Ease Lower Back Pain Now With These 10 Simple Exercises

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Introduction - Statistics on Low Back Pain (LBP)

Back pain is one of the most debilitating conditions, crippling many people at some point in their lives. It can range from being a dull, constant ache to a sudden sharp pain. In a survey conducted by the National Institute of Health Statistics, low back pain was the most common pain experienced, followed by severe headache/migraine pain and neck pain. [6]

The survey also showed that:

• 8 out of 10 people suffer from back pain at some point in their lives [4]
• Low back pain is the most common cause of job related disability and absence [1] [2] [3]
• Back pain is more prevalent among the 40-80 age group
• Back pain is more prevalent in women
• The incidence of low back pain as a result of disc disease or spinal degeneration increases with age
• The annual health care expense of patients suffering from back pain exceeds $90 billion
• Most of the time, the exact cause of the pain cannot be identified [4] 

The last statistic is the most disheartening. In my experience as a practicing physician ranging from primary family care to pain management to sports medicine, I have observed that the majority of conditions that people seek counsel for arises from a lack of attention to 2 things: exercise and nutrition. To be more specific, perfect movements performed in the form of exercise and proper nutrition that promotes a low inflammatory environment.

Anatomy of the Lumbar Spine

The lumbar spine, aka the lower back, is comprised of five bony structures called vertebrae (referred to as L1-L5). These vertebrae are larger because they support an impressive amount of weight from the upper body.

In order to offset some of the pressure, the spaces between the vertebrae are maintained by tough, dense, fibrous cushions called intervertebral discs. These discs act like shock absorbers to disperse forces impacted upon the spinal column. Each intervertebral disc contains an inner soft, gel-like material called the nucleus pulposus surrounded by outer rings of tough, elastic material, called the annulus fibrosus.  



Discs help absorb the shock of the numerous stresses and strains your back experiences every day. The annulus fibrosus are set up in concentric layers, like the rings in the trunk of a tree. When forces upon these tissues are too great, the layers break down.

When the material from nucleus pulposus is exposed and leaks out, it presents a very detrimental situation. Let us put it this way, nervous tissues do not get along well with the material of the nucleus pulposus.

It is stimulates the pain receptors called nociceptors, to send noxious signals to the brain, which then interprets the messages as severe pain.

The Three-Joint Complex 

The junction of the vertebral body (bone) with the intervertebral disc is often referred to as the three-joint complex: the disc in front and the two paired facet joints in the back. This allows for multiple axes for directions of movement. 

There are also ligaments that travel the length of the spinal column, holding the vertebrae and discs in place. The canal that runs down the center of the vertebrae is known as the spinal canal. The "spinal" or central canal houses the every important spinal cord. The spinal cord is the extension from the brain and brainstem which conveys information to and from the rest of the body.

Nerves are rooted into the spinal cord and they control motor function (body movements) and transmit signals (sensory) from the body to the brain. The nerve extensions exit the spinal cord through the vertebrae via holes called foramen. Damages to the disc or sprains to the joints can cause inflammation and/or pressures that can affect the central canal and the foramen. This is where nerve compression and damage occurs. 

There are multiple layers of muscles that control various levels of movement in the spine. Awkward or inefficient movement patterns, injury and trauma can damage the muscle (i.e. a strain, tear, or rupture).

Causes of Low Back Pain

Back pain can arise from any number of situations. A concept that will be reiterated throughout this message is that the likelihood of injury dramatically increases if your body is not supported or protected during complex loaded movements. Here are some situations that can cause back pain: 

• Improper lifting (poor biomechanics)
• Repetitive strenuous activities with poor technique
• Fall from height
• Sports Injury
• Auto Accident
• Violent Action 

Here are some facts and lifestyle habits that are precursors to back injury: 

• Poor posture
• Excessive body weight
• Smoking
• Poor nutritional choices which lead to excessive weight and increased inflammation

And finally, here are some symptoms to be aware of that may require to consultation by a medical professional: 

• Weakness in the one or both legs
• Tingling (pins and needles) sensation in one or both legs
• Burning pain in one or both legs
• Loss of bladder or bowel control (this paired with any of the above requires immediate medical attention 

In order to keep things simple, I will divide back pain into 3 main categories: 

1. Musculoskeletal
2. Neurological
3. Visceral 

Musculoskeletal Back Pain

The most common causes of back pain are related to injury and/or overuse to the bones, muscles, tendons, ligaments, fascia, vertebral bodies, and vertebral discs. The most common injuries in this category are: sprains, strains, fractures, spondylolysis, spondylolisthesis, and intervertebral disc injury. 

Sprains: Joints are articular surfaces at which bones meet together. Ligaments are strong bands of connective tissue that connect one bone to another. A sprain is a stretch or tear of the ligaments. Severe sprains and rupture require the supervision of advanced medical care.

