Fix Lower Back Pain
Felt With Long Standing, Walking, Running -
(Feels Better To Sit or Bend Over)
Includes: Pain from Swayback, Hyperlordosis, Facet Joint, S.I., Spondylolisthesis, Zygapophysial Joint Syndrome, some forms of Stenosis, Sitting with too much lumbar curve, PLUS neutral spine & functional use of core and abdominal muscles - What they do may surprise you.
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Bookspan, MEd, PhD, FAWM
Named "The St. Jude of the Joints" by Harvard School of Medicine clinicians
Director Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine - The Fixa U (tm) School of Healthy Medicine
Welcome to my web site, DrBookspan.com. This article on fixing your lower back pain is one page on my large no-charge web site. My work is evidence-based primary-source sports medicine that you can use yourself, right away, to fix back pain, neck pain, knee pain, other injuries, and learn healthier training methods. I also put fun stories on this web site of my lab research in environmental medicine of the human body in extremes of heat, cold, injury states, altitude, underwater, and different nutritional states. Main navigation links (Site Map) are at the bottom of this page.
This page covers one important technique, that I spent years investigating, to fix lower back pain felt with standing, walking, running, and during certain exercises. This pain is often a sign of standing with a simple bad spine position of too much lumbar inward curve (hyperlordosis). This technique represents years of my work in the lab. Don't worry. You can start fixing your own pain yourself, now, today using this summary. Don't wait.
Not all exercise is medicine. Not all medicine is healthy. Much cost, time, and worry currently spent in medical treatments are unnecessary, and often unhealthful. It's not health care if it's not healthy. I change that. Education is crucial to world health. I have developed information through years of research in the lab, and put it here on my web site for the benefit of the world. Get better and the world will be better.
I have a wealth of knowledge still to give on this and other areas. Read my books for more. Hope I will get to meet you in my CLASSES or maybe in a rare Private Appointment. Have fun.
Answers In A Nutshell
- If you get lower back pain mostly from standing activities, and the pain stops when you sit or lean over, or lie down with knees up, this article explains the most common reason, and what to do.
- If you are not comfortable to lie flat face up without a pillow, or face down, or stand up straight, this article explains why and how to fix that too.
- If you were told you have facet damage, S.I. syndrome or spondylolisthesis (vertebral shifting, also called anterolisthesis and retrolisthesis depending which direction), Zygapophysial joint problem, or pars defect, this will show how to stop the cause of the pain, and prevent a major cause of the damage to the area. This technique also makes the needed vertebral space to stop pain from some forms of stenosis.
- Many people who are told they have "flat back" may not in reality have "flat back" and do stand and move with the opposite problem of "swayback" The definitions often are not clear to some practitioners, or patients are tested or scanned lying down, or in ways that change actual curve.
- You do not need surgery, extended medical treatments or bed rest to relieve this kind of lower back pain. You do not need to strengthen your "core" - that is a major myth. This article explains why. You do not need to give up impact activities like running or martial arts, give up weights or heavy occupational work, or other activities you love to do. You do not need special lifting belts, expensive beds, ergonomic chairs, or other devices to do what you can do with your own body yourself.
- Exercises and ongoing treatments do not stop this cause of pain. Pain felt with long standing, walking, running, is usually from too much inward curve to the lumbar spine. This is a slouching habit, not a medical condition. This method teaches you how to stop this kind of slouch, called hyperlordosis. As soon as you stop the painful slouch, the lower back pain from THIS problem should be gone. No exercises needed; It is a retraining of how you hold your lumbar spine, explained below. This method also shows you how to stop this kind of slouch during exercising and gives a variety of levels and kinds of exercise - for the health and benefits exercise brings. Don't confuse a direct way to fix this one source of pain through stopping your slouched lumbar posture, with "doing exercises" in hopes to fix some misunderstood pain.
- If you have been told to push or tilt your backside or hips far out in back to stand or squat, this article explains that fad, and what is healthier to do instead.
- If you have been told you must "bend your knees to protect your back" this article shows why that is not so, and how you can control your own spinal angles even with your legs straight - needed for standing and other real life. This is different from doing sets and reps of exercises, then going back to injurious spine positioning habits.
- The most important time you use your abdominal muscles is standing up. Not by any tightening. You cannot move well with tight muscles. Abdominal muscles prevent swayback by bending the spine forward enough to keep you straight upright, not leaning back or letting the pelvis tilt. This does not ever come from stronger muscles, or from conventional ab exercises, but by you using the muscles you have deliberately and voluntarily until it becomes habit. This article explains how. This article also explains how to use abdominal and core muscles the way you need them for real life and movement.
- Many common medicines and prescription drugs can cause back and body pain. Un-needed treatments and surgeries are done - causing more pain and reduction in physical ability. Easy changes can stop the need for harmful medicines.
- Study of posture rules, exercises, and devices has shown they have made as much or more pain and damage as slouching, and do not create healthy movement. They are also no fun. Instead, healthy spine positioning during movement needs to be learned. Then all daily movement builds-in healthy, comfortable, positioning habits.
- This is not "alternative medicine." This is evidence-based sports medicine techniques of neutral spine, applied to real life - where you actually need it. This free web site also has articles so you can understand how to fix your disc pain and sciatica, another covering other causes of back pain, one covering healthy pain-free sitting. After learning how to stop pain with standing and walking, and running (etc) using this article, check those next. A list of these and others is on the Clinical Page. The end of this article (where it says "More fun...") gives many helpful links to pages on this site for more help. The Bottom of every page on my web site gives main navigation links.
- My entire book The Ab Revolution covers this one topic in depth.
Now go fix your pain
What Does Swayback Look Like?
ALL the following are Swayback (Hyperlordosis) and Not Neutral Spine - Too Much Inward Lumbar Curve
What Causes Pain From Swayback and How To Stop That Cause
- When you let your lower back sag inward too much (red photograph below-left), the higher angle of the vertebrae pinches and compresses joints of the spine called facet joints (also called z-joints, for zygapophysial), surrounding soft tissue, discs, and greatly increases shear force (structural strain by lateral shifting). Standing this way is slouching. Slouching and allowing too much inward curve (swayback, also called hyperlordosis) is sometimes regarded as natural, but so is slouching your shoulders, a common cause of neck pain. So is wetting your pants. A little control, and life is healthier.
