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Outsmarting Lower Back Pain (Feldenkrais based)
 9780976942108,  0976942100

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I "A revolutions #.Vjj j t s i i u ' j

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to solving the low back pain puzzle."

Your solution to low back pain is finally here with this innovative step-by-step program!

Outsmarting Low Back Pain Gordon Browne, PTGCFP Julie Browne, PTA GCFP

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welcome "A revolutionary new approach to solving the low back pain puzzle.' www.outsmartinglowbackpain.com

Copyright © 2005, Movement Matters, Inc. ISBN 0976942100 / LCCN 2005904765

Table Of Contents

Table Of Contents Chapter One: Introduction Introduction

2

Chapter Two: Assessing Your Individual Bias Assessing Your Individual Bias

18

Movement Bias Checklist

24

What Hurts Checklist

28

Chapter Three: Bracing Your Back Bracing Your Back

31

Lesson #1 "Bracing Your Back"

34

FYI #1 Tricks of the Trade

36

Lesson #1 Drills

37

Lesson #2 "Balancing Your Pelvis"

38

Lesson #2 Drills

40

FYI #2 "This is Hard".

...43

Chapter Four: Using Your Legs To Move Your Pelvis Using Your Legs To Move Your Pelvis

46

Lesson #3 "Psoas Psit-ups"

48

Lesson #3 Drill

49

FYI #3 Principles of Ideal Movement

51

Lesson #4"Floor Sit Bending".

52

Lesson #4 Drills

53

FYI #4 Stretching

55

Lesson #5 "Hip Circles"

56

Lesson #5 Drill

57

Table Of Contents Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

59

Lesson #6 "Sit to Stand"

61

Lesson #6 Sitting Drills

62

FYI #5 Modest Sitting

65

Lesson #7 "Bending from Standing"

67

Bending Drills

71,72

Standing Drills

73

FYI #6 Your Back"Bank Account".

77

WIFS Drills

79

FYI #7 The Goldilocks Effect

82

Squatting Drills

~

83

Chapter Six: Controlling Rotational Stresses Lesson #8 "Log Rolling"

92

Rotational Drills

94

Lesson #9 "Anchoring Your Feet"

95

More Rotational Drills

97

Chapter Seven: Recognition and Control of Walking Stresses Recognition and Control of Walking Stresses

100

Walking Drills

104

Chapter Eight: Mobilizing Your Mid-Back Mobilizing Your Mid-Back

108

Lesson #10"Lengthening Your Spine"

111

Lumbo-Thoracic Differentiation Drills

112

Rotational Differentiation Drills

114

Table Of Contents Chapter Nine: Now What? Now What?

118

Master Checklist Master Checklist

128-133

Reference and Acknowledgement Reference and Acknowledgement

135

Chapter One: Introduction

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\ "A revolutionary new approach to solving the low back pain puzzle.1 www.outsmartingiowbackpain.com

Chapter One: Introduction

This program is all about movement.. .recognizing how you move now and how you could move better. With this video program, you will discover specific movements or positions that are pleasurable for your back while learning to recognize and control movements or positions that increase your back pain. You will learn to wake up unused parts of your body.. .by getting other muscles and joints off the bench and onto the field so your low back can get a breather. Learning to move in other places and using different muscles allows the abused parts of your back time to rest, heal and ultimately helps to prevent future back episodes or further back breakdown. With this program, you will learn to take charge of the situation, to know what to do and to have the physical skills to accomplish what you want. If this notion of taking responsibility for your pain and taking credit for your recovery appeals to you, you have hit the mother lode in this program! What Approach is Right for You? Have you noticed the many ways of treating low back pain there are? Chiropractors adjust vertebrae, massage practitioners release fascia and physical therapists strengthen muscles. Doctors prescribe pills, acupuncturists channel your energy and surgeons cut away small parts of your body. Even among the different disciplines there are many different approaches to the problem and many differences of opinion on what is wrong and what can be done. Some people seek to relieve back pain by adjusting their surrounding environment. Purchasing a new bed, wearing different shoes, using a back brace, sitting in an ergonomic chair, standing on a cushioned surface and wearing orthotics are some examples of external adjustments. The underlying premise here is that you can adjust your ENVIRONMENT to control your back pain. Others seek to relieve back pain by adjusting their body's environment. Taking medication to change your chemistry, receiving a massage to relax your muscles, getting an adjustment from a chiropractor or an osteopath to align your bones, submitting to an intense session of deep tissue massage to release fascia, getting zapped by ultrasonic waves or electrical stimulation or poking your skin with needles to improve energy flow are some examples of internal adjustments. The underlying premise here is that an EXPERT can adjust your body in such a way as to reduce back pain.

Chapter One: Introduction

If you have tried any or all of these solutions to low back pain and have had excellent results, fantastic! If you have tried various solutions with partial success or if none of your fixes have worked to your full satisfaction, don't despair. You probably haven't tried everything yet! What else is there besides external adjustments of your environment and internal adjustments made by a professional? You could try making your own homegrown internal adjustments. Consider the possibility that there might be something not entirely perfect with the way you are moving and posturing your body, that the way you move and hold yourself might have something to do with your back pain. The underlying premise here is that YOU can control the way you use your body in such a way as to reduce back pain. Most of us are not used to paying attention to how we move and use our bodies; we put our bodies on autopilot and go along for the ride. Imagine how your back would feel if you could understand and learn to recognize for yourself what you are doing to strain your back, what makes it hurt? What if you could understand and learn to control those strains by changing the way you use your body? What if you could recognize and recalibrate your habitual and unconscious muscle and postural imbalances; getting your back off autopilot and taking charge of the controls? What if you could find ways of moving your back that make it feel better? YOUR BACK WOULD FEEL BETTER...YEE HAW! Medical Model and Movement Model of Low Back Pain Traditionally, we in the medical professions have treated low back pain with a medical or pathology model. We want to identify the tissues that are to blame and affix a diagnosis. Is pain coming from bone, connective tissue, discs, joints, nerves or muscle? As a physical therapist, I was trained in various pain provocation tests designed to identify irritated tissues. Once identified, we then treat the affected tissue with modalities (heat, ice, electrical stimulation or ultrasound), manual joint mobilization, tissue release techniques or exercises to stretch or strengthen individual muscles, joints or fascia around the affected area. This medical model of low back pain is a very logical approach, and one that works to some degree of success with many people. For the rest of this book and video, however, we will be working with a movement model of low back pain. In this movement model of low back pain, we are concerned less with the specific tissues at fault and will focus more on the specific movements or postures at fault.

Chapter One: Introduction

A movement model of low back pain starts with a fundamental question: how did those tissues become inflamed, herniated, subluxed, degenerated or spasmed in the first place? Tissues become irritated in response to injury, and injuries can be due to either trauma or repetitive stress. Traumatic injuries include falling from a second story window, getting in a car wreck or slipping and falling down a flight of stairs. Repetitive stress injuries are both far more common and much more insidious than the traumatic kind. These injuries are a direct result of how we organize our bodies to move in the course of our daily lives. You might: Stand in such a way as to compress facet joints. Sit in such a way as to overstretch ligaments. Bend in such a way as to pop a disc. Twist in such a way as to grind the sacroiliac joint surfaces together. Lift in such a way as to strain the deep muscles of the lower back. Over time, these habitual repetitive strains add up. Eventually, muscles become chronically fatigued and joints and discs begin to degenerate because of too much movement in a particular direction. These chronically strained tissues become easy pickings for the next potential injury that comes along. All it takes at that point is the final straw.. .getting out of your car, bending over to pick up the newspaper, lifting the garbage can, reaching across your desk or stepping unexpectedly into a pothole in the sidewalk. If your low back pain is a result solely of traumatic injury, you will certainly benefit from a course in remedial movement education to assist in your recovery. You will want to restore full movement and function of both the injured parts and associated areas to prevent scar tissue formation and any altered movement or postural patterns that may make future back trouble more likely. If your low back pain is a result of repetitive stress injuries, you will definitely benefit from a course in remedial movement education by learning to recognize and control postural and movement stresses. This is the essence of a movement model of low back pain: how am I moving or posturing myself to cause or perpetuate my pain, and what can I do to change how I move so I don't abuse my back?

Chapter One: Introduction The Power of Habit Why do we damage ourselves the way we do? How could we be our own worst enemy? Why don't we automatically sense when we are hurting ourselves and change the way we do things to reduce that stress? Basically, because we are creatures of habit and most of us are not used to paying attention to the way we use our bodies. A Russian researcher named NA Bernstein first articulated a conundrum of human movement in 1967: we have more choices in movement than we know what to do with. Bernstein's Problem states ".. .with such large numbers of degrees of freedom possible in the human body, the controlled operation of such a system requires a reduction of redundancy and a reduction of the number of degrees of freedom." In other words, with so many bones, joints and muscles in the human body, there are an almost infinite number of possibilities in movement and posture. Because we don't want to reinvent the wheel each time we reach for a glass of water, walk out to the mailbox or bend over to pick up our shoes, we develop motor habits. We create our own unique postural and movement habits out of necessity to reduce the chaos of too many choices. We learn these habits primarily in early childhood, but they can then be influenced by injury, occupation or chronically fixed emotional states. Our habits are invaluable and necessary. Imagine the complexity of driving your car with a separate steering wheel for each tire and multiply that difficulty by a hundred! We want the whole system (chassis or skeleton) to respond to a simplified request (turn the steering wheel one way, reach for your drink, pick up the laundry basket or lean over to kiss your kid). Habits are good in that they simplify our movement choices, and we can put our bodies on autopilot while we focus our conscious attention on more important matters. But, habits can be bad too. If our movement or postural habits are inefficient or poorly organized in the first place, we place undo strain on certain tissues. Even if our movement and postural habits are efficient, but imbalanced and invariable, we still place undo strain on certain tissues. Invariable means moving the same joints into the same directions, stretching the same ligaments, shearing the same discs and contracting the same muscles all the time. Our habits create wellworn pathways, yawning ruts in the road that inflict repetitive stress injuries on the lower back. Our habits are so intimately interwoven into our lives, and have been with us for such a long time, that we become oblivious to their existence. Our habits are so successful in allowing us to ignore our bodies that we all do just that. We might know something about care and feeding; diet, sleep, 5

Chapter One: Introduction

not smoking and regular cardiovascular or muscle building exercise. Sadly, most of us have no idea how we use our bodies in movement, how the way we move our bodies can contribute to our musculoskeletal misery or bliss. We don't know enough about musculoskeletal hygiene! The rest of this booklet and video is designed to lift the cloak of invisibility off your movement habits and to educate you on how you can outsmart your low back pain. What You Need to Learn and How You 're Going to Learn Lt To be successful in your struggle against low back pain, you will need to develop some movement skills. Some of these movement skills are physical skills. You will need to develop some specific physical skills for your particular movement bias: • • •

Joint mobility in habitually tight places. Muscle strength in habitually weak places. Fascial or muscleflexibilityin habitually tight places.

Some of these movement skills are self-awareness skills. Self-awareness skills include an ability to perceive: • • • •

Your own unique movement and posture patterns. Muscle effort or relaxation. The relationships of different body parts to one another. Your relationship to gravity.

How are you going to learn these physical and self-awareness skills? By getting down on the floor, moving your body in complex and unusual ways and by paying attention to how you are moving. In just a short while you will be cracking open the video section of this program and will be engaging in a series of exercises or movement lessons designed to improve your competence in both categories. These exercises are very specific and unorthodox in both what types of movements are performed and the way you will learn them. The exercises are designed to be informational. Informational Exercise Obviously, generic exercise alone is not the whole answer to the back pain riddle. When doing repetitive exercises, you are getting physiological benefits: cardiovascular fitness, blood flow, blood pressure, etc. However, it's very likely you are just moving the way that you always do. You 6

Chapter One: Introduction

may even be reinforcing your damaging motor habits. The kind of exercise you need when dealing with low back pain is not quantitative: how heavy are the weights, number of repetitions, time and distance of a run, time spent on the bike or calories burned. The style of exercise you need when dealing with low back pain is qualitative: how coordinated, smooth, balanced, comfortable, efficient, fluid and stable. There are three primary characteristics of informational exercise: • • •

Proprioceptive Self-Awareness- Pay attention to quality of movement when you exercise.. .nothing is going to change if you keep it on autopilot. Functional Context- Exercise that mimics real life.. .and that improves your ability to function in real life. Pattern Specificity- Exercise individual pieces as part of the whole.. .looking at relationships between your lower back, pelvis, legs and chest/upper body.

Our first principle, being proprioceptively self-awareness during exercise, means paying attention to what you are feeling.. .listening to what your body is telling you. If you know what you are doing with your back, you are able to avoid or control damaging movements and arefireeto choose more pleasurable options. Your proprioceptive listening skills are your compass for finding your way out of the low back pain wilderness. When following the movement instructions on the video, you will be cued to pay attention to certain things. Your attention might be directed to your contact against thefloor,to your perception of muscle effort or your awareness of distinctions between two different movement options. Don't worry; this is not a test and it's really not as hard as it may sound. Just give it a try and I'm sure you'll get the hang of it! Our second characteristic of informational exercise, linking exercise to functional context, means making movements that relate to everyday activities. We move in the real world for some definable reason...our exercise should have a purpose; something that relates to how we function in the world. We move to orient ourselves to our environment: to see, hear, taste, touch and smell. We move to balance ourselves: we have a need to be upright and to keep from hitting our head on the ground. We move to manipulate objects: to push, grasp, kick, caress, strike, rub, pull or throw. We move to locomote: to walk, run, climb, swim, crawl, jump or ride a bike.

Chapter One: Introduction



We move to change positions or to make transitional movements: rolling from our side to our back or moving from a chair to standing.



We move to communicate with others: movements of lips, tongue and breath while talking, as well as facial expression and body language. We move for vegetative purposes: to breathe, eat, eliminate body wastes or procreate.



The exercises that you will soon be performing are designed to weave specific functional contexts in with the movements you will be doing to enhance your physical skills (flexibility or strength). You will be directed to move for a reason: to control your movement front to back, to reach for an imaginary object, to move from sitting to standing, to take a step onto a stool, to look over your shoulder, to swing a pole or to roll from your side to your back. The third characteristic of informational exercise is pattern specificity. Pattern specificity refers to the need to take into account the relationship of your low back to other parts of your body. The movement or shape of your lower back relative to your hip joints and thighbones is the primary relationship we will be working with. The movement or shape of your lower back relative to your mid-back and chest is the second relationship we will be addressing. Specifically, you will need to know whether your low back is moving in the same direction as your hip joints or mid-back (a global relationship) or whether your low back is moving in the opposite direction (a differentiated relationship). Take a breath...read on and we'll explain in detail this idea. Pattern Specificity... Global or Differentiated, Habitual or Non-Habitual To illustrate the concept of pattern specificity in posture, let's take a look at a common example: the person who collapses backward in a rounded sitting position. (Fig. 1-1) In comparison to upright sitting posture, the person who slumps is rounding or flexing her spine. Simple enough so far. Now, what are the hip joints doing? Relative to the upright sitting position, the hip joints are moving in a direction of extension (straightening). This makes the relationship between the low back and the hip joints a differentiated one.. .back flexion and (relative) hip extension. If this person wants to sit up straight, she will need to make a differentiated movement of back extension and hip flexion.

Hip Extension

Fig. 1-1 Slouched sitting features a differentiated relationship between hips and back.

Chapter One: Introduction

Let's look at another example: the person who stands with a sway back (lordosis in medical lingo). (Fig. 1-2) In comparison to a more upright standing posture, the person who sways her back is arching or extending her back. Now, what are the hip joints doing? Relative to upright standing, the hip joints are moving in a direction of flexion or bending. This makes the relationship between the low back and the hip joints a differentiated one.. .back extension and (relative) hip flexion. If this person wants to stand without the sway back and the postural strain this exerts on her low back, she will need to make a differentiated movement of back flexion and hip extension.

