 I'm your host Christine Linders, physical therapist and board certified orthopedic clinical specialist. This show is designed to bring you not only the most effective physical therapy tips but also holistic information to help you achieve total body wellness. Today I'm going to drop the mic on back pain. I, your virtual physical therapist, will be giving you the evidence-based solution you've been looking for to end back pain for good. Let's go straight to video number one. Let me introduce you to your secret weapon to end lower back pain and get a flatter stomach. Your transverse abdominis or TA, as I call it, is your deepest abdominal muscle. It's been around since the beginning of time, just waiting for you to call on it to help support your back. But no one told you it was there. If you have back pain, you need your TA to form the anatomical girdle with your deep back muscles to support your spine. You see, the TA contracts just after your brain has the initial thought for motion. Your brain thinks, I'm going to reach for that glass of milk. Your TA fires, then your arm moves. Try it. Pull your belly button in towards your spine. Go ahead, suck it in. Now that you know it's there, use it before you move and enjoy a pain-free lower back. So there you have it, the secret to ending low back pain. I've been using this technique since 2002 or three, and each time, even now, today that my patients learn it, they always come back saying, that really works, or that made all the difference. I even had one gentleman say about four years ago that he felt victimized, that he'd had back pain for 35 years, and no one told him how to suck it in. No one told him how to engage his anatomical girdle. So when you engage your anatomical girdle, when you suck it in, you activate your trans versus abdominis muscle. It's your deepest abdominal muscle, and it runs sideways across your body like this. So it also gives you a narrower waistline or a flatter stomach, as I usually say, because it works. It holds your contents in. But also more importantly, when you suck it in, you activate your deepest low back muscles, and those back muscles stabilize vertebrae for vertebrae stigmentally in your spine. And that's what keeps those vertebrae safe and prevents them from shifting or being vulnerable while you go about your day. So here's the step by step on how to suck it in to activate your anatomical girdle in video number two. To learn to engage your trans versus abdominis correctly and engage your anatomical girdle, I'm going to show you how to do it in standing first. So you're going to stand up, and I'll visualize that for you. You're going to put one hand on your diaphragm here, one hand on your belly button below, and you're going to pull your belly button in like that. So you just suck it in. Suck it in. You don't want to pull it in from here, too, because then you stop your diaphragm from breathing. You can hear how it changes the sound of my voice when I do that. You just want to pull it in from here. Your trans versus abdominis. And if you see it from the front, the fibers run this way. So when you pull your belly button in, you see it shrink my waist. Belly button in, belly button in. So practice that in standing first. That way you can use it, pull your belly button in, bend to pick something up, pull your belly button in, reach for the car door, pull your belly button in, put your short on up over your head. Enjoy. So that's a nice simple way to learn it while you're sitting or standing is using your hands. And you don't want to stop your diaphragm from moving because your diaphragm needs to be free to breathe for you. And also you heard by the sound of my voice that when I pull my diaphragm in, it's also hard for me to talk. But you may feel a little strained on talking, because when you pull your belly button in to activate your trans or abdominis, it does tug on your diaphragm because the trans or abdominis intersects into the side fibers of the diaphragm like that. It's a basket weave attachment into the diaphragm. And that's why the transverse abdominis and the diaphragm also help so much for pastoral support. So if you were to come into the clinic, I would teach you lying down. I would go through my assessment. You'd be on your back with your knees bent and your feet flat on the table. And I would teach you how to find your neutral spine and how to suck it in. So let's look at video three. To find the position of your neutral spine, you want to lay on a firm surface. So if you can't get to the floor, you can use your bed. But I'm going to explain to you why it's better to do it on a firm surface if you can get down to one. So I'm going to show you on the ground here. So I'll move my arm so you can see. So you want to have the point of contact with your tailbone and your rib cage here, but not in your lower back right here. So you don't want to pin your back flat by tucking your buttocks under. And you can see as I roll my pelvis like that. And you don't want to arch your back up all the way like that. You want to find a position that's in the middle where you're resting on your tailbone. And to engage your anatomical girdle, you want to suck it in. So you want to pull it in from your belly button and blow like this. Here, pull it in. You can see it narrow