- Two main ways people create too large an inward curve. One is tilting their hip and pelvis forward, and the other is leaning the upper body backward. Other people do both at once, as pictured in the left-hand example below. It is a shame when people do their exercises for health with this unhealthy posture. It even used to be taught by trainers and gyms. It was a fad for a while, now it is known that neutral spine is healthier and stronger for exercises.
- Restoring neutral spine is a simple posture change that you can do immediately - red example, below right.
Photo #1 Left - overly arched, not healthy. Note belt line tipped down in front (and up in back) and the upper body leaning (slouching) back.
Photo #2 Right - neutral spine. Note level belt line. Upper body is more vertical.
No tightening or "sucking in"- it is movement of the pelvis and or spine, where needed.
Eugene C. Kelley, Esquire writes:
"I wanted to thank you for all of your kindness. Your books and workouts literally provided the only pain relief I had for a long time. You are by far the kindest medical person I have encountered over a four year saga (except my wife who is a nurse and would get mad if I did not qualify my praise)."
One Quick Way to Learn Neutral Spine
"Neutral Spine" does not mean whatever shape your spine takes naturally. Neutral spine means a specific position where the upper body does not tilt backwards, and the pelvis does not tilt forward or backwards but is vertical (the exact amount of pelvic angle is debated. From my years of lab work I found that in almost every case, vertical pelvis works best.) Here is how to change a swayback to less swayed:
- Stand with your back against a wall. Touch your heels, backside, upper back, and the back of your head against the wall. Do you have to increase inward curve of your lower back or raise your ribs for your head to reach the wall? Does your belt line tip down in front? Does it hurt or strain to straighten this much? This tells you you are standing in a painful way.
- Gently, without forcing or tightening anything, press your lower back closer toward the wall. Feel your pelvis and hip change in tilt, and reduce the lower spine inward curve. Don't flatten completely against the wall, simply learn to reduce an overly large inward curve.
- Feel that your hip is no longer tipped downward in front. The large space between lower back and the wall becomes a smaller space. Don't round your body forward of the wall or make anything hurt. You know you are doing this right when the pain STOP, not when it hurts.
A Second Way to Feel The Same Idea of Changing Swayback to Neutral
- Stand up and put one hand at the top of your abdominal muscles (front center where ribs come together is a reference point for this) and the other hand at the bottom of your abs on the front center of the pelvic bones (the actual origin of the abs).
- Notice the distance between your hands. Notice if your lower back has a large inward curve, if your belt line tilts downward, and if your upper body is leaning backward.
- Move your torso so that your hands come closer together until your body is upright and the too-large inward lumbar curve is reduced to neutral.
Left photo: Academy student Mireille demonstrates swayback (hyperlordosis). Ab muscles too long. RIght photo: Neutral spine. Ab length shortened without tightening.
"I had been suffering for years from lower back and side hip pain, and underwent X-rays, and went to many physiotherapists and doctors to hear only that I should reduce my activity. One doctor even prescribed Xanax medicine to me and said I need to stop training, stop doing squats and lunges. But since limiting exercising means to me to die & live insipid life, I continued to train, but with pain until I read in this page by Dr. Bookspan about how to fix sacroiliac pain and hyperlordosis so now I am pain-free. I also benefited from many other pages on the web site."
- Mireille Harmouch, personal trainer, student of the Academy Of Functional Exercise Medicine.
A Third Way to Feel The Same Idea of Changing Swayback to Neutral
- Stand up and put both hands on your hips - fingers face forward - toward the front. Thumbs face backward.
- Roll your hip under so that your thumbs come downward in back. Fingers rise in front. Feel that your hip is no longer tipped down in front. The large space between lower back and the wall becomes a smaller space. It may help to do this with your back against a wall. as above.
- This movement is the same as taught above to reduce a too-large lower back arch and returns your spine to neutral spine. When you walk away from the wall, keep the new neutral spine position.
How Much To "Tuck" The Pelvis?
If your pain is from leaning your upper body backward, then you may not need to tuck your hip at all. If your pelvis is not tilted to start with, then tucking will not do anything that is needed. Make sure you understand what is needed before trying random motions and wondering why that does not work.
If you slouch so that your pelvis is tilted, then you tuck until it is vertical. No more than that is needed.
If you tuck too much, or tighten abdominal or gluteal muscles, that will not fix pain.
Do Not Push Your Pelvis Forward
Often, people push the lower body forward, which increases hyperlordosis, not fixes it. Then they think the "hip tuck" does not work, when they never tucked or straightened the pelvis, they made things worse.
The idea is not to push the pelvis forward, but to make it vertical instead of tilted.
Many people who have hyperlordosis by leaning the upper body backward, also push the pelvis forward. They need to bring the pelvis back to the midline, check that it is vertical, and use their "tucking" maneuver for the upper body to bring it upright and vertical.
When You Correctly Fix Swayback To Neutral Spine, Improvement Should Be Immediate
My work is not exercises or therapy to do for weeks. My work is designed to give you instant feedback if you are doing it right or not.
Swayback does not take "treatments" or exercises or strengthening to fix. If you have swayback and do not immediately feel the pain stop when you correct to neutral spine, then you have not done it right.
See and Practice Comfortable Neutral Spine
A video should appear above of one of my students, David of Belgium. He starts with overarched lower spine and shows how to change overarch (hyperlordosis) to neutral spine while standing. Click the > arrow and practice with him. Note: eventually you should be able to do this without having to bend the knees - and do this regardless of any knee position.
If the video does not load on your device, this is supposed to be the direct link to it on my Flickr account - http://www.flickr.com/photos/39972966@N03/4899716752/ If any videos still do not show up let me know at - helpfulreader@DrBookspan.com
Why Do People With This Kind of Back Pain Often Feel They Need To Bend Forward To Feel Better?
People familiar with good movement mechanics know that constant forward bending isn't healthy for the spine. Why would someone feel better to bend forward that way? Remember the reason they hurt in the first place - excessive inward lumbar curve that bashes structures inward. They feel they need an "antidote."
The mistaken idea of "fixing" back pain with forward bending has resulted in numerous unhealthful exercise and pain rehab programs relying on excessive flexion (forward bending) exercises, which cause other problems for discs, and much hip pain and dysfunction.
If you don't crush your lower back with excessive inward curve - swayback/hyperlordosis - then you will not need to stop and relieve the pain. You will not get it in the first place.