Back Extension

Hip Extension

Fig. 1-2 Swayback standing is another example of differentiated hips and back.

These examples are postural, but movements can be categorized as global or differentiated as well. Rounding your back from a hands and knees position is a simultaneous movement of back

Fig. 1-4 Some everyday movements require differentiated hips and back.

Fig. 1-3 Some common exercises feature differentiated hips and back.

flexion and (relative to starting position) hip extension. (Fig. 1-3) Moving from sitting to standing may involve a movement of simultaneous hip flexion and back extension. (Fig. 1-4) In fact, most common movement and postural patterns we perform as adults are of the differentiated variety. Ergo, most of the movements we should be practicing in informational exercise are of the differentiated variety.

1

Fig. 1-5 Some common exercises feature a global flexion relationship between hips and back.

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Hip

^C^gEcmcp. Jf~~— Flexion Back Flexion

f

What does a global movement look like? Abdominal crunches feature a global flexion movement: back flexion and hipflexion.(Fig. 1-5) Lying on your

Chapter One: Introduction

back over a large ball is a global extension movement: hip extension and back extension. (Fig. 1-6) Raising your arms, head and legs to look forward while lying on your belly is a global extension movement common among the very young and common in many exercise systems: hips and back are extending. (Fig. 1-7) Curiously, many of the exercises prescribed for low back pain are of the global variety.

Hip Extension Back Extension

Hip Extension

Fig. 1-6 Other exercises feature a global extension relationship.

Fig. 1-7 These types of global extension exercises should not be done by everyone.

Single or double knee to chest (global flexion) and diagonal arm and legs lifts in various positions are some other common exercises using global movement patterns to influence a differentiated world. This is not to imply that these exercises are wrong. They may in some cases be used initially to wake up some lazy muscles or give some comfort to your back. But if you do these global types of exercises, they should be only a beginning. At some point, you should be progressing to the more functionally relevant differentiated movements in exercise. To take this idea of pattern specificity a step further, you will also need to be aware of which differentiated movements or postures get you into trouble and which ones can help to get you out of trouble; which patterns are habitual and non-habituall You will want to de-emphasize movements and postures that take you into your direction of instability and discomfort; these are usually your habitual differentiated patterns of posture and movement. Therefore, you will be particularly keen to exercise into your non-habitual differentiated directions of movement. You'll need to move differently to feel better! By moving non-habitually, you will: • • 10

Strengthen habitually weak muscles and stretch habitually tight muscles, fascia and joints. Relieve stress on chronically complaining tissues and give them hope that reinforcements have arrived.

Chapter One: Introduction

• •

Teach heretofore uncooperative groups of muscles to play nice together for the first time in a long time. Reinforce new motor habits and reward yourself with improved comfort and ability to function.. .not to mention the glow of pride you will bask in as you learn a brand new movement skill!

Go to your Video... Start at the Beginning And Watch the Introduction and Overview Continue by previewing the self-assessment session if you want to get a heads up on where we are going. Return to the booklet and finish this chapter, start reading chapter 2 and follow the directions for when to perform the self-assessment session. Habitual Differentiated Patterns Create Habitual Muscle Imbalances Let's take a look at some of our examples of postural biases and extrapolate to likely muscle imbalances. Why do you need to know this stuff? You don't, really. You could skip this discussion and continue with chapter two if it makes your brain ache. But, there are advantages to understanding who the principal actors are and what roles they have to perform in this upcoming play. Take a quick peek at the underlying bones of the spinal system. (Fig. 1-8) The spinal system consists of a bowl shaped pelvis at the bottom, 24 odd shaped connecting bones called vertebrae, 24 ribs and a head that balances on top of the whole pile. Bones act as spacers and levers and are moved by muscles. The muscles you will want to pay particular attention to during the exercise sessions are those muscles that are too short/tight and those muscles that are too long/weak. Having an understanding of the likely relationships between your habitual postural and movement biases and your muscle imbalances will make the exercises you perform that much more informational.

Longissimus capitis

Fig. 1-8 The back extensors arch your back or help prevent it from rounding.

What are the likely muscle imbalances for the stick person in Fig. 1-1 whose pelvis is rolled back on the seat and whose back is round through its entire length? If you look at the trunk, you will 11

Chapter One: Introduction

see that the front is shorter than the back: the muscles along the back of your spine (Fig. 1-8) and the muscles between the ribs on the back of your chest are longer than the abdominal muscles and the muscles between your ribs on the front of your chest. (Fig. 1-9) In this falling back position, the muscles on the front of her body are working to help prevent her from falling over backward. Try this out yourself if you'd like. Sit in a chair toward the front edge of the seat and roll your pelvis backward on the seat, letting your whole back round backward. Can you feel the effort in your stomach muscles? Try exaggerating the sensation by leaning back a little farther, as if to barely touch your mid-back to the seat back behind. Feel the effort in your belly.

Fig. 1-9 The abdominal muscles round your back or prevent it from arching.

Therefore, we could anticipate that likely muscle imbalances at the torso would be short and contracting stomach muscles and long and weak back muscles. So, why_ not just strengthen the back muscles and stretch the stomach muscles and call it good? While that is part of what she should be doing, we still have to take into account what is happening in the hip joints. Recall that this posture is a differentiated one and that we need to address muscle imbalances at the hip joints, as well as at the torso. What are the likely muscle imbalances for the person in Fig. 1-2 who rolls her pelvis forward on her legs and arches through her back? Likely muscle imbalances at the torso will be just the opposite of the person who rounds all the time. The person who arches all the time will be short and tight through the back muscles and will be weak and long in the abdominal muscles. And, though part of what she should be doing is to strengthen her belly and stretch her back muscles, we again have to take into account what is happening in the hip joints.

12

Chapter One: Introduction

Muscle Imbalances at the Hip Contribute to Lumbar Imbalances and Instabilities Take a look at some muscle illustrations. The gluteus maximus (Fig. 1-10) and hamstrings (Fig. 1-11) are muscles in the back of the hip and thigh. They extend or straighten your hip joints... they move your thighbone backward relative to your pelvis. Or, with your foot on the floor, straightening your hips acts to roll the top of your pelvis backward.. .this is called posterior pelvic tilt. (Fig. 1-12) This roll of your pelvis into posterior tilt acts to round your lower back.

Ischial tuberosity Level of cross section Semitendinosus Tendinous inscription

Biceps femoris, long head

Semimembranosus Biceps femoris, short head

Gluteus maximus

Fig. 1-10 The gluteus maximus straightens your hip or rolls your pelvis into posterior tilt to round your back.

Medial condyle of femur Tibia

Lateral condyle of femur Fibula

Fig. 1-11 The hamstrings act with the gluteals to straighten your hip or flatten your back.

Fig. 1-12 When the top of the pelvis is pushed back by the gluteals and hamstrings, the back rounds.

13

H

Chapter One: Introduction

Other muscles that tend to work with the gluteals and hamstrings are the deep external rotator muscles of the hip (Fig. 1-13) and the abductor muscles on the sides of the pelvis.. .the gluteus medius (Fig. 1-14) and gluteus minimus. (Fig. 1-15) We could collectively call these hip muscles that straighten your hips and round your back your hip extensors. Gluteus maximus (cut) Gluteus medius (cut)

Gluteus minimus Piriformis Superior gemellus Obturator k internus nferior gemellus

Greater \ sciatic foramen Lesser sciatic foramen

Obturator internus

Obturator externus

/

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Ischial tuberosity

" ^Quadratus femoris

Sciatic nerve Fig. 1-13 The deep rotators of the hip provide rotational stability of your pelvis and commonly act with the hip extensors.

Gluteus medius

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•• 3 I Gluteus maximus / (cut) Gluteus

minimus

Gluteus maximus (cut)

Fig. 1-14 The gluteus medius also provide lateral stability of your pelvis and works well with the hip extensors.

Gluteus maximus

Fig. 1-15 The gluteus minimus tags along with the other hip extensors.

These are the muscles that are responsible for reducing the sway back posture of Fig. 1-2. When they are too tight, the hamstrings and other hip extensors prevent full bending of your hips, which prevents your lower back from arching or straightening. When the hip extensors are too tight, they act to create the slumping posture of Fig 1 -1. 14

•i H H H H H

H H H H

•1 H

Chapter One: Introduction

\

Another major muscle group around your hip joints are the hip flexors...they act to bend your hips and to arch your back. The psoas and illiacus (Fig. 1-16) and the rectus femoris (Fig. 1-17) are muscles in the front of your hip and thigh. Other muscles that tend to work with your hip flexors are your adductors, the muscles on the inside of your thigh (Fig. 1-18)

Level of cross section r—Psoas minor

Wm,

nS H

Pectus emoris

Vastus 1||1 lateralis—UH

tit*

—Vastus medialis

Pubic bone ^Lesser trochanter -Femur

Fig. 1-16 The illiopsoas bends your hip or rolls your pelvis into anterior tilt to arch your back.

Lateral 111 ^SSBP ,^ Patella patellar WMJSF' retinaculum--^!!?!^-®!' ^ Medial patellar Patellar sS-wf retinaculum ligament'—r -—Tibial tuberosity — Tibia

Fig. 1-17 The rectus femoris is part of the quadracep group and is another hip flexor that arches your back.

Adductor magnus (adductor minimus part) Pectineus (cut ends) Adductor magnus (posterior attachment) Adductor brevis (posterior attachment) Adductor longus (posterior attachment) Adductor magnus (posterior attachment)

Obturator foramen Pubis Adductor brevis Adductor longus Adductor magnus (middle part) Adductor magnus (ischiocondyiar part) •Tendinous (adductor) hiatus

Femur Patella

Fig. 1-18 The hip adductors provide rotational stability and tend to follow the hip flexors.

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15

Chapter One: Introduction

Your hipflexorsbend your hip joints.. .they move your thighbone forward relative to your pelvis. Or, with your leg effectively heavier than your pelvis in most positions, these muscles act to roll the top of your pelvis forward.. .this is called anterior pelvic tilt. (Fig 1-12) This roll of your pelvis into anterior tilt arches or extends your lower back.

Hip Flexors

Fig. 1-19 When the top of the pelvis is pulled forward by the hip flexors, the back arches.

Your hip flexors are responsible for hauling your pelvis back upright from its falling back position (Fig. 1-19) and for reducing the slumping posture of Fig. 1-1. When your hip flexor muscles are too tight, they prevent full straightening of your hips and act to create the sway back posture of Fig 1-2. Shortly, you will be doing some self assessment drills in which you will be making some educated guesses about your own likely movement bias and muscle imbalances. You will be asked to place yourself into one of three broad categories: arching biased, rounding biased or multidirectional instability. Knowing what instability category you fall into will guide you in determining which particular movement skills you will need to learn. This next chapter begins to ask questions about individual movement and postural bias.. .what are you doing that might contribute to your back problems? Notes:

16

Chapter Two: Assessing Your Individual Bias

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"A revolutionary new approach to solving the low back pain puzzle.' www.outsmartinglowbackpain.com

Chapter Two: Assessing Your Individual Bias

Which Way Does Your Pelvis Fall? When we talk about individual bias in your low back, what we are talking about is the habitual shape and position of your back and pelvis relative to vertical. Just like having a preference for orange juice over coffee or action films over romance films, your nervous system has a preference, or bias, in using and positioning your lower back. Let's look at habitual positioning, or posture, first. Posture is extremely complex, and no one individual is exactly like another, but we are going to simplify things a bit by separating initially into two categories. Our first assessment of postural bias is a grossly simplistic one: do you tend to allow your pelvis to roll forward or backward? We are starting with the pelvis because the position of your pelvis determines the shape of your lower back. The front-to-back balance of your pelvis on a chair seat (sitting) or on top of your legs (standing) is the primary distinction we will make initially because front-to-back is the direction of maximum instability for your pelvis.

Fig. 2-1 A bicycle is unstable left/right and stable front/back.

Fig. 2-2 The pelvis is unstable front/back and stable left/ right in sitting. 18

Think of the direction of stability of a bicycle. Because of the arrangement of the wheels, a bicycle is very stablefront-to-backbut very unstable left-to-right. (Fig. 2-1) Now, contrast thefront-to-backstability and side-to-side instability of a bike with the side-to-side stability and front-to-back instability of the pelvis in sitting (Fig. 2-2) and standing. (Fig. 2-3)

Fig. 2-3 The pelvis is still unstable front and back in standing.

Chapter Two: Assessing Your Individual Bias

Pelvic Bias Creates Instability in Your Low Back Obviously, this "two-legged stool" arrangement of the pelvis in sitting or standing is not very stablefront-to-back.With this arrangement, the pelvis is always in the process of falling either forward or backward. Ideal posture would be one where the pelvis falls a little bit in one direction, is immediately perceived and pushed back upright by the appropriate muscles, then falls in the other direction. This movement in the opposite direction is then immediately perceived and the opposite muscles take corrective action. This subtle wobble from front-to-back would allow the spinal joints and discs to remain close to a neutral place and would help maintain a balance between the opposing muscle groups of the trunk, pelvis and hip joints. This is analogous to trying to balance your kitchen chair on two legs or balancing your bicycle without a kickstand.. .recognize the direction of fall, make the correction and wobble back and forth so both muscle groups can have their chance to both work and rest. Sadly, the ideal is not the norm. What the vast majority of us do is to allow our pelvis to fall in one direction or the other, and then hold that "fallen" position with muscle effort, joint compression or connective tissue stretch. Imagine letting your kitchen chair or bicycle fall in one direction and holding it there.. .this roughly simulates how posture and muscle imbalances are created. No big deal at first, but hold that chair or bike exactly there for a half hour and see what gets tired, strained or irritated by the invariance. Over time, these invariant positions lead to chronic stresses on the same muscles, joints, discs, nerves and ligaments. These invariant positions can strain tissues enough to cause pain relatively early in life or may accumulate over time to create degenerative changes and slow breakdown of tissues that causes pain a little later in life. To control these strains, you will need to recognize what your pelvis and low back are doing.. .you will need to make a self-assessment about the habitual shape of your back and the habitual direction of fall of your pelvis. This book is not about self-diagnoses. Determining whether your pain comes from disc, joint, muscle, ligament or bone is the job of a medical professional. Fortunately, when proceeding from a movement model of low back pain, we don't necessarily need to have a specific diagnosis. Because you are out to change your own internal environment, all you need to know is available in your own body.. .all you have to do is listen to what your body is telling you, then take action on it.

19

Chapter Two: Assessing Your Individual Bias

Postural

Types...InitialSelf-Assessment

Let's look at some common postural types, as if looking at someone from the side. We will describe five types altogether: two involve rolling the pelvis backward, two involve rolling the pelvis forward and one features a vertical pelvis. After reading through the descriptions and looking at the illustrations, mark your initial guess about your perceived postural type on your Postural Checklist. To understand your posture, you need to know which way your pelvis habitually falls and how your spine reacts to that movement. Think of how your body reacts when you fall backward from sitting. As your pelvis rolls backward relative to vertical, your whole back

Fig. 2-4 The reaction to falling backward is to round the back.

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rounds and your head comes forward. (Fig. 2-4) Imagine the results of falling back without making this balance reaction^. (Fig. 2-5) This rounding movement of the spine in reaction to the falling back or rolling back movement of the pelvis is c&lledflexion.

Fig. 2-5 Those who didn 't learn to round when falling back are no longer with us.

What happens if you fall forward from a sitting position? As your pelvis rolls forward relative to vertical, your whole back arches and your head pulls back. (Fig. 2-6) This arching movement of the spine in reaction to the falling or rolling forward of your pelvis is called extension.

20

Fig. 2-6 The reaction to falling forward is to arch the back

Chapter iwo: Assessing Your Individual Bias

Two of our postural types involve rolling the pelvis backward (called posterior pelvic tilt) and flexing the lower back. Two of our postural types involve rolling the pelvis forward (called anterior pelvic tilt) and extending the lower back. The last postural type features a vertical pelvis and spine. Following is a list of the five postural types:

Fig. 2-7 A full round postural type.

