What to Do with Anterior Pelvic Tilt AND Disc Herniation!
Welcome back!
How NOT to get up when you have a disc bulge!
I was working with a new back pain patient today…
And I always watch how they move around before I start doing any “formal” assessments. The reason why I do this is because most of these daily operations are unconscious, meaning the back pain sufferer isn’t aware that they are doing them.
So, anyway, as he was laying on the floor, showing me some exercises that his physical therapists (yes, “s”, meaning quite a few) have given him, (which did I mention, FAILED to give him relief), I noticed that when I asked him to stand up, he tried to perform essentially a full sit up to the seated position.
So what?
Well, in this case, this patient has had spinal surgery, and a disc fusion, which means that flexion of the spine is a big “no-no”. That and due to the fact he was in pain, his abdominal muscles were not activating very well. Getting up from a lying position in this manner should DEFINITELY be avoided.
I taught him, as I recommend to ALL back pain sufferers, to turn on their side, and push themselves up to a seated position in order to get up.
Your back will thank you a TON for this! I promise!
–Sam Visnic
Lower Back Pain in Sitting vs. Standing
Does sitting really cause back pain? In my opinion…NO!
Here are two different scenarios:
- Hurt more standing and get relief upon sitting
- Hurt more sitting and get relief upon moving around or standing
What are the possible reasons for these situations:
In number one, bad posture and muscle imbalances may be causing the pain. Particularly when there is excessive anterior pelvic tilt, such as when the psoas and/or quadriceps muscles are too tight, pain in the standing posture can be present.
Another issue that can be the cause of pain while standing, especially when there is no pain for a short time, then the pain gradually comes on, is due to ischemia. That is, lack of blood flow to muscles. This is usually due to the type of situation that I just described about anterior pelvic tilt, but there can definitely be biochemical causes of ischemia.
Either way, in this situation, you are likely to say “When I get off my feet, whether that be sitting or laying down, my pain goes away.”
In the number 2 situation, there can also be issues with ischemia, particularly if you have a desk job and sit “hunched” over a computer for 8 hours per day!
Another potential reason is that there may be a structural problem with the spine itself. When a disc bulge is present, sitting can make you feel worse than standing. Why? Because pressures on the spine are significantly higher during sitting than standing.
When I work with patients with disc bulges, I suggest that if possible, they transition their sitting work stations into standing work stations. Yes, it does suck to stand all day, but it’s FAR less painful, and can dramatically speed up the healing process.
The other thing that can cause you to have more pain in the sitting position that relieves upon standing is either spinal disc degeneration, or spinal stenosis. Both of these situations can be related, since they both involve loss of height in the spinal discs, thus increasing pressure on the nerves that exit the spine.
However, just as well, you can have no pain in the seated position, but still have one of these conditions. I have seen patients with other types of spinal derangements, who have no pain sitting, because they sit in such a way that does not increase the pressure on the area that which is dysfunctional!
Bottom line…
Neither is “bad” for you if you have back pain, but either of which CAN make you hurt more depending on what is causing your pain.
–Sam Visnic
What is a Disc Bulge/Herniation?
Sciatica…Mis-Diagnosed!
One of the more common issues that I tend to see in my office is that of “pseudo-sciatica”. What this refers to is when someone tells me that they have been diagnosed with sciatica, but their symptoms aren’t exactly what you would find in a true case.
Sciatica is essentially when the sciatic nerve, which exits the spine, and travels through the middle of the butt muscles, and down the leg, becomes compressed by either a disc bulge, spinal stenosis, degeneration, or even by the muscle that externally rotates the hip, called the piriformis.
When the nerve is compressed or entrapped, the pain is quite obvious. Usually, it is a sharp pain, and may or may not include a numbness or tingling sensation going down the leg along the line of the nerve.
However, many diagnosed cases of sciatica actually don’t have these symptoms. The most common complaint is “dull aching” sensation around the hip region, and going down the leg in a sort of inconsistent pattern.
That, my friends, is a sign that trigger points may be at work!
As you can see in the picture above, trigger points (marked as “x”) when pressed on, can cause the same type of pain pattern as sciatica.
A simple test for trigger point activity is to press into the areas that are marked X, and see if the pain pattern refers down your leg. If this is the case, you could very well have a trigger point problem.
What is the treatment for trigger points? Simple:
1. Shorten the muscle in which the trigger point is found; This allows the muscle to “reset” and can often de-activate trigger points.
2. Ice or heat; Both can be effective at reducing trigger point pain, particularly when combined with #1.
3. Neuromuscular Massage therapy: This particular form of massage technique focuses on finding and releasing trigger points. In the hands of a skilled therapist, no trigger point can survive! lol!
4. Corrective Exercise: Fixing muscle imbalances is essential in eliminating trigger points, as they can be a major contributer to the development of them! Stretch the tight, strengthen the weak, thats what I say!
Sam Visnic–
On The Topic Of Disc Bulges…
Here are a few of my top suggestions/facts when it comes to disc bulges and back pain:
- Disc herniations can be caused by a single trauma, as well as chronic postural dysfunctions. Movement and postural dysfunctions can only be corrected by focusing on them.
