© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine, Philadelphia
www.DrBookspan.com

Dr. Jolie Bookspan's innovative methods are used by the military and top spine doctors.
Harvard School of Medicine clinicians have named her, "The St. Jude of the Joints."
The Ab Revolution™ No More Crunches No More Back Pain new Third Edition, expanded, now available

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This article explains the most common source of lower back pain that comes after long standing, walking, running. If you feel you need to bend over forward or stand with one foot up on a step to stop your back pain, this is the usual cause. The pain is easy to stop and prevent from returning.

What Causes The Pain?
When you let your lower back curve inward too much when standing (red photo lower left), it pinches and compresses the joints of the spine, called facet joints, and the surrounding soft tissue. This can also press on discs that are already injured. An overly large arch is not "the normal inward curve of the back." It is the cause of much mystery back pain that is easily fixed with proper positioning described in this article.

How to Reduce Overarching to Neutral Spine:
1. Stand with your back against a wall. Touch your heels, backside, upper back, and the back of your head against the wall. Do you have to arch your lower back or raise your ribs to touch your head? Does your belt line top down in front?
2. Put both hands on your hips - fingers face forward on the front of your hipbone and your thumb faces back on the back of your hipbone.
3. Roll your hip so that your thumbs come downward in back. Fingers rise in front. Your lower back presses closer toward the wall.
4. Feel that your hip is no longer tipped down in front. The large space between lower back and the wall becomes a smaller space.

This movement returns your spine to neutral spine and reduces a too-large lower back arch. When you walk away from the wall, keep the new neutral spine position.

Side view, Left - overly arched, not healthy. Note belt line tipped down in front and up in back.
Right - hip tilted under to reach neutral spine. Note level belt line.

 

What Do Abdominal Muscles Have to Do With The Pain?
The muscles that tilt your hip under and return you to neutral spine are your abdominal muscles.

You need to use your abs just enough to pull your spine into neutral position to prevent it from slouching (over-arching). Abs only help your back when you use them to move out of bad position into neutral spine.

Strengthening your abdominal muscles does not make them automatically support. It is a voluntary movement. When you don't use your abs to position your spine when standing, the ribs can lift up and/or the front of your hip may drop down in front. Your upper body may lean backward. Your low back increases the normal inward curve (becomes more swayed or arched).

A small inward curve belongs in your lower back (left-hand figure of the three in the drawing below). When you slouch your spine and increase the small inward curve, over-arching results, also called hyper-lordosis (middle and right figures below).

Kinds of Hyperlordosis
I have done several studies trying to measure hyperlordosis and to see why hyperlordosis hurts. It turns out that, historically, it has been tricky to measure overly-arched spinal angles in relation to the hip (middle drawing). It is even more demanding to figure how the lower spine angle relates to the upper body in hyperlordosis (right drawing). It's good to try to stay simple, so here is a simple summary drawing:

Neutral spine (left) compared to two kinds of lordosis posture.
Middle - hip tilts forward in front and out in back.
Right - upper body sags backward.
Both hyperlordosis postures overly-arch the lower back and make it ache after long standing.

 

 

Can You See Overarching In Real Life?

Now can you see hyperlordosis in real life? Above is a photo showing two kinds of lower back over-arching (hyperlordosis) - Anterior hip tilt (left). Upper body (thoracic) lean on right. Compare to the earlier shown drawing.

Check during activities to see if you are arching your lower back: When you stand. When you look up. When you reach up. When you carry a load in front like a laundry basket, chair, or baby. When you carry a backpack in back. Check to see if you can pull you shoulders back or drink a glass of water or take a photo without arching your back or leaning your upper body backward. This bad posture is surprisingly, taught in may gyms, or sought after as sexy. It is not. It is unhealthful and injurious bad posture that creates much lower back pain.

What Is Lordosis and Hyperlordosis?
Too much lordosis (hyperlordosis) is not a "condition." It is not something anatomic, unavoidable, or something that "just happens" to you like flu. It is not a disease that causes back pain. It is a simple, avoidable bad posture that causes back pain which that you can easily stop.

Technically the word "lordosis" originally meant the normal inward curve of the low back. It has commonly come to mean too much inward curve, allowing the lower back to sway. The technical word is hyperlordosis, meaning too much lordosis. Hyperlordosis creates much back pain including facet pain, which is pain and damage to the facet joints that hold your vertebrae together. The facets are the joints that your body weight presses on when you let your back sway or arch.

Hyperlordosis is the cause of much "mystery" pain - pain that does not often show up in X-rays or scans, and keeps coming back no matter how many exercises, massages, or "adjustments' you get. Many people get shots over and over, but the pain keeps coming back - the reason is that they keep standing and walking with their lower back arched.

