 Welcome to Think Tech Hawaii and my second episode of Movement Matters. I'm Christine Linders and I'm a licensed physical therapist. I've been practicing physical therapy for over 23 years in California, New York City, 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 I have my manual therapy certification. This is my show, Movement Matters, 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 that you love. Today's topic is low back pain. In the first part of the show, I will discuss why low back pain occurs and teach you about the specific group of muscles that needs to be activated in order to end the pain quickly and prevent re-injury. And in the second half, we'll be hearing all about Michael's experiences with low back pain and learn the simple way to reactivate these critical muscles so you too can heal your low back pain quickly and be back to enjoying your life. Welcome Michael, thank you for coming. Thank you for having me. I'm so happy to have you on the show. So we're talking about low back pain and I don't know if you know Mike but 80% of us at some point in our life will have low back pain. Now there's some statistics I'll post a link for from an article that I just had published but that's about 540 million people in the world that will have low back pain at some point in their life. Did you know that? No. I'm not sure if the audience knows that either but it's a big problem right now in our society. We do sit more and we're active but I think the problem is that when we sit, it's very difficult for us to sit without rounding our spine and it's the rounding of our spine that puts a little bit extra stress on their back. So I mean do you sit or are you pretty active? I'm pretty active. Yeah, what do you like to do? I surf, I play volleyball, I hike, I paddle board regularly and I don't know, play a little golf now and then, not very well. That's great. It's great to stay active and it's great to be active but what do you do when you have low back pain? So I think for the audience when you have an episode of low back pain it could be something that you don't realize you know you're doing and that's what I wanted to show. So in image number two, some of the things I tell people are that poor posture that you don't realize you could be doing while you're sitting reading a magazine. In the upper photo, you see this person sitting reading the magazine and their back is only slightly rounded but that slight rounding creates stress and increasing percentages of stress on your low back. It's the bottom underneath your shoulders, your trunk, your organs. In the picture below, you could see this person sitting with good posture supported reading their magazine so those are the things I think people don't realize add up that create extra stress on their back and then they go and they bend over to pick something up and hurt their back. In image number three, you see posture while you're washing your face, brushing your teeth, shaving, anything like that and in the picture on the left where the spine is rounded that's how people typically do it because you would never know that there's anything wrong with that but on the picture on the right with the flatter back that's what you need to do to keep your low back safe while you're brushing your teeth, while you're washing your face. That's something that we do every day, twice a day for all of our life so that's a lot of repetitive stress that we can have on our low backs. So why do people have recurrent low back pain? So I'm going to explain to you guys right now these two critical muscles that are responsible for keeping your low back free from pain. In image number one, you will see the picture on the left which is our deepest abdominal muscle. It comes in from the sides, kind of like a course that you're wrapping around yourself that is the transversus abdominis. The image on our right is the multifidus muscles. Now these muscles are the deepest segmental spinal stabilizers. They run right up just to either side of our vertebrae, the spiny oaky bones in the back. If you bend forward, you can feel them. They're on either side and they are the primary muscle for keeping each one of your vertebrae stable while you move throughout your day. Now there's been research proven, which you'll see in the link that I'll provide, that even after one episode of low back pain you don't regain the function of these multifidus muscles in your back without specific training. And that's what I want to show you today is how to retrain these muscles. So let's meet Mike. Picture number four. We talked a little bit about Mike. He's very active. He serves, he paddles. He goes hiking with his grandkids. I heard this weekend that you had to go serious four by fouring on your trip. What is serious four by fouring? Well, it's a road on the west shore that goes up over a mountain and there's a campsite on the other side. Oh, that's awesome. How much time did it take you and was it bumpy road or was it climbing up and down? It was a good four wheel drive. It's the first time I've had to use four wheel drive in Hawaii and I had to use four wheel drive. So could I get there in my Hyundai hatchback? If a helicopter dropped