor subdominus before you lift a leg, before you lift your arms. Lifting the arms is more beginner because nothing has happened at your spine. You're just pulling your arms back which puts a load on the lumbar multifidus low down and in the lower back so that you're firing them together and really getting control of your anatomical girdle. So what if you have scoliosis and back pain? Let's look at the multifidus muscles to see what effect the curve has on these crucial muscles. Okay, so in this photo, you'll see the x-ray on our right that shows the curve is bending a little bit more towards the right. And on the left where you show the drawing that my illustrator, my late father, drew this for me before my talk, the muscles on the inside of the curve are held in the shortened position while the muscles on the outside of the curve are putting under strain or under stretch as the spine is bending over towards the right. Where that becomes important is because the multifidus are like little Christmas trees and the main way that they stabilize us is functioning together instead of one at a time. One's not pulling harder than the other in the healthy spine. So with the scoliosis, what I need to look at in the clinic with my patients is making sure that I help to loosen up the short side that is holding the spine that way in a rigid fashion, especially when an older person that say like late 20s, 30s, 40s and above where their spinal curve was fixed when they stopped growing but now the muscle shortening on one side and the muscle under constant strain on the other side has really started to affect their curve and that's where people could end up having back pain, neck pain, shoulder blade pain, hip pain. So what I like to do in my treatment is really try to loosen up the muscles on that short side to allow me to do anti-curve strategies and allow them to open up what has compensated over time where people usually have pain is on the longer side, on the side that has been stretched so to speak or under strain. So most people tend to complain of pain on that longer side where the ribs are rotating back where the spine is bending away from because those muscles are getting pulled over time. So in my treatment sessions, I like to focus on that. All right, what happens to these muscles within the curve as I explained is that certain parts of the curve on one side will get in the shortened position and other parts will be held in the lengthened position. What you need to do to unwind your curve is to first lengthen these muscles and then strengthen and stabilize while you correct your positioning to achieve symmetry as you go about your day, especially if you're sitting. So image seven shows a simple way to normalize your curve and prevent pain while you sit. And if you can see in the image, I drew a line to highlight that the curve is bending to the right. And what I had this person do to stabilize that while they sat at their desk all day long is just fold the towel underneath the left buttock and you could see the spine was straightened out. You'll need to see someone who's specialized in scoliosis or a physical therapist or have someone take a picture of you from behind in order to figure out which way your curve is and which side you need to put the towel under because you don't wanna put it under the wrong side because you don't wanna progress your curve any further. So the next video shows a three-dimensional correction for the same curve in sitting. A curve like Rachel's who is bent to the right. To do an auto-correction in sitting, you would hug yourself, shift your rib cage to the right so that your body bends to the left but doesn't lean to the left. Turn your chest to the right, making sure that your right shoulder stays higher than the left. And then you breathe in and out lifting your chest up and then lifting your chest down to get a three-dimensional correction out of the direction her curve is. Okay, so I know that this may look complicated at first. So I wanted to show you in the real as well. So if your curve is bending the way I'm bending so that my left shoulder is a little bit higher, what you wanna do in sitting as I showed in the video is to switch the direction. But it's important not to lean over. You see the difference? So I'm sitting here like this, that's my scoliosis curve. You shift your rib cage over so that one shoulder moves higher. And that's why I was trying to point out with my finger on the shoulder. You shift over so now you're bending a little to the left. Then you spin like you're on a stick so that you're turning to the right, keeping your right shoulder up. And then you do some breathing because it's important to expand the rib. So you breathe in and you breathe out. Anyone that has scoliosis has ever done this exercise has always told me, oh my gosh, I feel like that releases something in my back or I feel like that's releasing the tension in my neck because you're putting the muscles that have been shortened for such a long time on a stretch, you're opening up your curve, your lungs feel better, your ribs feel better, you're taking a deep breath and all the tension that was from your curve being like this for since you were a teenager is now being undone. And it's so easy to do. Once you figure out how to do it, it's so easy to find an anti-curve strategy for yourself that you can do at work. And in our next video, this shows a great standing anti-curve strategy for the same curve. For a curve like Rachel's, we wanna focus on going out of the curve. So you could stand against the wall with the shorter side of the curve's arm up on the wall, bend the same side knee so you're bending left and then you could take your left hand and reach back and forth through to get the rotation component. So those are just some very simple strategies that you can learn and work with your physical therapist. You can come in to see me. I can help you figure out your curve. I like to draw you out for people. I tell people, I'm gonna give you to you. Once I draw you