Fix Lower Back (Lumbo-Sacral and S.I.) Pain
Standing, Walking, Overhead Lifting, and Running
(and sitting with overarched lumbar spine)
pain (sacroiliac), facet pain, hyperlordosis, swayback, tilted pelvis,
spondylolisthesis (anterolisthesis and retrolisthesis), pars, some kinds of stenosis, the bad posture of leaning back during pregnancy,
mystery low back pain, and some lower body impingement syndromes
PLUS neutral spine & functional use of core and abdominal muscles - What they do may surprise you.
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Hello, You're on the web site of Dr. Bookspan, pioneer of functional sports medicine (sports medicine how you actually use it in real life). This is a no-ad, no hype site dedicated to getting you back to your life - healthy, mobile, and happy. There are hundreds of free articles here on my web site for you to have a better life. I make this available to you at no charge to you for a better world. Main navigation links for this site for more are at the bottom of this page.
This page covers one important technique, that I spent years investigating, to fix lower back pain felt with standing for long periods with too much lumbar inward curve (swayback), this pain is usually felt during running, lifting overhead, upright activities like tennis, soccer, and others, and during certain exercises. It is evidence-based, primary-source, tested sports medicine research and techniques, now used by military and top spine centers around the world.
Don't worry. Lower back pain can be easy to fix. This article shows what to do for the most common source of lower back pain that occurs during and after long standing, walking, running, and certain exercising. People with this kind of pain usually feel they need to bend over forward, sit down, or stand with one foot up on a step to stop the lower back from aching. Instead of needing these odd short term maneuvers, this article shows you how to stop the cause. Then you will not get the pain in the first place and can stand, walk, run normally, and do more activity than before, rather than limiting your activity. Welcome to Health Care Reform School.
Not all exercise is medicine. Not all medicine is healthy. We change that. No health insurance needed. Much cost, time, and worry currently spent in medical treatments are unnecessary, and often unhealthful It's not health care if it's not healthy. I have developed information through years of research in the lab, and put it here on my web site for the benefit of the world. Get better and the world will be better.
Answers In A Nutshell
- If you get lower back pain after long standing, walking, overhead activities, or running this article explains the most common reason why, and what to do. Some people feel better to lean over forward or sit or raise one leg, while others don't - if they do these things keeping the same overarched spine that hurt in the first place. This article explains.
- If you are not comfortable to lie flat face up without a pillow, or face down, or stand up straight, this article explains why and how to fix that too.
- If you were told you have S.I. syndrome or spondylolisthesis (vertebral shifting, also called anterolisthesis), or pars defect, this will show how to stop the cause of the pain, and prevent a major cause of the damage to the area.
- Many people who are told they have "flat back" turn out to stand and move with the opposite problem of "swayback" The definitions often are not clear to some practitioners or they are tested or scanned lying down or in ways that change actual curve.
- You do not need to have surgery, extended medical treatments or bed rest to relieve this kind of lower back pain. You do not need to strengthen your "core" - that is a major myth. This article explains why. You do not need to give up impact activities like running or martial arts, give up weights or heavy occupational work, or other activities you love to do. You do not need special lifting belts, expensive beds, ergonomic chairs, or other devices to do what you can do with your own body yourself.
- If you have been told to push or tilt your backside or hips far out in back to stand or squat, this article explains that fad, and what is healthier.
- If you have been told you must "bend your knees to protect your back" this article shows why that is not so, and how you can control your own spinal angles even with your legs straight - needed for standing and other real life. This is different from doing sets and reps of exercises, then going back to injurious spine positioning habits.
- Many common medicines and prescription drugs can cause back and body pain. Un-needed treatments and surgeries are done - causing more pain and reduction in physical ability. Easy changes can stop the need for harmful medicines.
- If you want to learn neutral spine, or how to use abdominal and core muscles functionally, this article is for you.