You'll see the overly-arched (lordotic) posture in an astonishing number fitness videos, magazines, books, and classes. They may say, "keep neutral spine" but they arch their back and stick out their behind in dozens of exercises from leg lifts, to lifting weights, to bouncing around in aerobics. It is not neutral spine to have a large inward curve. It is not "just the way you are made." It is bad posture that you can change.

Did you know why there is often a foot rest in pubs? People who arch their lower back get back pain from long standing at the bar. They feel better when they put one foot up on the foot rest. The reason putting one foot up on the low foot-rest reduces back pain is that you unwittingly reduce the large lower back arch. You don't need a foot rest to reduce the arch. Just change your spine positioning yourself with the hip tilt technique and stand with neutral spine. Then you won't have the arching that causes the pain.



Use Abs To Prevent Overarching (Hyperlordosis) When Reaching and Lifting Overhead
Check to see if you arch your lower back when reaching overhead. That allows upper body weight plus the weight of things you are lifting to press downward on your low back. You may be doing this dozens of times daily doing things as simple as putting things on shelves, pulling off shirts, even combing and washing hair. Damage accumulates.

Left shows leaning back and tilting the hip forward in front and out in back.
Right shows keeping the hip level and leaning the upper body backward.

Left shows leaning the upper body backward and letting the hip tilt downing front and up in back when reaching upward. Right shows straightening the hip (tilting it under so that it does not tilt out in back) and pulling the upper body forward instead of slouching backward.

 

Feel This Technique Work
When standing, your hip should be vertical, not tilted, from the top of your upper leg bone to the middle-point of the crest of your hip. Try this:

1. Look at the double photo above, and stand facing a wall, as in the photo, with one arm outstretched. Put the knuckles of your curled fist against the wall as if you had just punched the wall. Elbow slightly bent.

2. Stand badly, shown in the left-hand photo. Stick your behind out in back. Let your lower back arch inward. Let your upper back lean backward. Press your fist hard into the wall. You will probably feel pressure in your lower back.

3. Now, keep pressing your fist hard but stop the bad positioning by tucking your hip under you, shown in the right-hand photo. The movement is like a hip thrust or a standing crunch. The arch in your lower back reduces. The first thing you will notice if you do this right is your back stops hurting. You should also notice a stronger push against the wall and new strength in your arm and upper body. You will feel the muscles in your trunk and abdomen working.

Use Your Abs To Prevent Overarching and Hyperlordosis While Wearing Backpacks
Heavy bags and backpacks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem. Use your ab muscles to prevent arching and maintain good posture against a posterior load. Your bags could be a built-in abdominal muscle exercise.

Arched lower spine drops the weight of your pack on your low back. It results in much lower back pain after backpacking. It is not from the bag - just how you stand when you carry it.
Don't let your lower back arch. Instead, tilt your hip under you to reduce the arch to neutral spine.
Reducing the arch using your core muscles keeps the weight of the pack on your abs and off your lower spine.

Use Your Abs To Prevent Overarching and Hyperlordosis When Carrying Things in Front
Check to see if you lean back when carrying an anterior load, like a chair or a baby.

It is not true that being pregnant makes your posture arch. It is preventable by just using abdominal muscles to stand without arching. Of all good times to prevent this arching, this it is.

Leaning backward when carrying things in front, as in all three examples above, increases the lower back arch, pinching and pressuring the lower back.

It's Not Arching (Back Extension) By Itself That is Bad
Arching your back, by itself, is not the problem in back pain and posture control. The problem is not using muscles to keep your upper body weight off your low back. You need to use your abs during moves where you extend your back (like a big tennis serve) while standing. Don't just allow your lower back to fold backward under your upper body weight. By holding your upper body weight forward with your abs you can lean and extend back without your weight pressing onto your low back. This is often confused, and some people state you must never arch your back. However, healthful back extension is an important and good-feeling exercise for back health and is covered in the back pain article on this web site (and my books).


If You Don’t Believe That "Tightening" Is Not How to Use Your Abs, Try The Following:
1. Tighten your abdominal muscles, as commonly taught. Press your navel to your spine. Tighten the entire area. Now breathe. Note that such tightening would not be possible or useful for daily activity.

2. Next stand with arched lower spine posture. Tighten your abs and surrounding musculature. Note that the lower spine angle does not change.

3. Stop tightening the area so that movement is now unrestricted. Tuck your spine and hip to remove the lordotic arch, straightening your posture. Now you see that "using your abs" means moving them, just like any other muscle, to move your body.