Fig. 2-8 A full arch postural type.

1. The full round features a backward falling pelvis (posterior pelvic tilt) and a spine that rounds or flexes along its whole length. (Fig. 2-7) This type is pretty common. 2. The full arch features a forward falling pelvis (anterior pelvic tilt) and a spine that arches or extends along its whole length. (Fig. 2-8) This type is not as common.

Fig. 2-9 The half arch features a differentiated relationship between low and mid-back.

Fig. 2-10 The half round features the opposite differentiated relationship.

3. The half arch features a forward falling pelvis (anterior pelvic tilt) and an arching low back, but with a rounding mid- to upper-back. (Fig. 2-9) The mid-back is differentiated from the low back.. .mid-back rounds and low back arches. This is probably the most common postural type in western cultures. 4. The half round features a backward falling pelvis (posterior tilt) and a rounding low back, but with a straight mid- to upper-back. (Fig. 2-10) The mid-back is again differentiated from the low back. This type is very rarely found in the wild. 21

Chapter Two: Assessing Your Individual Bias

Fig. 2-11 The columnar posture approaches the ideal 5. The columnar postural type features a vertical pelvis and a vertical spine. This is also rare, but highly prized by those who possess one. This posture illustrates the concept of bearing weight skeletally.. .using your muscles to move your bones into a place that supports your weight with minimal soft tissue strain and minimal muscular effort. (Fig. 2-11) Postural Checklist (Best Guess) Qvjf • • • • •

Full Round Full Arch Half Arch Half Round Columnar

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Assessing Postural and Movement Bias Which Direction Does Your Pelvis "Fall" Let's do some experimenting. We'll get into a number of different positions that will assist you in determining which movement category you fall into. To make things even simpler, all you really have to know at this time is whether you fall into the arching or the rounding categories. Read through and study this assessment section, then proceed to the video and follow along with your Movement Bias Checklist as you perform your self-assessment...then come back to read through the rest of the chapter. On your Movement Bias Checklist, you will be asked to determine whether a certain position or movement suggests a Rounding bias (R-clue) or an Arching bias (A-clue). Follow the instructions on the video and circle the appropriate clue. Be sure to familiarize yourself with the use of your 22

Chapter Two: Assessing Your Individual Bias

®

DVD player. Learn to use the pause button, as you will be seeing this blue icon a lot as you proceed through the video. You will be asked to stop the video frequently and to practice what has just been described and demonstrated.

The skip forward or back button will help you to jump to the appropriate spot in the video for your next scheduled lesson or drill.. .check the menu to find the chapter and scene you want. Learn to use the slow motion feature on your DVD player.. .there will be times where you will want to slow down the action to see better or to more easily follow along. Keep in mind that this video is not meant to be done in one long sitting.. .it is broken up into a bunch of sections and is meant to be slowly digested over a period of several weeks to months. There are a few mundane things you will need as you progress through the video. One, you will need some floor space.. .just enough room to lie down and spread your arms and legs wide. The floor should be carpeted or have an exercise mat or blankets to cushion your surface. If absolutely necessary, a bed will do. Two, you will need a sturdy pole.. .like a closet rod or a martial arts "bo staff." This pole should be from one to one and a half inches in diameter and around six feet in length. Make sure it is smooth...no splinters. Three, you will need a chair with a firm and level seat. Four, you will need a few bath towels or a blanket that you can roll or fold up.. .this will be used later in the video.

Go to your Video...Do the Self-Assessment Session. Mark Your Results in the Following Movement Bias Checklist

23

Chapter Two: Assessing Your Individual Bias

Movement Bias Checklist %

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"A revolutionary new approach to solving the low back pain puzzle.' www.outsmartinglowbackpain.com

ChapterThree: Bracing Your Back

Importance of the Transverse Abdominus and the Multifidi

Sheath of j' -,t rectus abdominis ;§'' posterior lamina-—*~-* —Transversus abdominis Thoracolumbar fascia

Sheath of rectus abdominis anterior lamina-

Fig. 3-1 The transverse abdominus is a core stabilizer of your back.

Fig. 3-2 The multifidi are also core stabilizers.

One of the more obscure muscles of your abdomen is the transverse abdominus, henceforth to be known as TA. (Fig. 3-1) This horizontally oriented muscle has recently been found to be very important in treating low back pain. This muscle, along with a series of deep and short muscles along the spine, called the multifidi (Fig. 3-2), are now understood to be important stabilizers of the vertebrae of the lower back. Australian researchers Paul W. Hodges, CA Richardson, GA Jull and JA Hides have written multiple articles on lumbar stabilization and Jhe relationships these muscles have to spinal movement. Take a look at their work (search online for "pubmed") if you are a science kind of person. What you need to know for our purposes is: •

The TA and multifidi help to control shearing stresses of the vertebrae relative to each other.



Studies have correlated low back pain with lack of use of these muscles and have correlated reduction of low back pain with improved use of these muscles. Ideally, the muscles that stabilize the vertebrae relative to each other are contracted before any movement of your bones occurs... the nervous system anticipates potential joint strain and takes a proactive stance.





32

You will be learning to access these muscles during the video and will be learning to blend their use with larger movements of your pelvis, legs and spine.

Chapter Three: Bracing Your Back

You will be asked to "apply or slacken your brace" many times during the video. Your "brace" is simply the contraction of your TA and multifidi muscles to stabilize your vertebrae relative to each other. These contractions will be facilitated or coordinated with squeezing/contractions of the muscles of your pelvic floor...so "bracing" can include these pelvic floor muscles along with the intersegmental stabilization muscles. This basic "brace" will then be coordinated with or differentiated from breathing movements and movements of your pelvis and low back. This will be described in the video and you will have ample opportunity to practice your "brace" as you proceed through this program. It's about time to fire up your DVD player again and proceed to the section on intersegmental stabilization. Follow the instructions on the video for lessons and drills. I would recommend you go through each lesson twice and do the drills section from each lesson twice.. .following the instructions on the video. If you need more time to absorb the information, repeat the lesson or drills as many as four times.. .but don't get too bogged down. These suggestions are not etched in stone.. .move through this program at a pace that works for you. Don't feel that you have to do every single movement shown. If something is too difficult or if something irritates your back, don't just plow ahead. Do what you can, skip what you can't do comfortably and keep moving ahead. It should take you four to seven days to complete each lesson with their attached drills. Don't rush through this program. Take your time to learn the movements and concepts well. Try to incorporate what you have learned about being aware of movement and postural stresses and controlling and stabilizing your back into your daily life. Do the math and figure eight to twelve weeks to complete the whole program.. .more if you skip a lot of days or if you pause to linger over certain lessons or drills. Before starting each movement lesson or drills session, be sure to read over the descriptions of what you will be doing, as well as the purpose and applications of the movements. Then, do the lesson or drills and read over the short descriptions again. Correlate what you do and feel to what you read and understand.

33

Chapter Three: Bracing Your Back

Be sure to take care of yourself when doing these movements. Listen to what your back is telling you about comfort or strain. Generally, it is a good idea to start out slowly and to make small movements when first doing a newly described movement. By moving slow and small, movement is both safer and more informational. DON'T DO MOVEMENTS THAT HURT! If something doesn't feel good, try making it smaller and reducing your effort or experiment with finding different trajectories of movement or with finding other places within your body to move. MAKE NOTE OF MOVEMENTS THAT FEEL GOOD! Look for first-aid movements and use them regularly to give your back a little movement medication.

Lesson #1..."Bracing Your Back99/23 minutes In the First Lesson You Will Be: • •

• • •



Lying on your back on the floor and rolling your pelvis gently up and down on the floor. Learning to access your intersegmental stabilizers, or your "core" muscles, by alternately contracting and relaxing them. We are referring to the contraction of these core muscles as your "brace." Learning to coordinate your brace, or core muscles, with the muscles that move and control the position of your pelvis and low back.. .your big hip and thigh muscles. Timing the movements of your breath while filling and emptying your belly and chest in coordination with your core muscle control. Contracting and relaxing your pelvic floor muscles as a way to facilitate your core muscle contractions. Your pelvic floor muscles refer to the sphincters and smooth muscles that control your pelvic plumbing and genitalia.. .anus, urethra, vagina and testicles. Learning to maintain "core stability," or to "apply your brace," independent of your breath, movement of your pelvis or shape of your lower back.

Purpose of Lesson • •



34

Access and gain control over your core muscles. This is a basic movement skill that will be blended into all the rest of the lessons and drills. Access, control and balance the big hip and thigh muscles that move and control the position of your pelvis and low back in front-to-back directions. This is another basic movement skill that will be blended into all the rest of the lessons and drills. Improve your personal awareness of individual bias. Continue to pay attention and ask questions about how you are moving and using your body. Notice which direction feels easier, which feels harder and which feels more comfortable.. .don't go back on autopilot after marking your Checklists.

Chapter Three: Bracing Your Back

Application of Lesson Contract your core stabilization muscles in the presence of any movement stressor... bending, lifting, pushing, pulling, reaching, rolling over in bed, walking on icy surface, etc. Relax your core stabilization muscles in the presence of skeletal stability... sitting, lying, reclining, squatting, standing and kneeling. Don't keep your pelvic floor muscles puckered constantly! You can use the movements in this lesson for first-aid when your back is cranky. Breathing and pelvic floor coordination can stimulate a calming/relaxation response. Gentle rocking of your pelvis can calm and balance your hip/thigh and lower torso muscles and can gently lubricate your joints and pump out static fluids. Give yourself a homework assignment... something easy to start. Cue yourself to apply your brace when doing two or three common activities during the day. Opening car or refrigerator door, tying your shoes, taking out your garbage, getting out of your car or something else of your own choosing. If you are having a hard timefindingyour lower belly while lying down, or if it is hard for you to contract your lower belly without also contracting your upper belly and collapsing your chest, try leaning backyurf slightly from a floor sitting or chair sitting position.. .but keep your back straight as you lean back rather than rounding your back and collapsing your chest in a balance reaction as you did in the lesson. Feel how this slight lean back with a straight back and lifted chest kicks in your lower belly. Once you can find it, lie back down again and find it there as well.

Go to your Video... Do Lesson #1- "Bracing Your Back » Again, I would suggest you do each lesson twice, then go on to the drill session and do each of these twice. The number of repetitions mentioned for each drill are only suggestions. You will have to determine how much is right for you. Many of the movements in the lessons and in the drill demonstrations are shown large to be better seen.. .you can always make these movements smaller to accommodate your own physical abilities.

35

Chapter Three: Bracing Your Back

FYI #1- Tricks of the Trade •

Reciprocating movements. When moving, you will rarely be moving in just one direction. Most often, you will be alternating between rounding and arching movements, between right and left movements, between pushing and pulling movements or between falling and coming back up movements.These reciprocating patterns of movement help your nervous system to recognize the differences between opposites, help recalibrate a truer neutral and help balance and coordinate muscles that work in opposition to each other.

• Start with slower and smaller movements, and then proceed to bigger and faster. Going slow and small when first doing a movement variation gives you the time to feel more accurately what your body is doing. Going faster and bigger later makes newly learned movements more automatic/spontaneous.



Changes of venue. You will be doing many of the same movement patterns many times, but in different positions, different relationships to gravity and with different functional intensions. This helps you to recognize recurring patterns of movement and how to apply those newly learned patterns to a variety of daily activities.

• Application of constraints. Deliberate use of very specific movement instructions, in specific positions, that constrain your ability to move the way you always do. "Doing this while also doing that, while in this specific position" requires a specific muscle to contract or a specific area of your spine to move. Gets you out of your groove and makes you solve a puzzle.



Use of reference points. You will be asked questions about how you perceive yourself in certain positions and while doing certain movements before, during and after lessons. Pay attention and use changes in how you feel or how you move to decide for yourself which way of moving or posturing feels best or is less stressful for your lower back.

36

Chapter Three: Bracing Your Back

Lesson #1 Drills Overview of Lesson #1 Drills •





Start with the summary movement from lesson, "Tuck or Arch with Brace." Usually Arching Biased and Multidirectionals should tuck with brace.. .Rounding Biased should probably arch with brace. "Side Lie Tuck and Arch" is a change of venue variation of the same movements you were doing in the lesson. Some people find that a side lying position helps them to better feel how to use their legs to move their pelvis and low back. Be sure to coordinate movements of your pelvis and back with applying and slackening your brace in the appropriate direction. "Wall Tucks" is another change of venue variation of the same basic coordination... applying and slackening your brace while rolling your pelvis forward and back. Standing with your back against a wall, you will emphasize pushing the top of your pelvis backward and flattening your lower back while applying your brace.. .then slackening your brace as you roll your pelvis back to neutral on the wall. This is especially for the arching biased and the multidirectionally unstable.

Purpose of Lesson #1 Drills • •

Reinforce ability to access/control your core stabilizing muscles. Reinforce ability to access/control pelvic mobilizing and stabilizing muscles.. .your hip and thigh muscles.



Practicing the same motor skill in different positions or contexts avoids the problem of situation specific learning.. .the trained bear that can ride a specific bike in a specific direction around a specific track. You need to learn how to use these skills in a wide variety of conditions. Use "Wall Tucks" to strengthen weak gluts and train them in early control of standing and Weight-in-Front stresses (more on this in the appropriate section).



Application of Lesson #1 Drills • • •

Same as for "Bracing Your Back".. .general use of your core stabilizers in the presence of a movement stressor. Side Lie rocking movements of your pelvis and gentle movements of your low back can be nice first-aid.. .especially the variation with your leg lifted. Standing with your back to a wall and rolling your pelvis to flatten your back can be a nice substitute if standing without support bothers your back. 37

Chapter Three: Bracing Your Back

Go to your Video... Do Lesson #1 Drills Lesson #1 Drills Session:

1. Start the session by lying flat on your back on the floor and noticing your contact, shape, left/right balance and comfort of your low back as you did to start in the lesson. 2. Summary movement- "Tuck or Arch with Brace." Do up to 10 times in the appropriate direction for your bias.. .2 sets. 3. First Drill- "Side Lie Tuck and Arch." Up to 15 times in each direction.. .emphasize your appropriate direction. 2 sets on each side. 4. Second Drill- "Wall Tucks." Up to 10 times at each of three placements of your feet... far out away from wall, part way in toward wall and in close to wall. 5. Cool Down- Lie flat and reassess your contact, shape, balance side-to-side and comfort.

Lesson #2... "Balancing Your Pelvis"/26

minutes

In the Second Lesson You Will be: • • •



38

Lying on your back and lifting one foot off the floor while stabilizing your pelvis and back with your opposite leg.. .pressing your other foot into the floor. Learning to balance your core muscles left and right, by alternately contracting and relaxing them in diagonal patterns. Learning to coordinate your core muscles with the muscles that move your pelvis and low back in left and right directions.. .using the same big hip and thigh muscles, but coordinating them a bit differently than in the first lesson. Learning to coordinate your opposite side hip flexors and hip extensors on your two legs to shift your weight and to rotate your pelvis.. .you will start learning about your pelvic force couple.

9*

ChapterThree: Bracing Your Back

Purpose of Second Lesson Improve balance of your core muscles left/right. Lifting of one leg to trigger a push from the other.. .creating a diagonal roll of your pelvis upward on the floor and stabilizing your low back from arching. Strengthen your gluts and hamstrings. Feel the burn when you push into the floor...but watch out for cramps in the backs of your legs. (If this happens consistently with you, do the same movements while lying on your back, but with the soles of your feet up on a wall and with your hips and knees bent to about ninety degrees). Lengthen your hipflexorswhen lowering your lifted leg nearly to the floor; feel for a stretch in the front of your hip as you reach the back of your knee and the small of your back toward the floor at the same time. Improve awareness of left/right imbalances or bias. Improve pelvic force couple muscle balance.. .reduce rotational asymmetry of your pelvis and torso and reduce rotational stresses to your low back. Application of Second Lesson

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Use when bending one or both legs up from a lying position.. .push one foot into the floor or bed to stabilize/prevent the weight of your lifting leg from dragging your pelvis downward on the floor and arching your back. Beware of lifting both legs at once, either in real life or in exercise.. .you won't have a leg to stand on/stabilize with. You may find a diagonal direction offirst-aidhere. If arching biased, try the two rolling up diagonals.. .does one feel a bit more unfamiliar? That is probably a direction of firstaid. You are going to find the first of several references to "ONE OF THE TEN ESSENTIALS!" in this lesson. These are movements or concepts that we think are especially important. Some of them you might want to use as part of a daily movement routine and others are particular skills that you should be utilizing in the course of your daily activities. When going hiking, you should always have the "ten essentials"...extra clothes, water, food, first aid kit, compass, map, etc. There are actually fifteen of the "ten essentials" in this book, but we always over pack.