- Pain felt with long standing, walking, running, is usually from too much inward curve to the lumbar spine. This is a slouching habit, not a medical condition. Exercises and ongoing treatments do not stop this cause of pain. This method teaches you how to stop this kind of slouch, called hyperlordosis. As soon as you stop the painful slouch, the lower back pain from THIS problem should be gone. No exercises needed; It is a retraining of how you hold your lumbar spine, explained below. This method also shows you how to stop this kind of slouch during exercising and gives a variety of levels and kinds of exercise - for the health and benefits exercise brings. Don't confuse a direct way to fix this one source of pain through stopping your slouched lumbar posture, with "doing exercises" in hopes to fix some misunderstood pain.
- This is not "alternative medicine." This is evidence-based sports medicine techniques of neutral spine, applied to real life - where you actually need it. This free web site also has articles so you can understand how to fix your disc pain and sciatica, another covering other causes of back pain, one covering healthy pain-free sitting. After learning how to stop pain with standing and walking, and running (etc) using this article, check those next. A list of these and others is on the Clinical Page. The end of this article (where it says "More fun...") gives many helpful links to pages on this site for more help. The Bottom of every page on my web site gives main navigation links.
What Does Too Much Inward Lumbar Curve Look Like - ALL the following are Swayback and Not Neutral Spine
What Causes The Pain and How To Stop The Cause
- When you let your lower back sag inward too much (red photo below-left), the higher angle of the vertebrae pinches and unequally compresses joints of the spine called facet joints, surrounding soft tissue, discs, and greatly increases shear force (structural strain by lateral shifting). Standing this way is slouching. Slouching and allowing too much inward curve (swayback, also called hyperlordosis) is sometimes regarded as natural, but so is slouching your shoulders, a common cause of neck pain. So is wetting your pants. A little control, and life is healthier.
- Two main ways people create too large an inward curve. One is tilting their hip and pelvis forward, and the other is leaning the upper body backward. Other people do both at once, as pictured in the photo below. It is a shame when people do their exercises for health with this unhealthy posture. It even used to be taught by trainers and gyms. It was a fad for a while, now it is known that neutral spine is healthier and stronger for exercises.
- Restoring neutral spine is a simple posture change that you can do immediately - red photo lower right.
Photo #1 Left - overly arched, not healthy. Note belt line tipped down in front (and up in back) and the upper body leaning (slouching) back.
Photo #2 Right - neutral spine. Note level belt line. Upper body is more vertical.
No tightening or "sucking in"- it is movement of the pelvis and or spine, where needed.
One Quick Way to Learn Neutral Spine
- 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 increase inward curve of your lower back or raise your ribs for your head to reach the wall? Does your belt line tip down in front? Does it hurt or strain to straighten this much? This tells you you are standing in a painful way.
- Gently, without forcing or tightening anything, press your lower back closer toward the wall. Feel your pelvis and hip change in tilt, and reduce the lower spine inward curve. Don't flatten completely against the wall, simply learn to reduce an overly large inward curve.
- Feel that your hip is no longer tipped downward in front. The large space between lower back and the wall becomes a smaller space.
Another Way to Feel This Same Idea:
- Stand up and put both hands on your hips - fingers face forward on the front of your hipbone and your thumbs face back on the back of your hipbone.
- Roll your hip so that your thumbs come downward in back. Fingers rise in front. Feel that your hip is no longer tipped down in front. The large space between lower back and the wall becomes a smaller space. It may help to do this with your back against a wall. as above.
- This movement reduces a too-large lower back arch and returns your spine to neutral spine. When you walk away from the wall, keep the new neutral spine position.
The idea is not to push the pelvis forward, but to make it vertical, not tilted. Often, people push the whole lower body forward, which only increases hyperlordosis, not fixes it Then they think the "hip tuck" does not work, when they never tucked or straightened the pelvis, they made things worse.
See and Practice Comfortable Neutral Spine
A video should appear above of one of my students, David of Belgium. He starts with overarched lower spine and shows how to change overarch (hyperlordosis) to neutral spine while standing. Click the > arrow and practice with him.