you off. So four by fouring is a great thing to do but I have a lot of patients that also tell me that it's jostling on their back if they hit a bump in the road just because of the sudden compression that has on your back or if you're riding a jet ski or you're in a boat on the bumpy wake of somebody else's boat that that can be tough on your back if you're having back problems. So I was wondering how you did, but you were okay. Yeah, that part was okay. Excellent. So let's talk a little bit about your history of low back pain. You know, it's hard to say. At one point I thought I took a pretty good fall when I was about 28 years old doing some construction work and I just flipped over and landed right on my butt and it hurt for a while. It was pretty painful for a while. Did you break anything? No. Oh, good. And so when did you notice you started having back pain? Well, that's probably the start of when I noticed having back pain. Now, earlier, when I got married in 73 which was about five years earlier I looked at the pictures from the wedding and I'm leaning in every single picture. I see. Yeah. So, you know, chances are there's something that happened prior to that fall. Yes, that's right. So Mike and I met on Labor Day and we talked a little bit about his back and he was telling me what he was just telling you about having noticed being crooked in some photos and one of the things that someone could have that notices that is a thing called scoliosis and there's two different kinds of scoliosis that you can have. One of them being the kind that is because you are doing this all day long for 50 years, you're a dressmaker, you're a watchmaker, you're turning to do something, you're a nanny and you're always one way and your spine muscles will over develop on one side but the other kind is one that you can get either as a small child or through your adolescent growth spurt and that's the kind that you think about is someone like Mike who's noticed in his younger years that he was actually standing a little bit crooked as something that happened in his preteen to teen years where the spine takes on a curve of its own and the reason why they call it idiopathic is because they don't really know what specifically causes it. Idiopathic meaning no known cause. So what are your symptoms like? You're very active. You surf, you play beach volleyball. I think you mentioned you played this morning. Fantastic. Yeah, you know, I mean, I can last so long and then I have to relax and if I don't relax and I have a bed that conforms a little bit it has a zero gravity position which helps a lot for sleeping at night until then I didn't ever get a good night's sleep. Generally speaking, when I'm sitting at anywhere in a meeting or here even, I'm very fidgety. I have to move all the time because my back is uncomfortable if I leave it in the same place. Okay, yeah, so that's an important thing to know is that you need to keep moving. If you do have an episode of back pain one of the bad things that you can do is just to be still. It's important when you first hurt your back to take some rest, maybe lay down on some heat, lay down on some ice, work on getting rid of the muscle spasm which is the body's protective mechanism for letting you know something's wrong and not allowing further injury. But after that it's very advisable to take short walks, keep moving but remember you've got to pay attention to how you move now. You don't want to do something silly that you're not aware of like bending over your sink with a rounded back or sitting reading a magazine slouching into your sofa. You want to maintain what is called the neutral curve of the spine which is the path that our normal spine takes back and forth. We met on Labor Day and we looked at your body a little bit and I think if we look at the video number five this is what I saw when we looked at Mike walking and this is where Mike and his wife were mentioning how oh yeah I think he tends to walk a little crooked especially if you've done a lot that day. It's so interesting looking at this because I have no idea I'm bent off to the side until I look at this video. And for the audience what's so important there is every time he steps on his left leg you see his shoulders drift off to the right. Now your vertebrae are stacked on top of each other so when that happens there's a thing called shear which is like a sliding back and forth that can happen. Now if Mike was just walking down the hall a few times like that that's not a big deal but if Mike is walking down the hall all day long down the beach out to surf running around playing volleyball like that that's where you get that wear and tear that leads you to having pain injury, disc herniations all kinds of problems like that. Now I think what Mike mentioned to me is you had an x-ray at some point I forgot when that was. Actually a couple times my daughter worked for a chiropractor in San Diego and he took an x-ray on my back I bought a series of adjustments it was very helpful. And my daughter was in talking with a doctor and she sees this x-ray up on the monitor and she goes oh my gosh who is that and the doctor said that's your dad. Oh So is that the you had