Pelvic Tilt Measurement
A common email question I receive is about measuring pelvic tilt. The best way to measure pelvic tilt is with a specialized set of calipers that were developed by neuromuscular therapist Paul Chek. These can be quite pricey, and are only usually found in the offices of skilled therapists.
The other way to measure pelvic tilt, which is quick, cost-free, and easily done is home is by looking at your belt line in the mirror. Usually, the front of your belt line rests either slightly above, or slightly below the Anterior Superior Iliac Spine, which is the small bony protuberance just above your thigh. The backside of your belt line usually rests again just above or below the Posterior Superior Iliac Spine, which are found about 2 inches to the side of the spine.
When you look in the mirror at your side view, you will look at the angle of the belt line. For men, the line should be parallel to the ground, with neither the front or the backside higher than the other, with normal measuring 0-5 degrees. For women, the angle should be slighter lower on the front side than the backside within approximately 7-10 degrees being normal.
It is important to note, that these are the “textbook” normal values for pelvic tilt. It should not be the ONLY evaluation for normal function and balance of the core muscles. You should also evaluate the range of motion and strength of all the associated muscles in order to really test total function of this area. You do NOT have to be perfect, but close enough to be out of pain!
Sam Visnic–
Welcome back!
Exactly HOW Fast Should Back Pain Relief Happen?
This is a bit of a tricky question. It can refer to the amount of relief you have after a therapy directed at relieving back pain, OR long term relief.
You may have been told that back pain relief takes time, perhaps weeks or even months. While this may be true for decreasing back pain as the “big picture”, it certainly does not refer to how fast immediate relief can be achieved.
For example, one of my outcomes in working with back pain sufferers who have not received relief from previous therapies is either:
- Reduce the INTENSITY of the pain: Say, for example, on a 1 to 10 scale, with 10 being the worst, your pain is an 8 when you walk in my office. Our outcome would be to bring it down to anything lower, such as a 7,6 or better. That would represent a reduction in pain intensity.
- Reduce the FREQUENCY of the pain: This refers to how often you experience back pain. If you have back pain everyday, then a decrease in frequency might mean that you had 2 “good days” of minimal back pain during the following week after the therapy session.
Each session of therapy, which may include any number of approaches, from corrective exercise, corrective stretching, neuromuscular therapy, and even relaxation training, should progress in its effectiveness as each session passes.
I see it as sort of a “mathematical formula”. Meaning, when a certain sequence of movements and interventions are used, it equates to a certain level of pain relief, thus decreasing the intensity or frequency of your back pain.
Each session should focus on improving upon that formula, and results should ideally improve as the formula gets more and more directed toward your unique situation.
If, after 3-5 sessions of any therapy, you are not seeing improvement in either intensity or frequency of your lower back pain, something is wrong. You may not be performing the therapy correctly, OR that therapy is not effective enough to continue using.
-Sam Visnic
The MOST Common Back Pain Symptoms Are…
Back problems need to be separated into two groups:
Back Pain….and….Spinal Conditions!
These are actually 2 different issues, and must be addressed as such. The trick is being able to figure out the difference between them. Symptoms can vary widely with lower back pain, for example, here are just a few:
- Numbness in the legs
- Tingling in the legs
- Pain in the legs without associated pain in the actual lower back
- Pain which occurs with specific postures or positions
- Different sensations of pain such as stabbing, throbbing, heat, shooting, dull ache
- Pain that tends to move in location
Neuromuscular Therapist
3 Lower Back Pain Fighting Strategies
Lower back pain is now affecting about 90 % of the population with at least one “episode”, and the occurrence of chronic back pain is rising. Of the many strategies to helping heal this health malady, four have really stood the test of time. Here they are.
- Stretching: Stretches for lower back pain are very effective at improving blood flow, loosening tight muscles, and promoting overall muscle and postural balance. It is highly suggested that you only stretch the muscles that are tight for your unique body, while avoiding the muscles that are already weakened or need exercises.
- Rest: Getting off your feet when you have back pain is effective, but only short term. If you are not getting relief within 36-48 hours of being off your feet, then experience shows that back pain may get worse as a result of lack of movement and blood flow. It may be more effective to have “active rest” in which light movements and stretches are alternated with complete relaxation of the involved muscles, which usually means lying on your back with pillows under your lower back.
- Ice or Heat: The age old debate is whether to use ice or heat. Ice should be used for acute injuries or immediate inflammation, such as a back strain that just occurred. Once back pain becomes chronic, heat may be more effective because it improves blood flow to muscles that have tightened due to the condition.
–Sam Visnic
Ice vs. Heat, whats better for lower back pain?
The age old question, ice or heat?