39

Chapter Three: Bracing Your Back

Go to your Video... Watch the Preview and Do Lesson #2- "Balancing Your Pelvis" Reread the description of the lesson and repeat the lesson again tomorrow or the next day., .then proceed to the following drills.

Lesson #2 Drills Overview of Lesson #2 Drills

40



Start with the summary movement from lesson #2, "Alternating Leg Lifts." Arching Biased and Multidirectionals will roll pelvis in upward diagonal.. .Rounding Biased will roll pelvis straight across or even slightly downward on the floor. ONE OF THE TEN ESSENTIALS!



"Arching Leg Lifts" is a change of venue variation of the same movements you were doing in the lesson.. .but with an emphasis on allowing the weight of your leg to pull the top of your pelvis forward and to arch your back, rather than on pushing the top of your pelvis back and rounding your back. This variation is especially useful if you are rounding biased.. .train your hipflexorsto pull your pelvis forward and to help straighten your back, as in sitting in a chair.



Lowering your leg while rounding your back during this drill can be emphasized if you are a fairly hardy arching biased or multidirectional^ unstable individual. This part of the movement emphasizes hip extensor strength, hip flexor length and stabilization of your pelvis from your standing leg.



"Standing Leg Lifts" is another change of venue variation of the same basic stepping movement. Standing with your foot up on a chair (or a lower Stool if a chair seat is too high), you will lift and lower one foot while stabilizing your pelvis and back with your standing leg. Feel how this movement gets both your TA and gluteal muscles to work.. .feel your lower belly with yourfingertipsand squeeze a bun to confirm muscle contractions.



Try to keep your brace on and independent of your breath as you proceed through these drills.

Chapter Three: Bracing Your Back

Purpose of Lesson #2 Drills •

Use "Arching Leg Lifts" to strengthen your hip flexors and back extensors.. .train them to roll the top of your pelvis forward and to arch your back. Emphasize if you are rounding biased.

• • •

Improve your awareness of left/right imbalances or bias. Strengthen your gluts and hamstrings. Lengthen your hip flexors when lowering your lifted leg nearly to the floor; feel for a stretch as you reach the back of your knee and the small of your back toward the floor at the same time.



For extra credit, try this same movement (very carefully) while lying on your back on the floor with one leg bent up and one leg long. This will require more stretch from your hip flexors...but is provides less stability for your lower back. Use "Standing Leg Lifts" to emphasize a push from the your standing leg.. .this encourages your pelvis to tuck and your back toflattenand trains you to stabilize your low back from arching in a standing position. ONE OF THE TEN ESSENTIALS! Use to encourage your TA/lower belly to contract.. .try to do without contracting your upper belly and collapsing your chest.





Application of Lesson #2 Drills •

If you are rounding biased, can you start figuring out how to use your hip flexors to pull yourself more upright while sitting in a chair? Pull the top of your pelvis forward using the weight of your legs as a counterbalance.



If you are arching biased, let your pelvis roll back a tiny bit back in sitting and catch yourself with your hipflexors.This reduces muscle overuse and tension in the low back extensors and reduces joint compression in comparison to rolling your pelvis forward and arching your lower back. If you are arching biased or multidirectionally unstable, can you start figuring out how to use your hip extensors to reduce arching in your low back when standing? Push the top of the pelvis backward into posterior tilt using the floor as an anchor.



• •

Use a strategy of placing one foot up on a stool, step or chair seat and pushing your pelvis to vertical with that foot to prevent your low back from arching when standing. Start practicing one leg standing and lifting the other leg high. This is an excellent way to further strengthen the core muscles and your hip extensors. Use a wall, tree or furniture to balance against if needed.. .extend the amount of time you can hold this position. Do many times a day. 41

Chapter Three: Bracing Your Back

Go to your Video... Do Lesson #2 Drills Lesson #2 Drill Session:

1. Start the session by lying flat on your back on the floor and noticing your contact, shape, left/right balance and comfort. 2. Summary movement- "Alternating Leg Lifts." Do up to 15 times to each side.. .2 sets each. 3. First Drill- "Arching Leg Lifts." Up to 12 times on each side.. .2 sets each. Emphasize your appropriate direction. 4. Second Drill- "Standing Leg Lifts." Up to 12 times to each side.. .2 sets each. Don't forget to allow your pelvis and shoulders to turn a bit as described. 5. Cool Down- "Tuck or Arch with Brace." Up to 10 times. 6. Lie flat and reassess your contact, shape, balance side-to-side and comfort.

r*

42

Chapter Three: Bracing Your Back

FYI #2-"This is Hard" • We hear this all the time from our patients...how difficult it is to do this style of exercise. While not the pulse pounding, sweat popping or vein bulging type of exercise one normally thinks of when "hard" is a commonly applied adjective, I will acknowledge that this type of exercise is challenging...and that it is hard because it has to be. By hard, most people are referring to the unaccustomed need to concentrate on what they are doing when exercising and the fact that they are being asked to move in unfamiliar ways.



Most of us are used to thinking about exercise as cranking out miles in jogging, putting in time on the exercise bike or the treadmill or keeping track of how many times we can lift an amount of weight. This quantitative exercise is concerned with quantity...how long, how far, how heavy or how many. What we are asking you to do in this video is qualitative exercise... how smooth, how easy, how different (before/after and left/right), how balanced, how pleasurable, how comfortable or how much effort. To improve smoothness, ease, balance, pleasure, comfort or effortlessness in movement, you need to pay attention to what you are doing and learn to move differently from the way you move habitually.



One of the reasons it is so important to pay attention to what you are doing is that, left to your own devices, you will likely revert to a way of doing things that is more familiar. Your habitual patterns of posture and movement are very easy...easy to find and easy to maintain. Your non-habitual patterns of movement or not easy to find or maintain...but are crucial to your low back health. Your habitual patterns are easy but, like the sirens of old, will lull you into a false sense of complacency before dashing you on the rocks of lumbar instability. Therefore, movement biased exercise for low back pain needs to be thoughtfully hard; it needs to work new muscles and move new joints and access different pathways in your brain. Learning to stabilize your back is a physical skill on par with learning how to golf, play a piano or operate a computer keyboard...there will be an initial period of awkwardness when first learning new movements, then things get easier as you practice and apply what you have learned.

43

Chapter Three: Bracing Your Back

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44

Chapter Four: Using Your Legs To Move Your Pelvis

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Chapter Four: Using Your Legs To Move Your Pelvis

Controlling the Fall Recall for a moment the section of the booklet discussing the front-to-back balance of the pelvis. When falling forward, your pelvis rolls forward and your back extends in a balance reaction... what are your legs doing? The hip extensors are responsible for halting the roll of your pelvis forward and for pushing your pelvis back upright again. (Fig. 4-1) There are three corollaries here:

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Fig. 4-1 The hip extensors catch your fall forward and push you back upright again.

If you are arching biased, you will need to develop stronger gluts and hamstrings to push the top of your pelvis backward and to lengthen/round/flex your lower back. If you are rounding biased, you will need longer and more flexible gluts and hamstrings to allow your pelvis to roll forward and to allow your lower back to arch or straighten. If you are multidirectionally unstable, you will need both longer gluts and hamstrings to minimize back rounding stresses and stronger/more competent gluts and hamstrings to control back arching stresses.

Fig. 4-2 The hip flexors catch your fall backward and pull you back upright again.

When falling backward, the top of your pelvis rolls backward and your back flexes or rounds in a balance reaction...what are your legs doing? (Fig. 4-2) The hipflexorsare responsible for halting 46

Chapter Four: Using Your Legs To Move Your Pelvis

the roll of your pelvis backward and for pulling your pelvis back upright again. There are three corollaries here: •





If you are arching biased, you will need longer hip flexors to allow the top of your pelvis to roll backward and to allow your lower back to lengthen/round/flex, especially in standing and walking. If you are rounding biased, you will need stronger/more competent hipflexorsto pull the top of your pelvis forward and to arch or straighten your lower back, especially in the context of sitting. If you are multidirectionally unstable, you will need stronger hipflexorsto control rounding stresses and longer hipflexorsto minimize arching stresses.

Preview of Coming A ttfactions In the first lesson of this section, you will be in a belly up orientation while sitting on the floor. You will be rolling forward and back.. .rolling backward toward your back and pulling forward to extend taller in afloorsitting position. This belly up orientation emphasizes lengthening (while sinking back) and strengthening (while pulling back forward) your hipflexors.If you are arching biased, you should emphasize the sinking back movement; if rounding biased, you should emphasize the pulling forward to straighten movement. If multidirectionally unstable, generally follow the arching biased emphasis but limit too much movement into extremes of rounding your low back.. .don't roll very far back or pull very far forward. In the second lesson, you will be in a belly down orientation while sitting on thefloor.You will be rolling your pelvis diagonally forward and back and asymmetrically rounding and arching your back. This belly down orientation emphasizes lengthening (while arching forward) and strengthening (while pushing backward) your hip extensors. If you are arching biased, you should emphasize the pushing back and rounding movement; if rounding biased, you should emphasize the rolling forward and straightening movement. This lesson also emphasizes finding a neutral back through an awareness of reciprocating movements.. .and starts to work on bending and coming back up with a neutral back. In both lessons, you will want to know what your bias is and emphasize your non-habitual direction...but make sure you still go in both directions. Reciprocating movements help you to coordinate and balance your hip and torso antagonists and to recalibrate a truer middle/neutral spine. If you have assessed yourself as multidirectionally unstable, go slowly and be careful as you go through these movements. Make your movements smaller so you don't go to end range 47

Chapter Four: Using Your Legs To Move Your Pelvis

of either direction. Concentrate mostly on loosening up your hips and moving evenly throughout your whole spine, emphasize moving more in your chest and mid-back than you do in your low back.

Lesson #3..."Psoas Psit-ups"/20

minutes

In the Third Lesson You Will: • • • • •

Be lying on your back and rolling your pelvis to lift your back off the floor sequentially... bridging. Be sitting on the floor and rolling back, then swinging back up to sitting again... sometimes holding your knees and sometimes not. Be rolling back toward your back and coming back up again on a diagonal.. .up to side sitting. Continue to work on coordinating your brace with movements of your pelvis and back. Continue to learn to control the position and movement of your pelvis and low back from your legs.. .emphasizing controlling your fall back and coming forward with your hip flexors.

Purpose of Third Lesson •

• • •





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Strengthening your abdominal muscles and lengthening your hipflexors.If you are arching biased, emphasize the movement of sinking/rolling your pelvis backward and rounding your spine. Strengthening your hip flexors and back extensors. If you are rounding biased, emphasize the movement of pulling your pelvis forward/pushing taller. Balance your pelvic force couple muscles and your torso muscles left/right by rolling diagonally to side sitting. Strengthen and loosen up your mid-back. By rolling your pelvis forward and arching with your legs bent up in floor sitting position, the bend of your hips constrains your pelvis from rolling too far forward and prevents your lower back from arching very much.. .this funnels straightening movements more to your mid-back. In the bridging movement, use to strengthen your hip extensors and to differentiate them from your back extensors. Be sure to lift your hips without arching your lower back and keep the muscles of your lower back relaxed and long. In the bridging movement, use the floor as a tool to loosen up your mid-back and rib cage.. .be sure to keep your stomach muscles relaxed as you roll up and down along your mid-back.

Chapter Four: Using Your Legs To Move Your Pelvis

Application of Third Lesson •



• •

Training your hip flexors to improve your sitting posture. If you are rounding biased, use your hipflexorsto haul your pelvis upright from a slumped sitting position and to straighten your back. If you are arching biased or multidirectional, use your hipflexorsto control the position of your pelvis in a very slight "falling back" position.. .maintain an upright posture without overworking your low back muscles by arching. Good candidates for first-aid movements.. .emphasis on rounding movements for the arching biased and vice versa. Use literally as a way of getting up from lying to sitting.

Go to your Video... Do Lesson #3 - "Psoas Psit-ups" Do the lesson twice, read the bullet descriptions a few times, then forge ahead to the drill session.

Lesson #3 Drill Overview of Lesson #3 Drill • •

Start with the first summary movement from this lesson, "Bridge with Butt Pinch." Continue with the second summary movement, "Psoas Psit-ups." ONE OF THE TEN ESSENTIALS!



Solo drill is "Hold Knee to Roll Up." Continuing to work with hip flexor length, hip extensor and abdominal strength.

Purpose and Application of Lesson #5 Drill • •

Use for same purpose as lesson.. .improve upright sitting posture, first-aid and application to common activity.. .getting up from a lying down position. Use this rolling back while holding knee movement to really stretch your back into rounding.. .can be a great first-aid movement if you are arching biased.

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Chapter Four: Using Your Legs To Move Your Pelvis

Go to your Video... Do Lesson #3 Drills Lesson #3 Drill Session:

1. Start the session by lying flat on your back on the floor and noticing your contact, shape, left/right balance and comfort. 2. Summary movement- "Psoas Psit-ups." Do up to 15 times. 3. Summary movement- "Butt Pinch Bridges." Up to 10 times. 4. Solo Drill- "Hold Knee to Roll Up." Up to 10 times to each side.. .2 sets each. 5. Cool Down- "Alternating Leg Lifts" up to 15 times each side. 6. Cool Down- "Tuck or Arch with Brace" up to 10 times. 7. Lie flat and reassess your contact, shape, balance side-to-side and comfort.

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Chapter Four: Using Your Legs To Move Your Pelvis

FYI #3- Principles of Ideal Movement •

Economy of effort Don't put any more effort into a movement than you really have to. Don't strain to move farther, but figure out what you have to let go of to allow your bones to move more

freely. • Even distribution of movement. Don't continue to force movement in places that already move too much, but figure out what else you can invite to participate in any given movement.

• Proportional use of synergistic muscles. Use your larger muscles more intensely to move your larger bones for larger movements. Use your smaller muscles less intensely to move your smaller bones in more delicate movements.



Use your legs to control the position and movement of your pelvis. Corollary to proportional use of synergists. Use your much larger hip muscles to move and position your pelvis and use your smaller torso muscles to control the relationship between your pelvis and your chest.



Bearing weight skeletally. Arrange your bones "vertically" over each other so your bones support the weight of the bones above... not through muscle effort, joint compression or by overstretching connective tissue.

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Chapter Four: Using Your Legs To Move Your Pelvis

Lesson #4... "Floor Sit Bending" / 26 minutes In the Fourth Lesson You Will be: •

• • •

Sitting on the floor and leaning forward on both hands. While rounding and arching your back coordinate the movements of your pelvis and back with reaching movements of your arms. Doing reciprocating rounding and arching movements while using an awareness of these movements to recalibrate a more neutral spine. Learning to bend and push back upright with a neutral spine and with control from your legs. Coordinating your brace with movements of your pelvis and spine, directed from your legs.

Purpose of Fourth Lesson •

Strengthen your hip extensors and hip external rotators.. .control the roll/fall forward of your pelvis and the arch of your lower back. Especially for controlling arching stresses; emphasize pushing your pelvis back and rounding/lengthening your back.