another one since then or is that the most recent? No I've had another one since then I had a kidney stone and they had to take some pictures of my lower back area and that showed that everything was tweaked I had a follow up appointment and when I walked in the doctor was astonished that I was still moving around. That's unbelievable and I think for the audience the take home point there is that you may have an episode of back pain and you go to your doctor and you get an x-ray or an MRI and it looks horrific like Mike's daughter saw and said oh my gosh who is that how are they walking the doctor said I don't know how you're moving around like that the x-ray and the MRI what you find don't necessarily predict how bad you'll be because I've seen some patients who had terrible x-rays and they're walking around with a stiff back they don't even have pain but you're worried that they shouldn't even move because it looks so unstable in the in the image so when you get your x-ray and your MRI it's just telling you about what mechanical faults you have going onto your spine narrowing of the canals is it uneven are some of the vertebrae sliding side to side is there discs bulging and pushing on the nerves and that's just information that we as health professionals use to try to match up with some of the symptoms that you have so we know the severity but someone like Mike who is surfing doing exercises he does a lot of heavy construction as a hobby right with your own plates not necessarily as a hobby but as a request from people I'm I can't say no to yes people like me I can't wait to have you help work on my future home someday but Mike stays with a strong core Mike has exercises that he does that keep his really messed up x-ray healthy despite how bad it looks like and that's so important so is there there's some exercises I think you mentioned you learned from massage therapist or Rolfer who we both knew from San Diego I went to a Rolfer in San Diego knowing that I had these issues for a while and he he showed me several exercises and probably if I had kept up with the things he taught me and learned more of what he had to offer I might not be as bad as I am now but you know I still do the exercises that he showed me on a regular basis and you showed me some that are just really good too they fit really well with what I'm already doing and that's great and I think the combination is has some kind of effect I'm not sure what it is yet but well that's good so this is movement matters we're going to be taking a short break I'm here with Michael Brennan and we'll be right back to learn a little bit more about how I've provided Michael with some exercises and exercises he's done in the past that can help you as well get rid of your low back pain fast we'll be right back Hi I'm Rusty Kamori host of Beyond the Lines I was the head coach for the Punahou Boys varsity tennis team for 22 years and we're fortunate to win 22 consecutive state championship this show is based on my book which is also titled Beyond the Lines and it's about leadership creating a superior culture of excellence achieving and sustaining success and finding greatness if you're a student parent, sports or business person and want to improve your life and the lives of people around you tune in and join me on Mondays at 11 a.m. as we go Beyond the Lines on Think Tech Hawaii Aloha Aloha my name is Becky Sampson and I'm the host of It's About Time on the Think Tech Hawaii a digital non-profit organization that's raising public awareness join us on Wednesday at 2 p.m. where we talk about real issues some of the topics will include entrepreneurship health life skills and growing your business so once again this is Becky Sampson on It's About Time on Wednesday at 2 p.m. on Think Tech Hawaii Mahalo Okay we're back we're live this is Movement Matters I'm talking with Mike Brennan and we're going to be learning about these secret muscles that you can activate to help get rid of your low back pain fast now so Mike we were just discussing some of the exercises that a massage therapist had given you and then also I'd given you a few I believe it's one week ago have you tried some of those exercises yeah I try to do them regularly we were camping this weekend so I didn't get to do all of them okay but yeah I've been pretty diligent regularly now do you notice I know it's been quick but do you notice any possible changes or feel anything different in doing the exercises more regularly I don't know how to say this it's hard to yes but it's hard to admit I mean I've gone through so many things with my back and some of them have been helpful but this I mean I'm here and I don't feel like I need to fidget okay good to me that says something positive excellent after I played volleyball this morning I'm usually pretty sore and I'm not that kind of sore right now okay so I'll take that as a positive trend but I think it's important for us to follow up with Mike in a few weeks see if that trend has carried on with being regular with the exercises and trying a few new things right that's great I hope that continues for you another thing is I actively work my core as much as I can and I believe that that's probably