What Do Abdominal Muscles Have to Do With Stopping Back Pain?
- Strengthening the core or abdominal muscles does not fix the pain because it does not stop the cause, which is too much inward curve. Stopping the painful bad posture stops the pain.
- Abdominal muscles only help your back when you use them to move out of bad position into neutral spine. Strengthening your abdominal muscles does not make you stop slouching, and strong abs do not automatically support anything. It is a voluntary movement. No amount of ab or back strengthening will stop you from standing badly.
- The most important time you use your abdominal muscles is standing up. Not by any tightening. You cannot move well with tight muscles. Abdominal muscles prevent swayback by bending the spine forward enough to keep you straight upright, not leaning back or letting the pelvis tilt. This does not ever come from stronger muscles, or from conventional ab exercises, but by you using the muscles you have deliberately and voluntarily, until neutral spine becomes habit. This article explains how.
Kinds of Hyperlordosis
In my research career, I have identified several kinds of hyperlordosis, all the same concept. It's good to stay simple, so here is a summary drawing. #1 Neutral Spine, #2 Anterior Hip Tilt, #3 Upper Body (thoracic) Lean:
Can You See Swayback (Hyperlordosis / Overarching) In Real Life? Compare the photo below to the drawing above:
Now can you see hyperlordosis in real life? The photo shows #2 Anterior Hip Tilt, #3 Upper Body (thoracic) Lean.
Can You Tell If You Are Standing in Swayback? (Hyperlordosis / Overly-arched lower spine)
Check - When you stand. When you look up. When you reach up. When you carry a load in front like a laundry basket, chair, or child. When you carry a backpack in back. Check to see if you can pull you shoulders back or drink a glass of water or take a photo without leaning backwards or increasing the inward curve of the lower back. This bad posture is, surprisingly, taught in many gyms, or done deliberately mistaking it for a cute posture. It is not. It is unhealthful and injurious bad posture that interferes with healthful movement and creates much lower back pain.
Hyperlordosis is the Cause of Much "Mystery" Pain
Hyperlordosis pain does not often show up in X-rays or scans, and keeps coming back no matter how many exercises, massages, or "adjustments' you get. Many people get shots over and over, but the pain keeps coming back - the reason is that they go back to swayback posture.
You'll see the swayback (hyperlordotic) posture in an astonishing number fitness videos, magazines, books, and classes. They may say, "keep neutral spine" but they arch their back and stick out their behind in dozens of exercises from leg lifts, to lifting weights, to bouncing around in aerobics.
It is not neutral spine to have a large inward lumbar curve. It is not "just the way you are made." It is bad posture that you can change.
Did you know why there is often a foot rest in pubs? People who arch their lower back get back pain from long standing at the bar. They feel better when they put one foot up on the foot rest. The reason putting one foot up on the low foot-rest reduces back pain is that you unwittingly reduce the large lower back arch. You don't need a foot rest to reduce the arch. Change your spine positioning yourself with the hip tilt technique and stand with neutral spine. Then you won't have the arching that causes the pain.
Don't Tilt The Pelvis, or Push Your Backside Far Toward the BackPeople hear they need a small inward lumbar curve, so they make a big one. They tilt their pelvis forward in front with the backside tilting out in back. You can see this unhealthy practice in many fitness publications, videos, and gyms. There is supposed to be a small inward curve to the lower back for shock absorption and protection of the discs. But only a small one. Increasing the inward curve does not help more, It causes pain of its own.You will have a healthy lumbar curve without tilting your pelvis. The pelvis should be vertical - from the crest of the hipbone down to the top of the leg bone - like the seam down the side of pants or shorts. The seam should not tilt forward at the side of the hip.The belt-line should be horizontal. Some people visualize the proper pelvic angle by thinking of a bucket full to the top with water. Hold the bucket upright and vertical so the water doesn't spill out, not tilting forward.
Notice and Correct If You Lean (or Tilt or Slouch) Your Upper Body Backward
You will have too much inward lumbar curve if you lean your upper body backward. Even if your pelvis is vertical and your belt-line level, leaning backward causes swayback. I named it "Thoracic Lean" for lack of a better name (and am still working on a better name).
Leaning the upper body backward is common. There are several reasons people do it. Mostly it is simple slouching. Often people do it deliberately, mistakenly thinking they are "standing up straight" -but they are actually leaning the upper body backward.Here is one way to tell if you lean back: Turn sideways and look in a mirror. See if you can tell, and if you can feel the slouch or tilted position. Bring your upper body forward enough to become upright. Taking side-view photos also helps, if you use them to see where your body is in space in relation to where you think it is.
Feel This Technique Work
When standing, your pelvis should be vertical, not tilted, from the top of your upper leg bone to the middle-point of the crest of your hip.
- Stand facing a wall, or any sturdy surface as in the photo above, with one arm outstretched. Press the knuckles of your curled fist against the wall. Stand badly, shown in left-hand photo. Tilt your hip out in back. Let your lower back arch inward. Let your upper back lean backward. You will probably feel pressure in your lower back (don't do this with injury).
- Now, while pressing your fist hard, change to neutral spine by tucking your hip under to vertical, shown at right. The movement is like a pelvic tilt or a standing crunch. The arch in your lower back reduces. The first thing you will notice if you do this correctly is your back stops hurting. You should also notice a stronger push against the wall and new strength in your arm and upper body. You will feel the muscles in your trunk and abdomen working.
A video should appear below, from my Flickr page, of my student Dennis demonstrating this technique against a wall. Click the arrow. or the image area:
If the above video doesn't load on your device, try directly from my Flickr page: https://www.flickr.com/x/t/0094009/photos/thefitnessfixer/22991412054/
Prevent Overarching (Swayback/Hyperlordosis) When Reaching and Lifting Overhead
Check to see if you arch your lower back and lean the upper body backward when reaching overhead.
You may be doing this dozens of times daily doing things as simple as putting things on shelves, pulling off shirts, stretching arms overhead, even combing and washing hair. Damage accumulates.#1 Left - Leaning the upper body backward, and tilting the pelvis.