Strengthen your back extensors and to stretch your hip extensors and external rotators. Especially for controlling rounding stresses; emphasize rolling your pelvis forward to bend at your hips and to straighten through your spine. Loosen up and strengthen your mid-back in the direction of arching/extension. By bending to the max around your hip (get your belly near your thigh), your low back can't arch very far.. .this funnels movement requirements farther up your back.





Recalibrate a truer neutral low back (neither rounded nor arched).. .improve your ability to accurately perceive the shape of your low back.

Application of Fourth Lesson •

• •

52

Use side sit positions on the floor to read, watch TV, chat with spouse/kids/friends, pick up kids toys/spilled bag of nails. Use unusual positions that demand different/nonhabitual use of your bones and muscles. Put a knee and thigh up on kitchen counter, bathroom counter or workbench if possible to better control leaning stresses. Use outdoors.. .side sit on the ground for weeding, planting, digging and other garden related activities.

Chapter Four: Using Your Legs To Move Your Pelvis

Homework assignments.. .find and maintain your neutral back in chair sitting while bending to 1) tie shoes and 2) get up to stand while maintaining the shape of your back by pushing from your legs.

Go to your Video... Do Lesson #4- "Floor Sit Bending » Do this lesson twice and read material on this lesson twice, then move on to the drills.

Lesson #4 Drills Overview of Lesson #4 Drills •





Start with the summary movement from this lesson, "Butt Cheek Pushups." This movement strengthens your hip extensors and gives you some repetitive experience in bending and coming back up again with a neutral back. "Hurdler's Stretch" is a hamstring stretch. Be sure to roll your pelvis diagonally forward and to straighten your back to push taller as in the lesson. Place the hand you are leaning on farther forward or back on the floor to accentuate or reduce the intensity of your hamstring stretch. Relax the leg you are trying to stretch.. .let your knee bend a wee bit and let the your leg roll outward. ONE OF THE TEN ESSENTIALS! "Sit to Crawl" is a transitional movement from side sitting to a hands and knees position. Opt out if your knees or wrists can't handle this. This movement continues to emphasize stretching and strengthening your hip extensors and external rotators.. .using an early developmentally based movement to reaccess old movement skills.

Purpose of Lesson #4 Drills • • •

Lengthen your hamstrings... critically important if you are rounding biased or multidirectionally unstable. Strengthen your back extensors, especially mid-back extensors.. .important for all three categories. Strengthen your hip extensors.. .pushing your knee/thigh into the floor to control the fall forward of your pelvis in bending. Important if you are arching biased or multidirectionally unstable.

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Chapter Four: Using Your Legs To Move Your Pelvis



Learn to come back upright from bent/leaned over position by pushing from your legs rather than pulling up by arching your back and overworking your back extensors.

• •

Integrate your intension to reach and to look with movements of your pelvis and torso. Stimulate multifidi contractions.. .the small muscles deep in your back that work with the TA to control intersegmental stability.

Application of Lesson #4 Drills •

Moving around gracefully on the floor (scrubbing spots on kitchen floor) or on the ground (moving along a row offlowersto snip and weed). Getting down on the floor can often be much easier on your back than trying to stand with your hands on or near the ground... especially with prolonged or repetitive movements or if rolling or sliding something heavy across the floor.



Good first-aid movements for both flexion and extension biased.. .loosening up your hips, stretching and strengthening your hip and torso muscles. Pay attention to the amount of pleasure you get from each of these movements.. .later you will be asked to pick out some favorites.

Go to your Video... Do Lesson #4 Drills Lesson #4 Drill Session:

1. Start the session by lying flat on your back on the floor and noticing contact, shape, left/ right balance and comfort. 2. Summary movement- "Butt Cheek Push Ups." Do up to 10 times on each side. 3. First Drill- "Hurdler's Stretch." Up to 10 times each side.. .2 sets each. 4. Second Drill- "Sit to Crawl." Up to 10 times each side.. .2 sets each. 5. Cool Down- "Psoas Psit-ups." Up to 15. 6. Cool Down- "Butt Pinch Bridges." Up to 10. 7. Cool Down- "Alternating Leg Lifts." Up to 10 to each side. 8. Cool Down- "Tuck or Arch with Brace." Up to 10. 9. Lie flat and reassess your contact, shape, balance side-to-side and comfort. 54

Chapter Four: Using Your Legs To Move Your Pelvis

FYI #4 - Stretching •

Stretching effectively is a learned skill...that muscle you are trying to stretch is more than just a piece of meat.There are two things about stretching you should keep in mind when moving to limber up: 1. You need to learn to let go or relax your muscles, and 2. The connective tissue, or fascia, that surrounds and envelopes your muscles needs to hydrate and remodel.

• The muscle you are stretching needs to let go. There is a specialized kind of muscle fiber called the muscle spindle that acts as a trip-wire in stretching. When a muscle is being stretched too far, or when the end-range of a joint is approached, the muscle spindle recognizes that things have gone far enough and is "tripped"...this makes the muscle contract to protect itself or the joint it helps control. When a muscle is too tight/short, what you will want to do is to reset the tripwire to a longer length, not to keep tripping the alarm.



If you are stretching too far or too fast, or if you are not paying attention to your perception of effort in the muscle you are trying to stretch, it's as if you are stretching a rubber band... it just springs back into place again when you let go of the stretch. What we are looking for is not an elastic stretch, but a plastic stretch...like stretching out silly putty. Go slowly and start with small movements to better feel the sensation of letting go and the sensation of contracting. Listen to your muscles and actively relax the little rascals when stretching.



While muscle tissue itself is very elastic and can change instantaneously with a change in muscle spindle length and nervous system control, the connective tissue or fascial envelopes that surround muscle bundles need some time to change. The basic building block for connective tissue is called collagen fiber, which is inelastic. The ability of the fascia to lengthen is a function of the ability of the fibers to slide freely relative to each other and of the fluidity of the underlying ground substance. Try drinking plenty of water during this time to keep your tissues as hydrated as possible.



Keep at the movement variations or drills that emphasize the desired stretch for several months and apply your newly gained range of movement to daily activities. This keeps up steady pressure on the connective tissue to remodel and lengthen over time. This illustrates the SAID Principle: specific adaptation to imposed demand. Connective tissue gets tight and short when no demand is placed upon it...when the muscle spindle tripwire is set too short. Connective tissue changes over time and gets longer when a demand is placed on it. Demand that your hamstrings get longer by lengthening them when bending or when getting out of a chair. Demand that your hip flexors get longer by standing and walking with a more vertical pelvis or by using some kneeling postures during daily activities. 55

Chapter Four: Using Your Legs To Move Your Pelvis

Lesson #5... "Hip Circles"/27

minutes

In the Fifth Lesson You Will Be: •

Standing with one foot up on a chair seat or stool and kneeling on the floor with one foot forward. From these positions, you will be doing reciprocating rounding and arching movements while using an awareness of these movements to recalibrate a more neutral low back in standing and kneeling.



Keeping your back long, neutral and stable while moving your pelvis around in circles. Only do this in standing if your knees are too grouchy to kneel. Doing circular movements of your pelvis around your thighbones to loosen up your hip joints and stretch and strengthen some key hip muscles.



Purpose of Fifth Lesson •

Stretch your hip flexors by pushing your pelvis toward vertical andflatteningyour lower back.. .especially if you are arching biased or multidirectionally unstable. Emphasize the "forward and in" part of the circle.



Strengthen your hip extensors and hamstrings by pushing your front foot into the floor to push the top of your pelvis backward... especially if you are arching biased or multidirectionally unstable.



Stretch your hip rotators and illiotibial band (hip pocket and outside of hip and thigh)... emphasize the "back and out" part of circle. Stretch your hamstrings by emphasizing the "back" part of the circle.. .lean your torso forward and sit your pelvis back toward your back foot. Especially if you are rounding biased.. .multidirectionals need skills but need to be careful not to push too far.



Stretch your hip adductors (inner thigh muscles).. .emphasize the "inner" part of the circle. Reinforce and challenge your ability to perceive and maintain a neutral lower back. Reinforce bending strategies of counterbalancing, maintaining a neutral spine and using your legs to control the forward fall of your pelvis.. .then pushing yourself upright. Use again to flog your TA and multifidi into action.. .achieved by leaning forward and back with a neutral spine.

• • •

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^ Chapter Four: Using Your Legs To Move Your Pelvis

Application of Fifth Lesson •



If your knees can handle the kneeling position, substitute this half kneeling position for sitting frequently but for short periods of time throughout your day. Sitting constantly tends to shorten your hipflexors...give yourself some variety during the day by kneeling for a few minutes and lengthening your hip flexors. Both the half kneeling and half standing positions (stand with one foot forward on step stool, stair or chair seat) are useful for controlling standing stresses and weight-in-front stresses. Both skills put a premium on the ability to push your pelvis to vertical and to stabilize the top of your pelvis from rolling forward.

Go to your Video... Do Lesson #5- "Hip Circles M Repeat the lesson twice and read over the bullet points twice, then do the drills.

Lesson #5 Drill Overview of Lesson #5 Drill •





Start with the summary movements from this lesson: "Half Stand and Half Kneel Hip Circles." These movements strengthen the deep rotator muscles of your hips.. .enhancing pelvic stability. Use one of these to stretch those pesky hip flexors if yours are tight. ONE OF THE TEN ESSENTIALS! "Bicycle Circles" continues to work with your deep hip rotator and abductor muscle control. By introducing some up and down movements of your pelvis in this vertical circle, these muscles need to work a little harder. This is a harder movement to do while keeping a neutral lower back.. .let yourself bend a bit side-to-side but don't let yourself arch or twist.

Purpose and Application of Lesson #5 Drill • •

Use these drills for same purpose as the lesson.. .strength,flexibility,core control... especially to lengthen your hip flexors and to strengthen your hip extensors. Use half kneeling and half standing positions to control standing arching stresses and weight-in-front stresses.

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Chapter Four: Using Your Legs To Move Your Pelvis

Go to your Video... Do Lesson #5 Drills Lesson #5 Drill Session:

1. Start the session by lying fiat on your back on the floor and noticing your contact, shape, left/right balance and comfort. 2. Summary movement- "Half Standing Hip Circles" or "Half Kneeling Hip Circles." Do up to 7 times in each direction.. .2 sets on each side. 3. Solo Drill- "Bicycle Hip Circles." Up to 10 times in each direction.. .2 sets on each side. 4. Cool Down- "Butt Cheek Push Ups." Up to 10 to each side. 5. Cool Down- "Psoas Psit-ups." Up to 15. 6. Cool Down-"Butt Cheek Bridges." Up to 10. 7. Cool Down-'Tuck or Arch with Brace." Up to 10. 8. Lie flat and reassess your contact, shape, balance side-to-side and comfort.

Go to your Video... Watch the Review and Select Level One Favorites. Write Down Your Favorites in Your Master Checklist.

Notes:

58

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

"A revolutionary new approach to solving the low back pain puzzle. www.outsmartinglowbackpain.com

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Sitting Stresses Sitting with the top of your pelvis rolled back too far creates flexion or rounding stresses on your lower back. (Fig. 5-1) If you sit like this and your back hurts when sitting, you will need to learn: • • • •

To lengthen your hamstrings and gluteals. To use your hipflexorsto pull your pelvis back upright and to use your back extensors to straighten your back. To strengthen your back extensors evenly throughout the length of your torso. To recognize the position of your pelvis and the shape of your back.

Fig. 5-1 Sitting like this puts a flexion stress on your low back.

Fig. 5-2 Sitting like this puts an extension stress on your back.

Sitting with the top of your pelvis rolled forward too far creates extension or arching stresses on your lower back. (Fig. 5-2) If you sit like this and your back hurts when or after sitting, you will need to learn: • • •

60

To let go of your overworking low back muscles and to let your pelvis roll backward to neutral. To use your hip flexors at a longer length to catch your pelvis as it rolls back to vertical, or even a smidge beyond. To recognize the position of your pelvis and the shape of your back.

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Lesson #6..."Sit to Stand99/20 minutes In the Sixth Lesson You Will Be: • • • •

• •

Requiring your pole for this lesson.. .fish it out and make sure it is handy before you begin. Sitting on a chair.. .again doing reciprocating rounding and arching movements and using an awareness of these movements to recalibrate a more neutral spine. Attending to the way you use your legs in sitting.. .controlling rolling back movements with your hip flexors and controlling rolling forward movements with your hip extensors. Making left and right side bending and weight shifting movements while sitting.. .then blending side-to-side with front-to-back movements to make circles with your pelvis and back. Keeping your back long, neutral and stable while bending forward to come up to stand. Standing and leaning with your hands on your knees and rounding and arching your back.. .again finding neutral by doing reciprocating movements.

Purpose of Sixth Lesson • •

• • •

Use to strengthen and balance your hip flexors and hip extensors in a context of maintaining an upright sitting posture. Use to improve distribution of movement through your whole spine. Emphasize the movement of leaning forward and arching your back to move the top of the pole forward. The pole funnels arching movement more toward your mid-back. Use to improve left to right sitting balance of your pelvis and low back.. .reducing asyrnmetrical sitting stresses and asymmetrical sitting symptoms. Use to improve your awareness of how to use your legs to shift the weight of your pelvis on the seat and to control left/right balance of your pelvis and back in sitting. Use to improve your awareness of how to control sit to stand stresses and bending stresses.

Application of Sixth Lesson •

Should be pretty obvious... improving sitting and standing posture... improving sit to stand movements.. .improving bending movements.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Go to your Video... Watch Sitting Intro and Do Lesson #6- "Sit to Stand9' Do the lesson twice and read over the material again, then move right along to the sitting drills.

Sitting Drills Overview of Sitting Drills •

Start with the first summary movement from this lesson, "Neutral Sit to Stand." ONE OF THE TEN ESSENTIALS!



Continue with the second summary movement, "Stirring the Pot." This movement features circular movements of your pelvis on your seat, directed from your legs, and circular/slinky type movements of your torso/mid-back and rib cage. This movement works to loosen up your mid-back, chest and rib cage and to open the lines of communication between your head and your pelvis.



Your solo drill from this session, "Diagonal Sit to Stand," features diagonal falling/rolling movements in sitting, then pushing up to stand on a diagonal.

Purpose of Sitting Drills •

• • •

62

Use "Diagonal Sit to Stand" to work on balancing your hip flexors and extensors on the same side. By moving diagonally, you are catching your fall back and to the left with your right hipflexorsand catching your fall forward and to the right with your right hip extensors. Balance your diagonal torso muscles.. .left abdominals and right back extensors and vice versa. Improve left/right sitting balance of your pelvis and torso. Improve your ability to come to stand asymmetrically, to push taller on one foot and to enhance left/right standing postural balance.

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Application of Sitting Drills •



• • • •

Use "Stirring the Pot" to loosen up stiff and cranky mid-back, shoulders, neck and arms.. .to lubricate and loosen up your hips.. .to relieve invariant stresses on your low back in sitting. Use at the office, take breaks at computer.. .do with or without pole. If you like a movement puzzle, try making the circular movements of "Stirring the Pot" in other positions.. .hands and knees and side sitting to each side. Do just for the joy of moving and the challenge of the puzzle. Use "Neutral Sit to Stand" as direct application to sit to stand movements and to bending and lifting movements. Use "Diagonal Sit to Stand" skills and apply to getting into and out of a car, cramped movie theatre, packed sporting venue, rockin' wedding reception, etc. Practice standing on one leg and pushing taller to enhance pelvic stability in standing and to prevent/control a "one legged flop" standing posture. Use when reaching diagonally from sitting or lifting/carrying something diagonally from low/middle to high/over to one side or the other. Rotate your pelvis and torso in the direction of your reach or carry to prevent your low back from rotating.