Strains: The joints in your body are made mobile by a combination of muscles and tendons. Tendons connect muscles to bones. A strain is an injury to either a muscle or a tendon. The strain may be a stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle and/or tendon. Severe strains and rupture require the supervision of advanced medical care.

Fractures: Fractures are a medical condition where there is a break in the continuity of bone. Fractures of the lumbar spine vertebrae are typically caused by forceful trauma. However, spinal fractures are not always caused by high force impact. People with osteoporosis, osteopenia, tumors, or other underlying conditions that weaken bone can suffer a fracture during normal, daily activities.  These conditions require the supervision of advanced medical care.  

Left, The pars interarticularis is found in the posterior portion of the vertebra. Center, Spondylolysis occurs when there is a fracture of the pars portion of the vertebra. Right, Spondylolisthesis occurs when the vertebra shifts forward due to instability from the pars defect.

Spondylolysis: This condition is a very common type of fracture in adolescent athletes. It is a fracture of the vertebral bone typically from unsupported extension maneuvers or repetitive extension stress.

Spondylolisthesis: This is a condition where the vertebral bones shift out of a position. If there is too much movement, the bones can start to put pressure on nerves which can create the radiating symptoms. Spondylolisthesis can occur in the presence or absence of a fracture.



Intervertebral Disc Injury:  The protective cushion between the vertebral bones is a shock absorber, but it is still susceptible to injury if not supported or protected.  Common Disc conditions are bulges, herniations, and degeneration.

Neurological Back Pain 

This is a category of back pain that results from a direct impact on the nervous system. Some of the conditions can arise from any of the previously stated musculoskeletal disorders putting pressure on the nerves. When an intervertebral disc is injured and begins to put pressure on a nerve creating low back pain and symptoms all the way down the leg to the heel, this is known as sciatica. Other conditions can affect the nervous system directly.  Some of these conditions include tumors and infections.

Visceral Back Pain

Visceral means pertaining to the organs of the cavities of the body. There are other systems of the body that are controlled by the nerves that exit the spinal cord at the level of the lumbar spine. There are several important points to note that are key to visceral causes. These include: 

• Pain not relieved by rest
• The absence of trauma
• The presence of symptoms related to organs in question 

Here are just a few examples: kidney stones, prostate pathology, digestive disorders.




At times there may be additional testing required to arrive at a more concrete diagnosis. These can include: 

X-rays: an imaging technique used to look for structural deformities. X-rays show the bony structures and any vertebral misalignment or fractures. Soft tissue damage to muscles, ligaments, or vetebral discs are not visible on conventional x-rays. 

Magnetic Resonance Imaging (MRI): utilizes a noninvasive, magnetic force instead of radiation to create a computer generated image. MRI scans go beyond the capabilities of conventional xrays. They also produce images of soft tissues such as muscles, ligaments, tendons, and blood vessels. 

Computerized Tomography (CT): is a three-dimensional image created from a series of two dimensional pictures. This test is ordered to see bony structures that cannot be observed on conventional x-rays. It can also be an alternative for people who are not able to undergo an MRI procedure. 

Blood work: this is not routinely performed to diagnose the cause of back pain; however, if the physician is suspect of visceral complications, inflammation, infection, and arthritic conditions, then a blood test may be required. 

Urinalysis: this is not routinely performed to diagnose the cause of back pain; however, it can provide useful information to support other test that have been ordered. 

These are the most common tests that are utilized for further evaluation. Even with all the technological advances that medicine has today, medical tests may still not yield a diagnosis or the cause of your back pain. At times, the cause of back pain is unknown.  In my clinical experience, once all life threatening and severe conditions have been ruled out, the condition of back pain comes down to everyday human performance. 

When to Consult with a Physician

Although this book is designed to provide you with applicable knowledge of healthy nutrition and proper movement patterns, it is unfortunately not the answer to all conditions. It is advisable to seek the recommendation of a healthcare provider if you are experiencing any of the following: 

• Pain that does not improve with rest or suggestions from this book
• Pain after trauma (such as a fall, a collision, etc)
• Pain that radiates or refers to other parts of the body:

Radiating pain (aka radicular pain): pain that originates in one location and follows the course of a nerve to another location.

For example: sciatica is a condition that exhibits symptoms of low back pain and pain traveling down the sciatic nerve which travels all the way down the back side of the thigh and lower leg to the heel of the foot.

Possible causes of radiating pain: degenerative changes of intervertebral discs (bulges, herniations), stenosis (pinched nerves), arthritic conditions.

Referred pain: pain that is more generalized and usually occurs in surrounding areas of traumatized or injured tissue.

For example: the gluteus minimus, the smallest of the 3 gluteal muscles, can create debilitating symptoms if it is tight or in a spasm.  According to Dr. Travell, it is known as the "Pseudo-Sciatica" muscle because its trigger points can refer pain mimicking the symptoms associated with true neurological sciatica.

Possible causes of referred pain: muscular trigger points, sprains (ligament damage), strains (muscular damage), arthritic conditions.