#2 Right - Straightening the pelvis and upper body to vertical
Prevent Overarching (Swayback / Hyperlordosis) Carrying Loads - Backpacks, Packages, Pregnancy
- Loads Carried on the Back - Check to see if you increase the lower spine arch when carrying a load on your back, like a knapsack, or someone piggyback. Heavy bags and backpacks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem. Hold neutral spine against a posterior load. Your bags will be a built-in abdominal muscle exercise.
- Loads Carried In Front of You - Check to see if you lean your upper body backward when carrying an anterior load (something held in front of you), like a chair, a package, a child, pet, a pregnancy, or anything. Stand upright.
- Pregnancy - It is not true that being pregnant makes your posture poor.You are leaning the upper body backward, and/or tilting the hip and pelvis forward. People do this to try to offset weight in front, the same as carrying a chair, grocery bag or dog as pictured in the examples below. You do not have to lean back or tilt your pelvis to carry more weight front. Use neutral spine so that your front (ab) muscles offset the weight. Even if it is true that you are more flexible due to pregnancy, you can (and need to) stand in neutral spine without leaning back. Of all good times to prevent this arching, this it is. Use the same pelvic tilt described above to change to neutral spine. You do not have to have backache when carrying a pregnancy.
LEFT - Leaning upper body back, pelvis tilted (ouch!) RIGHT - Upright and neutral
Prevent Overarching (Swayback / Hyperlordosis) When Wearing Heels and Standing on "Tip-Toe"
Standing on the ball of the foot, as when wearing high-heels, does not "make" you stand badly or "arch your back" (stand in swayback or hyperlordosis). You control your spine and can hold neutral spine the same as during all other standing, walking, and activity. People may lean backward and/or increase lumbar arch when they haven't trained balance and neutral spine. It does not take much training, just knowledge and doing it.
In the two photos below, my student Leslie demonstrates standing "tip-toe" (raised heels).
In the first photo, Leslie stands swayback (yellow arrow points to area of increased lumbar compression. Red line shows tilted pelvis).
The second photo shows standing with raised heels in neutral spine. Green line shows vertical pelvis. One foot is more forward for two reasons - first so you can see both feet and also that is part of how you walk, while wearing heels or not. (Note, in the second, corrected photo, Leslie is still leaning the upper body back very slightly. WHen you do this, keep upper body vertical for standing)
All movement to change swayback to neutral comes from the spine. There is no tightening of abs, there is no "sucking in," and no "navel to spine." That is not how you move. The belly looks slimmer and more athletic because the pelvis is no longer tipped into swayback, so the abdomen is not curved outward. Leslie is 75 years old in this photo. See her video of doing 30 neutral spine pushups on the Fitness as a LIfestyle page.
Next my student Paula:
In the above two photos, my student Paula shows standing in raised heel position, first with swayback (first photo with red X), then correcting spine to neutral (second photo with green check mark). Note that no knee bending is needed. I asked her to do this for photos in the middle of an exercise class. She had no warning or prep time. A great student.
Some People Are Too TIght in the Anterior Hip (front of pelvis) To Straighten To Neutral
Sometimes, the front hip muscles and connecting tissue get so tight, that you can't straighten the hip to stand upright. Then standing and moving is uncomfortable, but you are also too tight to change to healthier neutral spine, and trying to use neutral will also feel tight or uncomfortable.
The drawing below shows the forward bend (flexion) where leg meets body in the front of the hip. It is increasingly common for people to keep that front hip area bent for all they do - to walk and move and do exercise. I have seem people jumping rope and doing regular standing weight lifting like this, entire exercise classes, walk out of the class, and never straighten their front hip.
It is a common assertion that sitting makes front hip tightness (hip flexor tightness). I am finding, so far, from preliminary data from studies I am doing that there is a stronger correlation between tight anterior hip and thigh muscles (hip flexors) and people who do mostly flexion based exercises than from sitting alone - people who do most conventional exercises of leg lifts, pilates, yoga and other forward bending systems, and use that same bent posture for all their exercise. More on this work on my Lower Body Revolution page.
What to do if you are tight in the front hip? Stretch the front hip. The stretches I use are the ones that are the most effective in both stretching the front hip and thigh and also teach how to use that length with neutral spine. (You can have stretchy front hip and thigh and still stand terribly). Two examples are below:
Use as much neutral spine as you can. The motion of moving to neutral stretches the front hip because you stop bending that area and lengthen as far as a straight position.
When doing lunges, tuck the hip under until vertical (not pushing it forward), as described above. When you use neutral during lunges, you will feel stretch in the front hip even before you lower. The stretch will be felt, even standing in a lunge without lowering. That is how you know you are tucking properly. Then lower until you get the stretch you like and need. (Not until it hurts).
I have a large number of fun, good-feeling stretches for the front hip. They are not conventional stretches, but specifically designed to let you feel what the front hip does and how to lengthen it. Some area standing to get functional practice for things you actually do and others are lying down to practice relaxing too, and not tightening. See my book Stretching Smarter, take one of my classes, make an appointment, or contact me through Individual Care to learn many good healthy techniques to get needed resting length of the front hip (and anywhere else needed).
Below is a tweet from one of my Fitness Fixer readers on Twitter. Thank you for smart use of my work, Rob.
Prevent Swayback (Overarching / Hyperlordosis) When Sitting
- Most people who overarch the lower back or lean back when standing feel a lot better to sit down. Why? Many of them round their back more when sitting and take out that painful overarch. Other people don't. Those people are usually the ones who also sit overarched. Then sitting hurts the same way.
- Don't over-compensate to prevent rounded slouching when sitting. In other words, don't keep a large inward curve of the lower back when sitting thinking that will counteract too much rounding forward. It doesn't. it's too much other other way. Sitting with too much arch can make back pain. Use neutral spine for sitting too.
Don't overdo - don't use so much inward lumbar curve, shown above. That hurts too.
The Healthy Sitting article on this web site tells more.
If You Dont Believe That "Tightening" Is Not How to Use Your Abs, Try The Following:
1. Tighten your abdominal muscles, as commonly taught. Press your navel to your spine. Tighten the entire area. Now try to breathe in. Note that tightening would not be possible or useful for daily activity.
2. Next stand with overarched lower spine posture. Tighten your abs and surrounding musculature. Note that the lower spine angle does not change.
3. Stop tightening the area so that movement is now unrestricted. Tuck your spine and hip to remove the lordotic arch, straightening your posture. Now you see that "using your abs" means moving them, like any other muscle, to move your body.
