 and welcome to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist and also former back pain sufferer. I have an important question I'd like to pose to you today. What would your life look like if you didn't suffer low back pain? I want you to think about that. I want you to picture how good it would feel to be able to go about your day, enjoy your hobby, sports and family time without pain limiting you. Would it be worth trying something you've never tried before to end your pain? When my back was initially injured, I was terrified and I would have done anything. I was afraid to move. My leg was numb. My back pain was so intense and it was hard to just get through my work day, but I got through it by being consistent and persistent with my physical therapy exercises and it also helped me to innovate exercises of my own to help get me through my work day and through my life. Today, I'm going to reveal the back pain secrets that worked for me and have been proven in the literature for decades. You can implement them into your day immediately and be free from back pain at last. Let's go right to video clip one to learn about the two critical deep core muscles that you absolutely must have working for you to get rid of your back pain. 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. 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. Let's go to image number two. 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. When they contract, they stabilize each vertebrae on top of the other one. The easiest way to activate your anatomical girdle is to suck it in. Pull your belly button in towards your spine that activates these muscles. They co-contract together to give you the anatomical girdle. What I like to tell people to do when I first am 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 it 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. 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. 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, etc., 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 for good. That's it in a nutshell. And I know it may seem really hard to believe that it could be that simple to reactivate your deep core, but it is. And I also call it the hardest, easiest exercise you'll ever do because it's very easy in your mind to think, oh, pull my belly button in. But what's hard is sometimes it's hard to activate those muscles. And I want you to have hope because if you've had back pain for five years, 10 years, 35 years, like some of my clients in Connecticut who inspired me to write my book, you need to retrain these muscles. And I remember Jimmy saying it was so simple that he felt victimized that he had so much 35 years of back pain, injections, therapy and other treatments. And he never learned how to access the deep core. Those two little muscles, the transverse abdominis and the motivatives really are the key to getting your back healthy again. So how do you suck it in? Let's go to video number two to 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 triple tibetanus muscles in your back and you stabilize your low back to help you get rid of low back pain. It's very simple. You can see you just make your tummy look smaller and I'm doing it right now as I continue to breathe, but if you do the diaphragm as well, it compresses the diaphragm. So it may take a little bit of time for you to learn that and that's why I like to show people in standing because standing is a position that you're functioning in and you may have pain like some of my patients while they're washing dishes or pain lifting your grandchild or pain doing your laundry or standing cooking a meal and all you need to do is pull your belly button in, engage your transverse adominus which turns on those multiple tibetanus muscles in the back and gives you stability to your low back which equals less pain. Let's now go to video number three and 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 into stabilize your spine, take that message to heart and learn what you need to do to get out of pain. These are not new concepts in the literature although they may be new concepts in popular culture. I wrote this book and I was looking at some research to kind of support my theories and my expertise that I've been using with patients for a very long time and I was nervous at first. I was afraid what I might find or not find to support what I'd been doing and it was amazing that I found in articles from 1996 proving what I'm saying is true. After one episode of low back pain, those multifidous muscles in the back do not regain their function unless you specifically retrain them and also with people with low back pain it was proven that the transverse abdominis, the abdominal muscle, the functioning was delayed when people were moving versus people that didn't have low back pain. So all you have to do to rescue your back is retrain your back muscles. Now I love in the clinic to show people how to do it in neutral spine. Neutral spine is the position of the low back that is its natural position. It's a gentle sloping backwards curve. It's not a forward rounded curve and if you know yoga or Pilates and they do the cat and the cow, the angry cat is where you round your low back and the cow is where you sway your low back like a horse. The low back was designed with a mild sway to it and a lot of us from sitting in poor postures or holding ourselves in poor postures for too many years have formed more into a rounded low back and it makes you more vulnerable to low back pain and injury disc herniations as a result. So this neutral spine that I would show you in the clinic, I'm going to show in the next video, video number four. 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 transversal dominance correctly. So you want to land 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 on 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 your 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 transversal dominance and then progress to a one inch march to help you stabilize your low back and end pain. You can see when I made that comment about I'm a little bit weak when I lifted my right leg, my pelvis dropped a little bit to that side and then in the second one you saw how my pelvis stayed level and that's just because I was re-engaging my anatomical girdle. I blew up two discs, herniated two discs helping a patient in New York City many years ago and I had weakness in my leg, pain down my leg, numbness, it was really challenging time but re-engaging my anatomical girdle because I knew that my muscles weren't going to be firing after that injury was the key to getting me back to playing beach volleyball and running and enjoying time with my family and cleaning my house and