 Welcome back to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. If you have back pain, whether it's been for two days or 35 years and wanna learn the proven strategy to be rid of it for good, this show is for you. I have been a physical therapist since 1997 and have been rescuing people from low back pain for over 20 years, ever since I learned about the function of this one critical muscle. Let me introduce you to your transverse abdominis or TA as I call it. Let's go to image number one. Your TA is your deepest abdominal muscle and when you pull your belly button in towards your stomach and neutral spine, those fibers run horizontally. You can see it on the side around the waist and they move in together towards your belly button and they stabilize your spine. They narrow your waistline. When you pull your belly button in or suck it in like I like to say, you will engage the transverse abdominis. Those fibers will run towards the middle of your body, shrink your waistline, stabilize your low back, but more when you suck your stomach in to activate your transverse abdominis, your deepest back muscles, the multifidus will fire and give you an anatomical girdle. Yes, we all have one. It's inside. It's an internal anatomical girdle. And so when you pull your belly button into your spine, you activate your deepest low back muscles and you stabilize the spine down here when you move, when you're standing still and when you bend. So let's go to image number two. Well, I'll show you the multifidus muscles. These muscles, I got this image from commons.wikipedia.org. It's a great image of the multifidus muscles and that lower black line is pointing to them and they kind of are like Christmas trees. They run from the outside up and inward like the peak of a Christmas tree. And when they contract, they stabilize each vertebrae on top of the other one. So the easiest way to activate your anatomical girdle is to suck it in, pull your belly button in toward your spine that activates these muscles they co-contract together to give you the anatomical girdle. And so what I like to tell people to do when I first I'm teaching them this is to pull your belly button in before you move. If you pull your belly button in before you move to go get out from a chair, you're stabilizing your low back. If you pull your belly button in before you reach for your corridor, you're activating your anatomical girdle and you're stabilizing your low back. If you pull your belly button in before you bend to reach for the faucet or to rinse your face off at night you're stabilizing your low back and every single one of these small seemingly harmless movements that we do throughout our day can harm our low back, especially if we've had an injury or we have poor posture. And I want that point to be huge. Suck it in before you move. The way the transverse abdominis was designed was so that when my brain thought, I have an itch on my face, before my hand would move my transverse abdominis would fire and my arm would move up to touch my face. That's how it's been designed to work. But when you've had back pain or an injury or poor posture, et cetera, that mechanism might not be functioning well and that might be why you have pain when you go to move out of your chair or pain when you get up in the morning or pain when you've been sitting poorly at your desk. Your anatomical girdle is not stabilizing your spine as it should. So that's your transverse abdominis. The image up there is your multiple muscles. They are the deepest, segmental, final, stabilizing muscles. So get used to those two words because those two critical muscles are what you're going to need to get out of back pain or good. So let's not wait anymore. Let's go to video number three and let's learn how to suck it in. All right, so let's learn how to suck it in. Don't be shy. You have to learn how to do this to get rid of your low back pain. You need to retrain your anatomical girdle. So what you need to do, we'll show you in standing first. You're going to stand in the mirror, right? I'll show you close. You're going to suck it in. Transverse abdominis runs this way. When you pull your belly button in, it shrinks your waist and it pulls your belly button in, right? You can also suck your diaphragm in, but that's not what I'm asking you to do. I'm asking you to pull your belly button in from here. You can see the muscle fibers working this way from the side. Pull it in. Pull it in. Not from here. That's your diaphragm, just from here. Belly button in. Belly button in. When you activate that and you learn how to engage that, you engage your anatomical girdle. Activate your bultipitis muscles in your back and you stabilize your low back to help you get rid of low back pain. That is the number one thing that you need to get is to learn how to pull your belly button in. Learn how to activate your transverse abdominis because it's so easy to do. It's harder to learn how to activate the back muscles. They're deep. They're in the back. But what you can do right now to get rid of your back pain is to pull your belly button in towards your spine. Activate your anatomical girdle because know that when you pull your belly button in, those deep back muscles inside your spine and the back will fire to give you the anatomical girdle to stabilize your spine and you will be in less pain and you will get out of pain. I said in the intro, whether it's two days or 35 years, if your back is sore and you've had 35 years of back pain from, say, an old football injury or a fall or a car accident, if you have chronic pain, your anatomical girdle is not functioning well to stabilize your spine and