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The POSTURE Series, No. 4

By Sean M. Wheeler, M.D.

There is a difference between a teenager slouching and an adult slouching.

It is gratifying, as a nagger [a skill learned from my mother] to constantly bug a teenager about slouching and watch them follow your advice and obtain great posture. Gone is the insecure 16 year old and in their place is the confident 19 year old.

One can’t help but to look upon that young adult and feel a sense of pride in the constant badgering that accomplished such a feat. And yet, the same adult is unable to fix their own posture. Braces, electronic reminders, Lenten resolutions, shock collars, etc. and nothing seems to stick. Sure they sit up taller for a while, but the head is still forward and the middle of the back begins to hurt. It is not lack of willpower, no matter how much one beats themselves up over their posture.

Something has changed.

The fundamental make-up of a teenager slouch verses an adult slouch is completely different. Until the adult is able to understand the difference, they will always have posture problems.

ONE

The tissue isn’t the same.  We joke as adults that a child can stab themselves with a fork and watch themselves heal, but adults pull a muscle putting their belt on and two weeks later they still hurt. It is only funny because it is so true. A young person’s tissue just holds them together better.

Imagine a huge tent for a wedding that has a single large pole in the center. The cloth of the tent is new and taunt. The ropes and stakes that support the tent are strong. The whole structure is stable. Then someone runs into the center pole hard enough to make it wobbly. The tent as a whole is not as stable as it was, but because the cloth and the ropes and stakes are in such good condition, enough stability is maintained to make the tent functional. [This is the case of a young adult who begins to lose their bracing muscle strength.]

As the tent ages, the cloth begins to give a lot more. Tears easier and cannot be relied upon as much to provide stability. The ropes stiffen and become more brittle while the stakes bend. In an older tent, a wobbly center pole becomes an issue that must be dealt with if the tent is to stay up. [Please no comments on tent repair or stability, this is a parable on the aging body, not a treatise on tents.]

When injuries or bad positions occur, adolescents spring back into position like a Weeble. ["Webbles wobble but they don't fall down."] Adult tissue is like the part of the couch that one hates to sit on, because they sink in way too far. It is just not the same tissue.

TWO

Gluteus muscles are weaker. The muscles in the buttock that hold the leg into the hip in a stable position are bracing muscles. Muscles that have to work all day stabilizing the hip joint. As adult sits at their job, or find increasingly more efficient ways of completing their jobs, they slowly begin to lose the endurance of these bracing muscles. Sure, the gluts are still strong, but how is their endurance? When standing, how long until they lean into one hip? This is a sign of endurance in the stabilizing function of the gluteus. When the gluteus is weak, psoas tightens [see The Posture Series, No 3].

THREE

Pelvis is in the wrong position. Adults not only sit more, but have better chairs. Kids sit in terrible chairs and can’t wait to get out of them. Adults take their hard earned money and get the chairs they deserve. Then they lean back into them. They role their pelvis back, allow their tummy to pooch out and sit like this for hours. The days turn into weeks and months and then years and decades. The pooched out tummy becomes a norm that one would never see in teenagers. It becomes a sign of decreased deep bracing muscle strength around the lumbar spine. A teenager with their pelvis in the wrong position is okay because their tummy is drawn in all the time. An adult has to have their pelvis in the correct position because of this lack of endurance in the tummy muscles (not situps).

Adults then try to get their posture back and think all they need do is make a commitment to sitting up straight. Instead, getting their pelvis in the correct position is going to take a serious 180-day commitment to drawing the tummy in correctly, stretching hamstrings and hip flexors, strengthening the gluteus bracing muscles and deep bracing muscles. Add to this, knowing where the pelvis is supposed to be, rather than pretending they have an adolescent slouch.

CONCLUSION

These steps might even make putting on a belt less dangerous to one's health.

 

[Weebles is a trademark for several lines of roly-poly toys designed by Hasbro‘s Playskool Division.]

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 

The POSTURE Series, No. 3

By Sean M. Wheeler, M.D.

In part 2 of our Posture Series I explained how to get your pelvis in the correct position. This correct pelvic position is the essence of good posture, to assist in avoiding chronic low back pain.

Drawing the tummy in, pulling the pelvis into the correct position, achieves good posture and builds the endurance strength to the very muscles which stabilize the spine.