Note: eventually you should be able to do this without having to bend the knees - and do this regardless of any knee position.
Send in your own videos of your successes with this to post here for everyone to benefit: See how on Project 7.
If the video does not load on your device, click http://www.flickr.com/photos/39972966@N03/4899716752/
Why Do People With This Kind of Back Pain Often Feel They Need To Bend Forward To Feel Better?
People familiar with good movement mechanics know that constant forward bending isn't healthy for the spine. Why would someone feel better to bend forward that way? Remember the reason they hurt in the first place - excessive inward lumbar curve that bashes structures inward. They feel they need an "antidote."
The mistaken idea of "fixing" back pain with forward bending has resulted in numerous unhealthful exercise and pain rehab programs relying on excessive flexion (forward bending) exercises, which cause other problems for discs, and much hip pain and dysfunction.
If you don't crush your lower back with excessive inward curve - swayback/hyperlordosis - then you will not need to stop and relieve the pain. You will not get it in the first place.
What Do Abdominal Muscles Have to Do With Stopping Back Pain?
- Strengthening the core or abdominal muscles does not fix the pain because it does not stop the cause, which is too much inward curve. Stopping the painful bad posture stops the pain.
- Abdominal muscles only help your back when you use them to move out of bad position into neutral spine. Strengthening your abdominal muscles does not make you stop slouching, and strong abs do not automatically support anything. It is a voluntary movement. No amount of ab or back strengthening will stop you from standing badly.
Kinds of Hyperlordosis
In my research career, I have identified several kinds of hyperlordosis, all the same concept. It's good to stay simple, so here is a summary drawing. #1 Neutral Spine, #2 Anterior Hip Tilt, #3 Upper Body (thoracic) Lean:
Can You See Swayback (Hyperlordosis / Overarching) In Real Life? Compare the photo below to the drawing above:
Now can you see hyperlordosis in real life? The photo shows #2 Anterior Hip Tilt, #3 Upper Body (thoracic) Lean. Both hyperlordosis postures overly-arch the lower back and make it ache after long standing and activity.
Can You Tell If You Are Standing in Swayback? (hyperlordosis / overly arched lower spine)
Check - 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 leaning backwards or increasing the inward curve of the lower back. This bad posture is, surprisingly, taught in many gyms, or done deliberately mistaking it for a cute posture. It is not. It is unhealthful and injurious bad posture that interferes with healthful movement and creates much lower back pain.
Hyperlordosis is the Cause of Much "Mystery" Pain
Hyperlordosis pain 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 overly arched.
You'll see the overly-arched (hyperlordotic) 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. 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.
Feel This Technique Work
When standing, your pelvis 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:
- Stand facing a wall, or any sturdy surface as in the photo above, with one arm outstretched. Press the knuckles of your curled fist against the wall. Stand badly, shown in left-hand photo. Tilt your hip out in back. Let your lower back arch inward. Let your upper back lean backward. You will probably feel pressure in your lower back (don't do this with injury).
- Now, while pressing your fist hard, change to neutral spine by tucking your hip under to vertical, shown at right. The movement is like a pelvic tilt or a standing crunch. The arch in your lower back reduces. The first thing you will notice if you do this correctly 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.
Prevent Overarching (Swayback/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.
#1 Left - Leaning the upper body backward, and tilting the pelvis.
#2 Right - Straightening the pelvis and upper body to vertical
Prevent Overarching (Swayback/Hyperlordosis) Carrying Loads - Backpacks, Packages, Pregnancy
- Check to see if you increase the lower spine arch when carrying a posterior load, like a knapsack, or someone piggyback. 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.
- Check to see if you lean back when carrying an anterior load, like a chair, a package, or a baby. Don't lean back. Leaning forward to compensate is not the answer. See if the slouch is coming from leaning back or tilting the pelvis or both and correct accordingly as shown throughout this article.