you need to get it functioning better so that your pain can decrease. Chronic pain is your body's way of telling or your brain's way of telling your you that something is wrong and something needs to be done. So if you've had pain for two years, five years, 35 years, you need to suck your stomach and to stabilize your spine. Take that message to heart and learn what you need to do to get out of pain. So if you were in your first session with me and you came in with back pain or whatever your problem is and I'm teaching you how to activate your deep core, what I have people do is to lay down on their back to learn it so you can learn what is called neutral spine. If you're slouching, your spine is not neutral spine. The spine has three curves. I'll show you on the skeleton, actually. It's a little bit twisted, but there's a backwards curve in the neck here. There's a forward curve in the middle back and then there's a reverse curve in the low back. It goes backwards again. This person's had a little trouble, but it goes backwards, forwards, and then backwards again. So when you're slouching, you're taking yourself out of the nice low backwards curve that you have here. So neutral spine is that backwards curve that we were made to have in our low back. And so if you tend to be a sloucher, you may need to sit up a lot. You will have to sit up a lot straighter to get into your neutral spine. So let's go to video number four to learn how to suck it in a neutral. You must learn to suck it in from neutral spine, which is the natural curve in your low back to know that you're engaging the transition dominance correctly. So you want to lay on your back with your knees bent up and what you want to do is you want to suck it in from here. Pull your belly button in. Pull your belly button in. Just like that. You don't want to tuck your buttocks under or press your back flat. You don't want to pull your diaphragm in. And what you can do is you can place your hand on your diaphragm just below your rib cage and you can place your hand just below your belly button here at your belly button. And you want to pull your stomach in without pressing the diaphragm. So you belly button in. Belly button in. And you also want to pull your belly button in here. You can see it narrowing my waistline. Belly button in. That's neutral spine. Belly button in. To progress that, you can pull your belly button in. Lift your right foot one inch. Keep your belly button in. Lift your left. I'm a little weak there. I've had a back injury. Belly button in. Lift. Belly button in. Lift. That was better. Okay. So it's great. So you want to practice sucking your stomach in to activate your anatomical girdle, your transitional dominance, and then progress to a one inch march to help you stabilize your low back and end pain. There you have it. That's how you suck it in in your neutral spine. And there's two points I want to discuss about that video. And one of them is the back flattening. When I decided to write a book that I'm getting ready to publish of five years ago, it was because many people that I saw in New York City and then in Connecticut, when I taught them how to suck it in in neutral like you just saw, they said, you know what? Wait, I was taught to pin my back flat to activate this muscle. I was taught, why are you telling me not to do that? I don't understand why. Like I was told before. And so I didn't know what to say except for, you know, when I was in physical therapy school, they used to talk about posterior pelvic tilts and flattening your back to the floor. And how I took that to mean is for emotion. So if your spine is immobile, you can flatten your back to the floor and then arch your back to get mobility into your lumbar spine. That's a good way to just get some motion and nutrition to the disc. However, if you want to engage your anatomical girdle, if you want to suck it in, if you want to activate those deep back multifidus muscles, it's not going to work if you flatten your back because you will be using your rectus abdominis, the more superficial spinal flexor. But because you're using that, you won't be able to turn on your deepest segmental spinal stabilizers to multifidus. It needs to happen in neutral spine. So that's point number one. Number two, as I talk about me having a back injury, I have had a couple back injuries, but I herniated two discs helping a patient about eight years ago or so. And so I am constantly working on my anatomical girdle, but it enabled me to prevent having back surgery, having a fusion. And I suck my stomach in and I constantly retrain my brain how to operate. I play beach volleyball, I run in the sand, I do many activities, I surf and my back is fine. Every now and then, I get a little bit of symptoms when I'm at work and I have to twist. And then I work on my anatomical girdle. Again, it takes minutes and I'm back to being brain free. So I want to encourage you to get down on the floor, get on the table, get on your bed with a firm bed if you can so that you make sure you're in neutral and your back is not flat and learn how to suck it in a neutral because whether you've had it for two days or you've had back pain for 35 years, you need to learn that strategy. I want people to free themselves from back pain. I want the 80% statistic to go down and I want you to get back to enjoying your life. So let's look at video number five where we see some other benefits of sucking it in to engage your TA. So when you suck it in to engage your transverse abdominis it doesn't just create a co-contraction with your deepest back muscles. It also stabilizes your spine and your whole entire torso. So you