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Manual Therapy

4 Reasons Your Back Hurts and What to Do About It

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4 Reasons Your Back Hurts and What to Do About It

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The alarm goes off, you roll over to turn it off as you take a glimpse at the time, 6 AM.

Sigh, it’s okay, time to eat before heading to the gym. As you gingerly roll out of bed, you go to stand only to feel stiffer than usual. You make your way to the kitchen and are met with an immediate uncomfortable sensation. You continue to move but this sharp debilitating pain starts running throughout your back and radiating down your leg. As the sensation increases, you are frozen by the pain.


Tell me if this sounds familiar:

You sneeze and throw out your back
Bend over to tie your shoes, throw your back out
Rotate to place an object on the floor from a seated position and are met with back pain.

What all these innocuous scenarios have in common is that they’re not the reasons why your back hurts. They were the last straw, a coincidence because no one would argue that sneezing or tying your shoes are mechanisms for low back pain. There is no such thing as non-specific back pain, only reasons that have yet to snuffed out.


Relax…You’ll be Okay

Many individuals come into my office with some sort of “generic” back pain or self diagnosed sciatica. Their pain is real and they don’t care so much about what it is (at least not in the moment) and are more interested in if we can get rid of the issue.

After tissue exploration and manual therapy, we stand up to perform some exercises to help improve the tissue’s capacity. I’m quick to let them know its not as bad they think and that together we can solve this. Not surprising, most individuals I’ve worked on will remark that they feel immediate relief.

I’m not some magician, but I do let clients know that bending over, sneezing or standing up wasn’t the reason for their pain. Instead it was one of the following reason(s).

Your spine moves when your hips should

By now, most know that if you’re always putting yourself into bad spots, it’s not if but when will you get into trouble. Your body is no different.

The topic of posture is at the current forefront of social media with polarizing views that you have to be a certain way for perfect posture or that posture doesn’t matter. The truth is always somewhere in the middle. If you’ve read my work on Instagram you’ve heard me say this but it begs to be said again:

“The best posture for you is one that is always changing.”

Your movement capacity is the same. Say you have a job that requires you to bend over and move 15 lb sandbags. If you only needed to move 10 bags, you could essentially move them however you felt like and be fine. But if you needed to do that for 8 hours each day, 6 days a week; you’re probably going to want to move in a biomechanically sound manner.

Learning how to hinge, disassociate hip from lumbar movement and rotate well go a long ways in improving load bearing and avoiding an overuse pattern.

Related to movement from the hips and not the lower back would be the ability to contract into hip extension without compensation. Lying on the floor offers a great deal of stability and lets you see what each side is capable of doing.

If one can’t get good hip extension while lying down, there stands a solid chance there is excess motion elsewhere when upright.

Your Spine Doesn’t Segment Well

Can you Cat-Cow? Many have performed this ubiquitous yoga movement, but few have used it to asses their capacity to move their spine.

Common for individuals with lower back pain is an inability to move segmentally move their lumbar spine without overly hinging through their mid backs. When this is the case, a hinge point develops and this is the site of stress. The back is a bridge, so the load should be evenly distributed versus being placed just in one section of the vertebral column.

Your Hips Don’t Move Well

Single leg stability: You should be able to drop down to about an equal depth on both sides. This is an easy way to assess whether one hip moves better than the other. Things to note would be how smooth each side feels and if the foot/knee collapses during the squat.

The RNT split squat is a great way to help shore up the strength and subsequently their stability on that side as well. The band helps pull your knee into compensation, so you have to use your muscles to maintain proper tension and alignment during the exercise.

90-90 Hip Transitions: These are a fantastic way to mobilize and loosen up the hips before activity. I also like them to discern if there’s a control issue somewhere along the chain. You go from transitions to a lunge and squat pattern during them as well here.

You Have a Structural Problem

Spinal Compression Test
Take a seat and sit up tall
•Get into a good “posture” with your arms by your side (slight arch in your back)
•Grab the chair with your hands and pull up to compress your spine.
•Did you have pain in your back now that it we added a bit of compression in the rounded position?
•If so, it would mean that even when your spine is in a good biomechnical position, it doesn’t tolerate compressive forces well.

Shear Test:
•Same as above but let your back round out
•Did this recreate your pain?
•If so, it would indicate that your pain is triggered by lifting out neutral, flexion intolerance.


What to do if these tests come back positive?

Flexion Intolerance
•Try not to slouch too much when standing or sitting
•When bending down to grab things, learn to hinge properly or kneel down in addition to improving core strength
•Lie stomach down a few times a day.
Extension Intolerance

  • When standing, try to vary positions. When seated, sit back into your chair.

  • Work on improving mechanics during movement and core strength as well.