• Back pain compounded with:

Incontinence, trouble urinating, loss of control of bowel movements

Erectile dysfunction.

Weakness

Fever

Weight loss without diet modification

Menstruation or menopause

The Core

Protect Your House

Think of your core as a house. The center of the core is the viscera, the vital organs and spinal column and spinal cord, all of which are extremely valuable and need to be protected at all costs. The roof is the diaphragm, the back wall are the muscles of the back, the side walls are the oblique abdominal walls, the front wall is the abdominal wall, and the floor is the pelvic floor.

Each side of the house needs to be supportive and strengthened in its own right. If you only focus on one wall and forget about the others, eventually the forgotten structures give way and the contents of the house are no longer protected. Here are some common conditions that are a result of imbalance: 

• The Roof - Diaphram: hiatal hernia, gastroesophageal reflux disease (GERD), dyspepsia, indigestion, dysphagia, back pain
• The Rear - Back Muscles: back muscle strain, disc disease: degeneration, bulge, herniation, slip, spondylolisthesis (slipping of the vertebral bodies), arthritis, back pain
• The Sides - Abdominal Oblique Muscles: abdominal strain, hernias, back pain
• The Front - Rectus Abdominus and Transverse Abdominus: abdominal strain, hernias, back pain
• The Foundation or Floor - Pelvic Floor: incontinence (loss of structural integrity, not neurological malfunction), loss of bowel control (loss of structural integrity, not neurological malfunction), hemorrhoids, back pain

Now that you have a basic understanding of the anatomy in the lumbar region and the importance of protecting the vital structures within, it is time to learn how to engage your defenses. 

It is important that these structures are protected throughout movement. It is even more important to make sure that the movements are precisely accurate before placing loads upon them, especially excessive loads. As discussed in the anatomy section, the load upon the intervertebral discs is tremendous, and if your body is not supported and ready for action, injuries ensue quickly.

10 Simple Moves for a Healthier Lower Back

Okay, so this is the meat and potatoes of this book. In my clinical experience, these are moves stemming from various aspects of healthcare that can combat the majority of cases of back pain. Even if you suffer from a more complex condition, your body still needs to move well, so these will still help! 

1. Pelvic Movements
2. Pelvic Floor Contractions (AKA, Kegel Exercise)
3. "Lock and Load"
4. Plank
5. Full Depth Squats
6. Wall Facing Deadlifts
7. Kettle Bell Swings
8. Thoracic Mobility Glides
9. Vision: Near / Far Focus
10. Vision:  Vertical Saccades

For our purposes, these drills will be described from the Neutral Stance. As the individual masters the drill, they can be performed in various positions. 

Neutral Stance 

1. Find the bony prominence at the front of your hips on both sides.  This is known as the Anterior Superior Iliac Spine (ASIS).  Your heels should be placed directly under this landmark.
2. Point your feet straight ahead.  This is achieved by visually drawing a line along your instep.  They should point forward.
3. Knees are straight, but not locked into hyperextension.
4. Pelvis is in a neutral position.  To achieve this, gently squeeze the buttocks.  Next, pul your belly button towards your spine, this should activate your transverse abdominal muscles
5. The spine is elongated.  To achieve this, pretend there is a string attached to your head and pulling upwards.
6. The shoulders are pulled back and down away from the ears
7. The head is positioned so that the ear is in line with the shoulders
8. Chin is tucked slightly, so that the eyes' line of sight is straight ahead

MOVE #1:  Pelvic Movements

Why is this important?

Having control of your pelvis is extremely important. The pelvic area, defined as the lower part of the trunk between the abdomen and thighs, is where many of the body's stabilization muscles attach. As discussed before, muscles move joints. The effectiveness through which a joint is able to move, often determines the health of the surrounding muscles. 

How to perform Pelvic Movements:

Anterior/Posterior Pelvic Tilts

Begin in the Neutral Stance. Place your hands on your hips. This will allow you to feel the pelvic movements and provide positive feedback to improve the movement. Begin by squeezing your butt muscles, the gluteus maximus, and pulling your navel towards the spine, this should activate the transverse abdominis.

As you do this, you should feel your hands rock backwards slightly. This is called a posterior pelvic tilt, or tilting of the pelvis backwards. The anterior pelvic tilt, or forward tilting of the pelvis can be achieved by relaxing the 2 muscle groups that were just contracted.

You should start to feel the pelvis move in the opposite direction. Contracting the lower back muscles and arching the lumbar spine will tilt the pelvis further forward. Remaining in this position is not recommended as it puts increased pressure on the nerves exiting the spine and could potentially contribute to painful conditions. People who live the majority of their life in an anterior pelvic tilt position often suffer from low back pain at some point in their life.

Lateral Tilts

Begin in the Neutral Stance and place your hands on your hips. Think about the motion in your pelvis that will raise one hand while depressing the other. Your knees will mostly likely have a slight bend with this movement. Another cue that can help master this movement is to think about shortening the distance between your hip to the same side lower ribs, without bending the spine.