in my waist right here. Suck it in. What you don't want to do is you don't want to pull it in like this and stop your diaphragm from moving either. You want to pull in your belly button so that you can still breathe here and use your diaphragm while you keep this in. So learn to pull your belly button in and then breathe. How you could go wrong is if you pull your belly button in and you tuck your buttocks under like that. Because what that does is it uses the big six-pack muscle, your rectus abdominis. That's not what you want to do. That's more for just range of motion if you need to get your back moving. When you learn to engage your anatomical girdle, you want to be in neutral spine, point of contact with your tailbone and your rib cage, small space between your low back, and then you pull your belly button in and you enjoy. Excellent. So watch that again and again because that will help you to find your neutral spine. And I have a question right away. So will sucking it in make my stomach flatter? Yes, it actually will. And this is what's funny is because in 2003, I had a woman come in who had some incontinence as she was trying to make it to the bathroom and I was teaching her how to activate her pelvic floor muscles and I also was teaching her how to suck it in to activate her transverse abdominis because that is part of your deep core, your pelvic floor, your transverse abdominis, your diaphragm, even your vocal folds and your back muscles. So I was teaching her how to suck it in and she said, oh honey, is this going to give me a flatter stomach? And at the time I said I don't think so sorry but it's definitely going to help you with your incontinence problems working your pelvic floor and your transverse abdominis to try to keep the pressure right in your core as you try to go to the bathroom. So she came back a couple weeks later. I told her to suck it in and hold it for two minutes while she breathes and to work on that. And she showed me her waistline and she said, honey, look, it gave me a flatter stomach. And so I was new to working on the transverse abdominis back then and two years later, I think I went to a women's health section of the American Physical Therapy Association and sat in on a brief breakout session where they were talking about postpartum women and how so many want to do much crunches to get rid of that pooch or that belly that they have post baby and how activating the transverse abdominis, which I already knew because my patient showed me, would give them a flatter stomach whereas exercising the rectus abdominis by doing crunches would give you more of that bulging belly. So yes, sucking it in will give you a flatter stomach. And the reason why, as I explained before, is because the fibers run horizontally. And so when they contract, they support your abdominal contents as well. And after a pregnancy, all of that is stretched out and you need to activate those fibers to support your abdominal contents. So the second part of the question is, can I exercise if I have lower back pain? The answer is yes. And it depends on what type of exercise you want to do. If you have low back pain, doing a lot of bending or hip workouts as I've learned they're called over the pandemic, high intensity training, something else is the T, very high intensity running, jumping down into pushups, jumping back up into burpees, doing all these bending quick bending exercises. That's probably not something for you to do if you have low back pain. But going for a walk is a great thing for you to do. If you have low back pain, as long as it doesn't hurt when you walk, I've suffered from low back pain for a long time. I've had a couple severe back injuries. One of them working with a patient where I was left with numbness down my leg. And so walking is okay for me, but it has to be very short. Riding a bike is great for me. That is the best thing for my back when I'm having tension or episode from work, because I've had to twist to work on a patient's shoulder. Riding a bike for 20 minutes, a stationary bike opens up my back and I'm fine. But that doesn't work for everyone. But what you want to avoid is high impact activities. And of course, while you're doing the activities, you want to suck it in. So I hope that answered your question. Thank you so much. So I want to talk a little bit about what contributes to low back pain outside of bending and twisting and giving yourself a back injury. So the strength in your hips is critical to having a healthy low back. Having proper alignment when you walk is critical to having a low back. And what I mean by that is if you stand on one leg, which I'll show you in a minute, you want to have your pelvis level when you're on one leg and not leaning with your trunk off to one side. And also what I've seen in two people lately is they're walking with one foot turned out. I had two people on Friday and two people, one person yesterday who has that problem and is suffering some low back pain as a result. And why that happens is when you walk with one foot turned out, turned out because you've had a hip replacement or you've had a knee surgery or you've had a bunion surgery and you had to walk that way while you were not waybearing around crutches, that position doesn't set up the chain reaction for your glute