Instead of lying on the floor and hunching forward to exercise your abs, train your abs to work the way you really need them - standing up. By using your abs to hold healthy spine positioning during all your activities, you will get free exercise, and abdominal and core muscle training that benefits your life and helps your back Simply strengthening abs will not help your back. Using them to keep healthy torso posture is how it works.

What's Wrong With The Way Things Are?
You may have heard that developing your abdominal muscles will help your lifting, posture and your back pain. So why isn't it working? Why not just do abdominal crunches to prevent all the problems? A recent fitness industry survey looked at common abdominal muscle exercises and ranked them from most to least effective in using abdominal muscles. But the surveyors missed three basic concepts. An exercise can work a specific muscle but still promote bad posture and not be good for you. Even if an exercise activates your abdominal muscles, it still may not be useful for things you need for daily life. Simply strengthening a muscle will not transfer the posture skills you need for proper use in sports and recreation, or for back pain control.

What's Wrong With Crunches?
It's practically universal to see a gym full of people doing crunches, then stand up and walk away with arched backs and no use of abs, or knowledge that you are supposed to use abs standing up.
1. Crunches don't work your abs the way you need for real life.
2. Crunches don't train you how to use your abs the rest of the day.
3. Crunches promote poor posture, even when done properly.
4. Crunches make a person, who likely spends much of their day already hunched over a work area, practice that hunched posture which may be mechanically promoting the back and neck pain they think they are working their abs to prevent.

 

Some Abdominal Exercises
Instead of curling forward, here are exercises that work your abs and back at the same time, plus train you how to hold your back in healthy position when you stand up again. This innovation in core training is called The Ab Revolution™. Some Ab Revolution™ exercise examples follow. Hundreds more can be found in the book, The Ab Revolution™, and in our Ab Revolution™ classes.

- Isometric Abs
Lie face up, arms overhead on floor, biceps by your ears.
Press your lower back toward the floor to remove the arch. You will feel your abdominal muscles working to prevent your back from arching.
Hold hand weights an inch above the floor, without arching your back.
Keep your low back against the floor by using abdominal muscles to straighten your spine.

The "isometric Ab" exercise trains you to keep your back from arching against loads that you lift overhead,
as if you are standing. Practice until you can do this with straight legs.
A common false belief is that you must "keep knees bent to protect the back"
but how are you supposed to stand up and walk away? With knees bent? It is not your knees that change your spinal angle.
The way to protect your back is to use your abs to reposition it so that it does not sag into an exaggerated arch - knees bent or straight.

As you get better at this exercise, gradually straighten your legs so that you can practice posture the way you need it for standing up - spine held at healthy position without bending knees. There are trainers who say you must bend your knees to "protect your back" from arching. But it is your own abdominal muscles that are supposed to hold your back in position. How could you stand up and go about your life, if the only way to "protect your back" is to keep your knees bent? Use this exercise to strengthen your abs at the same time as retraining standing posture.

Why Do This Exercise? This practices holding neutral spine against resistance. This is how your abs should work all the time, when standing up, to prevent too much arching. Notice that you don't need to tighten your abs to do this. Just use ab muscles, like any other muscles, to move your body to healthy position. Don't tighten anything, just move your spine and learn how to move it when standing into healthy straighter posture.

- Hold a Push-up Position
In a push-up position (hands and toes, not on knees).
Tuck your hips under so that your lower back doesn't sway inward or arch. You will immediately feel your abs working when you do this. You will also immediately feel the pressure in your back disappear, that was caused by arching.

WHy do this? The purpose of this exercise is to train your abs at the same time you relearn how to hold your back when you are standing up. Keep your back straight, not letting it sag into an arch like a hammock. Tuck hips as if you were starting a crunch, but don't hike your behind up in the air or drop your head. Make your posture as straight as if you were standing up. Use a mirror, if available, to see yourself and learn what healthy position feels like. Use this new healthy position all the time, particularly when you stand and reach overhead.

Do you do pushups and allow your low back to over-arch, as in the drawing above?
This means you are not using core muscles to straighten your posture.
Arching pressures the low back and does not work your "core" muscles. Instead, tuck your hip to straighten your back, as below.

When you tuck your hip correctly to straighten your back, you will immediately feel your abs working, and the pressure in your low back will disappear. The weight of your body shifts to your abdominal muscles and off your lower spine.

A common but ineffective exercise is to stand on hands and knees and lift one leg in back. Look in "fitness" books and videos, and you will often see the models arch their back to lift their leg. This does not work the leg or hip muscles, and only reinforces faulty movement patterns - to yank your spine back to move your leg. Many people unfortunately also do this when standing and walking. It is no wonder they hurt.