Each of these therapeutic modalities has good benefits, but here are my rules for each:
Ice:
Ice is really good for acute injuries or inflammation. Ice serves to constrict blood vessels, therefore cut off inflammation. For example, if you just sprained an ankle, or twisted a knee, and it is in the initial stages of inflammation. In terms of using ice for your lower back, the only time I have seen it work well is for strains. So, for example if you lift too much and you feel like your back is starting to tighten up, and gets an achy, burning type of sensation, not really pain, but just tightness.
Heat:
Heat is my favorite choice for chronic pain. Once you are out of the inflammatory phase, most back pain is caused by a lack of blood flow, generally referred to as “ischemia”. Application of heat pads, or packs, causes dilation of blood vessels. This is an ideal therapeutic intervention for aching lower back pain It is also an excellent modality to use just prior to corrective stretching or exercises. muscles.
Back Pain Relief Methods
Every day it seems I am introduced to some new form of back pain relief method. Whether that be creams, pills, stretchers, core trainers, and on and on…
I’m always amazed at how these things tend to stay out on the market! If the companies that make these “quick-fixes” have such a massive cash flow to do endless marketing on TV ads, radio, and internet, that MUST mean that people are buying this stuff!
Of course, we have all been “duped” in the past by such marketing claims at one time or another. But, I think by now, you, as a smarter consumer (by virtue you are reading my site!), are hip to the fact that overcoming back pain takes a little more than some “quick-fix” remedy.
What are some of the back pain relief methods that DO work?
In my experience in successfully working with chronic lower back pain sufferers for almost 8 years now, these are some of the methods I have found to CONSISTENTLY produce results:
1. Corrective Exercise and Stretching: This is my primary tool for working with back pain sufferers. It JUST MAKES SENSE. Think about it, most people didn’t develop back pain in static positions, but instead, during MOVEMENT. So, that means that there is a problem with HOW you move, and thus, we need to use movement to assess what is causing the lower back pain, and select the RIGHT exercises and stretches based on your unique muscle imbalance situation.
2. Neuromuscular Massage Therapy: The problem with chronic pain is that once your body gets “into a pattern” of activating muscles in a “pain pattern”, it essentially develops a HABIT. This can create a situation where you may need to re-learn how to use your body. Now, practicing your corrective stretches and exercises will for sure help this, but at times it can take a while. That is where massage therapy comes in. When I do manual therapy, I can get done in 1 hour what would take you 3 weeks to do on your own. (Yeah, I’m THAT good! Lol!) The point is that direct intervention works quickly, particularly the MORE pain the individual has.
3. Upper Cervical Chiropractic: This is a “dirty little secret” in my bag of therapies that not many people know about! To make a long explanation short, the first vertebra under the skull (called the Atlas) has a TREMENDOUS impact on the position of the spine, due to its ability to affect postural reflexes. When this vertebra is out of alignment, it can cause functional scoliosis, imbalances in the pelvis, hips, and as far down as the feet and toes! If there is a problem with this area, it can be VERY challenging to get long term relief from pain. There is ONLY ONE kind of upper cervical chiropractor that I refer to! (For now, I will keep this one a secret, as I will be writing on the topic soon!)
4. Nutritional Therapy: Yes, I can hear your “sigh” as you read this one! One of the MOST overlooked aspects in the back pain equation is that of controlling inflammation through nutrition. Most of the time, over the counter drugs such as ibuprofen, aspirin, etc, and pharmaceutical pain killers are used to “numb” pain, and everyone KNOWS this works, but at the same time “scoff” at nutrition as being a means of anti-inflammatory relief. How do I use this you ask? Well, first of all, remove all factors that cause inflammation such as food allergies, food intolerances, and fix problems with bad digestion. DO NOT underestimate the power of a dysfunctional gut, and its impact on increasing back pain!
Of course, this list is by no means a complete one, as I use many different forms of therapies AS NEEDED on a case by case basis. All cases are different, and may need different interventions. These therapies have provided the MOST CONSISTENT results, and therefore are the ones I INVEST my efforts in.
–Sam Visnic
Back Pain Exercise
What Is A Muscle Imbalance?
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
Mechanical Low Back Pain
One of the more challenging aspects of the “lower back pain enigma” is determining if the root cause stems from one of the 3 areas:
1. Structural/Mechanical
2. Biochemical
3. Mental/Emotional
Any of the above 3 can contribute to chronic back pain, but there are a few solid indicators that can point to mechanical origins of the pain:
- Pain is cyclic
- Lower back pain is often referred to the butt and/or thighs
- Morning stiffness or pain is present
- Pain when starting movement
- Pain rises when bending forward and also on returning from a bent over position
- The pain can be made worse by extension, side bending, rotating, walking, sitting, or many forms of exercise
- The pain becomes worse as the day goes on
- Changing positions can make it better
- Laying on your back relieves the pain
These factors lead me to point the finger at mainly structural causes of lower back pain. However, as I have mentioned in other posts, the other 2 areas of health, biochemistry and mental-emotional stress can contribute to some of the reasons why the mechanical dysfunction exists!!
Sam Visnic–
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"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