the only thing that keeps me going can we say that again I actively work my core I do I actively work my core with different sit ups and stretches and all kinds of stuff to make sure that I've got enough muscle there to keep me playing that is the key right there so for all of you to activate the core those muscles I mentioned in the beginning the transverse abdominis and the multifidus I didn't mention this part yet when they contract together you get an anatomical corset or girdle that wraps around your girdle that helps to stabilize your low back and I'm going to show you in a little bit how to activate those muscles in your own body in five seconds we're going to do it here while we're sitting that you can get control of your low back pain right away but first let's look at Mike so we looked at Mike walking let's look at image number six Mike standing so I apologize for my sloppy finger on my phone but this is what I saw when I watched Mike stand there after we watched him walk I drew the bottom line as just a parallel to the floor and then I angled up where his pelvis is so what that's telling me with the the weavy line that I drew above is that his spine is bending a little bit to the left at the bottom so there's a little bit more compression that's happening on the left side of his spine and a little bit more opening happening on the right side of the spine meaning that the right side back muscles are going to have to work harder because they're getting a stretch reflex telling them to turn on as he walks you saw before his shoulders shifting to the right creating that that shear every step he took so that's one of the some of the exercises I did give Mike were to help level off his pelvis and make his back muscles a little more symmetrical what we also found in the exam image number seven is that on one side Mike's hip doesn't have good rotation and it happens to be on that left side that left side where his spine is getting a little bit more compression now you can have all kinds of symptoms from having a little bit extra compression on the spine it could be that you have pain down your leg or some numbness and tingling but also you can get a muscle spasm in the glute from nerve irritation that might not hurt but might just tighten up so this was one of the exercises that I gave Mike it's one of my favorites that I give to my patients that have had disc low back pain I have them lay on a flat surface you can do it on your bed if you can't get to the floor I don't want you to have more pain getting to the floor but I call this the knee to opposite chest stretch so your knee is lining up with your opposite chest or shoulder and you're pulling it that way and the lower hand is used just to gently pull your shin that way as well you get a deep buttock stretch a lot of people want to pull their knee way over outside of the shoulder but then their back comes off and you're twisting your back and I want your back to be safe while you're helping to stretch out some of the other muscles in your body so now Mike I think you mentioned to me before I checked your hips that you had one when you crossed your leg that you look I can do this but the other side you can't is that something you had noticed before we were looking at it or a long time I'm much more flexible with my right leg hip combo than I am with my left leg hip combo okay yeah and that's something that when you have a little bit of curve in your spine or you do have a scoliosis it changes sometimes the rotation of your pelvis as well and your hip bone the femur sits inside the pelvis so when the pelvis shifts the femur shifts and that can change the angulation with which your deep hip rotators have to hold on to that socket but again we're trying to achieve symmetry because the closer we are to symmetrical the less pain that we're going to have we don't have to be perfect none of us are perfect we want to get you a little bit closer so the muscles on both sides of your body can function optimally so let's talk about neutral spine in image number eight neutral spine is something that we all need to be able to perform in order to engage the transverse abdominis and the multifidus the anatomical girdle so in this image you can see a small space behind that person's back so it doesn't have to be that large neutral spine is the position that when you lay on the floor with your knees bent up and your feet flat on the floor it's the position that your spine is resting uncomfortably you're not pinning your back flat you're not arching your back it's just your most comfortable position the low back has a lordosis which is a backward curve and so you want to have a slight backward curve which is the normal curve when you're learning to engage your anatomical girdle and what I will tell people in image number nine is a cue called suck it in so what you want to imagine pardon me what you want to imagine is that you are pulling your belly button in towards your spine towards your back so you don't want to flatten your back to the floor you want to pull your belly button in just towards your spine and what that's doing is that's going to engage your deep back rotators so that they can form the anatomical