Psoas Quadratus LumborumPsoas & Quadrates Lumborum
The concept may sound simple, but so much could go wrong.

Two Muscles At Work

There are two muscles around the spine called psoas and quadratus lumborum that work to lock the low back into a fixed position.

The psoas [red pointer in the image] runs up from the hip along the front of the spine and attaches to the spine above the level of the belly button. It is a very strong muscle that helps stabilizes the hip and causes many problems when it is not functioning correctly.

The quadratus lumborum [blue pointer] is a smaller muscle that runs from the top of the pelvis to the lowest rib, and most of the time, works with the psoas to lock the spine down.

Dr Sean Wheeler Locked Down SpineCollege student to-be practices moving to campusHeavy Lifting

Most of the day your spine is stabilized using deeper muscles called bracing muscles that stabilize while allowing normal motion of the spine.

When you pick up something heavy, this is the only time you switch to the psoas and quadratus lumborum. They provide an extra level of stability needed during lifting. So in a perfect world, 99% of the day your bracing muscles stabilize you and 1% of the day the psoas and quadratus lumborum lock you down to lift something heavy.

Spasm

With back pain, sometimes the psoas goes into spasm in a failed attempt to protect the back and hip. When the psoas spasms, it pulls the pelvis into a poor position and the lumbar spine forward. 

DrSeanWheeler Pelvis Position Illustration2The quadratus lumborum is then forced to contract all day to fight this spasm and it leads to irritation of the quadratus lumborum and muscular back pain.

Some people who have back pain then have two problems, the original cause of pain, plus the body trying to stabilize them further and causing more problems.

How can you unintentionally cause psoas spasm? By drawing your tummy in too forcefully when attempting to get your pelvis in the right spot. In this case, improving your posture can actually lead to back pain.

What To Do

Here’s what you do: draw your tummy in to pull your pelvis into a correct position where your head feels comfortable over your shoulders. Then rock your shoulders side-to-side to see if your lower back feels locked down. If it does, take a deep breath and start over.

Over time this will become easier and feel much more natural. Holding this position all day is very difficult as it takes bracing muscle endurance and that endurance strength takes 6 months to achieve. So be patient and persistent.

When To See A Medical Professional

If all of this sounds like gibberish and you can’t get your pelvis to do any of these things, you may need to see a professional. If your back is locked down when not heavy lifting and you suspect your psoas is in constant spasm, you may need to see a professional. Otherwise, let’s keep following this path towards better posture.

More To Come

Coming soon, why adult posture problems are different than those of the teenager.

 

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. His oldest son Duke tried to imagine that he was lifting the pictured box while moving to college, but at the time of this column, he still has 4 months to wait.

The POSTURE Series, No. 2

By Sean M. Wheeler, M.D.

What brings any of us to a point where we are compelled to read an article about posture?

So instead of reading another article, why not just sit up straight?

If only.

In this second in a series, let's discuss the importance of pelvis position in good posture, and how poor pelvis position may indicate a deeper health concern: the possibility your body is losing its bracing functionality. A functionality vital to living without chronic back pain. 

Challenging Assumptions

One can set their phone to remind them to sit up, find a wearable device attempting to pull you into the correct position, and even special seats for posture assistance. New posture reminder devices are coming out all the time and yet…this article exists because good posture remains difficult to achieve.

Let’s start by challenging current thinking. One can’t just sit up straight to solve their posture problem. Not when the pelvis is in the wrong position.

Pelvis Tilted Forward

Dr Sean Wheeler Posture Pelvis ForwardPelvis forward looks like thisSome position their pelvis too far forward, tilted forward. Then they arch their back to get into an upright position. Most people have been taught this ‘pelvis-forward’ position is good posture.  

In fact, although no longer available, years ago I developed a posture App. In the first step I would tell users to maintain this pelvis-forward position. In a video accompanying the App I would explain that in this position your mid-back would get very sore after a few hours and that this was normal. Years later, I can tell you this is not normal.

I actually began to have back pain because of my will power and belief that I could eventually maintain this position all day.

It is reasonably embarrassing to be a published author on back pain and one of the world’s experts on back pain and to actually have back pain. This is NOT a correct position. The pelvis is too far forward.

Pelvis Tilted Backward

Dr Sean Wheeler Posture Pelvis BackwardModel demonstrates pelvis backwardThe next mistake is what is referred to as pelvis posterior [tilted backward]. With your pelvis in this position it is impossible to get your head over your shoulders.