Instead of lying on the floor and hunching forward to exercise your abs, train your abs to work the way you really need them - standing up. By using your abs to hold healthy spine positioning during all your activities, you will get free exercise, and abdominal and core muscle training that benefits your life and helps your back Simply strengthening abs will not help your back. Using them to keep healthy torso posture is how it works.
Arching (Back Extension) By Itself Is Not Bad
Arching your back to create movement to the back (like a big tennis serve), is not injurious by itself. The problem is compressing an overly extended segment of the spine under load. Instead, use your muscles to keep the load lifted, and off your low back. Don't allow your lower back to fold backward under your upper body weight. By holding your upper body weight upward with your abdominal muscles, you can lean and extend back without weight shifting and pressing downward onto your lower back. Supported extension and simple sagging in hyperlordosis are often confused, leading to rules that you must never extend the spine, rather than understanding the concepts and creating healthful movement. Healthful back extension is an important and good-feeling exercise for back health and is covered in the back pain article on this web site (and my books).
More About Lordosis and Hyperlordosis
Too much lordosis (hyperlordosis) is not a "condition." It is not something anatomic, unavoidable, or something that "just happens" to you like flu. It is not a disease that causes back pain. It is a simple, avoidable bad posture that causes back pain which that you can easily stop.
Technically the word "lordosis" originally meant the normal inward curve of the low back. It has commonly come to mean too much inward curve, allowing the lower back to sway. The technical word is hyperlordosis, meaning too much lordosis. Hyperlordosis creates much back pain including facet pain, which is pain and damage to the facet joints that hold your vertebrae together. The facets are the joints that your body weight presses on when you let your back sway or arch.
I have done many studies to measure hyperlordosis and to see why hyperlordosis hurts. It turns out that, historically, it has been tricky to measure overly-arched spinal angles in relation to the hip (middle drawing of anterior hip tilt). It is even more demanding to figure how the lower spine angle relates to the upper body in hyperlordosis (right drawing of Level hip/Thoracic lean). I have tried to pull out the important factors. I am still trying to give them good interesting and descriptive names. Please keep in touch with me and send your good ideas for names as I continue to research this.
What's Wrong With The Way Things Are?
You may have heard that developing your abdominal muscles will help your lifting, posture and your back pain. So why isn't it working? Why not do abdominal crunches to prevent all the problems? A recent fitness industry survey looked at common abdominal muscle exercises and ranked them from most to least effective in using abdominal muscles. But the surveyors missed three basic concepts. An exercise can work a specific muscle but still promote bad posture and not be good for you. Even if an exercise activates your abdominal muscles, it still may not be useful for things you need for daily life. Simply strengthening a muscle will not transfer the posture skills you need for proper use in sports and recreation, or for back pain control.
What's Wrong With Crunches?
It's practically universal to see a gym full of people doing crunches, then stand up and walk away with arched backs and no use of abs, or knowledge that you are supposed to use abs standing up.
1. Crunches don't work your abs the way you need for real life.
2. Crunches don't train you how to use your abs the rest of the day.
3. Crunches promote poor posture, even when done properly.
4. Crunches make a person, who likely spends much of their day already hunched over a work area, practice that hunched posture which may be mechanically promoting the back and neck pain they think they are working their abs to prevent.
This family fixed their pain together with me. It was my honor.
Part II - Real Core Training
You do not need to do exercises to fix back pain. Fixing back pain is mostly about stopping bad bending for all you do all day, stopping bad exercises, and using good bending and healthy exercise instead. All described above.
Core and ab exercise cannot stop swayback or change posture. Stronger muscles do not create any movement. Healthy positioning comes from you doing the needed movement away from painful slouching, and do not need stronger muscles to do that.
This section explains how to use this method to exercise for general health, and for better abdominal and core exercise that is also healthier for the spine.
A Little About The Ab Revolution Training To Understand and Use Neutral Spine:
Healthy core training is not doing a bunch of exercises to strengthen the core which then improves posture or fixes pain by itself. That is a large myth. The way your core works, IF YOU USE IT, is to deliberately move to neutral spine position without allowing swayback / hyperlordosis. You do not need stronger abdominal muscles to move your spine to healthy position. You need the knowledge and practice of what movement to use your abdominal muscles to do. Strengthening does not make movement or teach you healthy ways to move.
Keeping neutral spine uses the abdominal muscles with no tightening and no rounding or bending forward. The key is that neutral spine strengthens your abs. It is backward to strengthen your abs hoping that will automatically give you neutral spine.
I developed an innovation in core training. Instead of curling forward or doing a bunch of planks, I developed a system to exercise your abs and back at the same time, plus show you how you are supposed to use abdominal muscles to change spine position when you stand up again. This collective work including many dozens of retraining drills is called The Ab Revolution. Some Ab Revolution exercise examples follow. Hundreds more can be found in the book, The Ab Revolution, and in my Ab Revolution classes.
"What do abs do?" Abdominal muscles bend your spine. You can do conventional exercises to bend it forward until your spine rounds. However that does not teach you how to avoid swayback. When you stand, walk and run, you should not keep a rounded spine, or walk or run bent over forward. You need to use your abdominal muscles to bend your lower spine ONLY ENOUGH to change a leaning backward upper body to upright, and a tilted pelvis to vertical.
My Ab Revolution teaches you how to use your abdominal muscles the way you need for real life when standing, moving and living. I developed more than a hundred Ab Revolution retraining drills. Most of them are done standing, which is much of how you live your life. Below are three that are not done standing. They change conventional exercises into effective retraining drills.
THESE ARE NOT CRUNCHES. This is not an arm exercise. It is not a back pain fix - by itself. It teaches you how to stop swayback spine - only if you do it as taught. Then you are supposed to use the same knowledge when you stand up after learning this.
- Lie face up, arms overhead on floor, arms by your ears holding hand weights, one in each hand. Keep legs lying flat and relaxed on the floor.
- Notice the common result - most people allow their ribs to lift upward and the lower spine arches upward off the floor (increasing inward sway).
- To correct the increased lumbar sway, press your lower back toward the floor. Feel the change in tilt of the pelvis. You will feel your abdominal muscles working to do this right. See if you can flatten your back against the floor without your legs pulling upwards, which indicate tight anterior hip muscles that needs stretching.