Go to your Video... Do Sitting Drills Sitting Drill Session: 1. Start with an observation of your sitting posture.. .balance of your pelvis front-to-back and side-to-side, shape of your back, perception of ease or comfort. 2. Summary movement #1- "Neutral Sit to Stand." Up to 15. 3. Summary movement #2- "Stirring the Pot." Up to 10 times each direction.. .2 sets each. 4. Solo Drill- "Diagonal Sit to Stand." Up to 10 times each side.. .2 sets each. 5. Cool Down- "Level One Favorites." Do to your satisfaction. 6. End by sitting tall and straight for 2 or more minutes. Find a place where you are bearing weight skeletally and your eyes are as high on the horizon as possible.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Sitting Props Lumbar rolls and other supports for the lower back are commonly prescribed for low back pain. If you are rounding biased, a lumbar roll can work well. (Fig. 5-3) If you are arching biased or multidirectionally unstable, you probably don't want to continue to push your lower back forward with a lumbar roll. You might try a thoracic roll (Fig. 5-4), especially if you are of the Half Arch postural type. A thoracic roll pushes your mid-back into extension but invites your lower back to relax and lengthen backward into the space created by the thoracic roll.

Fig. 5-3 Lumbar rolls help control flexion stresses but do put an extension stress on your back.

Fig. 5-4 Putting a roll at your mitt-back can help straighten your mid-back but invites your low back to flatten toward neutral.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

FYI #5-Modest Sitting • One of the main themes of this program has been to use your legs to move and to control the position of your pelvis...and sitting is no exception. Most of us don't think of our legs as being part of sitting, but without legs you could not sit.. .your hip flexors keep you from falling back and your hip extensors keep you from falling forward. For optimal sitting, all the other muscles around your hips and waist should be quiet and relaxed... letting the four cornerstone muscles of your pelvis do their job of balancing your pelvis front/back and left/right on the seat with very minimal effort.



A common mistake many people (especially women) make in sitting is keeping their feet and knees too close together. This modest or "ladylike" way of sitting requires constant effort from the muscles on the inside of your thighs...the adductors. This constant effort from your adductors locks in or immobilizes your pelvis and makes for a very narrow base of support.

• Try the following experiment. Lie on your back on the floor for a moment and bend your knees up to place the soles of your feet on the floor. Place your feet and knees close together and stay there for a moment. You should be feeling some effort in the muscles of the inside of each thigh...they are working hard to prevent your knees from falling away from each other. Now place your feet wide apart and let your knees fall in toward each other...you should not be feeling effort in your inner thighs here. Go back and forth between narrow and wide feet and knees to improve your awareness of the effort in your inner thighs. Then, come back up to sit in a chair again and try the same thing., .place feet wide and narrow.. .clamp your thighs together then increase the space to approximately hip width. Where are your feet on the floor and how far apart are your knees when the muscles of your inner thighs are relaxed and your knees are over your feet?

• Try another experiment. Sit in your chair with your feet and knees very close together and try making circles with your pelvis on the seat or making the diagonal sit to stand movements. Try these movements again with your feet and knees wider apart. Which feels more stable, balanced or stronger? General rule of thumb in sitting: feet and knees are wide enough to allow circular movements in the seat and diagonal sit to stand movements without changing where your feet are on the floor.



If you find that you're a bit too ladylike for your own good while sitting, notice if the same basic habit applies when standing, lying on your back or walking. Constant contraction of your inner thighs is not a good idea in all positions or for all movements... use them when you need and let them go the rest of the time. While you might feel like you are sitting like a lumberjack initially, eventually you might enjoy the sense of balance and freedom of movement that comes with it. 65

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Bending Stresses

Bendmg stresses can result from your pelvis not rolling forward far enough relative to your legs, necessitating too much flexion at your lower back. (Fig. 5-5) If you bend this way and bending bothers your back, you will need to learn: • • •

To lengthen your hamstrings and gluteals. To strengthen your back extensors evenly throughout the length of your torso. To recognize the position of your pelvis relative to your thighbones and the shape of your back.

Fig. 5-5 Bending without allowing your pelvis to move enough creates a flexion stress.

L1 (

Fig. 5-6 Bending by allowing your pelvis to move too much creates an extension stress.

Bending stresses can also result from your pelvis rolling too far forward relative to your legs... necessitating too much extension at your lower back. (Fig. 5-6) If you bend or come back up this way, you will need to learn:

Fig. 5-7 Bending with a neutral back requires accurate control of your pelvis from your legs.

To strengthen your hip extensors to better control the forward fall of your pelvis and to support your lower back in a neutral shape. To recognize the position of your pelvis relative to your thighbones and the shape of your back. To differentiate low back and mid-back extension if you are in the Half Arch category (more on this later).

Ideally, what we would like to see is your pelvis rolling forward the appropriate amount.. .with the bending occurring around your hip joints and with a neutral back. (Fig. 5-7) This is a schematic only..we're not suggesting you bend with straight knees. 66

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

In this bending lesson and attached drills, you will learn to control your own particular bending stresses by finding and maintaining a neutral back while bending and turning around your hips. This is a belly down lesson that emphasizes the length and strength of your hamstrings and gluteals.

Lesson #7... "Bending From Standing"/17

minutes

In the Seventh Lesson You Will Be: •

Standing in split stance and horse stance positions and bending over by sliding one hand down your pole. Put some of your weight on the pole as desired to assist your legs and to protect your back.. .support more weight through the pole initially, then lessen your reliance on your arms as you become more proficient.

• •

Finding and maintaining a neutral lower back.. .both front-to-back and rotationaliy. Exploring strategies of bending involving a shift of weight forward or backward and left/ right.

Purpose of Seventh Lesson L—* *__• ±

• • • • • • •

Lengthen your hip extensors and to strengthen your back extensors.. .useful if you are rounding biased or multidirectionally unstable. Strengthen your hip extensors.. .useful if you are arching biased or multidirectionally unstable. Strengthen your mid-back extensors...useful for everybody. Lengthen your hipflexors...useful if you are arching biased or multidirectional. Challenge your awareness and ability to maintain a neutral lower back in several different directions. Coordinate your brace and core control with bending movements. Balance your pelvis on your legs rotationaliy.. .reduce rotational stresses at your low back in standing.

Application of Seventh Lesson •

The obvious.. .improved bending, more choices in bending and better awareness of neutral back in bending. 67

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Reduction of arching strains in standing... using "pushing pelvis to vertical" function of your legs to reduce arching in standing. Use one foot in front or horse stance with weight shifted back. Can be nice first-aid for rounding biased. For extra credit and to challenge your hip flexor length, try doing this whole lesson from a half kneeling position instead of a split stance and from a kneeling position instead of a horse stance. Do only if knees are up to the task. Bend from half kneeling positions at work and play., .find three opportunities to use in your daily activities. Complete the movement of coming all the way back upright to stretch your hip flexors.

Go to your Video... Watch Bending Intro and Do Lesson #7- "Bending From Standing" Reread your bullet points and do the lesson twice, then read and think about bending applications before pressing ahead to your drill session. Bending Applications Think about how you can apply what you have learned into real life activities. Use contralateral bending strategies. (Fig. 5-8)

Fig. 5-8 Use contralateral bending to control back strain.

Grabbing a beer out of the bottom of the refrigerator. Putting a piece of trash in the bin under the sink. Reaching down for the dipstick on your car. Bending to get a drink from a water fountain. Wiping your kid's nose. 68

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Use ipsilateral bending strategies. (Fig. 5-9) • • • • •

Picking up a book off a coffee table. Getting a bowl out of the bottom drawer in your kitchen. Bending to get a closer look at the report on your desk. Petting your dog and giving her a treat. Watering your plants.

Fig. 5-9 Shifting your weight back in an ipsilateral bend controls back strain.

Try bending from a horse stance position. (Fig. 5-10) • •

Picking up a bulky box. Scooping up your toddler.

• •

Picking up a piano bench. Getting the file out of the bottom drawer of the file cabinet.



Organizing your kid's toys.

Fig. 5-10 Having a wide base of support makes horse stance bending very stable.

Using upper extremity support when bending is an excellent way of reducing stress on your lower back. ..use this strategy whenever possible. (Fig. 5-11 through 5-13) ONE OF THE TEN ESSENTIALS! • • • • •

Picking up your toolbox. Getting the groceries out of the car. Cleaning out the sink. Bending under the hood of your car to pull the spark plug wires. Emptying your dishwasher.

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* * Fig. 5-11 Use a hand to support your weight when bending.

Fig. 5-12 Use a hand to support your back when pulling or lifting.

Many people complain of increasing low back pain when cooking or during other activities that involve a slight lean forward from a standing position. Even a slight lean forward is a bending stress...usually extension related. Be sure to apply what you learn about keeping a neutral back when bending in these prolonged leaning forward positions. A small adjustment here goes a long way.. .be sure to use your legs/hip extensors to control the amount of forward tilt of your pelvis, keep your back long and keep your back muscles as relaxed as possible. A substitute for bending forward is to sink your weight onto your back leg and bend that knee to lower your center of mass.. .reach down and to the side rather than down and forward. (Fig. 5-14) Get your hand lower to the floor by bending your knee, keeping your pelvis vertical and bending/ flexing through your whole back. This is used mostly while reaching for or picking up objects above knee height. Other substitutes for bending include squatting and kneeling.. .a bit more on this later.

Fig. 5-13 Use a hand to control weight-in-front stresses. Fig. 5-14 Shift your weight back and bend your knee and mid back to reach down. 70

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Bending Drills Overview of Bending Drills • •

Start with the summary movements from this lesson, alternate "Contralateral Bending" and "Ipsilateral Bending." ONE OF THE TEN ESSENTIALS! Then do "Horse Stance Bending." Be sure to apply your brace and maintain it independently of your breath and direction of movement for all these bending movements.



In "T-Bone Bending," you will lean into a wall with one hand and lift one leg behind... then rotate your pelvis around one hip, doing an alternate opening and closing movement. This is to strengthen, stretch and gain motor control over the deep rotator muscles of your hips.



In "Counterbalance Bending," you will lean into a wall with one hand and practice an ipsilateral bend by lifting one leg out behind. In "Split Stance Bending," you will lean again with one hand on a wall and practice a contralateral bend by sliding your opposite foot backward on the floor.



Purpose and Application of Bending Drills •

Same as for the lesson.. .note especially bending strategies with upper extremity support and the counterweight of your leg. Find lots of situations in which you can use these.

Go to your Video... Do Bending Drills Bending Drill Session: 1. Start with an observation of your standing posture.. .balance of your pelvis front-to-back and side-to-side, shape of your back, perception of ease or comfort. 2. Summary movements- "Contralateral Bending" and "Ipsilateral Bending." Alternate 5 times each direction...2 sets each. 3. Summary movement- "Horse Stance Bending." Alternate left and right 5 times each. 4. First Drill- "T-Bone Bending." Up to 10 times each side.. .2 sets each.

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«* Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

*•

5. Second Drill- "Counterbalance Bending." Up to 10 times each side.. .2 sets each. 6. Third Drill- "Split Stance Bending." Up to 10 times each side.. .2 sets each. 7. Cool Down- "Level One Favorites." To your satisfaction. 8. Finish with observation of standing posture. End lying on your back on the floor. Do the bending drills session a couple times, then go on to read about standing stresses and do the standing drills. Standing Stresses Standing stresses usually means too much extension. This can be a result of the top of your pelvis rolling too far forward (Fig. 5-15) or a result of pushing your pelvis too far forward then collapsing your chest backward relative to your pelvis. (Fig 5-16) There is also the one-legged flop stand, (Fig. 5-17) which creates a combination arching and one side compression stress.

Fig. 5-15 Standing with your pelvis roiled forward creates an extension stress on your back.

Fig. 5-16 Standing with your pelvis vertical but pushed forward and allowing your chest to collapse creates an extension stress.

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Fig. 5-17 Standing on one leg but collapsing creates both extension and one side compression stresses.

^



Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses If you stand like this and your back hurts while standing or afterward, you will want to learn: • • • •

To lengthen and relax your low back muscles to let your pelvis roll backward. To lengthen your hip flexors to allow your pelvis to be rolled backward. To strengthen your hip extensors to push the top of your pelvis backward toward vertical. To shift your weight backward to bring your hip vertically over your ankle and to reduce the backward collapse of your chest.



To recognize the position of your pelvis and the shape of your whole back.

Standing Drills Overview of Standing Drills • • •

Start with a summary movement, "Neutral Sit to Stand." Practice/emphasize pushing to standing with a vertical pelvis. Continue with another summary movement; "Half Standing or Half Kneeling Hip Circles." Emphasize the front part of the circle to lengthen your hip flexors. In "Half Standing" you will stand with one foot forward.. .on a chair seat, low stool or floor in front. Use your front leg to push the top of your pelvis backward and to lengthen your lower back.



In "Stork Standing" you will stand with one foot slightly forward and on the floor but with nearly all your weight back on your back leg. Shift your weight back onto your back leg and roll the top of your pelvis slightly forward and backward.. .learning to control the position of your pelvis with your back leg.



In "Butt Pinch Standing," stand with your feet apart in a horse stance or close together in a Charlie Chaplin stance. Shift your weight back and push with your gluts to roll the top of your pelvis backward and to lengthen/flatten/relax your lower back. ONE OF THE TEN ESSENTIALS!

Purpose of Standing Drills • • •

Strengthen your hip extensors.. .pushing your pelvis to vertical. Lengthen your hip flexors.. .opening the front of the hips to allow your pelvis to roll back more easily. Improve your awareness of the shape of your lower back in standing.. .improving how your pelvis is balanced on your legs/feet.

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Application of Standing Drills • •

Improved standing posture... reduction of low back arching and reduction of one-legged flop stresses. Improved control of weight-in-front stresses.. .the same basic patterns of movement apply to your next drills session.

Go to your Video... Do Standing Intro and Drills Standing Drills Session:

1. Start with an observation of your standing posture.. .the balance of your pelvis front-to-back and side-to-side, the shape of your back and your perception of ease or comfort. 2. Summary movement- "Neutral Sit to Stand." Do up to 10 times. Emphasize pushing your pelvis to vertical and pinching your butt cheeks together. 3. Summary movement- "Half Standing or Half Kneeling Hip Circles." Up to 10 times in each direction.. .on each side. 4. First Drill- "Half Standing." Up to 12 times on each side... 1 set each. 5. Second Drill- "Split Standing." Up to 12 times on each side.. .at each placement of your front foot. 6. Third Drill- "Stork Standing." Up to 15 times to each side.. .2 sets each. 7. Fourth Drill- "Butt Cheek Standing." Up to 15 at each of the two placements of your feet...2 sets each. 8. Cool Down- "Level One Favorites." To your satisfaction. 9. Finish with observation of your standing posture.. .then collapse and rest for a bit. Do the standing drills session a few times and read the bullet points, then go on to the WIFS description and drills session. 74

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Standing Applications Use a foot in front, or up on something in front of you to help with pushing the top of your pelvis backward and inflatteningyour lower back. (Fig. 5-18) Be sure to switch sides occasionally. Chopping vegetables in the kitchen, foot on a stool. Wood working in the shop, foot on a stool. Foot on a cart while in line at the grocery store. Foot on a bleacher seat while watching your kid's soccer game. Foot or knee on the bathroom counter while putting on make-up or shaving. Brushing your teeth while in a split stance.

Fig. 5-18 Put one foot up on a stool and use that front leg to push your pelvis upright and to flatten your low back.

In a split stance use your front leg to keep the top of your pelvis from falling forward and your lower back from arching. (Fig. 5-19) Be sure to switch sides occasionally. • • • • •

Waiting in line for a beer and a bag of popcorn at the ballpark. Standing around at a party and consuming cocktail weenies. Standing at the fence and shooting the breeze with your neighbor. Standing around the water cooler and complaining about company policy. Standing around the broken water main waiting for the supervisor to show up.

Fig. 5-19 Put one foot forward on the floor and use that front leg to keep your back from arching.

Use horse stances and shift your weight back to drop your tailbone and lengthen your back. (Fig. 5-20) Push your feet outward as if tearing the carpet between your feet.. .more on this in the rotational lesson. • •

Waiting for the bus. Singing in the choir.

Fig. 5-20 Place your feet wide and bend your knees a bit when standing for awhile. 75

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses



Standing ovation at the opera or monster truck rally.



