Occasionally, we get patients in the office for back pain seeking a second opinion.  These patients come with lots of questions and fear.  One of the questions they ask are, “Is there anything else I can do to help my back out?

What we find is that simple recommendations have profound effects.  Simple recommendations of how to sit, stand, sleep and transition (sit-stand, lay down-rolling over and rolling over to sitting up) are often left out.  Think about it.  How many times do you get up from a chair, couch, sofa or bench over the course of the day?  How long do you sit over the course of a day?  How long do you sleep?  If you get up from a chair 30+ times a day, that’s 30 times it could be helping or harming you.  If you sit for 6 hours a day, that’s 6 hours that could increase or decrease your back pain.  If you sleep 8 hours per night, that’s 1/3 of the day that could produce or reduce your pain.  Again, simple recommendations can have profound effects.  Get the point now.  Let’s just focus on 1 of these areas for sake of convenience, sit-stand.

If you watch a patient with back pain get up from a chair, they often initiate the motion by flexing their low back and rocking forward.  This is the exact mechanism that lead to their back pain, forward flexion/forward rocking.  It seems counter intuitive doesn’t it that the patient willingly and voluntarily would reproduce their own pain by simple getting up from a chair improperly.  It seems even more suspect that they would perform this maneuver of forward flexion and rocking 30+ times daily.  Even more shocking is that patients who have come for a second opinion have not been told that simple movements like this could help or harm them.  They haven’t been taught how to sit, stand, sleep or transition.   We don’t know why they haven’t been taught this.  Maybe their clinicians disregard these strategies as irrelevant?  Maybe their clinicians don’t know the proper postures and positions to be assumed during these movements?  Maybe the focus of care is directed elsewhere?

Regardless, a simple maneuver of moving through the hips (hip hinging) and lower body does have profound effects.  When repeated over and over correctly, this maneuver reduces compressive loads to the spine (reducing back pain) and becomes a great lower extremity training tool to build up the butt (glut) muscles.  The butt muscles are HUGE stabilizers of not only the back and hips but the entire lower extremity including the knee, foot & ankle.

Protective muscles for the spine and entire lower body

Protective muscles for the spine and entire lower body

It’s funny to see the face of a patient that moves improperly during the sit-stand transition when corrected.  Initially, they’ll report high pain levels and show facial grimmacing.

When corrected, they’ll giggle, laugh, smile or sigh in relief and then immediately turn to you bewildered how something so simple could help them.

A little tacky, but you get the point.

A little tacky, but you get the point.

Moments later you can see the light turn on.   They get a little upset that no one taught them this.  They get upset that a simple movement when executed improperly can be their undoing.  Sometimes, they are more mad than they are excited that they’ve now found an instantaneous method to reduce their back pain during the day.  This process could be averted if there was just a little more recognition that simple strategies can have profound effects.

The light is on and they are mad as hell!

The light is on and they are mad as hell!

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