Ultimately should you have an issue, be sure to visit a professional to help rule out any serious problems. The advice shared here should help the majority of individuals get on the right track, but you always want to be sure to not be overlooking a larger problem.

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If You Think You Have Carpal Tunnel, You Probably Don't

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Every year, over three million cases of carpal tunnel syndrome (CTS) are reported in the United States (Mayo Clinic). True CTS results from irritation or inflammation of the median nerve as it passes through the tunnel in your wrist. This tunnel is a narrow passageway of ligaments and bones at the base of your hand. Pressure can build up in this tunnel, resulting in numbness or tingling in the hand. Continued strain can lead to severe pain in your wrist, making work and daily activities uncomfortable to accomplish.

However, symptoms such as numbness, tingling, and wrist pain are oftentimes resulting from musculoskeletal dysfunction (meaning: tight muscles), and not true CTS.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed.  The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm.  CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed upon.

Many cases of Carpal Tunnel Syndrome are misdiagnosed for several reasons.

  • We don’t truly understand the causes of Carpal Tunnel. It seems to be aggravated by overuse and strong evidence that by correcting daily movement you can make significant improvement.

  • While the Median Nerve is implicated in CTS, it actually begins from the spinal cord and rooting through your neck and out almost every vertebrae before running down towards your fingers.

  • Given that the Median Nerve crosses many muscles on the way to your fingers. It’s no wonder that any number of factors might cause CTS-like symptoms like a tight muscle in your neck or shoulder may cause “tingling” in the fingers. And while it’s similar it isn’t necessarily CTS.

  • It goes misdiagnosed because most doctors aren’t necessarily well versed in understanding soft tissue related dysfunction. This leads to a general diagnosis of “tendonitis” which often will call for you to rest.

    • Do seek a second and third opinion if the doctor wants to inject you or schedule you for surgery.

Fortunately, carpal tunnel-like symptoms can often be easily managed with soft tissue work performed on the scalenes, pec minor, coracobrachialis, and several other upper extremity adhesion sites at the cervical spine.

Two very common suggestions to relieve CTS are cortisone injections in your wrist, or surgery to cut the transverse carpal ligament to release pressure.

While it may seem like a quick fix, I am strongly against cortisone injections as they have been shown to speed up degeneration of damaged ligaments and cartilage.

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Do I Have Carpal Tunnel Syndrome?

Many cases of CTS are often misdiagnosed but can be resolved with soft tissue work and improving every day movement. The following tests will help gauge if you should seek help from a medical professional:

1. Phalen's Test

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  1. You can perform this seated or standing.

  2. Passively let your wrist flop into a flexed position as shown in the diagram above.

  3. Hold this position for 60 seconds or until symptoms are reproduced.
    Positive response: numbness and tingling occurs on the palmar aspect.
    Negative response: 3 minutes passing without symptoms reproduced.

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(The two hand version above is an alternative way to test, though I prefer the one hand version.)

2. Tinel's Test

Tap where circled

Tap where circled

  1. Lightly tap over the median nerve as it passes through the carpal tunnel in the wrist.

  2. Follow your index finger from the tip, then down the palm and up the forearm looking for any sensation.
    Positive response: A sensation of tingling in the distribution of the median nerve over the hand or in the thumb or first 3 digits.
    Negative response: no sensations.

If either test returns positive, I recommend seeing a doctor. If both tests return negative, great! You most likely do not have CTS and can relieve symptoms without surgery.

What to do if both tests return negative:

1. Correct Your Posture

Great little infograph from The Art of Manliness on standing posture

Great little infograph from The Art of Manliness on standing posture

  • Focus on sitting up straight, shoulders neutral, and keep the chin in and head straight. By making sure you're sitting and standing upright, it will take the tension of the muscles that might be causing your CTS-like symptoms in the first place.
    Releated: Thoracic Spine and Breathing to help unlock better posture

  • Keep your wrists in a neutral position, not bent backwards. This can help prevent a lot of the tightening of the muscles which can possibly entrap a nerve.

2. Stretch

As stated above, something as simple as poor posture can give you CTS-like symptoms. Here are three main areas of the body and their stretches to relieve poor posture:

  • Upper shoulders and neck (upper trapezius, levators, SCM, scalenes)

  • Upper chest/shoulders (pectoralis major and minor, serratus anterior)

  • Forearm (numerous muscles, including pronator teres.)

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Upper Shoulders and Neck (Trap) Stretch: 

  1. Reaching your right hand down at your side towards the floor, let your head tip to the left.

  2. Slightly vary the angle of your head to feel different versions of the stretch.

  3. Hold this to each side for 15-30 seconds and repeat 2-3 times per side.

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Chest and Shoulder Stretch:

  1. Standing up straight with a tightened belly, reach your arms straight out to your sides at shoulder height (as seen above).

