Tuesday, March 26, 2019

An email to my kid about low back pain



I recycle.  My son, like many people, has some issues with low back pain.  He knows that much of the problem stems from a postural problem:  he tips the top of his pelvis forward most of the time, which brings the lower spine into too much extension.  Pilates can help!  He lives too far away for me to work with him on the equipment, but I sent him some mat exercises to do.  Here’s what I told him:

Obviously, without seeing you move, I can only guess about what is happening with your body.  You will probably need to experiment to figure out what works best.

When you are NOT specifically exercising, you will need to increase your mindfulness about the position of your pelvis.  Standing, you will want to think occasionally about rotating the base of your pelvis forward.  The Pilates mafia suggests imagining you have a foosball handle at the side of your hips and spinning it in the appropriate direction; this image may not work for you.  Sitting, you might find it helpful to scootch (how IS that word spelled?) forward toward the edge of the chair so that you can feel your sit bones in contact with the seat.  From there, you want to lift your head toward the ceiling (“lengthen your spine”) without jutting your sternum forward or hyperextending your lower back (“excessive lordosis”).  Some people find that contracting the abs helps with that; I find that thinking about making the lower back long works better, but you can experiment.  Mindfulness is annoying because you have to practice it a lot, but even if you fix your posture a couple of times a day, it will help.

In yoga, there are a couple of ways to approach forward bends and this is relevant to your issue.  One of the ways is the “peel down” method.  You can imagine (or actually try) standing against a wall and begin folding forward from your head, moving one vertebra at a time off the wall as you reach toward your toes.  It is important to keep the weight toward the balls of your feet because the hips naturally fall back to counterbalance the weight of the torso and ideally you are keeping your hips over your ankles as long as possible.  This is easier as your hamstrings lengthen.  Doing a forward fold this way (in Pilates, it’s called a standing roll down) can help you figure out where your spine prefers not to articulate into flexion (e.g., mine moves as a unit in the lower lumbar, which makes some stuff pretty darn challenging).  The second way of approaching a forward bend is more about moving from the pelvis.  It’s a variation of the “flat back” forward bend.  Instead of thinking about flexing each vertebra forward as you bend, you bend forward by rotating the pelvis over the heads of the femurs and the spine just goes for the ride.  Because you are thinking about the hip motion, you get a lot more awareness about how the pelvis moves, which you can use to correct posture the rest of the time.

You are already doing femur arcs/dead bugs and chest lifts, so I won’t go into detail about those.

The Pilates pelvic clock can be helpful for figuring out where the stuck spots are and for improving general control.  Doing it with Franklin balls or tennis balls or yoga tune up balls on either side of the sacrum can also massage out some of the pain while providing additional feedback about the movement.  You imagine that there is a clock with one edge at your pubic bone, one edge at your belly button, and the sides toward your hips.  I suck at the clock number thing, so I never cue it that way, but you need to know the points of the circle.  You exhale and tilt the pelvis toward the belly button and inhale, tilting toward the pubic bone.  It is tempting to make this a big movement and involve the powerful quads; don’t do it.  Keep it small and use the abs to do the work.  After a while, tilt side to side.  You may find that the hips don’t want to press up and down without moving toward or away from your head.  The goal is to keep the distance between rib cage and hips the same while one side or the other of the pelvis presses into the ground.  After you’ve done that a while, make pelvic circles.  You will probably find that one direction is easier than the other.

Next you can do some bridging.  In Pilates, bridging starts with a pelvic tilt toward the belly button.  Then the spine peels up one vertebra at a time.  (It isn’t just popping the hips up to the ceiling in one quick motion.)  At the top, take a big breath in.  As you exhale, peel your spine back down while consciously pulling your pelvis toward your heels.  Your butt will probably come down significantly closer to your heels and your spine will feel like it has a little more space to articulate.  If you have a workout partner, that person can actually pull your pelvis away from your head as you peel down; it feels really nice.

Bent knee opening is kind of like femur arcs, but to the side.  You begin with your legs in tabletop position.  One leg stays in place (this is harder than it sounds) while the other leg opens out to the side.  This trains pelvic stability and you have to use your abs to keep both sides of the pelvis firmly on the ground as you move.  Sets of ten are good.  Leg circles are a progression of this exercise and give bonus points for stretching the IT band.  One leg is long on the ground, the other is straight up toward the ceiling.  Keeping the pelvis level (again, much harder than it sounds), the lifted leg circles across the body, down toward the other foot, out away from the body, and back to start.  After about four circles, reverse directions.  And, of course, you need to do the other leg.

Try these and see how it feels.  It might be that you need to get more extension in your thoracic spine as well, but this should be a start.



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