- It is not true that being pregnant makes your posture poor. It is that you are leaning the upper body backward, and/or tilting the hip and pelvis forward, which pinches the lumbar spine. People do this to try to offset weight in front, the same as carrying a chair, grocery bag or dog as pictured in the examples at the top of this page. You do not have to lean back or tilt your pelvis to carry more weight front. YOU need to use neutral spine so that your front (ab) muscles offset the weight, not slouch it onto your lumbar spine. Even if it is true that you are more flexible due to pregnancy chemicals produced, you can (and need to) stand in neutral spine without leaning back. Stand without increasing the inward curve of the lower back (arching). Of all good times to prevent this arching, this it is. Do not lean or round the upper body forward to compensate - use the same pelvic tilt described above to change to neutral spine to stop the painful pinching. You do not have to have backache when carrying a pregnancy.
LEFT - Leaning upper body back, pelvis tilted (ouch!) RIGHT - Upright and neutral
Prevent Overarching (Swayback/Hyperlordosis) When Sitting
- Most people who overarch the lower back or lean back when standing feel a lot better to sit down. Why? Many of them round their back more when sitting and take out that painful overarch. Other people don't. Those people are usually the ones who also sit overarched. Then sitting hurts the same way.
- Don't over-compensate to prevent rounded slouching when sitting. In other words, don't keep a large inward curve of the lower back when sitting thinking that will counteract too much rounding forward. It doesn't. it's too much other other way. Use neutral spine for sitting too.
Don't overdo - don't use so much inward lumbar curve, shown above. That hurts too.
The Healthy Sitting article on this web site tells more.
If You Dont 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 try to breathe in. Note that tightening would not be possible or useful for daily activity.
2. Next stand with overarched 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, 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.
Arching (Back Extension) By Itself Is Not Bad
Arching your back to create movement to the back (like a big tennis serve), is not injurious by itself. The problem is compressing an overly extended segment of the spine under load. Instead, use your muscles to keep the load lifted, and off your low back. Don't allow your lower back to fold backward under your upper body weight. By holding your upper body weight upward with your abdominal muscles, you can lean and extend back without weight shifting and pressing downward onto your lower back. Supported extension and simple sagging in hyperlordosis are often confused, leading to rules that you must never extend the spine, rather than understanding the concepts and creating healthful movement. 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).
More About 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.
I have done many studies 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 of anterior hip tilt). It is even more demanding to figure how the lower spine angle relates to the upper body in hyperlordosis (right drawing of Level hip/Thoracic lean). I have tried to pull out the important factors. I am still trying to give them good interesting and descriptive names. Please keep in touch with me and send your good ideas for names as I continue to research this.
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 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.
Real Core Training - Train Your Brain To Understand Neutral Spine
Core training is not doing a bunch of exercises to strengthen the core. That is a large myth. The way your core works is to hold healthy position without allowing your spine to slouch into too much inward curve (swayback / hyperlordosis)
Instead of curling forward or doing a bunch of planks, 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 my Ab Revolution classes.
THESE ARE NOT CRUNCHES
Lie face up, arms overhead on floor, biceps by your ears.
Notice the common result - most people allow their ribs to lift. The weight pulled you into an arch instead of you supporting the weight with your muscles. Press your lower back toward the floor to reduce the lumbar overarch. You will feel your abdominal muscles working to do this right.
Hold hand weights an inch above the floor, without allowing your lower back or ribs to lift upward.
Keep your lower back stabilized towards the floor by using abdominal muscles to straighten your spine away from arching.Feel the lower abs, and often the stretch across the front of the hip as you maintain neutral spine.
Your upper body never lifts from the floor.
"Isometric Ab" retraining drill -
By itself is a great ab exercise (IF you prevent your lower back from increasing in inward curve)
The benefit to stop back pain comes when you TRANSFER this knowledge to lifting loads overhead when standing
without allowing the swayback that injuriously loads the lower spine.