Pelvic Circles

Begin in the Neutral Stance and place your hands on your hips. To create a pelvic circle movement is a combination of anterior, posterior, and lateral pelvic tilts. Remember not to use the spine to create the movements. 

MOVE #2:  Pelvic Floor Contractions (AKA, Kegel Exercise)

Why is this important?

As described earlier, weakness in the pelvic floor muscles can lead to conditions like incontinence, hernias, hemorrhoids, sexual dysfunction and loss of bowel control. Contrary to common belief, pelvic floor contraction exercises are important for both female and males.

How to perform Pelvic Floor Contractions:

1. The easiest way to identify the muscles of the pelvic floor is start and stop the flow of urine.  Another way to activate the pelvic floor muscles is to clench the muscles that stop you from passing gas.
2. Once you have felt what it is like to contract the pelvic floor muscles, practice contracting them in various positions: lying down, seated, and standing though out the day.
3. Next practice being able to hold the muscle contraction. Try building up to 10 second hold per repetition. Then build up to 3-5 sets of 10 repetitions in a day.
4. Remember to breathe as you are performing this exercise.

MOVE #3:  "Lock and Load"

Why is this important?

The concept of "Lock and Load" is basically maintaining stability in your thoracic cage, otherwise known as your "core", as you are performing movements. This will protect your spine and pull in all the internal organs in a supported position. This is a key concept of movement. If the thoracic cage is not supported and stable during movement, the body compensates and begins creating inefficient movement patterns. This is also when injuries can occur. 

Now, just because one list of conditions may seem more overwhelming than the others, does not mean that you have to only pay attention to that part of the body.  It's all about balance. 

The Two Important Muscles that Should be Activated:

• Gluteus Maximus
• Transverse Abdominals

How to perform "Lock and Load":

You already have a good understanding of the "lock" phase from performing the neutral stance.  Now, you're ready to load. The area between the rib cage and the hip joint is what you want to remain stable throughout complex and loaded movements. There are some exceptions to this, but for rehabilitative purposes, we will focus on the "lock and load" of this area.

Move #4:  Plank

Why is this so important?

Planks are so beneficial since it engages all the muscle groups of the abdominal cavity.

How to Perform a Plank:

The plank position can be performed on the elbows and at the top of the push up position.  Key elements to performing a beneficial plank position are: 

1. Squeeze the butt muscles (the gluteus maximus). This will prevent your low back from sagging to the floor
2. Pull your belly button in towards your spine. This activates the transversus abdominus, which  supports your internal organs of the abdomen and supports it against the spine.
3. Keep your head in a neutral position. Looking straight ahead in relation to your body, not tilted back into extension or flexed forward
4. Elbow planks: place the elbows directly under the shoulder, so as not to put excessive stress on the shoulder joint
5. Hand planks:  place the hands directly under the shoulder, so as not to put excessive stress on the shoulder joint

If you are not able to perform a plank with your legs extended out on the floor, reduce the difficulty of the exercise. The best way to perform this is on stairs, with the feet at the bottom of the stairs and the hands placed at the stair level which you can maintain the above described plank. Performing planks on your knees is not suggested because it does not allow for proper activation of the butt muscles. 

MOVE #5:  Full Depth Squats

Why is this important?

The squat is one of seven primal movements. Primal movements are defined as a motion that is essential for survival and movement of the human body. If I had to choose one movement to teach a person, the full depth squat would be it. Culturally, people that perform full depth squats on a daily basis have much less incidence of low back pain and lower extremity pain. When performed properly, it engages the majority of the primary movement muscles of the body. More importantly it activates the: 

1. gluteus maximus, hip extensor
2. quadriceps femoris, knee extensor
3. gastrocnemius, ankle plantar flexor

All of these muscles are used to propel the body, which when utilized properly, takes responsibility away from the back muscles as a mover so that it can focus on its role as structural support. 

It's funny, when I ask a patient to show me a squat, the most common answer that I get is, "I don't do those, I'm afraid of getting hurt". When you go to sit in a chair, go to sit on the toilet to have bowel movement, go to get out of your car...guess what? You're doing a version of a squat.

So here's something to think about: If you perform these daily functions with poor form, how many bad repetitions are training into your body? The answer is A LOT! And this is why we have such an epidemic musculoskeletal problems: low back pain, hip pain, knee pain, flat feet leading to plantar fascitis. 

Full depth squats allows for proper movement at the ankle, knee and hip joint joints. These joints allow for the strong leg muscles to work efficiently and productively to move the body. Then the body doesn't have to rely on the back muscles to do the lifting. 

The primary job of the legs to provide a base for stability and to propel the body. The primary job of the spine is to provide structural support and protect the spinal cord, not to propel the body. When the spine starts taking on other responsibilities, that's when problems begin. 