- Hold hand weights an inch above the floor, without allowing your lower back or ribs to lift upward. Quickly start raising and lowering an inch or two repeatedly. Don't let your lower spine increase in arch. Control your spine position using your abdominal muscles. Done right you will feel your abdominal muscles working. That is instant feedback - you can feel your spine move to less sway and you feel your abdominal muscles do it.
- Keep your lower back against the floor by using abdominal muscles to straighten your spine away from arching. Feel the lower abdominal muscles work, and a nice stretch across the front of the hip as you maintain neutral spine.
- Your upper body and legs never lift from the floor. Head and neck stay relaxed.
"Isometric Ab" retraining drill -By itself is a great ab exercise (IF you prevent your lower back from increasing inward curve)
The benefit to stop back pain comes when you TRANSFER this knowledge to all the time, when walking, running, and lifting loads overhead without allowing swayback
The short video below shows Isometric Abs as done in my exercise classes to music. See the short description above to understand why and how to keep this an abdominal and core exercise and neutral spine retraining drill, not an upper body exercise alone. My student Annie demonstrates (there is music with this brief video):
If the video doesn't display on your device, try directly from my Flickr page: https://www.flickr.com/photos/thefitnessfixer/17050894548/in/photostream/
In this short movie, David Demets of Belgium and his first new baby Aiko demonstrate my "Isometric Abs" drill to retrain neutral spine against load. Turn your speakers on for what my readers call, "The Most Charming Fitness Video Ever Made." Notice he sits at beginning and stands at the end without using arms to balance or push off the floor:
If this video does not display on your device,
Trainers and instructors - See the Ab Revolution Syllabus for instructions how to explain, demonstrate and get a class to successfully do this Isometric Abs retraining drill in 30 seconds. Send me your videos of teaching this (best is teaching real people, not the camera) - less than one meg file size, and no more than 30 seconds explaining and no more than 30 seconds or less of everyone successfully doing Isometric Abs. Correct videos will get helpful feedback from me and will go up on this web site with your name, and you as role model - mail to: Success at DrBookspan.com (please do not clog my e-mail with large or unsolicited files).
Why Not Bend The Knees? There are trainers who say you must bend your knees to "protect your back" from arching. But it is your own abdominal muscles that are supposed to hold your back in position. How could you stand up and go about your life, if the only way to "protect your back" is to keep your knees bent? Use this exercise to strengthen your abs at the same time as retraining standing posture.
RETRAIN Your Push-up and Plank
Start a push-up (or plank) position (hands and toes, not on knees).
Tuck your hips under, as if starting a crunch so that your lower back doesn't sway inward or arch. You will immediately feel your abs working when you do this. You will also immediately feel the pressure in your back disappear, that was caused by arching.
Use a mirror, if available, to see yourself and learn what healthy position feels like. Learn how to correct to neutral spine doing a plank, then transfer this knowledge and practice standing, so that you use this new healthy position all the time, when you stand, walk, run, and reach overhead.
When you allow your lower back to increase inward curve,
you are not using core muscles, you are sagging your weight onto your lower spine.Tuck your hip to reduce inward curve and straighten your lower spine.
You will immediately feel your abs working. Lumbar compression from the swayback will disappear.
The weight of your body shifts to your abdominal muscles and off your lower spine.
The short video below shows fixing swayback to neutral spine for planks and push-ups. Better for the spine and more exercise. Planks and pushups do not work your abs without using neutral spine.
If the video above does not load on your device, click directly from my Flickr account: https://www.flickr.com/photos/thefitnessfixer/16884539117/
Why do neutral spine planks? The purpose of this re-training drill is to exercise your abs at the same time you practice preventing swayback for all you do, especially when it is needed in real life - when you are standing up.
Trainers and Everyone - Send me your video of changing swayback pushup or plank to tucked straight spine - less than half meg file size, and no more than 30 seconds explaining and doing total. Ideally - no speaking at all, so everyone, including non-English speakers benefit. Correct videos will get helpful feedback from me and will go up on this web site with your name, and you as role model. Full instructions on the Projects page for videos and photos. Mail to: Success at DrBookspan.com (please do not clog my e-mail with large or unsolicited files).
Rethink "Bird Dogs"
A common but ineffective exercise is to kneel on hands and knees and lift one leg in back, and/ or one arm in front or both. This position is sometimes called a "bird-dog" position. It does not work the back, hip, or leg muscles very much. Some people do it saying they are stretching or working the back muscles, especially the multifidus muscles. It cannot stretch the multifidus or other back muscles, since it is an extension exercise which is in the other direction. Without knowing that you must control spine position, it does reinforce faulty movement patterns - to increase lumbar curve to move your leg. Many people unfortunately also do this when standing and walking. It is no wonder they hurt.
Do you exercise in unhealthy ways? Notice arching your lower back (increase sway/ increase inward curve) to lift the leg (left).
Instead, tuck your hip under (right). As soon as you tuck correctly, you will feel a big difference - you will have to use your abs to tuck, and use the hip and leg muscles to lift your leg instead of arching your back. (Also - Use upper back muscles to raise your neck and head to level instead of bending back your neck at a sharp angle at one vertebra - lift chest not chin)
The hands and knees position gives extremely little exercise or stretch and does not train you how to hold your body weight up against gravity. It is not useful except if you use it to retrain how to not sag into weak, droopy, sagging lower spine. Here is what to do instead:
Instead of spending time on ineffective exercises, get off your knees. Hold a real push-up or plank position as in the drawing below. It will strengthen your arms and is more ab exercise - when done right. Make sure to use abdominal muscles to tuck under your hips or you will get no ab exercise. Hold a good pushup position. Lift one leg without letting your spine sag. To advance, hold this same position and lift one arm straight out in front of you. Don't drop your head or hunch your shoulder. Use your muscles to hold you as straight as if you were standing.
Use this neutral spine drill to train yourself to prevent your spine from sagging, then transfer that re-positioning skill to standing. You will change it from a mindless exercise to good abdominal exercise that also retrains functional movement habits when you stand, walk, and run.
Fixing Swayback is Better Exercise and More Exercise Than Allowing Swayback
Even if you do not have pain from allowing inward sway in the lower spine, you are still missing a lot of good exercise, and you are practicing bad posture during exercises "for health."
