Entries by dmiddaugh

The 3 Most Important Lower Back Muscles

Hey, welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Today we are going to talk about the three most important muscles for good lower back health.

The reason why I'm doing this podcast is, I've had tons of questions lately, from people with back problems that asked about which muscles they need to focus on, and which exercises they need to do to focus on those muscles. Now, being that this is a podcast, I can't really show you exercises. So, I'm going to talk about some concepts more importantly. And I say more importantly, because there are tons of exercises out there, and a good exercise for certain muscle may be a bad exercise for another muscle.

So it really is situational and it depends on your specific situation if you have a back problem, there are different things that you could do at this time versus, if you are a little bit better. Then an exercise that may have hurt you in the past, could actually be beneficial to you now. Specific exercises I don't want to go into right now. We'll talk about the muscle groups instead. So let's get into it.

The top three most important muscles to improve your lower back health.

Number one is definitely your abdominal muscles. Everybody kind of gets that. It's no secret in the healthcare field, especially if you are in the healthcare field. People know that your abdominals should be strong in order to have good back health. But what we often see people do is it they will come in saying I've been working on my abs, I've been doing sit-ups, I've been doing planks. They will show us exercises that they've found on the internet for ab exercises. And they will tell us it hurts their back. Sometimes it even creates a popping or clicking sensation in their back, and it leaves their back even more sore.

Personally, I've had that feeling myself, so I know exactly what they are talking about. But what we are finding in these people is that if you think about the abdominal muscles, those muscles run from the bottom of your rib cage, all the way down to the top of the pubic area, on the pubic bone and the muscles wrapped around your sides. Through tendons, they connect directly to your lower back bones, and the vertebrae so they can influence the lower back quite a bit.

Within your abdominal muscles, you have four different muscles. You have the rectus abdominus, the transversus abdominus, the internal obliques and the external obliques. And because these muscles are so large, as far as the space that they cover, they are actually really thin, almost paper thin. But they are broad muscles. They function differently in different areas.

When we talk to people, here in the clinic about their abs, one of the questions that I asked them is: Well, you have been working your abs out for your back problem. Sorry, it hasn't been helping you. But tell me this, when you work out your abs, do you find that your upper abs mainly get the workout, or is it your lower abs? Or is it everything? What part of your abs is getting affected more when you exercise your abs?

We get all kinds of mixed answers, and really depending on the way that their back problem is presenting, and the specifics of their back problem, if it's more of a disc issue, or a stenosis issue, or a nerve issue, you want to target different parts of the abdominals. You also have to test to see where you are weaker. Some people can know where they are weaker, they can feel it, and some people have no clue. They can't tell themselves where they are weakest and that's our job here in the clinic.

We will muscle test specifics of the muscles and be able to tell you “hey, you are weak in your upper abs or your lower abs, or there is evidence that you have been using your upper abs more so than your lower abs, because of the way that other muscles look, how they counterbalanced the loss of muscle balance.”

So be careful when you are working out your abs, whenever you are doing an exercise for your lower back, it should not hurt your back, it should not hurt during or right after, it shouldn't leave your back more sore. The effect that you should feel is that it didn't hurt one bit. In fact, it is improved a bit. And over time, as you continue to exercise, it continues to improve and feels better. But let's move on to the second muscle.

The second muscle that's critical for lower back health is the glutes. People don't really think about this one because it's not really a part of the lower back in most people's eyes. It doesn't connect to the vertebrae, the spine bones of the lower back. It's more in the hips, around the hip joints. But these muscles are so important, because if you think about them in the grand scheme of your body, they are huge. They are enormous muscles. They are thick and they are large as far as how much space they cover.

Which means that they have a lot of power and a lot of potential for stability in the rest of the body. And because they control the hips and the pelvis, which are the foundation for the rest of the spine. Without good quality control and strength from the glute muscles, you are likely going to run into some back problems.

One of the next questions that I ask people, whenever they are dealing with a back problem is I'll say, “whenever you go to exercise, like you told me you like to do lunges or squats or run or jump on the bike, or anything like that, how often do you feel the burning in your butt muscles?” About nine 9 out of 10 people say never, once every few months at most. And that to me is evidence that they are not targeting their butt muscles very well.

Many times, it's just a small tweak on an exercise that they are already doing to get the butt muscles to turn on the glutes, so that they can begin to do that same exercise in a way that is making their glutes work.

Classic example that we see here is with runners, most runners don't feel sore in their glutes unless they are sprinters. Srinters tend to use their entire leg muscles. You just have to if you are going all out sprinting. It's nearly impossible to do it without using every muscle. But for somebody who's doing more distance running, more cardio based running, not sprinting, somebody who is running, let’s say for several miles, 5K, 10K or longer distances, or even half marathons and marathons. They will usually say that they are sore and their hamstrings and their quads and their calf muscles. Hardly ever their glutes or if anything, they get just a tiny bit sore in their glutes, but it's heavily the quads and hamstrings.

This is evidence to me that they are not properly using their glutes, because glutes are a huge muscle like I said. Now some people say, well, the quads and the hamstrings are pretty big. And my response to that is, is Yeah, but they are mainly moving the knee, and the knee just bends and extends, the glutes control the hip joint and the base of the spine. There is way more importance on the glutes.