out, I explain your curve. I explain what so to speak short, what's long, what needs to be strengthened, what needs to be stretched and how you can integrate it into your day, into your walking routine, into your workout routine, into your desk job. So we're gonna go to a break and we'll be right back. This is Christine Linders, Movement Matters. We'll be back in a minute. Thanks to our ThinkTech underwriters and grand tours, the Atherton Family Foundation, Carol Mun Lee and the Friends of ThinkTech, the Center for Microbial Oceanography Research and Education, Collateral Analytics, the Cook Foundation, Dwayne Kurisu, the Hawaii Community Foundation, the Hawaii Council of Associations of Apartment Owners, Hawaii Energy, the Hawaii Energy Policy Forum, Hawaiian Electric Company, Integrated Security Technologies, Gailin Ho of BAE Systems, Kamehameha Schools, MW Group, the Shidler Family Foundation, the Sydney Stern Memorial Trust, Volo Foundation, Yuriko J. Sugimura. Thanks so much to you all. I'm Christine Linders. This is ThinkTech Hawaii and Movement Matters. We were just talking about anti-curve strategies for scoliosis and deep core activation for low back pain. And I wanted to finish our video series with just a general rate postural strategy that works every time at work. So let's look at this last video. And just as an easy, simple stabilization exercise while you're sitting at your desk, you pull your belly button in, sit up properly, rotate your hands out, squeezing your shoulder blades together. That's one of my favorite things. I give that to people, whether they have back pain, neck pain, shoulder pain, foot pain, especially if they're sitting at work. I give it to new moms who are constantly bending over a baby. I give it to people that are truck drivers or transit drivers or anyone that's doing prolonged sitting because as we reach forward to hold on the steering wheel, tend to the baby, me, work on patients, what you need to do is something that I call undo the sport. And that means you need to do something counteractive to all the muscles that you're using in the front of your body while you're going about your work, your job, your hobbies, et cetera. So that one shows a great undo the sport because it works the muscles in the upper back. It works your posterior rotator cuff. So great for people with shoulder injuries, people with bad posture, people with jobs that are in front of them and pretty much almost all sports is everything for the most part that we do is in front of us. I also showed, I think, when I was interviewed by Catherine Noor, my shoulder blade squeeze, which is something to do, like this stick them up or surrender pose, hands up to squeeze your shoulder blades because that's a great way because you're externally rotating your shoulders, you're retracting your scapula and you're bringing your head back between your shoulders versus the internally rotating your shoulders, bending forward and having your head down while you look at something. So I also wanted to talk a little bit more about the article. So the article was published in October in the hospital for special surgeries, orthopedic journal. They did a special rehab section and I was thrilled to be a part of that. Dr. Charles Cornell really helped to spearhead this project for me and helped me so much along with all the team at HSS to get me to make this article happen. How it came to be was I passed my book manuscript which is not out yet to Dr. Cornell to have him look at it on how to end low back pain and he was so taken by it. I wish I could have him on the show today. He was so taken by it that he walked into the office the next day and said, okay, that's really good. I'm doing a special rehab section in the orthopedic journal next year which just came out in October. Can you write up something for this? I think this is really important and he actually took it on and was doing my exercises and was noticing just a terrific difference. So I am happy that that article is published for all you guys and when you scroll down you'll be able to click on the link, view the article, download it for yourself and there's very important illustrations that are beginner, intermediate and advanced where you can learn how to engage your trans or subdominous, engage your anatomical girdle so that you can have the proper muscle firing whether you've never had low back pain before or you've had it multiple times that is the key and you'll see it in the article. The key is to make sure you retrain the trans or subdominous and the multifidus muscles in order to stabilize your spine because I think you'll recall even after one episode of low back pain the multifidus firing did not come back to normal until it was actually specifically retrained and I cite those authors in my article. So something else I wanted to talk about today and it goes back to I believe my first Think Tech episode with Jessica. I sprained slash broke my ankle on Sunday, a week ago on Sunday and I borrowed some crutches from a friend because my best friend has crutches so I didn't need to buy them so I was fortunate and since the boots are $250 I called my mom and I had her send it out to me from Connecticut so I would have the boot and I don't think I mentioned that in my first Think Tech talk. I know that we talked about it's very important to get an X-ray because you do wanna know whether you broke and sprained it, broke it if the break like mine was just a small crack. Sometimes when you sprain your ankle the ligament pulls the tip of the bone off of your fibula at the bottom. Now I didn't think I sprained my ankle when it happened even though I heard a crack because I'd sprained this ankle so badly before 15 years ago that I blew out all my ligaments so I figured they must be scar tissue I'll be able to walk it off and I knew this was different because an ankle sprain if anyone's had it is excruciatingly painful. It's the pain that you feel with an ankle sprain is you're looking at your ankle and it's a 20 out of 10. You don't understand