The BRACING Series: No. 3

By Sean M Wheeler, M.D.

The simple exercises that target the small gluteus bracing muscles from the STABILITY Series No. 1 and No. 2, may at first appear as exercises meant for the very old or very weak, or as exercises done only until one is ready to go back to the gym for a "real" workout.

I'm here today to disavow you of this mistaken assumption.

Let me start with a story.

I have a middle-aged patient who is a record-setting weightlifter for his age and weight-group. He's in another universe of strong, like guys on ESPN2 named Magnus who fling beer kegs for prize money.

He came to see me with pain in the back and knee.

We found that his small bracing muscles of the gluteus were weakened and his compensation for this weakness was causing his pain.

I had to deliver this diagnosis to a professional power-lifter, and he wasn't easily persuaded.

I described bracing muscles and explained that rather than actively lifting the weight, these muscles instead stabilize the legs for walking hills and stairs, for jumping down, or for squatting, as he does to pick up the barbell.

Bracing muscle weakness destabilizes the leg, which can lead to pain in the knee, hip and back.

Finally, he experienced a breakthrough when he realized that while squatting down to pick up the bar he had to deeply concentrate to keep his left knee from buckling in.

He was compensating by actively pushing his left knee out as he bent down and stood back up with the weight, and he'd been doing it throughout his career.

After this realization, he spent the next several months working on some of the exercises I present in The STABILITY Series.

If small bracing muscles were strengthened by lifting weights, anyone with all of my client's years of experience and training would have developed strong and capable bracing muscles and wouldn't need to compensate by pushing the knee out.

Now, he starts every workout by doing his stabilization exercises, before working to strengthen his action muscles.

The goal is to view stability exercise as an entirely different type of exercise, and prioritize the stabilization workout as necessary and the weightlifting as secondary.

Proper bracing muscle stability allows action muscle strengthening without injury.

Weightlifting by itself doesn't provide stability, only strength.

As you watch and engage with these exercises, remember that they are designed to strengthen these bracing muscles that provide stability, and you should do them for as long as you are active, whether you choose to do a strength workout separately or not.

Stability Exercise #3: Deep Bracing Muscles of the Spine

This exercise is for the bracing muscles of the spine.

Be aware: this exercise is much harder to master than the gluteus exercises described earlier in this Series.

The first step is to locate and isolate the bracing muscle without compensating with the surrounding action muscles.  This may require spending days doing only the muscle-finding part before progressing to the actual exercise.

In the effort to find these muscles, make sure that you are not tightening your hamstrings or rotating your pelvis.

If this exercise proves too difficult to execute, you may need to consult with a physical therapist or other professional.

Good luck.

Published in The BRACING Series

Life can be busy any time of year, especially around the holidays.

The holidays often demand that we each deliberately make time for wellness and exercise.  Like any of our daily preventive habits for overall health like brushing our teeth, physical wellness works best when practiced regularly.

Maintaining strength and stability is essential for our health and best accomplished by including both endurance and circulation training for our bracing muscles, and dynamic workouts for our action muscles.  

Even if you only have 5 minutes to spare, science shows you can still reap multiple benefits from a quick workout

The New York Times recently published an article titled "Really, Really Short Workouts" by Tara Parker-Pope.

Pope outlines several short, high-intensity interval training [HIIT] workouts. Anyone with any experience, or none, and any amount of time can try different HIIT workouts, making adjustments as needed. These scientifically-proven workouts incorporate a warm-up, with peaks of high-intensity exercise separated by lower-intensity, and a cool-down

Pope enthusiastically insists:

"You can try it with any aerobic activity you like. The principles of H.I.I.T. can be applied to running, biking, stair climbing, swimming, jumping rope, rowing, even hopping or skipping. [Yes, skipping!]"

HIIT is a step-up from traditional advice that one should be able to maintain a conversation while running or working out: instead, one shouldn't be able to complete long-winded sentences. The focus is on increasing intensity to a point where chatting is difficult because the workout is challenging your body closer to its limits.

Pope recommends incorporating a HIIT workout three times a week.

Even the 4-minute workouts show an improvement in health benefits after 6 weeks. Benefits include increased endurance and lower glucose levels (even in diabetics, even in a single session). One study showed that even for those struggling with coronary artery disease, high-intensity interval training was not only safe—but better tolerated than a more moderate workout.

Additionally, HIIT burns more calories both before and after than continuous aerobic training. The intensity increases calorie consumption and your body continues burning calories for 2 hours after the workout.

The benefits of high-intensity interval training extend past mere increased calorie burn: people report more enjoyment from HIIT than moderate-intensity activity. This benefit has a two-fold effect: people stick to workouts that they enjoy. A short, consistent workout is better than sporadic exercise or no exercise at all.