How to Perform a Full Depth Squat:

1. Top Position: Stand with your feet a bit wider than shoulder width apart, with your feet pointed straight ahead
2. Focus on keeping the heel, the ball of the 1st toe and ball of the 5th toe on the ground at all times
3. Lock and Load the thoracic cage
4. Look at a point about 10 feet out in front of you to help maintain head position
5. Bend at the hips and knees at the same time
6. Push the knees out. This creates stability in the hips and makes room for the pelvis to drop between your knees
7. Keep your chest up, and back straight
8. Bottom Position:  Drop your butt towards the ground, knees out and chest up. Try settling, getting comfortable and increase the time that you can hang out in this position. 

If you have difficulty dropping into a full squat, you can use varying surface heights to sit on so that you don't have a fear of falling over. 

You may feel like you are going to fall backwards, or even fall back the first couple times. So practice this movement on a carpeted surface and in a safe environment to prevent injury. Most importantly, take your time. Go slow enough that you can feel stable at each point of the descent and ascent. If there is pain at any point, slow down or stop.  You may need to refine your movement further. 

Additional concepts to note in the squat: 

Supportive Foot Position

The feet should be firmly planted into the ground. My good friend, International Champion Powerlifter, Nathan Baxter likes to teach people a protocol to achieve a good foot position.

1. Begin by standing with the feet together
2. Turn each foot out about 45 degrees
3. Square the feet up
4. Turn each foot out about 45 degrees again
5. Square the feet up again. And this is your starting squat foot position.

It is necessary to keep three points of contact on the ground: the heel, the ball of the 1st toe and the ball the 3rd toe. If the feet are allowed to be turned out, it increases the likelihood of a flat foot position, pes planus. Pes planus is an unsupported position and transfers negative forces from the forefoot, to the ankle, to the knee, to the hip, and the lumbar spine. Pes planus can also lead to conditions like plantar fascitis, which is most people describe as pain in the heel, sole of the foot and sometime into the balls of the feet. Plantar fascitis can lead to development of heel spurs.

Bone Rhythm

The first 1/3 of the squat should be focused on bone rhythm. Bone rhythm is the concept of moving the two ends of a bone at the same time, at the same rate. The femur, or thigh bone, is what we will be focusing on for bone rhythm of the squat. The two reference points are the head of the femur (at the hip joint) and the condyles of the femur (at the knee joint). These two reference points should be move at the same time and rate in opposite directions.

The focus from the 1/3 squat to the bottom position should be on the knees. Pushing the knees outward while maintaining foot position will create an external rotation of the femur and tightening of the soft tissue (fascia) around the head of the femur into the hip joint. This equates to increased stability.

Dropping below the 1/2 squat position will require mobility of the pelvis, hips and ankles. Without this, the body is unable to achieve proper positioning without compensation. The compensation is usually revealed at the weakest points of the body. 

Note that variations to foot position can be useful, however for the purposes of creating structural strength and integrity, the aforementioned squat procedure is the most beneficial from a rehabilitation standpoint.

MOVE #6:  Wall Facing Deadlifts

Why is this important?

Deadlifts performed properly nurture another primal movement, bending. Bending is the act of moving your thoracic cage forward by hinging at the hips. If you've picked something heavy up off the ground, chances are that you've performed a deadlift. 

Wall Facing Deadlifts are a good way to learn the motion of a deadlift. 

How to Perform a Wall Facing Deadlift:

1. Top Position: Place a weight a couple inches from the wall, preferably a kettle bell
2. Stand with your feet equally on either side of the weight a bit wider than shoulder width apart, feet pointed straight ahead, and the toes a couple inches away from the wall
3. Focus on keeping the heel, the ball of the 1st toe and ball of the 5th toe on the ground at all times
4. Lock and Load the thoracic cage
5. Keep your chest up, back straight, squeeze your shoulder blades together to keep your shoulders back
6. Push your butt back as you begin to bend, or hinge at the hips. The goal is to not let your face scrape against the wall
7. Push the knees out as they being to bend. This creates stability in the hips
8. Let the arms hang down in front
9. Bottom Position: Descend until you can reach the weight with your arms in an extended position.  At this point, you can either ascend without the weight or pick the weight up and perform repetitions. 

You may feel like you are going to fall backwards, or even fall back the first couple times. So practice this movement on a carpeted surface and in a safe environment to prevent injury. Most importantly, take your time. Go slow enough that you can feel stable at each point of the descent and ascent.  If there is pain at any point, slow down or stop. You may need to refine your movement further. 

Again, note that there are variations to this movement which are also beneficial, however for the purposes of creating structural  strength and integrity, the aforementioned deadlift procedure is a good starting point and beneficial from a rehabilitation standpoint.

MOVE #7:  Kettle Bell Swings

Why is this important?

Kettle Bell Swings is another excellent exercise to encourage bending.  The main focus is improving the body's efficiency of hinging at the hips. 