People usually go back and forth between each of these two positions; pelvis tilted forward vs. tilted backward. Maintain one position until they get tired and then go to the other. Some people will spend their day standing with their pelvis forward and sit with their pelvis tilted backward.

Correct Pelvis Position

The correct position is somewhere in the middle. At this point, people will often attempt to roll their pelvis into a middle position. Unfortunately it is not that simple.

If you choose to just roll your pelvis, you will be able to get to good posture, but only when you are sitting.

Standing with your pelvis in the correct position requires bracing muscle strength, and hamstring and hip flexor muscle flexibility.

Improving Pelvic Position For Good Posture

As described in my book UPRISE: Back Pain Liberation, by Tuning Your Body Guitar, bracing muscles are the muscles that brace and stabilize you so you can move. But improving pelvic position can be a nice start on the whole process.

Sometimes people are so tight they can’t move, or so pelvic unaware that they need exercises to loosen and become aware of pelvic position. This is best done in the hands of a physical therapist, but often your personal trainer, yoga or Pilates instructor can show you.

How To Do It

Start by standing. Then draw your tummy in slowly so that your pelvis rotates under you until you feel like you can stand up straight with no strain in your neck and a small arch in your back without tension in your mid-back. It is very important that you use the muscles in your tummy to move your pelvis into the correct position. It is also important that you are not clenching your abdominal muscles tightly, but gently drawing them in so that your tummy is somewhat flat.

Congratulations! Now hold it all day.

Warning: it will take you six months to build the endurance to be able to do this all day. These bracing muscles need to build the endurance to hold you in this position for many hours. Much like preparing for an endurance race like a marathon, this doesn’t happen in 6 days or 6 weeks. It takes 6 months. You have to build blood flow to muscles to get endurance. Circulation training. But it is worth it.

Correct pelvic position will change your posture and correct posture will change your life. A 180 degree turn in your life — for the better — in 180 days.

Seek Out A Professional To Assist

These concepts and instruction can be difficult to understand just reading an article or seeing pictures.

You really must have a professional put their hands on you and show you where your pelvis should be. Where you are weak, where you are tight and what you need to work on to obtain the goals you seek. As with most things worth doing, it is not easy and requires a commitment.

But unlike ‘just sit up straight,’ this advice will actually work.

 

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. His middle son, Sammy, is a little pensive about having his shirtless photos spread across the world wide web.

Dr Sean Wheeler MaggieFashion icon Maggie Wheeler, demonstrating great postureThe POSTURE Series, No. 1

By Sean M. Wheeler, M.D.

Chronic back pain patients often tell me they want to work on their posture.

They say it in the same way someone says they want to lose 10 pounds. Off-handed and nonchalant, like someone with good intentions who forgets to floss. They want to sit up straighter, but then their day gets busy and they forget.

Posture Awareness

The success and popularity of my posture collection on Google+ tells me people are becoming aware that maintaining good posture is not as easy as they once thought.

Posture is not just sitting up straighter, it is so much more than that. To have good posture, one must have enough flexibility, stability AND endurance to achieve the necessary positions and keep them all day. They must also have an understanding of what they are trying to accomplish. It is discouraging to think that all one has to do is sit up straight and commit to it, and then fail in this effort day after day.

Posture As Body Barometer

Posture is a barometer of a person’s musculoskeletal system. The ability to maintain good posture throughout the day is a positive signal that much is right. And, conversely, that forward head or the incessant heel strike is as much a sign that something is wrong as a weird rattling noise in a sports car. You can turn the radio up for a while to mask the rattle, but eventually the car is going to break down.

More Posture To Come

In a series of columns to be published here, I will define posture, then stability, and begin to fill in all the blanks so that you may avoid a life consumed by chronic back pain. These 'blanks' are often filled in by comments or questions you may wish to ask, so please don’t hesitate send me your questions directly or @DrSeanWheeler.

So…why is posture so important?

 

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. His youngest daughter, Maggie, has great posture and fashion sense, but a poor understanding of which shoe goes on which foot.

Back pain expert Dr. Sean Wheeler answers questions for those who suffer from chronic low back pain based on his new book, UPRISE: Back Pain Liberation, by Tuning Your Body Guitar.

HOW CAN I ACHIEVE BACK PAIN RELIEF?