HIIT also improves cardiovascular health by working out your blood vessels. Exercise physiologist and athletic trainer Scott Weiss, C.S.C.S. explains, “HIIT increases the flexibility and elasticity of arteries and veins better than continuous aerobic exercise. Because of the increased pressure demand of HIIT, the vessels actually get a workout as well.”

Arguably, the greatest gain of high-intensity interval training is in the shortened yet still highly effective workouts. Hectic schedules can incorporate HIIT into a lunch break or an early morning quiet time.

Your body craves both variety and stability - without stability, back pain can spoil a holiday; without variety, action muscles aren't challenged.    

All it takes is 5 minutes. Aim for variety, and most important, have fun.

[Image Source: Aurora Bootcamp]

Published in Back Pain Relief

Dr. Sean Wheeler expert back pain doctorSean M. Wheeler, MD Back pain medical expert Dr. Sean Wheeler advocates the urgent need for change in how those who suffer from chronic back pain are treated and cared for within the healthcare industry, including by medical insurance companies involved in payment approvals for medical treatment.  

According to Dr. Wheeler, decreasing long-term reliance on pain medication as a treatment option is needed, as the repeated use of these medications does not address the systemic cause of chronic low back pain.  

Now comes word of a new study supporting decreased use of opioids for relief from low back pain, in this report from today's New York Times:

"People with chronic low back pain are sometimes prescribed opioids for pain relief, but a review of studies has found opioids generally ineffective.

The analysis, in JAMA Internal Medicine, pooled data from 20 high-quality randomized controlled trials that included 7,295 participants. The studies tested various narcotics...

The drugs relieved pain slightly, but the effects were not clinically significant, and the medicines did little to improve disability...

Measured on a 100-point scale, the magnitude of relief did not reach the 20-point level the researchers defined as clinically effective, little different from NSAIDs [i.e., nonsteroidal anti-inflammatory drugs] like aspirin."

As characterized in the study:

"For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses."

Beyond today's news of opioid ineffectiveness, Dr. Wheeler commented:

"Fund researching on alternative effective pain management for back pain patients is a pressing need, in a field that has not seen a significant medical advance in four decades.

Research into bracing muscle® endurance as the cause — and source of relief — of chronic low back pain is overdue. 

It is time for our healthcare profession, including health insurors, to effectively address what has become the world's most disabling condition, that of chronic back pain." 

Read more about this latest research on opioid effectiveness in JAMA Internal Medicine, and in The New York Times.

 

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 in aid of understanding the cause of back pain, and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 

 

Published in Medical Research

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.

Published in The Posture Series

Shelley Lewis PTShelley L. Lewis, MS, PT Shelley L. Lewis, P.T., is a Director of Physical Therapy, overseeing a staff of 16 physical therapists at four outpatient clinics in greater Kansas City. Early in life Lewis realized how much she loved the study of human anatomy, physiology and kinesiology, a love later pointing to her career. 

With over two decades of experience in treating patients with pain, Lewis has this to say about sports medicine and back pain expert Dr. Sean Wheeler, and Dr. Wheeler's soon-to-be-published book, UPRISE:

In UPRISE, Dr. Sean Wheeler changes the way we look at back pain and musculoskeletal pain. As physical therapists, there has never been "one way" to treat back pain, but often we traditionally focused on 4-6 weeks of stretches, strengthening, and modalities. Instead, Dr. Wheeler focuses on incorporating long-term stabilization into functional activities and sport.

As a result, the diagnosis has changed, the prognosis has changed, even the vocabulary we use with our patients has changed. For example, we now speak of Bracing Muscles in need of Circulation Training. There is no more "core".

This refreshing physical therapy-centered model relies not only upon sports medicine and pain management doctors, but encourages collaboration with other healthcare professionals to offer the patient a period of pain relief, which then allows us to begin the stabilization—or Circulation Training—process. UPRISE offers a fundamental shift in the mind-set of treating back pain sure to impress and influence patients, medical providers, and healthcare insurance carriers worldwide.

Lewis received her Bachelor of Science degree in Biology—Exercise Science from the University of Nebraska, and was awarded her Masters of Science degree in Physical Therapy from the University of Kansas Medical Center School of Professions. 

Building on earlier praise for UPRISE from experts such as the alpha doc to professional athletes Dr. James Andrews, Hall of Fame Coach Bill Snyder, credited as Architect of the Greatest Turnaround in College Football History, award-winning Television Writer and Producer Lynne Litt, and Dr. Marc Valley, who advocates that the healthcare industry — from medical insurance providers to doctors themselves — become familiar with its teachings, UPRISE will soon add a powerful new understanding to the medical treatment of chronic back pain.

Look for Dr. Sean Wheeler's new book UPRISE soon, and reserve your advance copy at the link.

Published in Praise for UPRISE
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