- Inadequate body hydration levels must be addressed in spinal dysfunction, especially spinal discs!
- Respiratory mechanics as well as abdominal wall function is imperative to spinal function. Loss of function creates inability of diaphragm attachments to decompress L-4/L-5, the most commonly herniated disc.
- Rebuilding spinal discs takes nutritional support and good health. Your body makes new tissues out of what you put in your mouth. An inadequate diet and unhealthy lifestyle practices contribute to slow healing.
- Disc derangements do not HAVE to be operated on. There are specific movement techniques that can assist you in stabilizing your spine and reducing disc bulges.
- Healing from a disc bulge takes commitment and time. After a disc has bulged, it can take as much as 18 months to fully heal the torn annular fibers within the disc. This does NOT mean that it will take that long to get out of pain, but instead a reminder to take care of your spine over the long run in order to prevent future injury.
Sam Visnic–
The #1 MOST Common Issue In Back Pain Sufferers
Recently, I ran a survey amongst back pain sufferers from my email list, and an interesting question was posed to me. The question was:
“What is the ONE thing that is common in most back pain sufferers – meaning – what can the majority of us do that would make the greatest difference?”
Frankly, the majority of back pain cases have the same thing in common:
MUSCLE IMBALANCES
However…what is CAUSING those muscle imbalances is the real difference. You see, as I address clearly in my DVD set “End Your Back Pain Now!”, over 90% of individuals have an excessive anterior pelvic tilt. The common characteristics include:
Tight-Facilitated Muscles:
Psoas-Iliacus
Quadriceps
Adductors-Medial Hip Rotators
Lumbar extensors
Weak-Inhibited Muscles:
Abdominal wall (rectus abdominus, external obliques, internal obliques, transverse abdominus)
Hamstrings
Glutes
External Hip Rotators such as Piriformis
Now, keep in mind these are general. Some of those muscles are tight, some being weak. Many times not all of them, and some may be tight on one side, with an opposing pattern on the other. Many combinations can exist.
Correction of these imbalances must follow a logical outline. In my DVDs, I discuss how to stretch the tight muscles, and strengthen the weak muscles. This is the most logical place to start. I believe in assuming that the simplest approach will work. 99% of the time, this relieves pain relatively quickly, usually as soon as the back pain sufferer learns to perform the motions correctly. If the pattern keeps coming back, even as the routines are performed, then a deeper root cause should be assumed.
Too many times therapists and doctors assume the most DIFFICULT scenario. Such as some major joint malfunction, subluxation, etc. While these things may be present, addressing them may not actually be the best approach. For example; if a disc bulge is found on an MRI, most doctors assume the pain is coming from the disc, even if the symptoms don’t line up with a disc bulge. The next recommendation is usually a surgical consult.
To me, that jumps just a little to far too soon. There are many non-surgical approaches to disc bulge rehabiliation, such as the methods described by Robin Mckenzie, a well-known physical therapist from New Zealand who has an excellent approach.
This even assumes that the pain is from the disc. I have found many occasions in which a patient comes in and says they have a disc bulge, but when I have them perform movements that would normally make them HURT BAD if they had a disc bulge, interestingly they report no pain.
Don’t know how I got this far from the original intention of the question, but I do that from time to time!
Anyway, the most common issue with back pain sufferers is muscle imbalances. The FIRST step is to address them directly with stretching and strengthening movements, then go from there!
Check out my DVD for an EXACT program on how to do this:
–Sam Visnic
Why Your Health Care Providers Haven’t Been Able To Fix Your Back!
A back pain tale…
You wake up one day and realize that your back pain has been gradually increasing over the last few months. You decide to make an appointment with your doctor.
You visit your doctor and have an MRI done and its shows you have a minor disc bulge. You have no physical signs of disc bulge, which include a lateral shifting of your pelvis, or immediate pain upon bending forward, no pain during coughing or sneezing, or any major symptoms that would indicate a disc bulge, however, your doctor is convinced that your pain is coming from the bulge. By the way, no movement testing was done.
Your doctor first recommends that physical therapy may help. A prescription is written and you’re on your way to the therapist. The first day, your therapist does some general flexibility testing, takes a list of your symptoms, and some notes. From that day on, you meet with the therapist’s assistant when you visit to do a general back pain program that every patient gets. After doing physical therapy for 8 weeks, 3 times per week and doing exercises and back stretches, ice or heat and muscle stimulation with electrodes, you feel a bit better, but the pain keeps coming back, particularly if you miss a therapy appointment. You decide its time to re-visit your doctor to get another suggestion.
Your doctor then refers you to an orthopedic surgeon, who reviews your case, and your MRIs, and additional relevant information. The surgeon then recommends one of the following options; you can do nothing and see if it goes away on its own, have an epidural, or schedule surgery to repair the disc. Again, no movement testing was done.
So, first you decide that an epidural is the least invasive option, and your back is really bothering you, so maybe it will give you relief, and surgery doesn’t sound good to you. After receiving the epidural, you experience a minor reduction in pain, and wait a few weeks to see what develops. Over the next few weeks, you feel pretty good, and have noticed that the pain has calmed down a bit. You go back to your own daily routine. After a few more weeks, you notice that your pain levels are starting to rise again, and visit your surgeon for a follow up visit.