The time and effort dedicated to this goal will be different for each individual, but it is achievable.

Your first assignment is to read Chapters 1-5 of UPRISE, without skipping ahead. Take from these chapters how the body works and doesn’t work, and why so many have been unable to overcome their chronic back pain.

Next, read Chapter 6 to understand the Tune Me process, its four physical goals and seven principles in committing to treatment and achieving freedom from chronic back pain to resume a full live.

WHY NOT SKIP AHEAD TO CHAPTER 6, AND APPLY TUNE ME TO MY BACK PAIN TREATMENT?

It is important to first understand the cause of the condition before deciding upon treatment.   

The need to understand why we are not making progress in back pain treatment can not be overstated, and is answered in UPRISE Chapters 1-5. The current pain treatment system is broken and failing patients. The author has narrowed WHY it is broken to three interrelated factors:

1. Back pain leads to instability in the back, which leads to disc breakdown, 

2. Back pain is not static — one kind of pain causes another, which makes back pain a progressive condition, and

3. Muscle weakness that develops following chronic pain is different than has ever before been described in back pain.

To break away from the broken healthcare treatment system, you must have a grasp of these three factors. It is by understanding these three factors you will stabilize your quest to be part of a new system that actually works for you and your pain.

WHAT'S WITH THE GUITAR?

Body Guitar™ is a new phrase that refers to something [your body] as being the same as another thing [a guitar]. Thinking about your body as your Body Guitar™ — with your spine the neck and strings of a guitar — creates a new conversation about chronic back pain leading to a new understanding — the concept of Bracing Muscles™ — to bring relief to those who suffer.

This body to guitar comparison offers a simple way to understand a complex medical topic, by helping to translate how our bodies work and must be kept in shape.

Guitars and your body — both of which are musical instruments as demonstrated, perhaps, by how many of us sing in showers — must be tuned, adjusted and cared for throughout the lives of each.

In addition, Dr. Wheeler, the author of UPRISE, who has committed his career to understanding and liberating sufferers from chronic back pain, loves music and plays the guitar.

THIS IS A LOT TO TAKE IN. WHAT CAN HELP WITH MY FOCUS?

As he explains the issue of muscle weakness, you will learn the muscles to which Dr. Wheeler refers are Bracing Muscles – a particular type of muscle that must provide a bracing function, through all day endurance for your low back to remain stabilized. 

Focus on the fact that bracing muscle performance is key to your stability and healthy back. When these muscles perform with all day endurance, other muscles [known as action muscles] can do their job. But when bracing muscles are unable to provide all-day endurance it can cause havoc with action muscles. Often, this involves action muscles doing work they were never meant to do. This "confusion" among muscles builds and causes the debilitating back pain many know quite well.

HOW SHOULD I APPLY WHAT I HAVE LEARNED?

Integrate the four goals and seven principles of Tune Me into your daily life, again as discussed in Chapter 6 of UPRISE.

With you as your chief advocate, find your "people" — your healthcare team — to help you further understand your body. To treat your pain for the short term so that next, over a few short months though your own self-discipline and quality physical therapy, you can be liberated from chronic back pain.

Apply what you’ve learned, in a disciplined plan to restore your body's bracing function — achieving endurance and stability — by way of good posture, flexibility in your action muscles, and mobility of the joints surrounding your bracing muscles.

WHEN WILL I BE LIBERATED FROM CHRONIC LOW BACK PAIN?

For most chronic sufferers, within 180 days.

While UPRISE does not claim all who suffer from chronic back pain will completely alleviate their longstanding back pain, Tune Me can provide significant, measurable improvement liberating the sufferer from the daily debilitating effects of their chronic pain.

The objective is to liberate the sufferer from their chronic pain to live a full life.

Tune Me has been developed to halt the progression of back pain and decrease pain significantly. This is no small achievement. It is revolutionary. And, as you will understand from Chapter 7 of UPRISE, a conversation worth continuing.

 

In Dr. Sean Wheeler’s book, UPRISE, he guides us through his journey — of understanding back anatomy, the progressive nature of back pain, and the cause of that progression.  How it gave him the tools to achieve back pain liberation for his patients. How failure in the medical community to understand this process has created a 40- to 50-year inertia in this field. And how — for sufferers and specialists alike — it’s time for a revolution in the way we treat chronic pain.

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