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? 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. Use ab muscles, like any other muscles, to move your body to healthy position. Don't tighten anything, simply move your spine, and use this drill to learn how to move your spine the same way into healthy neutral position when standing.
RETRAIN Your 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.
When you allow your lower back to increase inward curve,
you are not using core muscles, you are sagging your weight onto your lower spine.
Tuck your hip to reduce inward curve and straighten your lower spine.
You will immediately feel your abs working, and the pressure in your lower back will disappear.
The weight of your body shifts to your abdominal muscles and off your lower spine.
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.
Rethink "Bird Dogs"
A common but ineffective exercise is to stand on hands and knees and lift one leg in back, and/ or one arm in front or both. Look in "fitness" books and videos, and you will often see the models arch their back to lift their leg / arm. 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 in unhealthy ways? Notice arching your lower back (increase sway/ increase inward curve) to lift the leg (left).
Instead, tuck your hip under (right). As soon as you tuck correctly, you will feel a big difference - you will have to use your abs to tuck, and use the hip and leg muscles to lift your leg instead of arching your back. (Also - Use upper back muscles to raise your neck and head to level instead of bending back your neck at a sharp angle at one vertebra - lift chest not chin)
Use this same ab technique when standing and lifting your leg in back (for example to do kicks or back leg presses).
BUT this hands and knees position is still almost no exercise and not very useful except to retrain how to not sag into weak, droopy, sloppy, arched lower spine. Then see below to do some real help:
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. To advance, hold this same position and lift one arm straight out in front of you. Don't drop your head or hunch your shoulder. Use your muscles to hold you as straight as if you were standing.
Use this neutral spine drill to train yourself to prevent your spine from sagging, then transfer that re-positioning skill to standing. You will change it from a mindless exercise to good abdominal exercise that also retrains functional movement habits when you stand, walk, and run.
This 'holding straight' drill is used to consciously simulate and retrain carrying shoulder bags and not letting your spine sag sideways under the load:Turn to the side on one arm, hold your body straight, using oblique abs to prevent sagging. When you can do this, lift the top leg so that you are standing on one arm and the side of your bottom foot. Use the knowledge from this drill to retrain standing position with packages and bags on one hip without sagging. Your bags change from back pain from bad body mechanics into built-in exercise and ab training.
For more Ab Revolution, 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 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.
Hundreds Of Fun ExercisesThe short drills shown above are a few Ab Revolution retraining drills. There are hundreds more. Try the workshops, and get the new FOURTH edition book The Ab Revolution No More Crunches! No More Back Pain! (the eBook works better than the Kindle - if you are a Kindle expert, contact me so we can make the Kindle edition great too - Amazon's software makes some photos not show up in some readers). In any format you choose, eBook or print, or Kindle, the book has two parts. The first shows how to reposition to neutral spine. No exercises needed to fix pain. The second part is all the fun you can have getting in shape using this concept.
Don't Tilt or Stick Your Hip Out Far In Back
People hear they need a small inward lumbar curve, so they make a big one by tilting their pelvis so that the hip tilts forward in front and the backside sticks out in back. You can see this unhealthy practice in many fitness publications, videos, and gyms. Some people visualize the proper pelvic angle by thinking of a bucket full to the top with water. Hold the bucket upright and vertical so the water doesn't spill out, not tilting forward.
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).You will have a healthy small lumbar curve without tilting your pelvis to jutting the backside far to the back. The pelvis and hip should be vertical - from the crest of the hipbone down to the top of the leg bone - like the seam down the side of pants or shorts. The seam should not tilt forward at the side of the hip. Straightening with a hip tucking maneuver returns your spine angle from tilted to vertical and to neutral. You will have the needed slight lumbar curve when you use neutral spine. Keeping neutral spine instead of allowing the hip to tilt uses your abdominal muscles. The key is that neutral spine strengthens your abs. It is backward to strengthen your abs hoping that will automatically give you neutral spine.