why it hurts so bad. With this one it hurt, it was hard for me to put weight on it and I had to stop playing and people had to help me get off but I could still stand there, I didn't cry. I wasn't sweating in pain and so I kind of knew this was different but the key for me was getting the crutches and I think that's anyone with an ankle sprain don't take it lightly, get some crutches and do limited weight bearing. Oftentimes with the kind of break that I had you can do weight bearing. It doesn't have to be non weight bearing because mine doesn't require a surgical fix. But the boot is key because I'm a physical therapist and this happened on Sunday and I worked 10 hours on Monday so I took the crutches, I didn't have the boot yet and I sat on a stool and I scooted around. I hopped around on one foot but I didn't want to injure my arms or my hands because that's how I help people. So the boot came out on Thursday, I put the boot in and I have to say as I knew what happened my pain on Friday walking around without crutches at work with the boot was zero and with the crutches hobbling around without the stabilization that a boot provides I don't know somewhere between a four to a six on and off during the day whether I put weight on it or not. So I think that's another important thing to tell people when you do have an ankle sprain if it's not just something that doesn't swell and something that doesn't bruise mind swelled mind bruise I tore something I went and had to check it out. It's very important to get yourself stabilized because it is critical to heal it fast and heal it in the right position and every time we strain it or you point your toes when you sleep when I sleep I have to tuck the sheets underneath so that my foot is pulled up in a somewhat of a neutral position and when I roll on my side and my foot rolls a little bit down that's when the pain wakes me up and it bothers me. So I do wear a light lace up at night it's important not to wear a very tight wrap at night because your nerves with the swelling can sometimes get inflamed. I know that from learning that through my time as a physical therapist but unfortunately I also learned that from experience when I had sprained the same ankle 15 years ago I typed it so tightly because when I lifted my foot I felt like it just suctioned off my leg and I typed it so tight so that I could just function because the pain was so severe and my nerves got really irritated and I had a little bit of a separate problem there. So I hope you learned a little bit with that. So we still have some time left and I wanted to talk a little bit more about what Rachel and I talked about last two weeks ago with sciatica. So sciatica has become a blanket term for pain that's running down your leg and I wanted to let everyone know that if you are suffering from sciatica or pain in your butt that's trickling down in your hamstring or you feel some calf numbness or some foot numbness try to remember that most of that is likely coming from your back even if you don't have back pain or back soreness or a back problem. So I don't want you to get that far down the road and think that oh, maybe it's just my piriformis muscle pinching on my sciatic nerve which does happen but it tends to happen in more in people that are long distance runners, sprinters, walkers if you have a weak foot. So I don't want people to just think I need to stretch my glute, strengthen my glute because sometimes strengthening your glute can be irritating to the sciatic nerve. I wanna make sure people know go in to see your doctor, go in to see a physical therapist, have someone look at your back, begin the course stabilization even if you don't have back pain because everyone would benefit from learning to engage their trans or subdominous. Everyone will benefit from learning to engage their anatomical girdle, get their multifidus in the back functioning normal so that if you don't have low back pain you won't have low back pain. Low back pain has become something that is 80% of us or more will experience it at some point in our life and I know two years ago, Good Morning America referenced a series of articles by the Lancet that we're talking about the low back pain epidemic and I've written into them a few times actually to try to get them to talk about the trans or subdominous, the multifidus, the anatomical girdle but I didn't get lucky with the response but now that I have the article out I've been trying to get to them as well because they're a huge platform with a huge number of viewers that 80% are suffering from low back pain and what they need to learn is to pull their belly button in the correct way a neutral spine during the activities of daily living engage that with their multifidus retrain their multifidus if they've had back pain in the past. Hmm, excuse me. So it is an important thing to talk about the back pain epidemic and I'm glad that we were here today and I want you to help me to stop the low back pain epidemic. So what are other ways that you would need to use your trans or subdominous? Oftentimes a lot of women who have had babies in the past have talked about doing crunches and how do I flatten the poo? How do I flatten the lower belly where it gets stretched out when the baby's in there? And I used to tell people I don't know if this will give you a flatter stomach or not, but it actually will. I went to a seminar, I think four years after I'd first learned that it does give you a flatter stomach by one of my patients and it does. Doing the crunch is not the thing to get the flatter stomach after a baby. Pulling your trans or subdominous and engaging the deepest core muscle is. So I wanna thank you all for joining us today. I hope you enjoyed our show. If you wanna view or download the article, scroll down and click on the link in the description below and don't forget to hit the like and subscribe button to see more movement matters. I wanna thank Tech Hawaii, all of our sponsors and donors and Eric and Rob for getting this show together today. Aloha.