muscles to fire. And so when you step on that leg when you're walking or going up or downstairs, that butt muscle doesn't get this message from your brain to fire. And so your hip either drops or your trunk bends to the right and that compresses on the nerves. That is the most common reason that I see for people that complain of sciatica. So let's learn a little bit more about that in video number four. Now let's talk about sciatica. There are many reasons for this pain in the butt for lack of a better word. Sciatica is when you have pain that's running out from an area of your back, bumping into a nerve and causing that pain into your butt that can run down your leg. And my patient who I just explained to you was having some sciatica. He's a golfer. He's a left-handed golfer. He was in for his shoulder. So I said, well, let me just look at you really quickly and see what's going on. So I had him stand up on his right leg and he was fine and I had him do a squat and he was fine. I had him stuffed on his left leg and he was doing this. So I had him try it again and he was doing this and then I watched him walk and he was doing this on his left side. When that happens it compresses the nerves on your left side which can give you that painful back pain, butt pain and down your leg. So in the next video I'm going to show you what I gave him in two minutes that got rid of his problem. So that's a great way to identify if you're one of those people that has that hip drop. So I want to go straight to video number five to show you what I gave him to help us back. So here was the quick and dirty few things that you can do to end your sciatica pain all on your own. So first we did the knee to opposite chest stretch to stretch out the glute that was going into spasm. You want to hug your knee, line it up with your opposite shoulder and pull the other foot so it falls on the opposite side of your leg and stretch. You want to do both sides and breathe for about 20 seconds. Also I taught him how to do the second in and march to engage his anatomical girdle. So I taught him how to find his neutral spine, pull his belly button in without flattening his back and then march keeping his pelvis level. We did 20 repetitions of this and the last thing we did was to strengthen that weak glute that was keeping him hinging over his left side. I put a bander on his ankles, got his legs straight on the table, told him to pull his toes up, buns tight, slide his legs apart. We did 10 times sliding apart, then we did 10 times on his left side and 10 times on his right side and then we retested and what we saw was he was able to stand on his left leg without hinging over his spine. So that's fantastic. So I want to take a little bit of a break and ask you all how you're sitting right now watching this. Whether you're watching it live or you're going to be watching it later on tonight or tomorrow, I want to see how you're sitting. Are you sitting upright in your chair on bowls of your sit bones or are you slouched back more towards the back of your buttocks with your back rounded? I want you to pay attention to that because sitting is so important to the health of our low back and that's because the low back has a backwards curve and when you slouch, you round it and you completely reverse the curve which can lead to all kinds of back pain, neck pain, shoulder pain, hip pain. I can go on as you age and go about your day. So some of those problems that I've seen in people are stenosis or spinal arthritis and usually I tend to see them later on in life in their 50s on and some in their 40s now I'm saying who have desk jobs which is tough because we're still young in our 40s. So you have to pay attention to how you sit. So let's look at video number six to talk a little bit about spinal arthritis and stenosis and what to do if you have it. If you have arthritis in your spine, it's important to get your spine moving gently. Motion is lotion remember. So one great thing to do to start is to lie on your back and just rotate your knees side to side a little bit. You don't have to go all the way, you want to avoid pain. Drop your knees side to side. You also want to hug one knee into your chest and breathe three breath cycles each knee and then you're going to hug your knee to your opposite shoulder and stretch out that glue and breathe three times each knee and then you can hug both knees into your chest and you could rock side to side a few inches or you could pull your knees up a little bit to your left shoulder up a little bit to your right shoulder you can make circles anything to increase the mobility in your low back and then the other one if you can get onto your hands and knees that I like you pull your belly button in and you move your butt only as far back as you can without your back rounding you want to keep your back in that suede position you want to suck your stomach in to stabilize your spine and enjoy feeling better. So that's just a few things there's many that I go through with my patients when they come in with stenosis or spine arthritis because every body's body is different and I have to go through a assessment and find out what's tight what's weak what's short what's long to help them with their individual activities that they do throughout the day whether