all those lovely things. I want to debunk a myth now though because you I talked about how you don't want to pin your back flat or how the neutral spine is that backwards curve of your spine and one of the biggest myths that I heard when I was in New York City in Connecticut that prompted me to write my book was that people were saying when I was teaching them how to suck it in as you learned in the video prior in neutral spine, they were saying no I've learned that but I pinned my back flat, pinned it flat and I said no no no no don't don't pin your back flat keep like the little air there a small space where you feel your sacrum or your tailbone touching the table and then your shoulder blades but not the small of your back and they were asking me why should I do that because I've learned the other way before and I asked them to have faith and and to try it for me and I explained that the reason why you want to suck it in a neutral versus pinning your back flat is because you want those deep back muscles the multifidus muscles to fire in neutral to stabilize your spine if you pin your back flat you are no longer just using your deep core your transverse dominance and multifidus pelvic floor getting that co-contraction as soon as you pin your back flat that process of doing that uses your rectus abdominis which is a spinal flexor it bends you forward it's also a stabilizer but it spends you forward that's its action as soon as you flatten your back you engage your rectus abdominis and you can no longer get the stability from the multifidus because you have flex the muscle on the front so you want to just keep yourself in neutral and co-contract the transverse abdominis and the multifidus to get rid of your low back pain let's go to the next video where you can get some more information of an article I published in 2018 and I actually published an article two years ago on this um 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 dominance 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 transverse abdominis contraction there's more advanced exercises to work on your anatomical girdle to get your transverse abdominis 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 strength in 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 if you didn't get a good look at that link it's very simple you just google christine lenders and transverses of dominance and you will see my article pop up where you can download it for free thank you to the hospital for special surgery for supporting me and to dr cornell for being so inspired by reading my book draft to get the word out i've gotten so much information back from people about the article and it makes me feel good to help people near and far get over their battle with low back pain so besides learning to suck it in it's also important to have proper flexibility in your back so if we go to video number six i will show you the simplest stretches that you can keep your back safe and gain flexibility at the same time to relieve pain but in addition to pulling your belly button and engage your anatomical girdle you want to be sure that you have the proper flexibility in your glutes and your hamstrings which can when tight put extra strain on your low back and make you more vulnerable for injury or pain so if we look at video two if you are suffering from back pain because you've been bending cleaning doing too much gardening remodeling your home while you've been quarantined and staying at home these stretches are the go to you want to lay on your back on a bed on a floor draw one leg up clasp your hands in front of your knee and to hug your knee into your chest and you want to breathe three to five seconds it's an excellent stretch then you want to hug your knee to your opposite shoulder so your foot goes on the other side you put your outside hand on the outside of your knee and your inside hand somewhere on your shin and you hug your left knee up towards your opposite shoulder again breathe breathe in three to five seconds then just stretch your hamstrings you want to clasp your hands behind your knee let the knee relax keep your shoulder blades squeezed and your head on the table and then gently kick your leg straight to stretch those tight hamstrings and the last one is to draw both knees into your chest give them a hug and breathe three to five seconds that will do great to relieve all the tension in the big glute muscles your hamstrings to take the strain off your low back enjoy those stretches are excellent and they can be your first course of action if you have an episode of low back pain and they can also be your regular course of action try those stretches i still do them today to keep my back healthy i have some questions so a common question that i get in the clinic is what is sciatica so sciatica is a big general blanket term for irritation of the sciatic nerve which tends to cause pain running down your leg another term for it is radiculopathy which means there's been an irritation of nerve root that's coming out of your spine the most common causes of pain down your leg are actually pathology or a problem in the low back where a disc is either bumping the nerve or you have a narrowing of the canal around the nerve that's causing compression on the nerve and occasionally in someone who's a high level athlete or a runner that has weakness you can get sciatica which is a condition where there's a muscle in your buttock that gets overworked it's called the piriformis and in many people the sciatic nerve pierces the bottom fibers of that muscle and when that piriformis muscle gets overworked from running on say like an angle or if you have a hip weakness in the gluteus medius and your piriformis is overworking to take up the slack for your gluteus medius weakness you can get something called sciatica what i like to tell people though is sciatica doesn't just mean that it's coming from your hip it often in the clinic in my expertise it's mostly coming from the back i would say one out of 50 people that i see with back pain maybe even one out of a hundred have or a runner and are actually coming from the buttock muscle but it's mostly coming from the back and there's many things that you can do to prevent that strengthening the hip strengthening your deep core as i showed in all the videos previously and being very mindful of your posture if you are sitting leaning over to one side all the time you're causing compression more on that side of the spine if you sit cross legged all of the time you're causing compression on that side of the spine if you're sitting in your car leaning on the center console you're causing compression on that side of your spine and also over years the muscles get a little bit more shorter on that side