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!
Massage Therapy…Relax Your Way To Relief!
One of the back pain relief methods that I subscribe to most is definitely massage therapy. Massage has a very nice list of benefits to your back, including:
1. Improving circulation throughout your body.
Massage can reduce ishemia (lack of blow flow), which improves the endurance of your muscles, and thus their job of stabilizing your lower back. Move blood flow and endurance equals less pain!
2. Reducing or eliminating adhesions and scar tissue.
Both adhesions and scar tissue in muscles cause decreased blood flow and decreases strength. Massage therapy is an effective method for reducing these that may be found in your back muscles.
3. Improving muscle imbalances.
Massage therapy, when applied to your unique muscle balance, is very effective. When you relax your “tight” muscles, such as the psoas (hip flexor) and quadriceps (front of thigh) can reduce anterior pelvic tilt.
Bottom line…..Massage Therapy = Less back pain!
–Sam Visnic
How often should you do back exercises?
When considering how often you should perform exercises when you have back pain, there are a number of things to consider:
1. Should you even be doing exercises at all?? How much pain are you in?
When evaluating pain, I use a visual analog scale (VAS). For example, on a 1 to 10, with 1 being “not much pain at all, and a 10 being “worst pain I have ever felt”. Exercises are generally appropriate when you are a 6 or lower. Anything above, rest, relaxation, and even massage therapy is acceptable.
2. What kind of exercise program are we talking about?
Exercises based on your unique muscle imbalances are usually targeted at your weaknesses, as in my DVD program “End Your Back Pain Now!”, and rarely involve the actual muscles that hurt, those can be done more frequently. Doing exercises that directly target painful exercises are not a good idea unless you are being supervised by an expert.
3. What intensity level are the exercises being performed at? (Probably the MOST important factor!!)
I see a range of back pain sufferers in my clinic, from average joe and jane, to weekend warriors, to elite athletes. It may surprise you to know that when high level athletes see me for back pain, I give them deadlifts, pullups, and other full body movements to get rid of their pain. Why? They are usually much more coordinated that the average person, and are used to higher levels of physical exertion. Using this approach helps them get better faster.
The more intense the exercises are, the less often they should be performed. For example, if an advanced athlete needs to deadlift, I usually only allow them to do so 1x every 5-6 days. However, if the weight is very light, I have been known to allow 3x per week, but only for a short period of time.
The lower the intensity of the exercise, such as a Swiss ball reverse back extension (a butt exercise), may be done daily, if no significant soreness results from doing it, and pain levels are monitored.
Pretty much the same goes for light pelvic tilting, and other exercises that target postural muscle fibers. However, as mentioned, caution must be taken to ensure that fatiguing the targeted muscle group does not “destabilize” the lower back or sacro-iliac joints, and cause pain.
How To Improve Lower Back Stability
The term “stability training” has been thrown around quite a bit in the last couple of years, as the fitness community has gone core training crazy. The problem is, however, most of the gimmicks being used for this so called stability training are simply entertaining at best, and unfortunately do not produce the kind of results that they are believed to.
The Issue of Stability:
Lower back stability, as well as stabilization of all joints in your body, is dependent first of all on optimal muscle balance. When muscle imbalances are present, meaning one muscle is stronger than its antagonist, the joint involved becomes distressed as it fights to maintain its homeostasis.
For example in the lower back, two muscles that have a relationship include the abdominal muscles, and the back extensors. The abdominals have the job of flexing the spine, which flattens the lower back, while the extensors extend the spine, creating an arch in the lower spine. More often than not, the spine has an excessive arch due to the prevalence of anterior pelvic tilt, particularly in the back pain population. This leaves the abdominal muscles in a “lengthened” state, and usually test weak.
In this situation, the lack of balance between the muscles that flatten and extend the spine creates a potential state of “instability” in the spine. It is a relative state, in that you may be stable picking up the newspaper in the morning, but when it comes to more intense efforts, such as playing a pickup game of basketball, or tennis, the instability becomes much more of an issue.
Correcting this stability issue involves identifying the weak muscles, which in this case would be the abdominals, and identifying the tight muscles, which again in this case may include the lower back muscles, and providing appropriate corrective procedures such as exercise and stretching.