  2. Move your arms straight back as far as they’ll go without arching your back. You can do this with assistance from a doorway or wall to help your hands move back.

  3. Hold for 10-30 seconds, without pain. Repeat 2-3 times.

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Forearm Stretch:

  1. With your right arm held out in front of you, use your left hand to stretch the wrist stretching the hand up (shown above).

  2. Hold each for 15-30 seconds, 2-3 times. Repeat on other side.

3. Manual Therapy & Corrective Exercise

In conjunction with the improving your posture, wrist position, and stretching, manual therapy from a Licensed Massage Therapist can greatly relieve CTS-like pain. After finding and relaxing the contracted muscles in the above mentioned areas, corrective exercises are performed to offset any problems associated with poor posture and poor breathing patterns.


Has a doctor suggested wearing a wrist brace for extended periods of time (all day and all night, even when you're sleeping)? Restricting wrist movement isn't a solution and doesn't address the true underlying problem.

If this sounds like you and the tests above show you don't have true carpal tunnel syndrome, schedule a consultation in person or online and get rid of your tingling, numbing, debilitating wrist pain for good.

3 Reasons Your Lower Back Hurts That Has Nothing To Do With Your Back

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Lower back pain is something most of us will deal with at some point in our lives. You bend over to pick up your kids or tie your shoelaces and BAM! out of nowhere your back goes out. An overwhelming number of low back injuries stem from chronically poor body mechanics and even more likely from poor everday posture.

If you’re reading this on your phone, take a moment to sit up straight and pull the phone up so your neck isn't being cranked downwards.

Here are three things you need to know about back pain:

1. Back Pain Worse After Standing- Extension Based
 Back Pain Worse After Sitting- Flexion Based

For those who suffer from extension based back pain this is likely caused by: Short Hip flexors, poor glute activity and a lack of anterior core stabilization. The combination of weak glute function with shortened hip flexors often leads to lumbar extension substituting for hip extension during activities such as deadlifting, jumping, and running. Put simply if you aren’t putting your glutes into it, you back will be. 

A sure fire postural sign a person is a candidate for extension based back pain is viewed from the side via anterior pelvic tilt, or the back of your pelvis is higher than the front.

I meant to take a buttfie

I meant to take a buttfie

Flexion based back pain often afflicts those who sit for long periods of time like office workers or truck drivers. The main muscle that creates problems for these individuals is the Psoas. This is the only hip flexor that remains active once you draw your leg up above 90 degrees. Those seeking hip flexion like during a squat will get lower back rounding instead. Their problems are aggravated by a host of other factors such as: Poor glute function, cervical spine positioning, lack of thoracic spine extension and poor anterior core stability.

Someone with this type of back pain is in a catch-22. They need to stop sitting so much but they likely sit a lot due to work. For this individual I would recommend setting a timer to periodically stand up and stretch to break up the monotony. Along with taking time each day to use a foam roller or lacrosse ball to break up any soft tissue adhesions formed in the hip flexor muscles.

2.     Not All Back Pain is Due to “Tight” Hips

From an anatomical standpoint the hip flexors are a combination of muscles: illiopsoas, sartorius, and rectus femoris.

Lets focus on the Psoas.

The psoas attaches through the side of the lumbar spine and connects to the discs in the area of T12-L5. Because of this vertebral origin point, the psoas is also involved in 360 degrees of spine stabilization.

For those who believe they have chronically tight hip flexors, stretching them isn’t going to magically solve the problem because the underlying cause may not be tight hips but an unstable spine and poor core strength. If a muscle is short and tight, stretching it won’t release any neural tone which only leads to it tightening back up afterwards.

Their issues may be solved simply through core and glute activation.

A properly performed plank will solve all that ales you. Not only because by staying in a neutral position will you decrease recruitment of the illiopsoas but also by squeezing the glutes hard you’ll force the muscle to relax due to reciprocal inhibition.

Talking about hips and glutes leads me to the final point

3.     Poor Internal-External Hip Rotation

A quick screen for both:

Need Internal Rotation 35 degrees

External Rotation 45 degrees

Less than stellar results?

Corrections:

Need Internal Rotation- Side Plank

External Rotation- Prone Plank

The muscles that resist internal rotation are all located on the outside of the hip. By stimulating these muscles it forces them to all stabilize the spine and possibly allow your hips and core to work correctly.

On the other side of the equation are the muscles that resist external rotation found on the inside and anterior aspect of the hip. All these muscles co-mingle when it comes to core stability. Like in the aforementioned tip, when a properly performed prone plank is performed, the hip flexors are held in a tight stretched position to help the hips and spine stabilize.

Correcting these restrictions can bring relief to those suffering from chronic lower back pain. These screen are the beginning to figuring out if you need more mobilization or simply needed more stability.