If you think about the quad muscles themselves, they are long and slender, they only have one direction to pull, the glutes actually have multiple directions of pull. If you pit them against each other, glutes are way more important than the hamstrings. Your quads are for just about any activity.

Some common exercises that that we give people, will be some lunges and squats. We do our lunges and squats quite different than what most people think or have been shown. Oftentimes when we show people the way that we do squats or lunges, they will say, I never learned it this way. How come nobody ever showed me how to fire my glutes? They will be surprised, and some people will say, Well, I played sports all through high school, and I worked out in the gym with my coaches and my trainers. And nobody ever showed me how to do it like this.

My response to them is always, I'm sure that they had the best intense and that they were doing the best that they could with an entire football team or volleyball team or whatever team you are on. But they just don't have a physical therapist background like I do. I just look at the body differently. Luckily, they probably didn't have a whole lot of injuries. What they've done has been successful most of the time. So that's what they've been continuing to do.

But over time, over the course of years and decades, that's when that wear and tear starts to build up. And that imbalance starts to build up where they get stronger in their quads or weaker in their ABS or glutes, and then it begins to affect the lower back. It's totally fine, don't feel bad if you are like holy moly, I've never been using my glutes on squats and lunges, and I've been doing them for years and years and years. You have to find a way to make sure that your glutes are working on a regular basis that's critical for back problems.

But let's go into the final muscle group that is important for your back health. The low back muscles. Now this is obvious, a lot of people are probably thinking I’ve been doing exercises for that, but I feel that I need to get stronger, my lower back muscles are weak. What I want to do is dispel a few myths about this area and just to be specific, I'm talking about the muscles that are directly on the lower back. If you reach behind yourself and touch the sides of your spine. If you move off to the right or left, of the center of your lower back, those are the muscles that I'm talking about.

They are called the lumbar paraspinal muscles in the medical books. And they work whenever you bend backwards. Or a common exercise that people do to work them out is the lie on their stomach, and then pick up their arms and legs. Sometimes this exercise is called the Superman. And it makes the lower back muscles contract quite a bit. Now, these muscles are kind of small, and some people they get really big, and that's not a good thing.

Their primary function is not really to stabilize the back but more so to decelerate certain movements like flexion and rotation, for instance. You got to make sure that you are not too heavily strong on these muscles they are more for control. Isolating them out is typically not a good idea. Now sometimes we do tell people to do that. But most of the time we want people to not really feel their lower back muscles work really hard.

A common exercise that aggravates these poor low back muscles is deadlifts, and squats can do this as well. But we often have people that have had a history of doing weightlifting and they will say oh yeah, deadlifts killed my back every time I do it, I feel tight in my lower back. And if I do it enough, I'm stuck in bed for a while, I can't get up, I can't move around very good. And my back muscles just feel way too tight, especially on one side more than the other.

That's usually a sign of an imbalance. Their back muscles have been too dominant during the deadlift motion and they haven't used other muscles that they should be using to accomplish a deadlift. Those poor back muscles are rebelling, they are letting the person know that they are not doing what they are supposed to be doing. They are supposed to be stability muscles, not big weightlifting muscles.

A trick that I do with a lot of our back pain clients is we actually want them to get relatively weaker in their lower back muscles. Now I'm not saying you need to get weaker, like lose muscle, that's rarely ever a good thing. It's more so that we want the other supporting muscles to get stronger so that your lower back is relatively weaker, it's keeping it same strength, but we are not going to strengthen it aggressively like we might other muscles. We do it so that it is more in in proportion strength wise, so that the balances normalize around your lower back.

But these lower back muscles, they are critical. You can't live without them. They are extremely important, and you need them in good health. Most of the time when we are talking about good health for the lower back muscle, we just want them to not spasm, that's a common place for people to get spasms. If they are getting spasms, it means that they are using them way too much and using them inappropriately.

We are teaching people to move better in a way that doesn't make them spasm, we are teaching them to avoid twisting too much, because that will tend to set it off. Twisting is sneaky and it happens all the time. Whenever we are at home doing chores and awkward positions. It's almost inevitable to twist. But if you can take a moment to think about how you are going to move so that you don't twist, it can save you a heck of a lot of trouble later on in life.

Sometimes you have to twist it's just the nature of the situation that you are in. I can tell you I never twisted so much in my life until I started having children. When they were little, we had to get them in and out of the car seats. And getting a child into a car seat, especially when they are really little, and they have that big carrier those are pretty heavy. When they are like a year old, and they are almost starting to walk, and they are getting big and pudgy, that's a heavy baby. In order to get them in and out of the car in the backseat, it's just a little rough on the back. Sometimes you have to twist a bit. Now, I'm not saying you can't ever avoid twisting, but you want to minimize it to make sure that your lower back muscles are healthy and happy.

So there you go guys, those are the three most important muscle groups. It's more of a strategy than it is some specific exercises to do. Like I said, the specifics come from a well thought out plan on how to improve a back problem. I don't like to give out specifics online just because, I haven't had a chance to look at you. I haven't had a chance to figure out how your joints are moving, or how the muscle feel. What your specific actions activities are throughout the day.

The best is to get all of that factored in to diagnose and then develop a well thought out plan that we begin to systematically execute, and march to better health. It's amazing. I love helping people with back problems because it's like week to week, they are getting better, a little better, a little better. And you are going to love it when we hit the plan, right as we intended. When we get to week three or week four, and I tell people Yep, this is exactly where I expected you to be, you are sleeping better, you are moving better. I know, it's not completely gone. But you are definitely on the path to avoiding a surgery.