Crossing your arms and enduring the tirade from your boss.

Substitutes for standing include leaning back against something (Fig. 5-21) and squatting. • •

Lean back on the kitchen counter at a party. Lean back on your car while waiting for your wife to finish shopping.



Squat on the sidelines to watch your daughters' marching band. Lean back on your buddy's office door to share the latest gossip.



Try holding your standing positions for a minute or even a few minutes each. Strengthen your legs and give your back a break. A lot of us complain of a bad back and flabby thighs and butt... cause and effect or cosmic coincidence, you be the judge. Develop some endurance in your leg muscles and reinforce your skeletal alignment: weight in the middle of the feet, knees over feet, thighbones vertical, pelvis vertical or tailbone pointed tofloor,low back long and flat...upper back straightened to push head and eyes taller. Most people have back trouble in standing because they are not actively pushing into the ground. Leg muscles should be active in standing...to move bones into position to support weight. Tragically, many of us allow our legs to abdicate all responsibility in standing. We let our feet collapse inward to pronate our entire body weight onto the inner ligaments of our feet and ankles. We hyperextend/lock our knees so our quads don't have to work. We roll the top of our pelvis forward so our butts can kick back and soak up pasta and ice cream.. .and don't notice how this creams our poor lower back. We shift all our weight onto one leg and flop.. .again laying waste to entire swaths of low back tissue. If you want your back to feel better when standing, your legs need to step up to the plate and take the swing. Quads, hamstrings, gluts and the deep hip rotators need to cradle your pelvis in a velvet fist and anchor you in turn to the floor through your calves and stabilizing muscles of your feet and lower legs (esp. peroneus longus and posterior tibialis if you are keeping track of the supporting cast at home). Get your legs in shape by using them!

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

FYI #6 -Your Back "Bank Account" •

Boiled down to basics, taking care of your back is pretty simple...limit its stresses and maximize its pleasure. This requires having certain valuable knowledge...what strains your back and what makes your back feel good?Think of it as a complex debit and credit system, like your bank account. You make deposits and then write checks or take out cash to spend.

• What feels good... what kinds of deposits can you make? If you are directionaily unstable (rounding or arching biased), you can emphasize movements that move your back and hips into non-habitual directions. If you are arching biased, do rounding movements for your low back and straighten your hips to stretch your hip flexors. If rounding biased, try arching movements for your back and bend your hips to stretch hamstrings and gluteals. If multidirectionally unstable, there might not be a comfortable direction...you will have to carefully experiment to see if any movements or positions feel good. If not, you will have to be very careful with your expenditures.



For most, lying down and getting out of vertical for a while can be helpful first-aid. If arching biased, try lying on your back with your legs up on a couch or huge stack of pillows or with your knees bent and feet on the floor or up on a wall. Try placing a small/medium ball or a small pillow under your tailbone to roll your pelvis straight up on the floor or under one sitting bone to roll your pelvis diagonally in one direction or the other...experiment with resting with your pelvis rolled straight up on the floor or rolled up and to the left or up and to the right. If rounding biased, try lying on your belly with your head resting on your arms or your chest on a pillow to give you some prolonged time with your back in extension. Bend up one leg or the other to experiment with asymmetrical positions.

• The debit side of the equation is a bit more complex...we don't always know when money is hemorrhaging from our pockets, or how much each lift or twist costs our back. Develop a good intellectual understanding of likely categories of stress for your back...extension stresses, flexion stresses, rotational stresses, WIFS, walking, pushing laterally, etc. Then be vigilant and take your time when doing physical activity so you can develop a good understanding of how to control, modify or avoid the specific stresses from these categories as they present themselves during the course of your daily activities. Only you can design your back budget...spend wisely and do good things for your back whenever possible.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

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Weight-in-Front Stresses

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Weight-in-Front stresses refer to holding, lifting or carrying an object of some weight out in front of you. Picking up or holding something in front of you creates an extension stress. The Weightin-Front moves the center of mass forward and wants to topple the whole structure forward. (Fig. 5-22) If we didn't have legs, we would topple over...but would arch in a balance reaction. (Fig. 5-23) This makes your back extensors work. Because you do have legs, you can prevent yourself both from toppling over and from having your pelvis roll forward to arch your back. (Fig. 5-24) What you need to do is use your hip extensors to support or stabilize your pelvis on top of your legs. This reduces movement of your low back into arching, reduces further abuse of the too often overused muscles of your lower back and reduces compression and shearing stresses.

Fig. 5-22 Schematic representation of a weight-in-front. the whole structure topples forward.

Fig. 5-23 Weight-in-Front tends to arch your back and to roll your pelvis forward.

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Fig. 5-24 Prevent your pelvis from rolling forward and your back from arching by using your hip extensors.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

WIFS Drills Overview of WIFS Drills •

• •



Start with the summary movements from the bending lesson, "Contralateral Bending," "Ipsilateral Bending" and "Horse Stance Bending." Bending strategies blend into WIFS control strategies. Continue with some standing drills, "Split Stance Standing," "Stork Standing" and "Butt Pinch Standing." Standing strategies blend into WIFS control strategies. For your first drill, "Controlling WIFS with Foot Forward," you will be experiencing what controlled and uncontrolled Weight-in-Front stresses feel like by lifting a 6#-8# object out in front of you. Don't do a lot of these, just enough to be able to recognize the stress and to understand your potential strategies for controlling that stress. In your second drill, "Controlling WIFS with Weight Back," you will work with movements of shifting your weight back on one or both feet, bending your knees and tucking your tail as a counterweight to a weight-in-front stress. Shifting your weight back onto your back leg and rolling your pelvis past vertical and into posterior tilt is a very important one. Use it for standing and controlling weight in front stresses. ONE OF THE TEN ESSENTIALS!

Purpose and Application of WIFS Drills • • •

Use to improve your awareness of the effect on your lower back of Weight-in-Front stresses. Use to improve your awareness and understanding of how to control these stresses. Use weight-back stances for controlling standing stresses.. .one of the reasons I ask you to hold these positions for a while.

Go to your Video... Do WIFS Intro and Drills WIFS Drills Session: 1. Start with some summary bending movements- "Ipsilateral Bending," "Contralateral Bending" and "Horse Stance Bending." 5 to each side. 2. Continue with some standing drills- "Split Standing," "Stork Standing" and "Butt Pinch Standing." 5 to each side.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

3. First Drill- "Recognizing Weight-in-Front Stresses." Just enough of these to recognize strain. 4. Second Drill- "Controlling WIFS with Weight Back." Hold for up to 2 minutes at horse stance and one minute each with one-legged stance. 5. Cool Down- "Level One Favorites." To your satisfaction. 6. End by lying down to chill. Do the WIFS drill session twice and read the material, then watch squatting introduction and do the drills. WIFS Applications

Fig. 5-25 Controlling Weight-in-Front stresses with a horse stance.

Fig. 5-26 Controlling Weight-in-Front stresses by shifting your weight back and getting the weight in close.

Control weight-in-front stresses by anticipating the stress.. .moving your center of mass backward and rolling the top of your pelvis back. Cue your gluts and apply your brace. (Fig. 5-25 and 5-26) •

Getting the big bag of dog food out of the back of the van.

• • • • • • • •

Getting the barbwire out of the back of the pickup. Lifting a shovel full of dirt. Carrying your sleeping one-year-old son from the car to his room. Emptying your grocery cart at the checkout stand. Changing your clothes over from the washer to the dryer. Moving a lamp to a different table. Passing the massive bowl of your grandmother's mashed potatoes at the dinner table. Helping your elderly father out of his chair.

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Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

WIFS Avoidance and Modifications

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One way of controlling weight-in-front stress is to avoid it. Carry weight on your shoulder or to your side. (Fig. 5-27 and 5-28) Put the weight on your back instead. (Fig. 5-29) Use wheels whenever possible.. .you should have a hand truck and/or a wagon around the house. (Fig. 5-30 and 5-31) Sometimes you can roll something across the floor rather than lifting and moving it. Slide things across the floor while walking on your knees.

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Fig. 5-27 Avoid weight-in-front stresses by carrying things on your shoulder.

Fig. 5-29 Carry things on your back.

Fig. 5-28 Carry things to your sides with the weight balanced.

Fig. 5-30 Make sure to have some wheels around.. .your back will thank you.

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Fig. 5-31 Hand trucks and wagons are great. wheelbarrows are not. 81

Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

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FYI #7 - The Goldilocks Effect •

Being asked to make choices when exercising is a characteristic of informational exercise. During this WIFS recognition drill, and throughout the rest of the video, you are being asked to feel the differences between one way of doing a movement and another way. Why am I doing this? Why don't I just out and tell you everything you need to know? Basically, because I want you to be able to make up your own mind about how you want to move or posture yourself.



In the story of Goldilocks and the Three Bears, a young girl named Goldilocks broke into an innocent bear family home and helped herself to some food, rest and a little nap. She was presented with a choice for each activity. The food was of varying temperature and the chairs and beds were of varying firmness. She tried each in turn before selecting the one that was "just right" for her. How did she know which one was best? By trying a variety of options and making a qualitative decision about which one worked best for her.

• The applications of the Goldilocks Effect to learning new ways of moving your body are obvious. Compare your habitual ways to new ways or compare a few different options to the way you always do things (stand, bend, lift, walk, turn, sit, etc.). If you can train yourself to look for options in exercise and to make qualitative judgments, this skill can spill over into real life and you can apply the Goldilocks Effect to the way you fold clothes, empty the dishwasher, ride the tractor, dig the ditch or carry your laptop. Realize that you almost always have a choice in the way you do something... please think for a moment before acting by rote.

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Squatting Drills Overview of Squatting Drills • •

• •

• •

Watch the demonstration of squatting and kneeling possibilities... gets your center of mass low and helps in controlling bending and weight-in-front stresses. If, while watching the demo, you even briefly thought about having a phone nearby with 911 on speed dial, please skip over this section. Be selective about which movements to try and be reasonable about how much you do. "Wall Squats" is the first drill. Leaning back against a wall helps with balance and reduces the necessity to bend your toes or ankles so much. "Half Kneel to Half Squat" and "Kneel to Squat" are the last drills. These drills work with transitional movements from standing to kneeling to squatting. Very applicable to real life. ONE OF THE TEN ESSENTIALS! You might want to wear shoes, or even boots, when you first do this. This will be easier on your feet and toes than doing it barefoot. Try using a chair seat, using your pole or practicing these movements in a doorway to stabilize yourself with your arms.

Purpose and Application of Squatting Drills • • • •



Use to loosen up/stretch your knees, ankles and toes to make squatting easier. Use to stretch your quadraceps with "knee toward the floor" movements. Use to improve your balance/challenge balance reactions.. .be sure to keep your brace on. Use to improve your foot and lower leg strength and stability.. .your foot is where the rubber meets the road and needs to be stable/mobile/competent for your pelvis and lower back to be stable. Use to improve your ability to access functionally useful positions.. .controlling bending stresses and WIFS.

Go to your Video... Watch Squatting Intro and Do Drills

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r3 Chapter Five: Controlling Sitting, Standing, Bending and Weight-in-Front Stresses

Squatting Drills Session:

1.

First Drill- "Wall Squats." One leg and two leg versions.. .leaning into a wall and progressing over time to come farther away from the wall. No repetition suggestions.. .do to your satisfaction.

2.

Second Drill- "Half Kneel to Half Squat and Kneel to Squat." To your satisfaction.

3.

Cool Down-"Level One Favorites." To your satisfaction.

Go to your Video... Watch the Review and Select Level Two Favorites. Write Down Your Favorites on Your Master Checklist.

Notes:

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Chapter Six: Controlling Rotational Stresses

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Chapter Six: Controlling Rotational Stresses

Your lower back is stressed by rotational or lateral (side-to-side) shearing movements of your pelvis under a relatively more immobile torso.. .or by rotational or lateral shearing movements of your torso on top of a relatively more immobile pelvis. With both lateral movements and rotational movements, you will probably want your pelvis and torso to move side-to-side or to rotate together rather than to shear at your lower back. We will use log rolling movements to teach you to control rotational stresses by moving your pelvis together with your chest/thorax/shoulders, and to train your abdominal muscles to maintain that log-like relationship. Of course, logs can't initiate their own roll, so we'll have to use your legs to initiate and provide the power for turning and weight shifting movements. Your hips will also need to be mobile enough to allow sufficient movement of your pelvis in space. Not enough movement of your pelvis relative to your legs means all the more work you've piled on your low back. The upshot of it is, you will be continuing to work on hip mobility and on stretching/strengthening your hip and thigh muscles while attending to and maintaining a neutral back. Whether you are rounding biased, arching biased or multidirectionally unstable, you are susceptible to rotation or lateral shear stresses. Learn these movements well and apply them to your daily activities! Postural Rotational Bias We all have left/right differences or asymmetries in our bodies. This is a natural consequence of the way we develop in early childhood and of having a dominant hand. When we are very young, we are engaged in a furious learning process: learning everything from how to roll from back to belly, to grasping objects, to eating from a spoon, to vomiting on dad's shoulder, to climbing stairs, walking, etc. When we first learn a motor task at that age, we don't learn it evenly to each side. Initially, babies show a preference for rolling toward one side over the other, or will always go up stairs leading with one foot first. There are natural developmental advantages to this: learn a task, perfect it, and move on to the next task rather than taking the time to learn everything perfectly evenly to both sides. Every kid is highly motivated to sit up, crawl, come up to stand, walk and manipulate his or her environment.. .he or she works to improve a particular skill to proficiency on that side, then habirualizes it and goes on to the next thing.

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Chapter Six: Controlling Rotational Stresses

Kids are not interested in being ambidextrous, but in having a hand they can depend on to grasp an object and bring it to their mouths, throw it, stack it, look at it or show it to mom. If my next meal depends on the accurate cast of my spear or if I want to make absolutely sure to grab my inattentive kid before he steps in front of a car, I don't want to dither while trying to remember which hand I used last and whose turn it is next. I need to react without thinking.. .1 need to have a dominant hand. Because the rest of my body is integrated or coordinated with movements of my arm, this helps to create asymmetries throughout the rest of my spine, chest, pelvis and legs. When you move asymmetrically, your muscles develop differently from side-to-side and left/right muscle imbalances are created. These muscle imbalances are present not only in movement, but in resting or "static" positions as well...sitting, standing and lying down. These left/right muscle imbalances pull your bones around asymmetrically and create left/right pelvic imbalances and functional spinal scoliosis. Scoliosis refers to a side-to-side curvature of your spine.. .your spine is not geometrically vertical when looking at yourself from directly in front or back. Your pelvis is not level, one side of your rib cage and waist is a little shorter than the other, your shoulders are not the same height and your head isn't vertical and centered over the middle of your breastbone. Many people have scoliosis; some with a little bit and some with a lot. With some it will be glaringly obvious, others will catch fleeting glimpses but will be able to recognize the critter, and still others will find the whole question rather opaque. Start with two assumptions: everyone has left/right muscle imbalances and no one will ever fully get rid of them. However, these imbalances do create asymmetrical tissue strain and contribute to asymmetrical symptoms. If you have more pain to one side of your back than the other, or pain down into one hip or leg, you will want to get afirmhandle on your postural imbalances and work to lessen them. Even though you can't fully get rid of your left/right imbalances and rotational bias without a truly heroic effort and attention, you can certainly whack the things down to a manageable size. If your pain is dead center, you will still want to learn to recognize and control rotational movement stresses, but balancing your posture left/right will likely not be as big a deal. Recognition of your own postural rotational bias is a bit tricky. There is a section in the video on recognition of your rotational bias. You will be making visual and kinesthetic (movement sensation) observations in sitting and standing. After doing this video section, go to your Master Checklist and mark your best guess of your rotational bias in the appropriate place.