Do you exercise by arching your back to lift the leg (left ). Instead, tuck your hip under (right drawing). As soon as you tuck correctly, you will feel a big difference. You will have to use your abs to tuck and the muscles in back of your leg to lift your leg instead of just arching your back and pivoting from your spine joints. Remember not to "crane" or pinch back your neck. Use your chest muscles to lift your head to avoid bending your neck at a sharp angle. Use this same ab technique when standing and lifting your leg in back (for example to do kicks or back leg presses).

 

The hands and knees position gives very little exercise and does not train you how to hold your body weight up against gravity. Instead of spending time on ineffective exercises, get off your knees. Hold a real push position. It will strengthen your arms. Make sure to use abdominal muscles to tuck under your hips or you will get no core exercise. Hold a good pushup position. Lift one leg without letting your spine sag.

Prevent your spine from sagging into an arch under gravity. This will not only give you much abdominal exercise but retrain you how to stand up without letting your low back sag into an arch under gravity. When you can do this, hold this same position and lift one arm straight out in front of you. Don't drop your head. Use your muscles to hold you as straight as if you were standing up.

 

Here is another fun exercise to train your oblique abs to hold your posture against changes in load. Turn to the side on one arm, hold your body straight, using oblique abs to prevent sagging in the middle. When you can do this, lift the top leg so that you are standing on one arm and the side of your bottom foot.

A 'holding straight' drill to simulate and retrain carrying shoulder bags and not letting your spine sag sideways under the load.

 

For a more challenging Ab Revolution exercise, hold one leg out to the side, holding a straight pushup position. Lift the opposite arm and hold. Then try pushups like this.

Hold a good flat "plank" (pushup) position. Hold one leg out to the side. Lift the opposite arm.
You will feel your abs working hard to hold your body straight against your body weight.

The Ab Revolution™ Works Your Abs In Hundreds Of Fun Exercises
Practice variations of the "hold push-up position" exercise, using the hip tuck to reduce overarching. There are dozens of variations. Try them carefully and safely, increasing as you improve. The "hold-pushup" and all the variations are only one kind of Ab Revolution exercises. There are hundreds more. Try the workshops, and get the new expanded (2007) third edition book The Ab Revolution™ No More Crunches! No More Back Pain!

Don't Stick Your Hip Out In Back
There is supposed to be a small inward curve to the lower back for shock absorption and protection of the discs. When you lose the inward curve by rounded forward sitting, standing, and bending over, it pressures the discs and eventually damages them (Disc Pain article). The problem is that people hear they need a small inward curve, so they make a big one by tilting their behind out in back. You can see this unhealthy practice in many fitness publications, videos, and gyms. You will have a healthy small curve without sticking your hip out in back. The hip tuck returns your spine to neutral instead of overly-arched. You will have the needed slight inward curve when you hold neutral spine.

 

How Long Does It Take To Stop Lower Back Pain With The Ab Revolution?
If your pain comes from overly arching your lower back, you should feel the pain and lower back pressure stop the moment you tilt your hip back under you and no longer overly arch. If you're not feeling better right away, check what you are doing compared to what is presented above. Are you leaning your upper body back? Did you push your hips forward instead of tucking (tilting) under to straighten? DId you round forward instead of becoming straighter? Are you tightening or clenching any muscles?

If you do not overly arch, then reducing the arch will not change the source of the pain. Make sure there is not something else contributing to your pain. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.

 

No More Tightening
This is new and different from what we learned in school and at the gym. New research has shows a better way. This is good news. Discard outdated "tightening" your abdominal muscles, or any muscles to use them, or the old "press navel to spine." You cannot breathe properly or function that way, and walking around with "tight" muscles is a factor in headaches and stress/strain related muscle pain. Just use your muscles to hold your spine in healthy position, easily, no matter what you are doing or carrying.

When you carry any loads in front of your body, don't arch back to "balance it" or let the weight pull you into an arch. With packs on your back, don't arch or hunch forward. Use your ab and torso muscles to tip your hip back under you and lift your weight up and off your low back. With a bag on one shoulder, don't let it pull you to the side; simply use your own side (oblique) muscles to hold your posture against the sideways pull. It's free exercise and it's good for you.

With this new knowledge you'll strengthen your abs and get ab exercise without going to a gym. You'll burn calories. You'll be straighter and taller. You'll save your back. You'll be healthier. You'll exercise your brain. It's a whole different way of thinking about abs. It's a revolution.

 

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