can see how if I'm slouching the letters above my head O-N you can see more of them. And when I stand up straight you can see less of them but also if I was standing relaxed and I suck my stomach in it also stabilizes my spine. So if you feel like you've gotten shorter or you're slouching into this bad posture here sit up straight suck your stomach in and you long get your spine a lot of the reason for compression and nerve pain for spinal degeneration is because of the proximity of the bones and the disc gets closer and closer and more squished and the nerves have less space. So when you suck your stomach in it helps to support your spine grow your spine and you notice it by seeing less of the letters above my head. That's a great video for many reasons. Never one you can kind of see my shirt moving as I pull my belly button in as my spine elongates when I engage my anatomical vertebral. So that's kind of great but also talking about degeneration and how when you slouch it alters where your discs move and the relationship that your discs have to your spinal nerves. So if you are sitting up in neutral your discs are in neutral that's kind of how our bodies were designed. But when you slouch the vertebrae move closer together in the front and the discs are pushed and squished like a normally if they're let's say here they get squished like this and they go towards the back. When they go towards the back they crowd the canals on either side of your vertebrae where the spinal nerves come out and go down and supply your muscles and everything. And that's why sometimes people will have leg pain when they're sitting in the car leg pain when they're sitting in their desk if they're slouching because they're moving their discs back and crowding that space where the nerves are. And if you have a herniation and say part of your disc has now breached here and it's bulging out it can contact that spinal nerve. So that's another reason why it's important to mind your posture as well as suck your stomach in. Let's go to video number six so we're going to learn an exercise to activate your deepest back muscles. In order to activate your deepest back muscles as well and exercise them you can do these couple exercises. So sitting you want to suck your stomach in you don't want to be slouching you want to suck your stomach in here bring it in engage your anatomical vertebral and then you're going to reach forward and reach backward you can keep your arms apart like that keep your stomach pulled in it's going to activate these muscles here if you reach around you'll feel them poke up as you reach out you can clasp your hands together and do it this way keep your stomach sucked in while you're breathing because I'm talking and then you progress to standing so you stand up you don't stand this with your pelvis entering the room before you you stand this way and neutral so you have that nice low back curve here you suck your stomach in and then you reach forward backward reach forward backward you can use a weight or a ball reach forward backward again make sure you're not leaning this way neutral spine suck your stomach in forward backward or forward backward I keep talking about the influence that posture has on your spine so if you are watching this video right now and you are hunching please put your shoulders back and sit up straight and suck it in so that's a great way to activate your multivitus muscles you just sit and you raise your arm out I can do it right now suck my stomach in stick my arm out suck my stomach in stick my arm out I can raise them forward here you can hold a weighted ball it's a great way just please don't be slouching when you do it because then you're pushing your disc posteriorly and you're making yourself more more vulnerable to have low back pain and if you are really suffering severe back pain now that I advise you to stand up it'll encourage your body to be more towards neutral when you're standing because your legs will be straight but please try these exercises so let's go to video number seven and talk a little bit more about this posture influence on back pain so a rounded posture strains the low back and there's a lot of different things that you can do to change that but there's a couple very simple ones I'll show you right now so let's say that you've been sitting like this for years or you're used to doing your computer work like that one sit up straight sit up straight you can squeeze your shoulder blades what I tell people to do is put your hands on either side of your shoulders so that your thumb brushes and you squeeze back I call it the stick them up or the W I look like a W squeeze back squeeze back squeeze back if you catch yourself slouching at your desk or you're slumped over squeeze back squeeze back you can also interlace your fingers behind your head and then push your elbows back push your elbows back it's a great stretch you can lean side to side and breathe to stretch lean side to side and breathe and if you have an exercise band you can grab it here palms up and rotate out the important thing is don't just rotate out from your shoulders make sure you squeeze your shoulder blades squeeze your shoulder blades that will help and also if you are older and you're slouched and you have trouble with balance you have back pain when you walk do this before you get up to activate your postural muscles so that your muscles are ready to perform for you to hold you upright while you walk and don't forget to suck it in that last scenario came up yesterday at work where I held an older person in his late 80s early 90s come in and he was having a lot of trouble getting up from his