girdle so if we go back to the camera Mike do you know how to engage your transverse abdominis in neutral I can't even say it I know so I call it TA they call it t-r-a-t-r-v-t-v-a it's nicknamed a lot of things I nickname it TA because transversus abdominis is a big mouthful so if you're going to activate your TA you're going to take your belly button and pull it in towards your spine your spine you just did it right now and that's great and you do do that anyway because you're working your core so when you pull that in what activates that what we don't know about is those deepest back muscles from that first slide they fire together and give you this anatomical girdle and they run from one vertebrae to the next to the next to the next and they go up a couple levels so that gives you the stability to your low back so with you doing all that excellent core work you're activating your anatomical girdle which is enabling you despite your x-rays to be able to play sports golf which is a lot of rotation on the spine surfing paddle boarding hiking acting like a five-year-old with your grandkids right so let's go to image number 10 image number 10 is specifically for the anatomical girdle so what you're going to do with that is you want to be on a supported surface so if you're laying on a floor or a bed you're going to need a sizable pillow under your stomach so that your spine will be a neutral and if you don't have that pillow your spine could sway into more of a lordosis and we don't want that so I often have people lay over their countertop, their kitchen table their bed with your leg hanging off so that you can have your spine stable and you're going to suck your stomach in pull your belly button into your spine and lift one leg up if you're going in the top photo where you're laying on the table you want to lift your leg up not so it goes beyond your back but just enough so you feel that buttock muscle tighten and then you put it down you pull your belly button in, you lift the other leg up just so you feel your glute muscle tighten and then put it down the reason why I don't want you to have your lift your leg higher is then you're extending your spine and you're putting too much stress on the low back if you go to the picture in the bottom which is laying on your bed, laying on the floor laying on a massage table you want to have a pillow that enables you to keep your spine in neutral and again you can see from the image the leg is just lifting an inch or two up off the table you don't want to go higher and you don't want to have pain that's the key but when you do that you're activating your multifidus muscles and on the bottom picture as well if you try to lift your leg and you experience any discomfort whatsoever in your low back when you do it you need to make sure that you suck your stomach in first before you lift it and if you still have discomfort all they have people do is pull your belly button in and lift your hands off of the table so you're like in a little W position you don't lift your head, you don't lift your chest you just lift your hands up and you put them back down doing that also will activate those multifidus muscles in your back. You just need to suck your stomach in first so I don't believe I gave you these exercises Mike but you've been doing an exercise that I was going to show you all along which is when you almost get in that position over the table but you're doing it over a therapy ball right? so how long have you been doing that exercise? quite a while that's part of my ab workout that's great I think the message for everybody listening is you just have to do some core activation and you need to do it consistently make sure you keep your spine in neutral which is that position that you would be over the therapy ball on the table in those images on the floor or your bed with a pillow under your stomach so that you can keep engaging the transverse abdominis or TA multifidus so that you can be wearing your anatomical girdle as you need to be because that's the key and the simple thing like Mike and I just did right now is if you're sitting, you suck your stomach in you just gave yourself the anatomical girdle so if you wanted to bend down to tie your shoes or scratch your foot I would tell you and I tell my patients this the day one when they come with back pain pull your belly button in, suck your stomach in bend down and scratch your leg belly button in, reach and open the fridge door belly button in, get into the car if you're doing something for your spine it's outside of being perfectly straight, pull your belly button in if you are sitting there in a movie and your back hurts suck your stomach in, give yourself your anatomical girdle so that you can have that support to your low back, does that make sense? Yeah it does, it's actually part of martial arts That's right. I did that for about eight years and part of what I did was you think about your one point which is two inches below your belly button and that is what helps you stabilize your core Okay that's fantastic, so thank you so much for coming on the show Mike this is Movement Matters thank you so much, thank Tech Hawaii for hosting our show, aloha everyone