Once in your surgeon’s office to find that the exact same options are all that’s available to you. Surgery is still not enticing to you. What do you do now??
99.9% of chronic back pain cases are stuck RIGHT here!
So, what’s WRONG with this scenario??
Right now, let’s get something out of the way. I am NOT anti-traditional medicine nor am I against medical doctors. Medicine absolutely has its place, and we are all so blessed to have a doctor around should we break an arm, get an infection, or need a specialty operation or medication to help overcome an immediate health challenge.
However, in the context of chronic back pain, the truth is, most medical care is not effective. There are many reasons for this, but the biggest reason is that assisting patients in overcoming chronic back pain takes time, patience, a number of visits, and effective systems for assessing and treating all aspects of health that contribute to back pain.
Think about the last time you visited your primary healthcare provider. First, how long did it take to get a visit? How long was your appointment? How much time did you ACTUALLY SEE your physician? How much time was used to visit symptoms, complete history, physical assessments of multiple muscles and joints, nutritional analysis, and creating an itemized list of potential contributing lifestyle stressors?
Bottom line, it’s not the doctor’s fault. Overhead costs of running a medical practice are immense, and insurances just don’t pay for spending that kind of time working with patients. They do what they have to do, which unfortunately, unless you have an acute episode of back pain that must have a surgical procedure done, or you really need pain pharmaceuticals to make it through the day, isn’t much of anything.
The other challenge with seeing your medical doctor about back pain is that the majority of MD’s are not specialists in movement therapy. Very rarely, if ever, are physical assessments done on patients in that setting. In order to effectively rule out certain causal factors of back pain, these forms of testing MUST be done. Unfortunately, the majority of MDs don’t know how to perform or interpret them.
So, how does an MD generally diagnose back pain?
That leaves visual tests to lead to a diagnosis. These tests can include MRI, CAT, or X-ray, amongst some others. There are MANY reasons why visual diagnostic tests can be misleading and can overlook the actual reason why backs hurt.
One of them is that these images are taken when you are lying down. Most chronic back pain sufferers don’t have pain when they are on their backs. Pain on standing or moving means that the problem is based on your body’s interaction with gravity, and how it stabilizes itself during motion. A visual diagnostic test may not reveal these issues.
Very simply put, if I were to bend over and pick up something from the ground, and my back goes out, then wouldn’t it make sense to assess the position of the body, and the activity of the muscles in this position? (or at least what they were SUPPOSED to be doing!)
With this use of visual diagnostic tools, the END result of the back problem is actually being assessed alone, may reveal how to treat the symptoms, but will not reveal the real root cause of the problem or how to treat the person so that it doesn’t happen again.
So, what are the primary treatment options? Pharmaceuticals or surgical intervention are commonly the only offered. Many ask and pose the question to experts to establish if these two options are in fact valid treatments. That is indeed a very good question. To answer that, the following references are provided by quite well-known and respected physicians, as well as industry journals for medical professionals.
Imaging studies overestimate the problem, resulting in an increased number of unnecessary surgeries, yet thousands of medical doctors and osteopaths don’t know this. Surgery is the last resort.
90% percent of MRIs read as abnormal.
Pretty scary stuff, eh?
–Sam Visnic
-
"Having someone like Sam to refer my patients to who is as comprehensive, brilliant and caring as he is makes my job so much easier!! I feel assured that my patients are in good hands and are going to get the results they so desperately want. I highly recommend Sam to anyone who is looking to resolve their back pain easily and effectively!”
-Dr. Holly Lucille N.D., R.N. -
“I've used Sam on more than one occasion to help me with back pain issues. As a full time web designer I often spent too many hours sitting behind the pc which led to chronic back pain. I started working with Sam a few years ago and his knowledge and insight helped me to alleviate my back pain issues and even improve my posture. Whenever I start to have back pain issues I just re-implement the tools and techniques he showed to me and in no time my back pain goes away. He really is the back pain specialist!”
-Jimmy Powell
Owner, Stellar Media Group -
“Sam is an excellent mind/body fitness coach & trainer. When it comes to eliminating complex back problems, Sam's your man. He is passionate about his work and dedicated to healing his clients. I highly recommend his services.”
-Michelle Armstrong
Author, "Manage Your Mind, Master Your Life" -
“In my experience it is rare to find a health practitioner who consistently cures the underlying issues, and successfully drives to total wellness. Sam has become our trusted family 'health support system' because he is one of those rare people. He has successfully helped my mother in law, sister, wife, daughter, and myself cure what western medicine has been unable to. We highly recommend Sam ... plus he's a cool guy !”
-Tim Parsey
Microsoft Partner, Dir UX -
“I was so impressed when working with Sam, from his detailed and thorough evaluation, to the great workouts and home exercises prescribed. I've referred a number of people to Sam and in the past we've used his DVD for gifts to patients for home care. I strongly recommend Sam's services and hope to be working with him personally at some time in the near future.
-Dr. Matt Costantino
HealthSource Chiropractic and Progressive Rehab