When we get to the end of the program and they are sometimes lifting weights, they are running, or they are back to their normal previous activities, at least. Oftentimes, they want to do even more than that. And I tell them, Hey, you got to just keep up a few things. It's not going to be as intense as it was the beginning. But at least now you know what you need to do to keep healthy for the long run.

We talk with them about these three important muscle groups, and we go into detail about what to do about each of them. So that once our clients end with us, they are no longer seen as for treatment, they know how to manage any flare ups they are going through later on in life, if the back problem starts to come back a little bit, in six months, or a year or two. They jump right back onto those exercises that they they've done in the past. And they have a much better sense of awareness about how to help themselves, before having to call somebody for specialist help.

So hey El Paso, I hope that this was beneficial to you. I hope that you learn something about your back problems, and the muscle groups that are important. How to decipher which exercises are good and not good, and when to pay attention to what you are feeling and all that. If you have any questions about your specific back problem, please give us a call. Our phone number is 915-503-1314 and talk to us about your back problem. We'd love to learn more and see if we can help you out and see if we are the right people to help you out.

Especially if you are looking to avoid having a back surgery. If you had a parent or grandparent that that had a back surgery or suffered from back problems, and you saw them in not the best shape at the end of their life, or are they getting older right now, and they are still around, thankfully, but not moving too well. Their quality of life isn't the greatest. The last thing we want is for you to end up like them.

If you have no back problem right now that's similar to theirs. More often than not, definitely 9 times out of 10 it is preventable. You can get a better without ever having surgery. And you don't have to be taking pain medications. You don't have to have a bottle ibuprofen on your grocery list every few months because you go through it. You don't have to have injections. If you are getting injections, that's just medication that they inject directly into the spine. And it's not getting you stronger. It's not teaching you to move better. It is not preventing the surgery. It's really just putting it off. So make sure that you do the right treatment to make to get this problem healthy again, we don't want you to have a lower back surgery that you could have avoided. Anyways, I wish you the very best day and we'll talk soon again.

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The Secret Cause To Lower Back Pain

Hey there, El Paso! This is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Welcome to the Stay Healthy El Paso Podcast. Today our topic is going to be the secret cause of lower back pain.

Now for people that suffer from low back pain, especially if they have gone to see a doctor for it, and they have had any sort of diagnostic imaging like x-rays or MRI. They have probably been told that they have a disc injury, a pinched nerve. For set arthritis is a common one, and stenosis. There are all kinds of common problems that doctors will spot on an MRI or an X-ray as well. Degenerative disc disease is another one that comes to mind.

But something that is rarely ever, to tell you the truth, I've never seen a physician or anybody that saw somebody for back pain, bring this up besides physical therapists, because this is the way that we think, something that I've never seen anyone talk about and this is the secret here is hip problems.

Hip problems in people can come off as painless a lot of times, and usually the way that it feels is tightness in some of the muscles around the hip. Occasionally you do see somebody that has some severe hip arthritis and they have obvious limitations. They can't walk right, they limp, they have trouble getting up and down from a chair, going up and down steps or curbs.

I'm not talking about those kinds of people that have an obvious hip problem. What I'm talking about is somebody who has an obvious back problem. That's where they hurt. That's what bothers them day to day, are off and on. But they don't really think about their hips. And the reason why this is a secret, because one of the first things that we do here in the clinic, whenever we get somebody with a back problem, is of course, we ask them about their back problem to tell us what's going on. Let's get to the bottom of it.

But once we start checking people by hand, I always check their hip. I have to see how much that hip goes up, down, sideways, and rotates, because the ball and socket joint of the hip has tons of motion. Of course, you have to have a pair of hip joints. And if one of your hips is not moving correctly, and it's forcing the other hip to move extra, it will likely cause your back to move differently. If this has been going on for a long time, then usually it contributes to some major back problem.

I can't tell you exactly which back problem is going to contribute to, but it just does cause problems in the back. Oftentimes, what we are doing here in the clinic in addition to treating some disc injury or arthritis in the in the lower back, where we're dealing with some hip problem as well, some muscle imbalance and arthritis problem in the hip, a lack of mobility in the hip. Lack of knowing how to use the muscles properly. That's actually a common thing. People don't even realize that they are not using their muscles, right. And it's so cool to see some pretty quick changes in most people.

Once we start working on their hip, once they get full mobility in their hip, they feel like they get a chance to do some exercises and get more stability through their hips. The back pain tends to reduce significantly. We will do this in combination with the back treatments, the direct back “hands on” treatment and exercises that we do for backs.

But it's the combination of these two that really get people to the point where they are feeling tremendously better. But I just wanted to do this podcast talking about this, because if you are out there and you're listening to this, and you've had x-rays, MRIs, you've been trying to get to the bottom of what your back problem is, and you're frustrated because nobody really knows what's going on. And in fact, sometimes you get people to bring in their imaging, their x-rays and MRIs, CT scans. And they say that they look pretty normal. That they have mild arthritis, mild things going on in their in their back. But the doctor told them that that's normal and that there is nothing that can be done.

It's so cool to get that client in here and be able to check out their hips and tell them, your right hip does not bend anything like your left hip. In fact, you've lost 20 degrees of motion here, 30 degrees of motion there, and your muscles on this hip versus that hip don't feel the same, they're stiff, they're tight, and the strength isn't the same at all. So we end up treating the hip and the back gets better.