How to perform a Kettle Bell Swing:

Since there are a variety of methods of picking up the kettle bell properly, for sake of progression, let's assume that you've picked up the weight with good "wall facing" deadlift form. Please do NOT face the wall prior to beginning the kettle bell swings. Make sure you are in a safe environment and have enough space to swing the weight. 

1. Starting Position: Place a weight a couple inches from the wall, preferably a kettle bell
2. Stand with your feet a bit wider than shoulder width apart, feet pointed straight ahead, with the weight in your hands
3. Focus on keeping the heel, the ball of the 1st toe and ball of the 5th toe on the ground at all times
4. Lock and Load the thoracic cage
5. Keep your chest up, back straight, squeeze your shoulder blades together to keep your shoulders back
6. Push your butt back as you begin to bend, or hinge at the hips
7. Bottom position: As the weight drops and passes down between the legs, slightly bend the knees and push the knees out
8. Continuation: At the point where the weight stops moving behind, begin moving the hips forward and squeezing the butt muscles, the gluteus maximus
9. The forward motion of the hips, should be a snapping motion
10. Caution: Do not thrust the hips so far forward that your upper body goes into hyperextension.  This will put increased stress on the lumbar spine
11. The forward motion of the hips, is the power generator for the movement of the weight and should dictate how high the weight travels
12.  Caution: Do not use your upper body and arms to lift the weight. Remember from a rehabilitative standpoint, the purpose of this exercise is to use the movement in the hips to create an efficient bending motion. The height to which the weight travels in front of the body is not the goal of this particular movement
13. To make the movement more fluid, think of your body as a pendulum with the hips being the hinge

MOVE #8:  Thoracic Mobility Glides

Why is this important?

The thoracic spine is comprised of 12 vertebrae and is located just above the lumbar spine.  The majority of people have poor posture which is comprised of: 

• A hunched upper back, Dowager's hump (increased thoracic kyphosis)
• Rounded shoulders (winging of the scapula)
• Forward head position (anterior head carriage). Erik Dalton, Ph.D. "For every inch of Forward Head Posture, it can increase the weight of the head on the spine by an additional 10 pounds." -Kapandji, Physiology of Joints, Vol. 3
• Rene Cailliet M.D., former director of the department of physical medicine and rehabilitation at the University of Southern California states that forward head posture may reduce vital lung capacity by up to 30%, slow down the gastrointestinal system and negatively impact cardiovascular function 

Not only is this postural presentation unattractive, it potentially has very damaging results to our vital systems. 

This poor posture is very restrictive and leads to a lot of compromise in the upper body and increased load in the lumbar spine. Learning to mobilize these joints can improve flexibility and control of movement patterns.

How to perform Thoracic Mobility Glides:

This is a drill I learned from Z Health® systems. It is important to focus on spinal movements, not shoulder movement, during these drills. 

Forward/Backward (Anterior/Posterior) Glides 

1. Stand in a neutral stance
2. Breathe in and then exhale while rounding the middle of the back
3. Breathe in as you reverse the motion lifting the sternum forward and up
4. Keep the low back as still as possible
5. Keep your face and abdominal muscles relaxed

Common Errors 

1. Shoulders creating the motion
2. Tightening abdominal muscles and/or holding breath
3. Tightening muscles between shoulder blades
4. Jutting the head and/or neck forward or back 

Side to Side (Lateral) Glides 

1. Stand in a neutral stance
2. Move or slide the middle of the back to the right and left
3. Try to isolate the movement in the middle of the back as much as you can
4. Maintain postural alignment throughout the motion

Common Errors 

1. Shoulders creating the motion
2. Tightening abdominal muscles and/or holding your breath
3. Moving the lumbar instead of the thoracic spine
4. Tipping, tilting, or rotating the trunk

Full Circle 

1. Stand in a neutral stance
2. Combine the anterior/posterior glide with the lateral glide motions to create a full circle
3. Try to isolate the movement in the middle of the back as much as you can
4. Maintain postural alignment throughout the motion
5. Perform in both directions 

Common Errors 

1. Shoulders creating the motion
2. Tightening abdominal muscles and / or holding the breath
3. Moving the lumbar instead of the thoracic spine
4. Tipping, tilting, or rotating the trunk 

MOVES 9 and 10: Vision Drills

Why is this important?

The next group of exercises are drills for the eyes. Why?! The eyes are a portal for the brain into the world. Improved visual function allows the eyes to interpret the world and provide accurate information to the brain, which enable the brain to organize information and predict movements with greater precision. Z Health® utilizes many vision exercises that enhance an athlete's performance and allows them to perform at an elite level. 

As a clinician, there are various drills that can be utilized to improve a person's function and neurological response. These are two drills related to vision that I have found to have a high probability for improving movement fast. These typically work well for the low back pain that comes on "out of no where." No incidence of injury, trauma, clinical or previous history. 