The following two examples of exercises, a pull up and an easy wall handstand, are not exercises that magically fix back pain, they are to learn how to use neutral spine during all your more active activities to prevent spinal compression and use your abdominal muscles in a functional way to get smarter healthier exercise.
Pull ups. With swayback, pictured in the pull-up below, abdominal muscles are not being used to hold the lower spine in neutral, which is supposed to be their job:
The two black arrows show the pelvis and the upper body are not held in line.
The red arrow shows the large swayback.
Even if you are doing an "exercise" you are missing all the abdominal exercise that should be part of it.
Try the same pull-up with neutral spine:
- Use abdominal muscles to pull and straighten your torso into one line, not two separate halves at an angle.
- The action is like a crunch until you are hanging straight, not bending in any direction.
- The moment you pull to neutral spine, you will feel for yourself how much abdominal muscles can add to exercises you already do.
To change your wall handstands to neutral spine:
If this short movie doesn't load or show up on your device, click the link below to see it on my Flickr Account: https://www.flickr.com/photos/thefitnessfixer/17003384442/
1. First, my student Dennis steps each foot back and up on a wall for an easy wall handstand,
2. Notice the swayback lower spine. It causes spine joint compression and doesn't use abs. Red arrow and frown face,
3. Then Dennis tucks his help to neutral spine. Healthier for spine, more exercise. Green arrow and face.
Thank you Steve Kramer PhotoEnvisions (http://seatraveler.com) for arrows and faces indicating teaching points.
Why Do I Say "Use Your Brain?
Most of my students have heard me say, or have seen my written articles which state, "use your brain to change spine position."
I was surprised it was misunderstood. Students changed it into standard "fitness" dogma that neurologic changes happen automatically and doing exercises that somehow fix things.
What it means is, "USE YOUR THINKER TO RECOGNIZE SLOUCH AND YOUR MEMORY TO REMEMBER TO FIX IT." The brain has many functions. Ab Revolution trains the deliberate conscious mental portion.
This 'holding straight' drill is used to consciously simulate and retrain carrying shoulder bags and not letting your spine sag sideways under the load:Turn to the side on one arm, hold your body straight, using oblique abs to prevent sagging. When you can do this, lift the top leg so that you are standing on one arm and the side of your bottom foot. Use the knowledge from this drill to retrain standing position with packages and bags on one hip without sagging. Your bags change from back pain from bad body mechanics into built-in exercise and ab training.
For more Ab Revolution, hold one leg out to the side, holding a straight pushup position. Lift the opposite arm and hold. Then try pushups like this:
Hold a flat "plank" (pushup) position. Hold one leg out to the side. Lift the opposite arm.
You will feel your abs working hard to hold your body straight against your body weight.
Hundreds Of Fun ExercisesThe short drills shown above are a few Ab Revolution retraining drills. There are hundreds more. Try the workshops, and get the new FOURTH edition book The Ab Revolution No More Crunches! No More Back Pain! The book has two parts. The first shows how to reposition to neutral spine. No exercises needed to fix pain. The second part is all the fun you can have getting in shape using this concept.
Got the Core? Get the "T"
What About Hamstring Stretching To Fix Lower Back Pain?
I did studies that found no relation between hamstring flexibility and lower back pain with standing. Then why does bending over forward seem to stop this kind of pain?
Flexing the back (bending or rounding forward) temporarily stops the pain because it stops the hyperlordosis - although only temporarily for the duration of the stretch. People don't know this and often go right back to standing swayback. Soon, pain returns from the compression of swayback. Another stretch, and the pain would seem to go away. It was the back stretch not the hamstring stretch. That back stretch became further confused with hamstring flexibility. The stretch itself is not as healthy as it could be and does not fix the problem. Neutral spine stops the whole cycle of mistaken identity. Enjoy my Hamstring Page to see more about this work.
What The Ab Revolution Book Has That This Article Does NotMy goal is that if you have pain from hyperlordosis, explained above, that you correct it to neutral spine right then with my information. I spent years in hyperlordosis research to identify and quantify this previously ignored source of so much lumbar and sacral pain. I want the world to be a better place with healthier happier people intelligently applying this breakthrough method. If this article alone fixes your pain, I am thrilled!
The full book has many more examples, expanded explanations, photos of the same principle applied to many different needed real life examples, and much that can be immediately put into use by those who want to teach, coach, lead health programs, help patients right in the office, or just make their own lives better
PART I shows how to stop lumbo-sacral pain during various upright activity in daily life, both non-active and active, such as long standing, walking, running, overhead lifting. It has many examples, (neutral spine, repeated for each) for all the different times that this principle is needed, but usually forgotten. There are photos showing overarched and corrected position for standing, walking, reaching, bending, running. This Part ! should show you how to stop the pain. No exercises fix the cause of the pain - that is a fad and a myth - unless you also stop the injurious and painful hyperlordosis too. Part I makes sure you have the examples needed. For all the different ways people learn, it also gives several (I think seven) different ways to understand, learn, incorporate, and internalize what is neutral spine and how to achieve it. It reinforces functional exercise as a lifestyle. Does the book need to repeat the concept for each different activity with photos and descriptions? Readers asked me to, and have shown me that they need it to!
PART II shows how to get exercise for general health and for high core training without flexion exercises. Innovative exercises are shown with swayback and corrected spine position photos and descriptions. The purpose is so that you can exercise in healthier ways using neutral spine for all the various exercise you need for health benefits, to improve sports skills, and for impressive abs if that's what you want. Don't confuse exercising with the simple PART I retraining that shows you how to stop a painful overarching habit, but that does not require any exercise to do it. The many (many) exercises are a variety of kinds and levels of difficulty so that everyone can try, and those who want, can advance. They teach many innovations in functional exercise and fitness. My book Health & Fitness - How to be Healthy Happy and Fit for the Rest of your Life has a chapter summarizing the topic, plus chapters on most everything needed for what the title says. See book descriptions on the BOOKS page so you can get all the books or eBooks that suit your needs.
NOTE - if you get The Ab Revolution book, check which edition is being sold. Make sure you get the FOURTH Edition, not earlier editions. My web site books page has example cover photos of the correct edition.
How Long Does It Take To Stop Lower Back Pain Using Neutral Spine Instead of Swayback (The Ab Revolution)?
If your pain comes from swayback (hyperlordosis as explained in this article) you should feel that the pain and pressure stops the moment that you stop swayback by moving your spine and pelvis to neutral. If you're not feeling better right away, check all the following.