I just want to make sure that you know that that's a possibility. And in some cases, we see a knee problem that can contribute to a hip problem too. We have to look at the entire chain of joints. If you think of a chain. The chain of joints would be the foot, the ankle, the knee, the hip, and then the low back and all the joints in the low back. Any problem in any of those joints, they all affect each other. But the hip joint is the most mobile joint of all of those.

It's critical to make sure that we look closely at that joint. Look at every possible motion that that it can do. All the muscles that control that hip joint as well are important to check out. There are tons, when talking about the glute muscles, people just think of the gluteus maximus usually, but there's gluteus maximus, gluteus minimus, gluteus medius. There's a tensor fascia that contributes to the glute function as well. There are deeper glute muscles like the piriformis, the superior inferior muscles, the operator muscles internus and externus, the quadratus femoris there are all kinds of muscles. The hamstrings even run through there too and can affect the glutes and to a lesser degree there are nerves as well, that are in the area.

If those nerves are affected, they can change the strength of the muscles throughout the hip. So we sometimes end up looking at the nerves and it's more of a nerve problem that's affecting the hip. But that's what we do here. That's what we specialize in is getting to the root of the problem, peeling back all the layers, looking at every possible contribution. Holistically, to a back problem.

What we tend to see is people that have gone through other treatments, and then they come in here to our clinic, they usually have the response of Wow, nobody's ever looked at my hip like that, or my back like that, or whatever body part we're looking at. Nobody's ever thought to check this, or thought to check that, or nobody's explained how all this works together.

That's just normal for us here. We look at every single aspect that could be contributing to a single problem and the way that we see it here at El Paso Manual Physical Therapy, is that it's what's necessary, and we are going to take the time to do that. Because if we don't, then we're shortchanging you we are not fully looking at the problem.

What I've seen happen in other places that I've been at, as far as working as a physical therapist is, there just isn't enough time. The skill level, the technique level of the healthcare professionals is specialized differently than what we are here. They may be really good at something else, but they're not good at looking at the root of the problem.

I'll give you a clear example. For instance, most PT clinics around the country without knowing it, without saying it, they are really specialists and helping people after a surgery. So after a back surgery or hip surgery, like a replacement or discectomy and they are really good at getting people to move again and walk again and get back up on their feet.

But helping somebody out who has not had a surgery is a whole different ballgame. That requires a different kind of specialty. And that's what we do here. We rarely ever see surgical cases. About 99.9% of our clients here are our clients that are trying to avoid surgery and injections and medications. When they come here, they haven't been to another clinic like ours, and they are always surprised at how in depth we have to go. Because after dealing with the surgery, a surgical case, it's usually pretty straightforward.

We as a physical therapist, from my perspective, any way I can, I usually have the surgical report in front of me so I know exactly what was done. The surgeon’s notes, and the patient will tell me, and you can obviously see an incision on the patient wherever they were operated. As a physical therapist, we have like x-ray vision, so we know what's under the skin at that point. What muscles are there. What joints are there. What nerves are there. And it's pretty obvious to know what needs to happen next. But in somebody who's never had a surgery before, somebody who's trying to prevent the surgery,

There's no incision, there's no surgical notes. There's no obvious sign of what's going on. You're having to work off of what the patient's telling you. Asking the right questions is critical, making sure that we pull the right information out. We have to figure out what they have done in the past, what's helped, what has hurt, how their day goes, how it feels at night, how it feels during the day, there are so many components to putting it all together to make sure that we can get this person to the point where they can confidently go back to the activities they were doing before they started having problems, and truly escape surgery. As well as know what to do, to know how to prevent the problem from coming back so that they're not having to take pain medications or go get an injection at some point later on.

So there you have it. That's the secret to lower back pain - the hip. Checking out the hip and all the details around the hip and finding the root of the problem.

Hey, guys, thanks for listening. I hope that this podcast was beneficial for you. If you have any questions, if you're dealing with a back problem, and you have questions about it, or you think you might have a hip problem, feel free to give us a call at 915-503-1314 and we can talk more. I look forward to talking to you in the next podcast episode. Have a great day.

The show is available on Anchor | Spotify | iTunes | Google Podcast | and others...

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Herniated Discs, Bulging Discs, Degenerative Discs – Possible Treatment Options

Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh. I'm a physical therapist and I'm the owner of El Paso Manual Physical Therapy.

Today we are going to be talking about herniated discs, bulging discs, and degenerative disc disease and there are other things that happen to discs as well. Specifically, after we go over what is all this stuff and how does it happen? We will also talk about what the treatment options for disc injuries like these are. Let's just get into today's topic.

What is the difference between a herniated disc, a bulging disc, degenerative disc, or a slipped disc? There are all kinds of problems that can happen to discs. At the root of it all is a disc injury. You can get into specifics based on what doctors find, if you have ever had an MRI, if you have had a back problem, maybe you are listening to this right now, because you have a disc problem, and you want to learn more.

You might have looked at your MRI report or your X-ray report. Or you might have talked to the doctor, and they told you about what was going on. They may have used the word, you have a herniated disc, or they told you that you have got a bulging disc, or you have degenerative disc disease. There are all kinds of things that can happen to a disc.