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Chapter Six: Controlling Rotational Stresses

Because you have already been doing a lot of diagonal and side-to-side movements in previous lessons and drills, you have already been working on recognizing and reducing rotational or sideto-side asymmetries. A few clues from previous material might be helpful if your video self-assessment is a bit foggy: •

During the "Floor Sit Bending" lesson. The side it was easiest to sit on is probably your direction of rotational bias. If side sitting to the left and sliding your right hand forward was easier compared to side sitting to the right and sliding your left hand forward, you are probably biased to left pelvic rotation.



During the "Hurdler's Stretch" drill. The easiest hamstring to lengthen is usually the direction of easiest pelvic rotation... if your left hamstring is looser than the right, your pelvis probably has a left rotation bias. During the "Half Kneeling Hip Circles" summary movement. The tightest hip flexor is probably the side of pelvic rotation.. .if your left hipflexoris tighter than the right, your pelvis probably has a left rotational bias. During the "Contralateral Bending" drill. The easiest contralateral bend is probably the direction of your pelvic rotational bias.. .if sliding your right hand down the pole with your left foot forward is easier than other side, your pelvis probably has a left rotation bias.







During the "Diagonal Sit to Stand" drill. The easiest side to come up to stand on is probably your direction of rotational bias.. .if coming up diagonally from back and to the right to forward and up over left foot, your pelvis probably has left rotation bias.

These are just some of the many diagonal or rotational movements that we have already done that might provide you with additional clues. Dig as deep as you'd like! What do you suppose happens when your pelvis is always twisted on top of your legs? You can generally expect a rotational instability of your spine in the opposite direction. If your pelvis is habitually twisted to the left, your spine will probably be rotating right.. .you will be more susceptible to right rotation movement stresses, as well as being under constant fire posturally. Which brings us to our next question: what are some categories and examples of rotational movement stresses?

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Rotational Movement Stresses One category of rotational movement stress is when your upper body twists in space on top of either an absolutely immobile or relatively immobile pelvis. •

Sitting or standing and reaching across your body. Reaching to the left with your right hand without moving your pelvis will rotate your spine to the left. Raking, sweeping, cleaning windows, or reaching for your coffee cup, bar of soap, pair of pliers or dials on your car radio.



Pushing an object to the side. Sliding a bag of groceries to one side on your kitchen counter, pushing open a sliding glass door or sliding window, pushing hanging clothes to one side on a closet rod or moving a potted plant or couch away from a wall. (Fig. 6-1)



Sitting or standing and reaching behind your body. Reaching into the back seat of your car with your right hand rotates your spine to the right.



Reaching or pushing straight forward or pulling straight back with one hand. Reaching directly across the table for the dinner rolls, pushing a vacuum cleaner, pull starting a lawn mower and opening a heavy glass door. (Fig. 6-2)



Looking left and right along the horizon. Turning to look over your left shoulder when backing out of your driveway rotates your spine to the left.



Pulling an object behind you with one hand. Walking with a wheeled suitcase or dragging a recalcitrant child by the hand. (Fig. 6-3)

Fig. 6-1 Pushing sideways is a rotational stress.

Fig. 6-2 Pulling with one hand is a rotational stress.

Fig. 6-3 Pulling something behind you with one hand is a rotational stress. 89

Chapter Six: Controlling Rotational Stresses



Resisting a pull from one side. Controlling a dog on a leash or a fish on a hook. (Fig. 6-4)

Another category of rotational movement stresses is when your pelvis rotates underneath an absolutely immobile or relatively more immobile chest and torso. •

Belly dancing or dancing the "Twist."



Walking with a twist or "Waddle"... or walking with a lateral shear or "Swish." Will

Fig. 6-4 Resisting a pull sideways requires three layers of stability.

be explained and addressed in the walking section. Acceleration and deceleration of ballistic turns. This is a fancy term for rotating quickly. Swinging a baseball ball/tennis racket/golf club or throwing a discus/football/Frisbee. Your legs initiate the movement (usually and ideally)... if your abdominal muscles are not maintaining a log roll or at least a shouting distance relationship between your pelvis and chest, your pelvis goes running off and leaves your chest to catch up later. This creates a rotational stress to your low back, both with the initiation of the swing and when stopping the turn. (Fig. 6-5) Making quick change of direction movements. Dodging an opponent in soccer, juking a defender in basketball or quickly responding to catch an errant throw. Moving your legs sideways relative to your torso. Swinging your legs into or out of a car, kicking a soccer ball, rolling over in bed, some low back twisting exercises or some martial arts kicks. (Fig. 6-6)

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Fig. 6-5 Fast turning movements need to be stabilized during both acceleration and deceleration of the swing.

Fig. 6-6 A transitional movement like getting out of your car can twist your back.

Chapter Six: Controlling Rotational Stresses



Pushing sideways against a relatively immobile object or resisting movement of an object. Driving a screw into a wall, taking down a tree with a chainsaw or holding a long ladder vertically and keeping it from falling left or right. When you push sideways against an immobile object (or even when the object can eventually move) your abdominal muscles have to contract to make your torso a stable base from which your arms can push.. .otherwise, as you push sideways to the left, your chest and shoulders would turn to the right. (Fig. 6-7)

Fig. 6-7 Pushing against an immobile object is a rotational stress.

When your abdominal muscles contract to stabilize your chest and shoulders, they have a simultaneous effect on your pelvis (where the belly muscles connect). When pushing to the left, your stomach muscles contract to prevent your chest and shoulders from twisting to the right.. .this ends up twisting your pelvis to the right underneath your relatively immobile upper body. If you push left, your pelvis twists to the right and your spine twists to the left. This twist of your pelvis will need to be recognized and stabilized, and that will be done with your big hip and thigh muscles. When possible, avoid the rotational stresses of pushing sideways or pushing or pulling heavier stuff with only one hand. Try to push or pull straight forward or straight back with two hands to reduce rotational stresses. (Fig. 6-8) Another category of rotational stress is when an outside force moves your whole body in space.

Fig. 6-8 Use two-handed pulls and pushes to reduce rotational strain.



Riding in a car/bus/roller coaster and taking a right hand turn; centrifugal force rotates your pelvis to the left and rotates your spine to the right. True for both sharp turns in city or wide arching curves on freeway.



Riding on buses and sitting facing the aisle; acceleration and deceleration of the bus creates a lateral shearing or rotational stress.

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Riding in a car/truck and going over bumps/holes in road that throw your car from sideto-side; lateral shear and rotational stresses of "4-wheeling."



Doing doughnuts in an icy parking lot with your dad's car.



Turbulence on an airplane.

I would suggest revving up your DVD player and going through the rotational self assessment section, the two rotational lessons and their attached drills, then returning to read over the parts on postural and movement rotational stresses again... you will have a different appreciation of the written material once you have experienced movement proprioceptively.

Go to your Video... Do Rotational Recognition Drills Go to your master checklist and mark your best guess based on sitting and standing self assessment and on your perception of left/right differences on key prior movements as described above. Do the described rotational recognition drills and mark your master checklist again, then come back to read about your next lesson.

Lesson #8..."Log Rolling"/22

minutes

In the Eighth Lesson You Will Be: • • • •



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Lying on your side and lifting an arm and a leg. Needing two or three bath towels or a blanket that you can fold up to provide a long, flat pillow for your head when lying on your side. Rolling from side-to-side on the floor, keeping a stable relationship between your chest and pelvis; a log roll. Reaching one hand forward and back while lying on your side.. .coordinating the intension to move your hand (manipulate) with rotational movements of your pelvis and log rolling movements of your torso. Reaching one hand forward and back with one leg lifted and will likely tire out some seldom used muscles. Imagine pushing and pulling some imaginary object as you do this.

Chapter Six: Controlling Rotational Stresses

Purpose of Eighth Lesson • • •

Loosen up your hip joints.. .improving rotational range of movement of your pelvis relative to your legs. Strengthen your deep hip rotator and abductor muscles.. .waking up muscles that move and stabilize your pelvis rotationally in space. Establish awareness of "rotational neutral" movement.. .moving your chest and pelvis, shoulders and hips together in a log roll.

Application of Eighth Lesson •

Literal use.. .rolling from side-to-side in bed or on the floor, though bed partner and presence of bed covers may necessitate a modification.



Push outward with a knee to control sideways movement of your pelvis while riding in a car. Push outward into the car door with your left knee when taking right hand turns; prevent the rotation of your pelvis to the left and the twist of your spine to right. Use this as a homework assignment.. .drive around a block a few times taking right hand turns to help identify a rotational stress and to learn to control that stress from your legs. Try left hand turns.. .is there anything your right knee or leg can push out against or do you have to stabilize with your right hand/arm?

Go to your Video... Do Lesson ##- "Log Rolling" Do the lesson twice and read over the material again, then move right along to your first set of rotational drills.

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Chapter Six: Controlling Rotational Stresses

£ ^

Rotational Drills Overview of Rotational Drills • •

Start with the summary movement from lesson, "Side Lie Scissors." Your first drill is "Side Lie to Side Sit." This is a continuation of "Side Lie Scissors" that brings you up to side sitting.



Your second drill is "Sitting Rotational Reach." You will be sitting in a chair and reaching forward and back, coordinating your rotating pelvis with your intension to reach forward and pull back. Your third drill is "Standing Rotational Reach." You will be standing in a split stance and holding your pole.. .reaching again forward and back and coordinating with your pelvis. ONE OF THE TEN ESSENTIALS!



Purpose and Application of Rotational Drills •

Purpose is the same as in the lesson.. .loosen your hips, stretch and strengthen your hip rotator/abductor muscles and improve your awareness of a rotationally neutral back.

• •

Stretch hip flexors in "Standing Rotational Reach." Applications are straight forward; coming up to sit from lying down, reaching from sitting or standing, pushing or pulling with one hand.

Go to your Video... Do Rotational Drills

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Chapter Six: Controlling Rotational Stresses

Rotational Drills Session: 1. Start by lying flat on the floor and assessing your contact, rotational bias and your perception of length differences between your left and right sides. 2. Summary Movement- "Side Lie Scissors." Do up to 10 times each side.. .2 sets each. 3. First Drill- "Side Lie to Side Sit." Do up to 7 times to each side. Then come up alternately to one side then the other, rolling across your back.. .up to 5 times to each side. 4. Second Drill- "Sitting Rotational Reach." Do up to 10 times on each side.. .2 sets each. 5. Third Drill- "Standing Rotational Reach." Do up to 10 times on each side.. .2 sets each. 6. Cool down- "Level One or Two Favorites." To your satisfaction. 7. End by lying quietly and reassessing your contact and rotational balance. Do the Rotational Drills session twice, reread the overview, purpose and application section, then keep going to your next lesson.

Lesson #9... "Anchoring Your Feet"/'47 minutes In the Ninth Lesson You Will Be: • • • • •

Requiring about 50 minutes for this one. This lesson is a bit longer than the usual 20-30 minutes you have been doing. Needing two or three bath towels or a blanket that you can fold up to provide a long, flat pillow for your head when lying on your side. Contracting your gluteal muscles, "pinching your butt cheeks," in several different positions. Lying on your side, pinching your cheeks and lifting a leg.. .then will do a version of the scissoring movement you did in the lesson #8. Lying on your back, pinching your cheeks and pushing your feet outward, "as if tearing or sliding the carpet"...to roll your pelvis upward and to roll your pelvis from side-toside.

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Chapter Six: Controlling Rotational Stresses

• • •

Lying on your back, rolling your pelvis from side-to-side with your legs and moving your chest and shoulders along with your pelvis.. .log rolling again. Standing and turning your pelvis from side-to-side.. .moving your chest and shoulders along in a log roll. Coordinating your hips with your feet.. .learning to stabilize your feet on the floor to complete the rotational stability chain from arms to chest to belly to pelvis to hips to knees to feet to floor.

Purpose and Application of Ninth Lesson • • • • •



Learn this second while lying down.. .push out from your hips to roll the top ofyour pelvis backward and toflattenyour low back. Pinch your cheeks again to assist with the roll ofyour pelvis upward on the floor.. .then let go ofyour cheeks and maintain your rolled pelvis and flat back through this "pushing out" movement.



Do the same thing in standing.. .pinch both cheeks and push outward from both hips to "tear the carpet". Then let go ofyour cheeks. Progress in all three positions to just pushing out to roll your pelvis. This is an elusive movement to find.. .you will also need to let go ofyour back muscles and hip flexors and will need to shift your weight back a bit toward your heels. This should roll the top ofyour pelvis backward on your legs and should allow your lower butt cheeks to relax. Learn this to avoid looking like someone who is holding a quarter between their butt cheeks while standing. This contraction ofyour upper gluteals and abductor muscles allows your lower gluteals to relax.



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Purpose same as lesson #8.. .loosen your hips, stretch and strengthen your hip muscles and improve your awareness of rotational neutral. Applications to pushing or reaching sideways from standing or lying. Applies to raking and sweeping. Scissoring movement of legs in lessons #8 and #9 both precursors to walking movements in walking chapter. Applies to standing.. .pushing out laterally with both legs as if to tear the carpet apart. Find this movement first in side-lying. With both legs long/straight, lift the top leg and pinch your cheeks to roll the top ofyour pelvis back.. .then let go ofyour cheeks and see if you can maintain the posterior tilt ofyour pelvis just from the "pushing out" movement.

Chapter Six: Controlling Rotational Stresses

Go to your Video... Do Lesson #9- "Anchoring Your Feet 99 Repeat the lesson twice and read over the comments on the lesson again, then march on to practice more rotational drills.

More Rotational Drills Overview of More Rotational Drills •

Start with a drill from lesson #8, "Side Lie to Side Sit." Continue with the summary movement from lesson- "Standing Triangle Tilts."



First drill is lying on your back, "Log Roll with Pole." You will lie on your back and tilt your pole from side-to-side.. .ups the ante on tilting your triangle by adding weight that challenges abdominal muscles to work. You can substitute pulley weights, elastic tubing or afriend/spousepushing sideways on your triangle if the pole is too light or if you can't feel your belly kick in.



Second and third drills are in standing- "Horse Stance Pole Swing" and "Half Horse Pole Swing." You will use a pole placed across your shoulders to practice log roll movements while rotating in standing.. .then will quicken the pace to recognize and control fast rotational movements. Be sure to keep your feet flat on the floor.. .don't let your feet roll in and out. Keep your knees out over your feet, which requires movement and strength from your hips. ONE OF THE TEN ESSENTIALS!



If you are really ambitious, do these movements against some kind of resistance. Tie some elastic rubber tubing to the pole or just hold on while you anchor the other end. Use these movements with pulley weights if you have them at your gym or home gym. I wouldn't suggest a lot of weight.. .and be sure to stay stable at your waist and move at your hips.

Purpose and Application of More Rotational Drills • •

Same as both lessons and first rotational drills session. Coordinates all three layers of stability: intersegmental stability controlled by your TA and multifidi, pelvic stability controlled by your hip and thigh muscles and torso stability controlled by your abdominal oblique muscles.

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Chapter Six: Controlling Rotational Stresses

Go to your Video... Do More Rotational Drills Do the drills twice, then move on to the next chapter on walking stresses. More Rotational Drills Session: 1. Start lying flat on the floor and assessing your contact and rotational balance. 2. Do the previous drill- "Alternating Side Lie to Side Sit." Up to 10 times to each side. 3. Do the summary movement from the lesson- "Standing Triangle Tilts." Up to 15 times to each side.. .2 sets each. 4. First Drill- "Log Roll with Pole." Alternating up to 15 times to each side.. .first slowly then at a quicker pace if it feels safe to do so. 5. Second Drill- "Horse Stance Pole Swing." Up to 15 large and slow movements to each side. Then 20-30 times small and quick...only if this feels safe. 6. Third Drill- "Half Horse Pole Swing." Up to 15 to each side.. .both slowly and more quickly. 7. Watch demo on vacuuming, sweeping and shoveling.. .finish out the chapter 7 video section. 8. Cool Down-"Level One Favorites." To your satisfaction. 9. Finish by lying flat on the floor and reassessing your contact and rotational balance. Notes:

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Chapter Seven: Recognition and Control of Walking Stresses.

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