- If you don' t have swayback, then, of course, fixing swayback is not what you need.
- If it hurts you ARE doing it wrong. Stop and assess. Check what you are doing compared to what is presented above. None of this is "exercises" to "do" but retraining drills to learn to stop doing the thing that hurts.
- Are you still arching from anywhere in the lumbar spine? Leaning your upper body backward? Did you push your hips forward instead of tucking (tilting) under to straighten? DId you round your upper body forward instead of becoming straighter?
- Are you doing bad exercises from other sources? It is common to do a few movement from my work, but continue or add injurious moves from other sources that slow recovery and re-injure.
- Are you tightening or clenching any muscles? Tight muscles can hurt and impede healthy movement. Although it was an almost universal fad to "tighten" ab muscles, tightening does not change faulty movement, inhibits normal breathing, and can make pain of its own.
- Are you overcompensating? Are you making new bad movement habits, thinking that will "undo" or fix?
- Are you changing this work from exactly the way it is presented into something else, or that you have heard elsewhere? This work is different.
- Is something else causing the pain, such as infection, shingles, growths, or other non-movement based situations?
If you did not have hyperlordosis before, (no swayback and no upper body lean back), then reducing the arch will not change your source of the pain. Make sure there is not something else contributing to your pain. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.
Summary - No More TighteningThis is new and different from what we learned in school and at the gym. New research has shown a better way. This is good news. Discard outdated "tightening" your abdominal muscles, or any muscles, to use them, or the old "press navel to spine." You cannot breathe properly or function that way, and walking around with "tight" muscles is a factor in headaches and stress/ strain related muscle pain. Tightening muscles does not change your posture. The "support" does not come from tight muscles, but using them to a healthy spinal angle:
- One kind of lower back pain comes from too much inward curve in the lower back. Too much inward curve can come from tilting the pelvis, or leaning the upper body backward, or pushing the pelvis forward, or any combinations of those three. Changing the painful posture means moving your spine like moving any other body part. Move out of painful spinal angle to vertical pelvis and neutral spine. Use healthy neutral position, easily, no matter what you are doing or carrying.
- The postural change is right then and there. No lengthy treatments needed.
- Learn the repositioning to prevent too-large inward curve to the lower back. Use that for how you stand and move in real life, not merely as an exercise.
- When you stand, walk, run, or lift overhead, notice if you are allowing a large inward lumbar curve - hyperlordosis. See if you are tilting your pelvis forward at the top and outward in the back. Tuck (pelvic tilt) back to upright vertical pelvis and neutral spine. Don't tuck so much that it huts - but so that it does NOT hurt. If it hurts, you are not doing it right.
- Make sure you know the difference between tuck (change angle from tilted to less tilted) and "push forward." Don't push your hip or pelvis forward, as that increases hyperlordosis, not decreases it. Don't "do" postures as a rule, understand what you are doing to hurt and change to healthier ways. Use your brain.
- When you carry loads in front of your body, don't lean back to "balance it" or stick your backside out, increasing the lower back inward curve (don't increase normal lordosis to hyperlordosis / swayback).
- With packs on your back, don't lean back or hunch forward.
- With a bag on one shoulder, don't let it pull you to the side; simply use your own side (oblique) muscles to hold upright posture against the sideways pull. It's free exercise and it's good for you.
- Does my work mean you never do any flexion? Of course not - that is misunderstanding the concepts. The idea is notice if you spend most of your day that way and then use flexion exercises on top of that. Then it is no mystery why you hurt. Understand, don't memorize blanket and arbitrary rules. Please don't combine other people's injurious stretches and exercises then come back to me and say my work isn't fixing that.
- Dont memorize rules and postures or think that an exercise or kind of exercise will fix back pain, - which is more likely from a number of all your bad movement habits.
- Often people tuck too hard, or tighten, or push their hip / pelvis forward instead of changing the tilt, then claim neutral spine is wrong or does not work. Use a side view mirror and learn to feel and tell how you are moving your body. Also if your pain is not from a too large too large tilt and you use neutral spine, don't complain it isn't fixing your pain just as you wouldn't, with any consideration, blame penicillin for not fixing your back pain unless your pain was from something needing that particular cure. Most of the people coming to me saying that neutral spine is making them hurt or isn't fixing their pain turn out to not be using neutral spine or actually able to produce it. If it hurts, you're doing it wrong. Make an appointment with me instead of debating the same wrong points on Internet forums.
Don't Change These Concepts and Methods To Fit Conventional Fitness Dogma - They Won't Work That Way:Henry Louis Mencken said, "Any man who afflicts the human race with ideas must be prepared to see them misunderstood" Even so, please don't change my work back into what you know, or what others say, or what you learned somewhere else. his is different and works differently than the pop fads that have become ingrained in fitness and health. To paraphrase Bertrand Russell, "An untrained man's report of what a knowledgeable man says is never accurate because he unconsciously translates what he hears into something he can understand." My work is primary source, and often - not what we learned in school and the gym. Remember, that is good.
With This New Knowledge of How The Core Works:
- You can stop this kind of lower back pain immediately.
- You'll know why your lower back hurt and how to prevent this kind of pain from returning.
- You'll strengthen your abdomen and core without going to a gym.
- You'll save your back without having to do exercises
- You'll exercise your brain - It's a whole different way of thinking about abs; It's a revolution.
(To keep this article a quick and easy summary, much is left out. The books tell more.)
What To Do Next:
Now that your back pain from hyperlordosis is gone and your abs are better, look how much you saved on ab machines and medical care :-) You can give to the poor, put a nice amount in the donation box - secure and safe through PayPal - and still have enough left for a vacation. I have no salary or paid job to write these for you. Donations go toward domain and site hosting so you can have these articles, and developing more methods for YOU. It's far less than the thousands most people spend on random exercise programs, special beds, and constant medical treatments for something that should, and can, be quickly stopped and prevented with this direct method. Thank you !
If you want to tell me this is all wrong, and someone else told you to tilt your pelvis far out because it is natural, and people do it in undeveloped countries, use the donate box to write me your complaint ($50 is a good amount to complain). Keep in mind that I get frequent reports from doctors working in "natural undeveloped countries" where they see back pain from hyperlordosis in their clinics daily. They find that teaching this technique stops the pain.
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