The difference is in a herniated disc, where there is a bubble that comes out and may press against a nerve, it may press against the spinal cord. It's usually just in one section of the spine. Whenever you hear about this happening in the lower back, they can go out directly backwards, towards the middle of the spinal cord, or they can go out to the side and not affect any nerves. Or they can come out halfway between the back and the side where there are some nerves that run out the side of the back.

That can be problematic as well. Bulging disc means there is an entire section of the disk that is wanting to come out. It's being shoved out a bit, but it's not a bubble. It's like a love handle that appears on the disk.

Degenerative disc disease is when the disc itself is degenerating, it's actually becoming injured over time. You might get some hardness that develops inside the disc, there could be cracks in the disc. It's like an old disc, essentially. But you don't have to be old necessarily to get it, and they can get older at one level relative to another level. Which means that you can have degenerative disc disease at L5, for example, but not at L4 or L2, or L3. We have to ask questions about how that got there. And we will ask those questions in a second.

Another common thing that you hear about is a slipped disc. Slipped discs are kind of unicorns in my opinion, they are not really found in medical research. You might find a mention here and there. But as far as what it actually looks like it's not really a thing. The picture that people have, when referring to a slipped disc, is that the disc actually slides out of position, and detaches from the bones.

What most people don't understand is that the attachment between a disc and the bone, the vertebrae, the spine bones, it is extremely stuck. There is no way it's going to slip out. It just doesn't shove out one way or the other as a whole, it might herniate. You might get problems with the disk, but to get it to detach from the bone., I've never seen that happen or heard of that happening. Slip disc, I think is kind of a misnomer. It's not a good term to use, but it's still commonly used out in the in the medical field.

Now, why do these problems happen? And are there different reasons for each one, and in my opinion, it's usually the same similar set of problems. It's set up different types of disc injuries. It just depends on your genetics. It depends on what your spine is predisposed to, getting the type of injury that is predisposed to. If you have parents that had similar disk problems, and that's probably why you are having that.

In small cases, it can be some specific activity that you repetitively do that sets you up for this type of problem. But they all have the same root problem, there is usually a muscle imbalance between the muscles that stabilize the spine. Now, we are going to go somewhat deep here, into the root of why a disc problem happens. So follow me and pause if you need to think about the words that I'm using for a second, I'll try to keep it as simple as possible.

In a lower back, and we are talking about the lumbar spine, the lower back. You have three main muscle groups that create all this stability in your lower back. One is the back erectors, these are the muscles that run up and down the sides of your spine. On the backside is your abdominals. Of course, the abdominals are on the front, but they wrap around and attach through tendons to the spine on the back, and they also attach to the pelvis, the bones that the spine connect to at the bottom.

Then the third group would be your hip flexors, specifically your psoas muscle, which is a hip flexor, and it runs from your thigh bone, the top part of your thigh bone deep in your hip, and it comes through the front over into the pelvis and attaches up into the lumbar spine.

Between these three muscle groups, you have to have proper balance so that your spine can stay in the best position possible so that the discs can work properly. Now if you have an imbalance and your spine doesn't stabilize properly, then you are going to present eventually with one of these problems that we've talked about. Either a herniated disc, a bulging disc, or some sort of disc problem. It's just a matter of time.

Usually the thing with discs is, they are super resilient structures. They are tough. They are hard to dissect. When we have cadaver dissections in physical therapy school, those things are super hard, you can't cut through them very easily, it's actually easier to cut through the bone than it is to cut through the disk. And disk tissues are designed to be shock absorbers. So they contribute to your spine working like a spring.

Now, if you google a picture of the spine, or if you by chance can see a skeleton around you or something like that. I'm in the clinic right now, so I'm looking at the skeleton. You may not be but if you just pull up a picture of a spine, or if you think about it, if you have a pretty good memory of what they look like. All the bones stacked right on top of each other right from the tailbone. Then you have the 5 lumbar vertebrae, that all stacked on top of each other. Then you have 12 thoracic spine vertebrae that all stack up on top of each other. And then you have the neck, the cervical vertebrae that all stack up on top of each other.

Our bodies are designed to stack, we are bipedal. In other words, we walk on our two feet versus dogs or cats or cows, they walk on four feet. Their spinal structures are different than ours, they have similar components, but the way that they are designed to absorb the forces of gravity and be able to get around, there are small variations that allow us as humans to be able to stack vertically.

Now the problem comes going back to that muscle imbalance. If you have an imbalance, the one of the first things that tends to happen is the lumbar spine, the low back begins to lose its position. You'll start to curve in your back too much. You are no longer stacked vertically, and you start to curve too much. Now what I'm telling you right now is a bit controversial in the medical field, because there are all this argument about how much curvature should you have in your lower back, same thing for the neck and mid back. But I don't think that there is one specific number that everybody should fit.

Everybody is a little bit different. And depending on your body shape, if you got a smaller waist or bigger hips, or if you are pretty straight, or whatever your shape is, there are small variations with everybody. But I think the general rule to follow is that you should be pretty vertical in your low back. If you start to curve too much, then your spine starts to bend in the middle of your low back. And if you think of a spring, if you bend the spring, it wants to come back to its straight up and down position. But if you hold it in a bent position, and then you make it absorb forces, it's only a matter of time before that metal spring begins to crack or break or not work properly.