How to perform Vision - Near/Far Focus 

1. Stand in a neutral stance
2. Focus on an object about 6 inches away from your face. For this drill, use a spot on your hand
3. Once the object is in focus, hold your gaze on that object for about 2-5 seconds
4. Quickly shift your focus to a distant object. You should be able to see definition in the distant object, so pick something that is within your visual capability
5. Again, hold your gaze on the distant object for about 2-5 seconds
6. Shift your focus back and forth at an even pace. If you need to, you can set a metronome to help you keep to a beat
7. Advancing the drill #1: As you become more proficient, you can create a greater distance between the near and far object
8. Advancing the drill #2: Decrease the gaze fixation time.  In other words, switch between near and far objects with greater speed. Make sure to be able to focus on the objects before switching. If you lose the capability of focusing, the speed is too fast.

How to perform Vision - Vertical Saccades

1. Stand in a neutral stance
2. Focus on an object about 6 inches above your neutral line of sight about an arms length in front of you. For this drill, use your outstretched hand and focus on your thumb nail
3. Once the object is in focus, hold your gaze on that object for about 2-5 seconds
4. Quickly shift your focus to an object about 6 inches below your neutral line of sight about an arms length in front of you. For this drill, use your other outstretched hand and focus on your thumb nail
5. Advancing the drill #1: As you become more proficient, you can create a greater distance between the vertical objects
6. Advancing the drill #2: Decrease the gaze fixation time.  In other words, switch between near and far objects with greater speed.  Make sure to be able to focus on the objects before switching.  If you lose the capability of focusing, the speed is too fast 

Saccades are fast movements of both eyes in the same direction, at the same time. Vertical refers to the up and down eyes. The theory of how this exercise works: 

So how does it work? The neural pathway activated by performing these exercises stimulates a part of the nervous system in the brainstem called the Pontomedullary Reticular Formation (PMRF). This part of the nervous system has many responsibilities, some of which include: 

• Somatic motor control: maintaining tone, balance and posture especially during movement
• Pain modulation: reducing some of the pain signals that are transmitted from the lower body to the brain

Chapter 6:  Reducing Your Pain Threshold

Inflammation Threshold 

1.  Inflammatory state of the body rises above the threshold = symptomatic
2.  Inflammatory state of the body well below the threshold = asymptomatic 

It is entirely possible for someone to have a relatively moderate condition and experience excruciating pain. It is also possible for someone to have a severe condition and experience very little pain. How is this possible?  Perception of pain and also threshold of pain. 

Just as there are inflammatory medications, there are elements that can encourage inflammation. There are many factors: food, environment, and emotions. There is a threshold for which if one continues to surpass it that will most likely experience higher levels of pain. Whereas, if the person lowers their overall inflammatory state and lives a lifestyle which encourages a level that is well below that threshold, they will be in a better position to tolerate pain. Certain foods cause inflammation in a large percentage of the population, resulting in digestive issues such as bloating, gas, constipation, and diarrhea, as well as other symptoms that are not digestive.



GOOD food is EFFECTIVE fuel

You've heard the saying, "food is fuel." That statement is true, but it could use some refinement and specificity: "good food is effective fuel." You've also heard, "you are what you eat."  That absolutely holds true.

Your body breaks down food through mechanical and chemical processes so that it can extract its nutrients for the body to build new cells, repair damages, and keep all systems functioning. If your body is provided with inferior materials, one cannot expect a superior end product. It's just not possible. If you want the best, you have to invest in the best. 

Avoid foods that are known to increase inflammation

• Refined sugars:  (soft drinks, doughnuts, chips, cookies, candies) 

Why are they damaging?

Our bodies are designed to handle them, but they cannot keep up with the quantities that the majority of people consume nowadays. Excessive amounts can lead to obesity, diabetes, tooth decay, acne, and inflammation. 

What to have instead:

Foods with natural sweeteners (i.e. honey, stevia), fresh fruits. 

Fresh fruit has natural sugars and also contain fiber so that the body has to work to breakdown the food, thus slowing down the release of insulin.

• Alcohol

Why are they damaging?

Alcohol, when consumed in excess, can damage the intestinal environment by destroying essential bacteria or gut flora.  And, of course, excessive alcohol consumption can damage the liver which is essential in its role in the detoxification process of the human body. 

What to have instead:

Water. The majority of our body is made of water.  All of our bodily functions require water to operate optimally.

• Pasteurized Dairy: milk products (butter, cheese, cream); can also be hidden in (breads, cookies, cakes, cereals)

Why are they damaging?

A large part of the population is, or becomes intolerant to lactose. Healthy bacteria and enzymes that are found in raw milk, are destroyed during the pasteurization process. Thus making it more difficult to digest. Milk is also a common allergen that many people test positive when evaluating for food sensitivities.

What to have instead:

There are other milk products derived from nuts, beans and other animals (check for individual sensitivities to these as well).

• Refined Grains: white rice, white flour, pastas, white breads

Why are they damaging?