Don't Lean / Tilt / Slouch Your Upper Body Backward
Your pelvis may be vertical and hip perfectly level at the belt line. You can still have too much inward lumbar curve if you lean your upper body backward. I have named it "Thoracic Lean" for lack of a better name (and am still working on a better name). Leaning back is common and there are several reasons people do it. Mostly it is simple slouching. Often people do it deliberately, mistakenly thinking they are "standing up straight." However, instead, of straightening their rounded upper body or bringing only the shoulders back from rounded forward position, they are actually leaning the whole upper body backward. Leaning the upper body back even used to be taught as posture, military style.
Here is one way to tell if you lean back: Turn sideways and look in a mirror. See if you can tell, and if you can feel the slouch or tilted position. Bring your upper body forward (not by rounding it, but by no longer leaning back) enough to become upright, not tilted back. Keeping neutral spine instead of allowing the upper body to tilt back uses the abdominal muscles. Taking side-view photos also helps, if you use them to actually see where your body is in space in relation to where you think it is. The key is that neutral spine strengthens your abs. It is backward to strengthen your abs hoping that will automatically give you neutral spine.
Got the Core? Get the "T"
Fun t-shirt shows how to use abdominal and core muscles for real life lifting and activity.
Click image or link for easy fun, abdominal muscle reminders.
What About Hamstring Stretching To Fix Lower Back Pain?I did studies that found no relation between hamstring flexibility and lower back pain For pain caused by hyperlordosis, flexing the back (bending and or rounding forward) when they stretched was temporarily stopping the pain because it stopped the hyperlordosis - although only temporarily for the duration of the stretch. They often went right back to standing with too much arch when they got back up off the floor. A while later, the back would hurt again from the crush of the overarching. Another stretch, and the pain would seem to go away. It was the back stretch not the hamstring. That stretch became further confused with flexibility. Even though the stretch itself was not as healthy as it cold be. Neutral spine would have avoided the whole cycle of mistaken identity. Click to see more about those studies.
What The Ab Revolution Book Has That This Article Does Not
My goal is that if you have pain from hyperlordosis, explained above, that you correct it to neutral spine right then with my information. I am the pioneer in hyperlordosis research. I spent years to identify and quantify this previously ignored source of so much lumbar and sacral pain. I want the world to be a better place with healthier happier people intelligently applying this breakthrough method. If this article alone fixes your pain, I am thrilled!
The full book has many more examples, expanded explanations, photos of the same principle applied to many different needed real life examples, and much that can be immediately put into use by those who want to teach, coach, lead health programs, help patients right in the office, or just make their own lives better.
PART I shows how to stop lumbo-sacral pain during various upright activity in daily life, both non-active and active, such as long standing, walking, running, overhead lifting. It has many examples, (yes, neutral spine, repeated) for all the different times that this principle is needed, but usually forgotten. There are photos showing overarched and corrected position for standing, walking, reaching, bending, running. This Part ! should show you how to stop the pain. No exercises fix the cause of the pain - that is a fad and a myth - unless you also stop the injurious and painful hyperlordosis too. Part I makes sure you have the examples needed. For all the different ways people learn, it also gives several (I think seven) different ways to understand, learn, incorporate, and internalize what is neutral spine and how to achieve it. It reinforces functional exercise as a lifestyle. Does the book need to repeat the concept for each different activity with photos and descriptions? Readers asked me to, and have shown me that they need it to!
PART II gives many more exercises. Innovative exercises are shown with overarched and corrected spine position photos and descriptions. The purpose is so that you can exercise in healthier ways using neutral spine for all the various exercise you need for health benefits, to improve sports skills, and for impressive abs if that's what you want. Don't confuse exercising with the simple PART I retraining that shows you how to stop a painful overarching habit, but that does not require any exercise to do it. The many (many) exercises are a variety of kinds and levels of difficulty so that everyone can try, and those who want, can advance. They teach many innovations in functional exercise and fitness. My book Health & Fitness - How to be Healthy Happy and Fit for the Rest of your Life has a chapter summarizing the topic, plus chapters on most everything needed for what the title says. See book descriptions on the BOOKS page so you can get all the books or eBooks that suit your needs.