If your spine stays bent too much, what tends to give out first is a disc. The disc can take a long time to get injured, but you'll begin to see a disc bulge or herniation. Over time, you can get degenerative disc disease, and it can be painful. But that's how disc injuries are set up.

Now, treating disc injuries is a whole different ballgame. We have to figure out what the source of the problem is. Is it truly just as muscle imbalance or other things? Is there weight to account for? If it's a female, have they been pregnant? How many times if you had a C-section? Because you are pregnant, they probably did cut open your abs and you probably lost strength to your abdominals, which is one of those stabilizing muscle groups.

Now I've got to ask the question, did you ever get that strength back in your spine, if it's curved? If it's too curved, what is too curved?

That's hard to determine. Even in the medical field, we don't know. We have people looking at x-rays, and actually measuring angles and everything. It varies from individual to individual because there are so many things to look at.

What will feel like if you have a disc herniation? It tends to feel like an achyness in the lower back, it can also set off muscle spasms. A true disc problem tends to generate pain right in the middle of the back, but you can have spots of pain that appear in different areas. It might change from side to side. Sometimes the glutes can feel painful as well. You might even have pain that runs down your leg. Because sciatica is a very common side effect of a herniated disc problem.

There are different versions of nerve pain that run down your leg Sciatica is one, there is another one called lumbar nerve ridiculous apathy. That's when you have a pressure from one of those discs that's pushing on a nerve, and it sends pain down into the leg. It could go all the way to your foot.

I've felt a mild sensation of that, and I remember feeling it down into my right big toe. It was painful. It was insane. So I felt it myself. But I've had plenty of patients coming in that describe the exact pathway of the nerve that's involved. We can usually trace it back to a loose disc in their spine because it's injured.

I just mentioned those words loose disc in the spine. Whenever I'm checking a client that has a potential disc problem. I actually look at the stability of every single level of their spine. This is important because what we should find is that it's uniform that pretty much every level of the lumbar spine of the lower back moves about the same. There are small variations. But there is a general normal amount of motion that each one should have.

What I tend to find in these people, that have very arched backs, they have some sort of history of a disc problem is that where their back hurts the most. The disc between the bones and in that level of the spine, tend to be loose in the bones that attached to the disc, and will move excessively. They'll move way too much, and if I poke in that area that people will typically say, Yep, you found the spot. That's it. That's where my back hurts all the time. It just doesn't feel very good for me to poke on there. But that's what I've got to do to figure out the problem.

Other signs that people tell us is standing for too long, doesn't feel good. They feel like they need to sit down to get relief. They will lean on things, lean on shopping carts, lean on tables or countertops to take pressure off their back. They are doing that subconsciously, they don't know they are taking pressure off their back always. But it will just feel good to lean out over this way. It takes pressure off their disk.

Another telltale sign of a disk problem is people that have trouble sleeping at night because of this back pain. They usually dread turning over in bed, if they go to twist and turn over to lay from one side to the other side or move on to their back or their tummy. It tends to kill them quite a bit. That's a more extreme example. But you do see that general twisting motions tend to not feel good. People who have children, for example, getting kids in and out of their car seats can be painful for them. Doing laundry, having to twist in awkward positions to get into a washing machine, or a dish washing machine as well.

That tends to be pretty uncomfortable on a back problem. They tend to not be able to stay bent over for any period of time. They usually are decently flexible, they can reach their legs or toes, even sometimes they even reach the floor. They don't tend to have a big flexibility problem. They may not be the most flexible person in the world either, but they don't report that they are inflexible. They have pain though, if they are staying in a bent over position for a long time, or if they are having to lean over and hold it for a while.

Some of these people tend to feel better when they lie on their stomach. It relieves your back problem versus lying on their back. They don't like it too much, especially when their legs are straight. They feel like they are very uncomfortable. When they lay on their back and their legs are straight, they have to bend them up, and bend their knees so that they can take pressure off their back.

Notice I keep saying take pressure off the back. That's really what is causing the problem, there is excessive pressure because the spine is bent and it's aggravating the disc problem. So if you get that excessive rotation that happens in the spine because it loosens if you are bent too far, and you walk like that, you live like that, you move like that, you start to rotate too much at that level of the spine, wherever the disc injury is at and it creates an instability at that disc over time. That's typically what sets up people for a bulge, or herniation. Or some people don't get that, they get degeneration over time.

Now, a big question that people frequently ask, whenever they come in for help with a disc problem is, can my disc heal? It's very confusing out there. And what I want to tell you is there is some research out there that shows that disc tissue can heal. There is no research out there that I've found conclusively that says that discs don't heal. What the research does say is that people with disc problems tend to not improve their discs. But that doesn't mean that there isn’t something out there that can make them heal.

There is evidence of discs healing, so I hope that's not too confusing. Just to say this one more time, there is no research that shows a disc can't heal, but there is research that disc can heal. And there is research that people that tend to have a disc problem basically tend to not do the right things to get better. So there is evidence that people don't get better is what it is.

Now, on the topic of disc healing, what we know is that it takes about a year for discs to heal, and it is possible to put scar tissue down in a injured disc area. As long as the disc isn’t injured so severely that it's pushing on a nerve, it tends to get better without surgery.