and the muscles get a little longer on the other side so 10 years down the road now you have a compression in your spine that you didn't do anything to deserve but it was because of a suboptimal posture that you were holding yourself in so let's go to video number seven to look more at how poor posture can contribute to your low 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 somebody really wants to think about how to mine their posture but that's why it's so important is i think you need to look at yourself and see what positions you're putting yourself in during the day that you might not be aware of it's not a bad thing if you're slouching you don't need to feel like you're lazy it's just a way that you've held your body the bad thing is it's harming your neck and back and so just look at yourself and say okay well wow i never thought about my posture i feel like i'm i'm sitting up straight have someone take a picture of you from the side to see for yourself if you are in fact in good posture or if there's room to improve on your posture so that your body can feel better it's it's something that i want to inspire you to look at so that you can have much less pain and discomfort in your life now let's talk a little bit more about these multivitus muscles the ones that you absolutely must retrain to get stability and to get out of pain in your low back in the next video i'm going to show an image of how i like to train the multivitus one way where it looks normal so let's go to video number eight this is my back and if you look just above my waistline you see these muscles kind of bulging and i have my spine supported on the table and i'm just alternating lifting one leg and then the other not even very far that's a low table but you can see they mostly look the same now i have retrained mine because they didn't used to look the same after i herniated those discs and i and i work hard on that i probably do it i don't know once a week now just to make sure that they're they're working well and the reason i wanted what i wanted to show you this is i had a lovely patient come in the other day who had back pain back surgery i don't even know maybe 40 40 years ago or something and we were rehabbing a different part of his body and his back went out twice and so i said let's get you in for back treatment and i was going to show him this exercise and then what i saw i had to videotape and he was kind enough to send me the video so let's look at video number nine where we can see what it looks like when your multifidus muscles are not working properly you can see with that leg if you look at the back you don't see much you see a little twist towards the right when he lifts his right leg now you look again you see muscles tense you lift the other one and wow that muscle on the bottom part of the screen is really bulging i i did a couple different angles because i wanted to show people that because i was so surprised to see it overworking that much you can see it again here wow it really bulges out on that left side above his waist and i wanted to take a video with his phone which he was kind enough to give to me because i said this is what's happening this your muscles are not firing together to give you stability they're firing one side at a time giving you mobility and you want your low back to be stable while you're walking around you don't want it to be wiggling like that so while we were rehabbing his knee that's what was happening anytime we tried to like step up the strengthening his back went out and he hadn't had to go out and i think he said like 10 years once every 10 years it goes out but that's why because remember after one single episode of low back pain you lose the function of those multifidus muscles those segmental spinal stabilizers unless you specifically retrain them and to reiterate you want to suck it in to get them to co-contract you want to suck it in in neutral spine not flat back not rounded to get those multifidus muscles to fire symmetrically and then you could do those exercises in those two videos to stabilize in video number 10 i give you a good picture of how to perform that exercise so i like people to lay on their bed and you can see i've got my whole back and my pelvis up there the break in my hips is just a little bit on the bed and the reason why i want you to do that is i want your spine supported i alternate lifting my legs and then you can see right there i pick one leg up and i start doing many circles so i'm sucking my stomach in i'm supporting my spine on the low mat now i'm moving my leg right left right left right left and that is what you can do to regain the function and the strength of those multifidus muscles i alternate legs because i want to simulate walking because we walk all day long and so i want them to work together and not one at a time while we're walking and now when i'm lifting the circles i started doing that for myself because i herniated the disc on my right leg and my glute got very weak and it ended up giving me a lot of foot trouble as i was walking around new york city so i had to work on strengthening my glute and stabilizing my spine at the same time so that's just another advanced exercise that you can do if you say hey you know what maybe you only have a little bit of back pain and it creeps up every year or two check your multifidus out and work it strengthen it in a supported environment so that you can get rid of your low back pain so i have one more video let's go to video number 11 where i show a way that you can learn how to suck it in and get your multifidus firing in standing as we do in function so how i do this i've just got a sport cord behind me you can use a theraband or anything attached to a door i am bending my knees sucking my stomach in and just leaning slightly forward to engage my transverse abdominis my rectus abdominis everything and then i'm gently punching my hands forward backward now i'm stepping forward backward while i'm holding my deep core tight tummy in slightly leaned forward to engage those multifidus muscles and now i alternate stepping now you can just punch it forward hold it statically and then just move your hands and do some perturbations because that helps with the core so suck your stomach in bend your knees get a band hold everything tense and gently punch forward backward nice and slow let your core control it so try that exercise i think you'll find that all the information in this show is something maybe new that you haven't seen or something that maybe you need to be reminded to do so please take this to heart because i want to help you win your battle against low back pain thank you everyone for joining us life is better when you listen to your physical therapist aloha