NOTE - if you get The Ab Revolution book, check which edition is being sold. Make sure you get the FOURTH Edition, not earlier editions. My web site books page has example cover photos of the right edition.
How Long Does It Take To Stop Lower Back Pain With The Ab Revolution?
If your pain comes from swayback - overly arching your lower back - you should feel the pain and 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 all the following.
- Check what you are doing compared to what is presented above (if it still hurts you ARE doing it wrong). Are you still leaning your upper body backward? Did you push your hips forward instead of tucking (tilting) under to straighten? DId you round your upper body forward instead of becoming straighter?
- Are you doing bad exercises from other sources? It is common to do a few movement from my work, but continue or add injurious moves from other sources that slow recovery and re-injure.
- Are you tightening or clenching any muscles? Tight muscles can hurt and impede healthy movement. Although it was an almost universal fad to "tighten" ab muscles, tightening does not change faulty movement, inhibits normal breathing, and can make pain of its own.
- Are you overcompensating? Are you making new bad movement habits that seem opposite of original unhealthy movement thinking that will "undo" or fix?
- Are you changing this work from exactly the way it is presented into something you have heard elsewhere? This work is different.
- Is something else causing the pain, such as infection, shingles, growths, or other non-movement based situations?
If you did not have hyperlordosis before, (no swayback and no upper body lean back), then reducing the arch will not change your 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.
Summary - No More TighteningThis is new and different from what we learned in school and at the gym. New research has shown 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. Tightening muscles does not change your posture. The "support" does not come from tight muscles, but using them to a healthy spinal angle:
- One kind of lower back pain comes from too much inward curve in the lower back. Too much inward curve can come from tilting the pelvis, or leaning the upper body backward, or pushing the pelvis forward, or any combinations of those three. Changing the painful posture means moving your spine like moving any other body part. Move out of painful spinal angle to vertical pelvis and neutral spine. Use healthy neutral position, easily, no matter what you are doing or carrying.
- The postural change is right then and there. No lengthy treatments needed.
- Learn the repositioning to prevent too-large inward curve to the lower back. Use that for how you stand and move in real life, not merely as an exercise.
- When you stand, walk, run, or lift overhead, notice if you are allowing a large inward lumbar curve - hyperlordosis. See if you are tilting your pelvis forward at the top and outward in the back. Tuck (pelvic tilt) back to upright vertical pelvis and neutral spine. Don't tuck so much that it huts - but so that it does NOT hurt. If it hurts, you are not doing it right.
- Make sure you know the difference between tuck (change angle from tilted to less tilted) and "push forward." Don't push your hip or pelvis forward, as that increases hyperlordosis, not decreases it. Don't "do" postures as a rule, understand what you are doing to hurt and change to healthier ways. Use your brain.
- When you carry loads in front of your body, don't lean back to "balance it" or stick your backside out, increasing the lower back inward curve (don't increase normal lordosis to hyperlordosis / swayback).
- With packs on your back, don't lean back or hunch forward.
- With a bag on one shoulder, don't let it pull you to the side; simply use your own side (oblique) muscles to hold upright posture against the sideways pull. It's free exercise and it's good for you.
- Does my work mean you never do any flexion? Of course not - that is misunderstanding the concepts. The idea is notice if you spend most of your day that way and then use flexion exercises on top of that. Then it is no mystery why you hurt. Understand, don't memorize blanket and arbitrary rules. Please don't combine other people's injurious stretches and exercises then come back to me and say my work isn't fixing that.
- Dont memorize rules and postures or think that an exercise or kind of exercise will fix back pain, - which is more likely from a number of all your bad movement habits.