If you think that you have this problem where its pushing on nerve because it's so painful. That might be the case but in people that that actually need surgery, the pain will be debilitating. I mean to the point where they cannot move, they cannot function. In very extreme cases, they are having accidents like a bowel and bladder accidents, like they are pooping and peeing themselves. I have seen a couple of those cases and they don't look very dramatic. What they tend to say is I've made it to the bathroom, but it's real close. There has been sometimes where I actually get myself a bit dirty. But I usually am able to hold it longer and get to the bathroom just fine.

If that's happening, if you have those kinds of symptoms, if you got debilitating pain down your leg, you need to go to the doctor and get a MRI, likely they'll tell you what to do, you actually might need a surgery. But if it's just back pain, and I say just back pain, it could be very painful back pain, but you are not having any bladder problems, or having debilitating pain that doesn't let you even stand up or walk. It could still be limiting you from sleeping enough at night. It may not let you be comfortable when you are driving, you may find that you need pain medication and extra help from the doctor. Those types of back situations almost always can get better without having to have a surgery.

Now, let's talk about what the treatment options are for a disc problem.

The most common place that people start, whenever they visit their doctor for a disc problem is, they get offered pain medications. This could be muscle relaxers, it might be strong heavy-duty pain medications, or the doctor might even recommend over the counter pain medications. And many times, that's enough to take the edge off so that people can function, work, take care of their family and kids, and get them through a flare up.

But if this back problem isn't handled properly so that it's getting better for the long term, it's usually just a matter of time before it flares up again. You have to make sure that you take the proper steps to manage this problem for the long term.

Other things that doctors will recommend are back support braces, they sell them at a drugstore, and sometimes even grocery stores have them, or you can get them online. There are special ones that you can cinch down real tight. Those tend to be pretty helpful for disc problems, but they are short sighted, they don't fix the problem for the long term. You have got to fix that muscle imbalance.

Usually there is some weakness within the muscle groups that stabilize the spine. There might be some movement problem as well. There is usually a slew of problems that all come together to create a disc problem. But wearing a back brace might allow you to not take as much pain medication.

The next thing doctors will often offer are injections for your back. They will inject corticosteroid pain medications, pain medication and an anti-inflammatory medication straight into your back so that you can have less pain and they are pretty effective. Most people report having immense pain relief for up to a few months. The thing is, they don't last forever, some people will flare down and they get a longer benefit of pain relief. They might be good for six months or a year, but we often hear the story where people say, yeah, I've had this back problem for almost 10 years now. I usually can rest it off, I usually can do some stretches, I usually can go to the doctor. If it's really bad. They'll give me an injection and then I'm good for another six months, or another year and then it just keeps happening over and over as the years go by.

They keep self-managing with injections, with pain medication, and with exercise that stretches those kinds of things. But meanwhile, their muscles aren't getting more in balance, they are actually getting worse. And they are working on a disc injury, on a herniated disc, or a bulging disc, or they are creating degenerative disc disease in their spine. It's just a matter of time before it starts to really be bad to the point where it can be debilitating. You have to be careful with those injections as well. Use them as short-term pain relief, but make sure you work on a plan for the long term.

There are a couple of different surgeries that are commonly done. There are more than these two that I'm going to mention, but these two are the most common. The first one is what's called discectomy. This is the minimally invasive surgery that's done out there. And the reason why they say that is because they just make one or two small incisions, and you actually leave the office the same day. You don't have to stay overnight, usually in the hospital, and they can sometimes put a Band-Aid over the incision and that's all you need to heal from the incision site. That's why they call it minimally invasive.

But they do go all the way down deep into your spine right where the disc is at. And they cut off the chunk that's bulging, or they shave it down, or they remove the part that's herniated in the clean up your disk so that it's more normal shaped. They are taking out disk tissue.

If you have that really severe pain that's going down your leg and you are having tons of trouble, it might be what you need. But you got to be careful in thinking that this is going to be the last time you are going to deal with this back problem. Because if you haven't worked on your muscles, your strength, the way that you move, fix the underlying root problem for your back, then it's likely going to come back. We often see people that have had multiple discectomies.

I had a client in fact, who already had two and was on his way to have in his third. His surgeon was recommending a third discectomy in his back. But he didn't want to do that again, because obviously the first two hadn't worked. All this is within a year and a half timeframe from when he had his first one. He came to me to try doing an alternative physical therapy. And he had done physical therapy as well. But he had done a type of physical therapy that had a different kind of focus than what we have here.

Here at our clinic, we figured out his muscle imbalance, we figured out what joints were stiff, which ones needed to be stabilized, went through the whole process. And by the end of his treatment plan, which we saw him for about four months. He actually was weightlifting. With a barbell, one of those big long weight bars. With 135 pounds on his back, we loaded up his spine. And the reason why we got to that point was a cool thing that happens in discs in your back and really all tissues in the body as they adapt to forces.

We got this guy to the point where his back was no longer flared up. He was saying, I don't have any pain, I feel fantastic. I can bend over, I can stand, I can walk, I can even jog a little bit. We really tested him before we put any weight on him, and he's a big guy. He used to play football. He's has a pretty big frame. So he's able to take some weightlifting just fine. You could tell his body is built for it. We put a little bit of weight on his body and we had him do some squats with like 10 pounds, and then 20 pounds, and we worked his way up gradually. He sped through it and I was making sure that he was safe and that no adverse reactions were happening.

We worked on this form and his technique, and he had corrected his muscle imbalance to the point where he could squat and load his spine so that his disks can feel that pressure and the cells inside the disks can detect it and tell each other to get stronger and denser so that they get healthier.