they're very active or they're more sedentary. So I have another question this is perfect are there sleep positions to help lower back pain? Yes there are if you are a back sleeper and any other kind of sleeper it is optimal to sleep on your back with a pillow underneath your knees and that is not realistic for everyone and I know that. There are stomach sleepers that have back pain and the reason why that stomach sleeping is a problem is because when you lay on your stomach your low back already has a backwards curve and then gravity pulls your belly button down into the mattress all night long while you're in your stomach and sways your back more and that's when people get up and they're like oh my god I can barely walk when I get up in the morning if that is you try to put a big enough pillow under your stomach when you sleep so that you don't sway your back all night. It is better if you try to change your sleep position but I know that that's impossible for certain people so do your best. So also side sleeping is a huge issue many people sleep on their side. My patient about two months ago she came in I talked about her in a previous show she made 300 masks and had severe pain she could barely get up in the morning when she had to use the restroom she was hunched over severe nine out of ten pain in her leg she was suffering I tried to get her to use a walker to help her but I also worked on her sleep position so I told her to put a pillow in her waist and the reason why you put a pillow in your waist is because your pelvis and your shoulders are wider than your waistline and so if you lie on your side and you have stenosis or you have arthritis or you have scoliosis or a disc herniation your waistline is going to get pulled just like your belly button on your stomach did down towards the mattress and you're going to be pinching the nerves on the upside of your spine and then you'll be pushing the discs toward the downside of your spine so let's watch video number seven if you have back pain and you're having trouble sleeping it's really important where you put your pillows if you're a back sleeper you want to put the pillow underneath your knees so that you can help this curve be level on the bed if you're a side sleeper however though it's very important because the shoulders and the hips are wider than your waistline to put a pillow here in your waistline to support this curve otherwise as you sleep this part of your spine gravity will pull it down towards the bed causing a side bending which is usually why people side sleepers wake up in pain and we'll go straight to video number eight to show how to sleep on your side okay side sleepers here's how you prevent that extra compression from happening while you get a good night's sleep you want to put a small pillow just above your pelvis in your waistline to support the waistline and then you have your pillow here it's always a good idea to put a pillow between your knees but it's not necessary you really want to have this curve so that your spine stays straight here and then if you're on your back you can just put a pillow under your knees and that helps to support that natural spinal curve so enjoy having a great night's sleep so I have another question thank you so much for sending these in should I suck it in when I exercise yes you should so when I walk around for exercise I walk down the hill and up the hill next door I will suck it in but I don't suck it in the whole entire time I'll suck it in for say 20 seconds while I'm moving and then it releases and then I'll suck it in again the importance when you're retraining your transverse abdominis falls on re-educating this muscle to work again because when you've injured your back your back whether it's because you had an injury or because your transverse abdominis was stretched out because you just had a few babies or you had a C-section or you hurt your back and your deep core has become faulty or you're a big time sloucher and you've reversed that curve in your spine and now there's almost no way for that thing to work because there's no space for it to really contract those are different reasons that you could be at risk for it so you want to pull it in frequently to gear it up how to work and if you remember from the animation video your transverse abdominis fires when your brain has a thought for motion so I just went to scratch my face before I moved my arm I my brain said I have an itch on my face my transverse abdominis fired my arm went up and itched my face that's how it's designed to work and so you want to suck your stomach in before you move so if I'm going to go get into my car I'm going to grab the door handle but I'll suck my stomach in before I grab the door handle I'll suck my stomach in before I sit in the sea I'll suck my stomach in before I bend down to reach for my purse or pick up one of my pets those are the kind of ways that you train the transverse abdominis so if you're doing zumba and you're doing all this side movement and having a good time suck your stomach in when you have to pivot back or suck it in stomach and when you have to throw an arm make sure you give your anatomical girdle a chance to stabilize your spine while you're doing exercise so the last thing I want to talk about I kind of gave you a little