- Often people tuck too hard, or tighten, or push their hip / pelvis forward instead of changing the tilt, then claim neutral spine is wrong or does not work. Use a side view mirror and learn to feel and tell how you are moving your body. Also if your pain is not from a too large too large tilt and you use neutral spine, don't complain it isn't fixing your pain just as you wouldn't, with any consideration, blame penicillin for not fixing your back pain unless your pain was from something needing that particular cure. Most of the people coming to me saying that neutral spine is making them hurt or isn't fixing their pain turn out to not be using neutral spine or actually able to produce it. If it hurts, you're doing it wrong. Make an appointment with me instead of debating the same wrong points on Internet forums.
Don't Change These Concepts and Methods Back To "What You Know" (Ingrained Wrong) - These Methods Work Only As Written and Intended:Henry Louis Mencken said, "Any man who afflicts the human race with ideas must be prepared to see them misunderstood" Even so, please don't change my work back into what you know, or what others say, or what you learned somewhere else. his is different and works differently than the pop fads that have become ingrained in fitness and health. To paraphrase Bertrand Russell, "An untrained man's report of what a knowledgeable man says is never accurate because he unconsciously translates what he hears into something he can understand." My work is primary source, and often - not what we learned in school and the gym. Remember, that is good.
With This New Knowledge of How The Core Works:
- You can stop this kind of lower back pain immediately
- You'll know why your lower back hurt and how to prevent this kind of pain from returning
- You'll strengthen your abs without going to a gym.
- You'll burn calories.
- You'll be straighter and taller.
- You'll save your back without having to do exercises.
- You'll be healthier.
- You'll exercise your brain.
- It's a whole different way of thinking about abs.
- It's a revolution.
(to keep this article a quick and easy summary, much is left out. The books tell more.)
What To Do Next:
Now your back pain from hyperlordosis is gone and your abs are better. Look how much you saved on ab machines and medical care :-) You can give to the poor, put a nice amount in the donation box - secure and safe through PayPal - and still have enough left for a vacation.
I have no salary or paid time or job to write all this and make this site. Donations go toward domain and site hosting so you can have these articles, and developing more methods for YOU. It's far less than the thousands most people spend on random exercise programs, special beds, and constant medical treatments for something that should, and can, be quickly stopped and prevented with this direct method.
thank you !
If you want to tell me this is all wrong, and someone else told you to stick your hip far out because it is natural and people do it in undeveloped countries, use the donate box ($50 is good) to write me your complaint. Keep in mind that I get frequent reports from doctors working in "natural undeveloped countries" where they see back pain from hyperlordosis in their clinics daily. They find that teaching this technique stops the pain.
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The Fitness Fixer - Dr. Bookspan's column on Healthline for 4 years. Almost 800 free articles archived so you can still use them to change exercise to healthier ways. Check for articles on disc pain, shoes, sciatica, back pain, nutrition, and more by alphabetical listing. Click here for fun Index. Updates through Twitter, above.
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Mental & Emotional Training - a page of Dr. Bookspan's short articles for stronger emotional health.Fixing Lower Back Pain With Fitness as a Lifestyle (Functional Fitness). Not fake fitness, reps of back exercises, or purchasing training "plans" and back pain devices, but making your daily real life into your own mental, emotional and physical playground of strength mobility and health.Cool T-Shirts, Mugs, Mouse pads, More. T-shirts for teachers and slouchers, mugs that remind healthy neck for drinking, Learn and promote functional health with UNcommon sense gifts from the Academy.
Books and eBooks. All my books together cost less than your pain killers,and show you how to stop needing them and be healthier than before. Fun, easy to read, illustrated, immediately helpful. More book descriptions and info, signed books straight from the author, eBooks, Kindle, and more CLICK my BOOKS page.
Healthy Martial Arts - top level book for all athletes to train thinking, spirit, and top performance
Health & Fitness THIRD edition - fix pain plus healthy living.
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