The actual selection of exercises to do this would include the ones that work best to strengthen that muscle. If the abs are weak, then performing variations of the plank and/or crunch, will serve to strengthen them, and thus reduce the imbalance relative to the lower back muscles.
Corrective procedures must follow some form of flow, and make sense. Something more therapists need to be aware of, before starting to jump on the “core stability bandwagon”.
–Sam Visnic
What Is A Muscle Imbalance?
We need to MOVE more!
Human beings are made to move. Our ancestors did a lot of walking and traveling. They didn’t sit at a desk all day long. Most of them were workers, farmers, hunters, or gatherers. They didn’t have the types of imbalances that we have today. They had to lift things. Their bodies were strong and conditioned. Today, unfortunately, most people are what I like to call “marshmallows”. They don’t perform any more physical activity than is required of them. Childhood obesity is at the highest percentage in history, mostly due to increased amount of hours in front of the television or video games. Adults aren’t much better. Most adults have low energy due to increased stress over finances, work, and crappy nutrition! It’s no wonder they don’t feel like working out. I frequently find during my evaluations of back pain sufferers that they are extremely weak in the muscles that support and move the spine. If you never work out, then one day try to pick up something heavy, you can easily injure your back! The goal of working out, or what I like to refer to as “training” is simply that; training the body to be ready and capable to perform daily tasks with a minimum amount of stress and effort on the body. Exercise must be specific, however. Going to the local 24 Hour Fitness and sitting on your butt on the leg extension machine isn’t going to do it! The goal is to perform “functional” exercise. That means squats, lunges, twisting exercises, and all other movements that you must perform on a daily basis in good form. Spending 20-45 minutes on the treadmill may not be what you need to get through your day. You must also be able to select the right exercises and stretches for your imbalances. I see many people go to the gym and are literally training themselves further into their imbalances. It’s sad, many of those people are going to end up in their medical doctor’s office or on an orthopedic surgeon’s operating table!
The Solution:
Select the right exercises and stretches to fit your muscle imbalance profile. Repetitions, sets, how much weight to use; these are all important factors that influence the outcome of your program. If you are constantly lifting up objects that weigh 20 lbs., then you need to be performing strength training exercises that teach you how to lift weights that are at least that heavy and even more. Leg extensions and leg curls are not going to help you lift a 30 pound child up when they are crying! When designing programs, I choose the correct protocol for the individual and their specific work or sports environment needs.
–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
How To Correct Muscle Imbalances
Muscle imbalance syndromes can be held in place by a complex web of interactions between various systems in the body. Corrective techniques vary widely, and many of them work quite well…BUT…unfortunately, they don’t last over the long run.
Take therapies like chiropractic, for instance. Many of my patients tell me that whenever they would see a chiropractor, they felt better right after their adjustment, but the pain and tightness would return shortly after, only leaving them to continue to need adjustments to stay out of pain. Certainly, this is not the case with all back pain sufferers that visit chiropractors, as some of them get long term relief from just a few treatments.
So, the question is: Why do some people get relief, while others don’t?
There are 3 categories that must be addressed in the total health of the individual. They include:
1. Structure: This involves muscles, tendons, ligaments, bones, and joints.
2. Biochemistry: This area involves all the chemical interactions within our bodies, including hormones, vitamin/mineral status, and all other sorts of biochemical interactions.
3. Mental/Emotional: This area involves the concept of how our minds and emotions affect how our physical bodies function.
The interesting thing is that any of the above 3 areas can CAUSE, CONTRIBUTE, or SUSTAIN muscle imbalance patterns. The reality is that dysfunction in one of these categories cannot exist alone, but rather directly affects the other 2 areas.
Many times when structural treatments do not last is not that they don’t work, but rather they do not address the biochemical and/or mental-emotional factors that are “holding” the muscle imbalance pattern or are causing it to return.
Its about time for us to not only conceptually understand how the body works as a whole, but instead, start developing PROTOCOLS and treatment programs that USE this information!
Sam Visnic–
http://www.endyourbackpainnow.com
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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