Refined grains along with white pastas break down quite easily into sugar and were found to elevate inflammatory markers in the body. Like refined sugars, they have a high glycemic index and are majority empty calories. 

What to have instead:

Unrefined or minimally processed grains. These foods can help prevent chronic degenerative diseases, cardiac disease, and diabetes.

• Refined Oils: polyunsaturated vegetable oils

Why are they damaging?

So what's the key element in refined oils? Trans Fats! Studies have shown that trans fats can assist in creating an inflammatory environment by damaging cells that line the walls of blood vessels. They have a high amount of omega 6 fatty acids which promote inflammation. 

What to use instead:

Cooking oils that have a more balanced ratio of omega 3 to omega 6 fatty acids. Macadamia nut oil has a 1:1 ratio of omega 3: omega 6 fatty acids. Omega 3 helps to protect the body against inflammation.

In summary, we are all human. Consuming these food groups in moderation is okay as long you do not have specific sensitivities. If the majority of your diet is based on these food groups, you are setting yourself up for chronic disease processes that currently dominate our society. 

An analogy that I share with my athletes is the comparison of the human body to a high performance race car. If you have ever watched a race, you will notice that the cars make multiple stops for check up, repair, and fueling before they even finish one race. They need to be meticulously maintained, care for, and fueled with the best gasoline or else they will not function. They run on high octane fuel, superior to the fuel that we put in our everyday vehicles. Your body is the same way. If you want to feel great, if you want superior performance, `then you have to give it the very best fuel.

Chapter 7:  Supplementation

As discussed in the anatomy section, the key components of the low back are the vertebrae, the disc and the joints by which they connect. Those joints have cartilage that  if worn can be assisted from supplementation.

Machine Motion joint health formula contains each of these ingredients, each of which is scientifically-dosed for maximum effectiveness.

Machine Motion Ingredients

Cissus Quadrangularis

Heralded far and wide for its countless benefits, cissus quadrangularis is one of the most powerful all-natural joint support supplements available. Cissus is rich in a type of plant sterol known as ketosterones. These phytochemicals are responsible for the numerous benefits of cissus supplementation. Machine Motion includes a premium-grade cissus extract standardized to 40% ketosterones.

Cissus supplementation has been well-documented to combat inflammation, relieve joint pain, and promote collagen synthesis. This is all in addition to its ability to enhance weight loss and cholesterol levels.

Acumin™

Developed by Novel Ingredients, Acumin™ is a trademarked extract of curcumin supplying 45% curcuminoids. This one-of-a-kind complex has been clinically shown to offer 5-6x greater bioavailability than conventional curcumin supplements.

Curcumin has long been used in folk medicine as a powerful, and all-natural, anti-inflammatory compound that combats both acute and chronic inflammation in the body. Curcumin accomplishes this via inhibition of Cytokine production and down-regulation of COX-2 activity, mimicking the effects of ibuprofen.

Bromelain

Naturally-occurring in pineapple, bromelain is a digestive enzyme that also serves as an effective pain relief compound, too. Bromelain has been used for centuries an all-natural anti-inflammatory agent to reduce redness and swelling. Furthermore, the versatile enzyme also has shown efficacy in treating the aches and pains induced by osteoarthritis.

Sodium Hyaluronate

Sodium Hyaluronate is a highly bioavailable form of hyaluronic acid, a glycosaminoglycan present in connective tissue that lubricates and cushions your joints. Countless studies have shown the effectiveness of hyaluronic acid, with some dubbing it the “fountain of youth.” Treatment with hyaluronic acid can reduce joint pain, improve symptoms of osteoarthritis, and may even reduce the need for joint replacement.

Q-Actin™

Machine Motion utilizes one of the newest, groundbreaking joint support supplements in Q-Actin, a patented, clinically-tested extract of cucumber. Research conducted on the novel extract demonstrates it significantly improves knee pain, stiffness, and physical function in patients suffering from osteoarthritis. Doses used in the landmark study were 20mg, the exact same dose included in Machine Motion!

Q-Actin is able to accomplish this by inhibit the production of TNF-ɑ, tumor necrosis factor alpha, an inflammatory cytokine associated with a number of inflammatory diseases including osteoarthritis. Reducing factors that promote inflammation promotes increased range of motion, decreased pain, and improved quality of life.

BioPerine®

All the joint support compounds won’t do a lick of good if you’re body isn’t able to utilize them. That’s where BioPerine® comes in. This industry-leading black pepper extract improves ingredient bioavailability, ensuring maximal uptake and utilization by the body. BioPerine inhibits various enzymes preserving ingredient integrity, certifying you get all the joint pain relief possible from each and every serving of Machine Motion.

References and Resources

Decreasing Inflammatory Threshold

10 Simple Moves

Supplements 

Disclaimer:

This book is not intended to be a comprehensive summary of the available information of this topic. The information provided is not intended to diagnose or treat medical conditions. Please consult with your health care professional for additional information.