chair and actually walking and he was slouching over and his back pain was just increasing he wasn't feeling good for a couple weeks so he was being more sedentary and sitting slouched more as you would if you don't feel well so I was telling him an Olympic athlete or an athlete at all has to warm up and prepare their body and why they do a warm up is because they're activating muscles so that when the gun goes off and they're a sprinter their muscles are ready to perform at the best level or as soon as the whistle blows or as soon as you start the game the first serve happens in a volleyball game your muscles are activated and ready to perform so that last little bit in that video if you are older and you are having trouble walking down the hall after sitting for a long time activate your muscles sit up straight pull your belly button and activate those final extensors that are going to help to hold your frame up and not let you slouch over your walker while you go down the hall we did it yesterday and my patient said to me wow you know my legs feel so much stronger I feel like I'm so much better able to walk and that was his complaint when he came in so if you are slouching a lot whether you're 20 years old or you're 90 years old this next video is a great stretch in video number eight okay so let's say you've been slouching for 10 or 15 years and you've gotten that more rounded posture here or you're just older person and you've collapsed as you've aged there's a way to stretch yourself out because everything here gets tight so you want to open up the space so it's easy way to do it at home and it's safe if you're an older person walk your hands up the wall stretch out all the tissues here get your hands up and breathe if you're younger and you're able you can bend your knees and stretch or reach your hands up and breathe and that's going to help you to open up all the structures here so you won't be so rounded enjoy that is such a simple stretch I always try to come up with easy things that you can do at home and that's why some of these exercises that I'm showing you are so simplistic there's so many more advanced exercises I can show you and I actually published an article two years ago on this a doctor in New York City Dr. Charles Cornell encouraged me to do it after reading my book draft and it's called the critical role of development of the transverses of dominus and the prevention and treatment of low back pain so in this article it's free we put the link up for you and it gives you everything you need to know plus the research that's been proving this to be true since 1996 in addition to some illustrations and descriptions of exercises to find a neutral spine exercises to progress your transverses of dominus contraction there's more advanced exercises to work on your anatomical girdle to get your transverses of dominus to work to educate your glutes as well as your multifidus muscles those final stabilizers and there's even more advanced exercises that you can do to progress your anatomical girdle and your core strengthen your core from the inside out so that your spine will be happy and healthy so if you want more references that that link is in there so one of the one of the things that I got brought up by my mom the other day was she was driving in the car she was coming back from busing in a friend and it was about an hour drive and her back was just aching her in the car and she said she did what I always tell her to do which is she sat this car seat up a little bit more forward threw it her butt back and she said I was a little uncomfortable because my head was touching the headrest and she's so used to be so far away from it but she said it made her back pain go away she also said she sucked it in that I was so proud of my mom so let's go to video number nine inspired by my mom to help you find a pain-free driving position one extremely common complaint that I get is people that have back pain or pain running down their leg while they're driving and there's a very simple fix for that you need to adjust your car seat so that your spine it remains close to neutral so one thing you need to do is bring the car seat up it's going to feel like it's too far forward but you need to maintain the proper position a lot of people are driving with the seat back and they're reaching rounded like this you want to get the seat up and you want to get in a place where you can sit in the car seat just like this now that's probably not enough so you want to get something squishy put it in your low back then that's a big big it just has to be there and it keeps you in that backward spinal curve and you'll know because your head will be on the head headrest you will no longer be like this where your head's super far from the headrest bring that up so that your arms are resting and enjoy driving in your car without pain don't be alarmed at how close you feel to the steering wheel which is actually the proper position for us to be driving in our car so there you have it there is your proven solution to eliminating your low back pain check out that article it's got about 26 to 36 references of these brilliant physical therapists and doctors etc that have dedicated their life's work to proving this technique to be true since 1996 and I want to thank everyone for joining us here you're helping me start the end low back pain revolution where we can decrease that statistic from 80 percent down that all of us will have low back pain thank you thank tecawaii and your donors and sponsors for allowing us to be here with you today and as always life is better when you listen to your physical therapist aloha everyone