Just like your skin will get calluses, if you are weightlifting or doing yard work, or house work that makes your skin get calluses around your feet as well. People get calluses on their feet all the time. That's the skins response to extra forces that's put on it so that it protects itself and makes it so that it's safe to do that activity again, without tearing your skin. If you get callus, that's good, because you didn't break your skin or get a blister, it wasn't too much activity too fast, because that's what will break your skin. Obviously, it was a tolerable amount for the skin.

We do the same thing in the back if we if we load the spine. Once it's all healthy, in a way that's tolerable, little by little over time. You can work your way up to where you are actually creating a protective amount of strengthening through the disk, but you have to lift weights to do that.

I just want you to be careful if you are out there and you got a disc problem. Please don't jump straight into weightlifting, like the story that I told you, you have to take it a step at a time, get expert help, make sure you are working with somebody who knows what they are doing, how to fix these muscle imbalances that we are talking about.

Don't jump straight into it. I'd be careful to working with a personal trainer as well, just because depending on their background, there are some trainers out there that are pretty good at what they do, but they may not have a full understanding of all the anatomy and the physiology. and the way that all this stuff works together. Their version of a squat may not be what you need. So you got to make sure you find the right kind of help to get to what you want to do.

That's just one story. I've got tons of other stories of people with severe disc injuries that are doing just fine now, even lifting pretty heavyweights.

Now, with surgery, and we were talking about the discectomy, the second most common surgery, if discectomy is not an option, or they've already tried them, and they haven't worked. The next most common surgery is a spine fusion.

When they do this, there are different ways they do it. But the most common one is where they put rods and screws into the bones of the spine to maintain the space of the disk and offload the disc, but at the loss of being able to move at that spine, that's why they call it a fusion. So those bones are essentially fused together through the hardware that's installed and it no longer allows movement at that level of the spine. It preserves the nerves and allows the pain to go away.

It's a miracle surgery, it really can make a huge difference. When done for the right person. There are people that lose the ability to walk because of a spine problem. And once they get a fusion done, and they can walk again because the nerves had the pressure taken off and they are normal.

If it's that bad and you need a spinal fusion surgery, then of course, consult your doctor and let them make that determination. But there are natural ways to take pressure off your discs using your own body, and there are ways to maintain that over the long term. And as we discussed, with weightlifting you can make your discs more dense.

My advice to you is, if you are dealing with a suspected disc problem, get started on getting help early, don't let it go on forever, don't let it fester and get worse and worse and begin to affect other things. Because it will create a nightmare situation for you. You don't want to have multiple surgeries or any surgeries for that matter. You don't want to have to be getting injections all the time and relying on pain medications, having to rely on putting on a brace all the time. You don't want to be defined by your back problem. You don’t want to be that person that is always talking about how much their back is bothering them.

I'm sure you'd much rather enjoy your work, your family, your life and be able to do the things that you want without your back bothering you.

So lastly, the next most common treatment for back problems is physical therapy. There are different types of physical therapy. I just wanted to highlight what we do here in the clinic at El Paso Manual Physical Therapy. Our specialty is manual physical therapy.

What that means is by hand, we spend a lot of “hands on” time with every client. And because we are by hand, moving every bone in the spine and checking it to make sure that it's moving properly. We look at the soft tissue, in other words, the muscles, ligaments, tendons, nerves, that might be affecting the situation.

We take a holistic approach when we are looking at the entire body, not just low back. Because oftentimes there is a hip problem that's feeding into the back problem. There is an upper back problem that's creating more pressure in the lower back, and even down into the knees, the lower legs, ankle and feet, we need to look at that as well. When you talk about the way that you are walking, about the way that you are running, or doing any other activity, we need to go in depth, and make sure that we address you as a whole person so that your back problem can get better for the long term and stay better.

That way you have the most control over your back, you know what to do, you know how to keep it healthy. If it ever starts to flare up on you, you know exactly what you need to get back to doing.

Physical therapy is amazing for back problems. You just got to make sure you find the right physical therapist that fits your needs. And that might just take a chance or two. You have to try different people, different companies and see what you like the best. There are different types of physical therapy clinics out there. And by and large, most of them focus on helping people after surgery. So if you have had a knee replacement or a back fusion, like we talked about a discectomy. Like we talked about meniscectomy and your knee, that's another type of surgery similar to a discectomy.

Going to these clinics that handle a lot of cases after surgery is a great idea. But if you haven't had a surgery, then going to a clinic that tends to see more cases that have just had surgery might not be the best idea, because they are just not going to be best suited to help you out. You might look out and find somebody that's great. But more often than not, you might end up doing very similar exercises to the people that just had surgery because that's how their systems are. H

Here at El Paso Manual Physical Therapy, we rarely see any surgical cases. We tend to help people that are just looking to avoid surgery. They haven't had surgery recently in the past, or they might have, and they just don't want the second or third surgery. But we are looking at people without them having had a surgery, so we are trying to fix a problem from getting worse, to the point where they need injections, they need to be relying on pain medications, and need a surgery. So be sure to do your research when looking for the right kind of help.

Thanks for listening guys. I hope this was helpful for you. I hope you know all about disc problem now and you know the best information so that you can make the best decision about how to move forward in helping your discs heal for the long term. Have a wonderful day. Bye.

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