break in the middle is sitting sitting is so important to the health of your spine and during this pandemic many of us have been sitting at home and now I just got an alert on my phone we're going to be going into lockdown and everyone's going to be at home again for another couple weeks and we want to keep your back safe so whatever chair you're sitting in you need to support your low back if it's a sofa and it's squishy you need to scoot your butt way back and put a pillow behind your low back so that it forces you to sit up straight you will feel comfortable trust me try it in your car if you're driving for work for delivery of food or meals to people that can't get out because they're older keep a support in your low back I have a patient right now who says he delivers he's retired but he delivers 30 to 40 meals a day right now in Hawaii and he got a higher car because he killed his back getting in and out of the car over and over and over again on that note let's look at video number nine to look about how to do your sitting posture to sit in your chair properly and avoid low back pain it's important to use some props so you're gonna need a decorative pillow and a blanket or rolled towel or something like that so I have an accentuated curve in my back so I'm not rounded I'm more too swayed as as my body type so when I sit in a chair and you too you want to scoot your buttocks all the way back you don't want it here you want it all the way back you want to take your decorative pillow on a diamond shape like this put it down in your back so you can support the curve in your back now that's perfect for me this might be too much for someone who's say rounded so if you are rounded then you can just take a flat blanket it's not as abrupt and then squish it into your back so it keeps you upright especially if you like to slouch in you can't slouch it and fall forward in this position now you can use this on your sofa on your futon your hard firm kitchen chair your recliner this is all great because the key is you want to keep your spine and neutral and not slouch like this all day compressing your spine in a bad position to get rid of your back pain so those are all great tips that I really want you to absorb take notes watch the video again when I post a link and if you need more information I did publish an article in the hospital for special surgeries for orthopedic journal last september on the trans or subdominous and everything you need to know to get rid of your low back pain strengthen your deep core strengthen your multifidus muscles it has illustrations and I'll be showing a link if we could pop that up where you can view that article for free it's published open access thanks to the hospital for special surgery so please read that article and digest the material show your friends show your family and that will help you get on your way to ending low back pain so I hope that you have learned quite a bit today with what we're doing here and I just want to let you know that back pain can be solved by sucking in and training your multifidus muscles as you'll see in that article or in some of my previous episodes but it's not to say that you're not going to hurt your back again after one episode of low back pain most people will have a recurring episode if they don't retrain their trans or subdominous and their deep back muscles the multifidus muscles so you want to make sure that you retrain that see me see a physical therapist watch these videos learn how to help yourself become more flexible improve your sitting posture so if you do have another episode of low back pain now you have the tools the stretches that you have to be in control of getting rid of your low back pain as my patient said in Connecticut years ago he felt so victimized after 25 years 35 years of having back pain he had a high school football injury that no one told him how to suck it in and when he learned it he said that's ridiculous I feel victimized that I didn't know this he's had pain down his leg pain in his back epidurals he did not have surgery but he's had so much treatment and therapy over the years and was suffering the same pain so this is why I do these shows for you is to give you all the information so that you will have the control over your body and have the tips and the tools or know where to go to get them so that you can get yourself out of pain wherever it is in your body and one of the reasons why I know that is because I unfortunately since I was a teenager have been injuring every aspect of my body I grew eight inches in two years I dislocated my shoulders my knees I sprained my ankles and torn so many ligaments I've had five shoulder surgeries I was recommended to have a neck and a back surgery which thanks to the tips and strategies that I employ many of them I discover on myself so that I can be there for my patients and treat my patients so that's how I come up with so much of this information and I want to say one last thing if you take away one point from today suck it in pull in your belly button it's simple it works just do it and then you can join the group of us who enjoy freedom from low back pain life is better when you listen to your physical therapist aloha and thank you everyone and thank tecawai for allowing us to be here with you today