Low Back Pain Relief Part 1: Sitting

One of the most common complaints I hear from new clients is "I have pain in my lower back". This isn't surprising to me when I observe how they sit with their tails sheepishly tucked under, perched right on top of their butt cheeks. I mean it makes sense, those butt cheeks do make for a nice little cushion. Unfortunately this is disastrous for your back because it puts pressure on the discs, causing pain and discomfort. It also disrupts proper breathing, creates dysfunction in the shoulders and promotes laxity and weakness in the abs.

Since our bodies don't come with an owners manual, we tend to defer to it's agenda, which is to exert the least amount of effort as possible. This is actually pretty efficient in the short term, as it conserves energy, however, it is often deleterious in the long term. Hence back pain.

So here we go- learning how to sit. It may seem silly, but most of us have never actually learned how to do this properly. As usual, I am going to try and break this down into as few steps as possible. The sixth step is is for extra credit, and focuses on breathing.

1. Find your SIT Bones and create a Triangular Base

• Stand up
• Lift your arms up over head
• Arch your back
• Stick your butt out
• Keeping your butt sticking out, sit back down

You should feel two prominent bones underneath of you (meet your SIT bones- you are supposed to sit on them), your butt cheeks should be behind you (after all, that is why it is called your "behind"). Your SIT bones and your perineum should make a triangle, with even pressure on all three points. OK, so this is a good start. we have a wide, stable base to perch on.

2. Find your Pelvic Bowl and keep it from spilling

• Place your hands on your hips
• Notice that your pelvis makes a cylindrical shape (meet your Pelvic Bowl)
• Notice that when you sit on your SIT Bones, your Pelvic Bowl is upright, and if it were full to the brim with water, no water would leak out from the front or back of the bowl (because you aren't tipping the bowl)

 3. Find your spine

• Your spine should have the feeling that is extending up out of the center of your pelvic bowl
• Your low back should be gently (not forcefully) arcing forward (picture the front of a bow and arrow) 

 4. Balance the Pelvic Bowl and the Bowl of the Ribcage

• The ribcage is also a cylindrical shape and can be thought of as the ribcage bowl. In this case, the bowl of the ribcage should be stacked over the bowl of the pelvis. It's a balancing act, similar to building blocks or stacking rocks. 

 5. Create an HOURGLASS!

• WITHOUT changing the shape of the spine
• Pull the front of the belly in and up (you can actually lift your belly button up)
• Pull the sides of the waist in toward the spine (think- away from the shirt)
• Gently hug the back muscles in and up toward the spine
• At this point you should feel like an HOURGLASS- wide base, wide top, narrow middle that hugs in on all sides

6. You get Brownie Points for BREATHING

• Imagine that you can put a stopper in the middle of the hour glass
• Now pull the breath into the top of the hourglass only
• Feel the bowl of the ribcage fill out on all sides- front to back and side to side
• Feel the belly being strong and supportive, don't lose the stopper, we don't want to fill the belly- only the ribcage.
• This strengthens the ABS and the back, relieving tension in the shoulders, neck and ribs.

Bonus tools:

• Take some colored tape and use it to place three small X's on the base of your chair that form a triangle, this is where your sits bones and perineum should be. This will remind you to sit on your triangular base every time you sit down.
• Print out an image of an hourglass and keep it taped to your monitor, reminding you to sit up properly.

Your body may be working overtime (even if you aren't)

Fridays are my work from home day, the day I take to do admin duties; write checks, review my Pilates schedule, pay bills, and when I find time- my day to post to Pilates Geek. On the days that I work from home I sit more than usual. I notice that for a couple of days following my WFH days I get a bit sore in my right shoulder and feel the need to adjust my neck regularly. Sometimes I even notice soreness in my jaw. On days like these I find myself wondering- how does the average person do this on a regular basis?

I understand that tech geeks and desk jockeys love their jobs, just as much as this Pilates Geek loves hers, but I cannot imagine what it would be like to work like this day in and day out without a good understanding of how to better adapt to the physical demands of sitting, typing, mousing, repeat...

So today's post is dedicated to the die-hard geeks (of any trade) who are held hostage to a desk all day (and, who most likely, love every minute of it).

In my last several posts we have discussed how to sit in good posture while working and how to breathe properly in order to relieve tension. We went over techniques to release and strengthen tight shoulders, and learned some simple exercises to do from just about anywhere. Today we are going to tackle a more subtle problem that can undermine the best of our efforts when it comes to posture and endurance at the desk- CLENCHING!

That's right, clenching. That nail biting, gum chewing, white knuckled, teeth grinding arm crossing aggressive habit that goes hand in hand with hard work and extreme focus. In fact, if you look around your office right now, you may be able to observe some of these behaviors first hand. See that guy over there with the little muscle above his jaw bouncing around like a little rabbit, or how about your boss over there snacking on his finger nails, ooh, or maybe him, that guy next to you on the phone without a headset squeezing his phone between his ear and his shoulder while he hammers away at his keyboard. It may be surprising how many examples you can pick out in just one sweep of the office. The simple fact is, these behaviors are so common we hardly notice them anymore, in others or in ourselves.

Unfortunately these unconscious and unnoticed habits create long term tension in the muscles, tendons and ligaments of the jaw, neck and shoulders. Over time the accumulation of tension causes muscles to spasm and inflammation to occur. When this happens regularly nerves become compressed, leading to pain, tingling and numbness in the arms, hands and fingers.

The first obstacle in correcting these habits is that they are usually unconscious. So you are going to have to use your habit radar and start seeking out some indicators that these things are happening in the first place. Once you pinpoint one or two of them, well, then the real work begins...

Here are a few things to be on the lookout for, and what to do to correct them once recognized:

Phone cradling- this one is pretty simple, make an effort to use your headset and avoid holding the phone to your ear. Even holding the phone with your hand for more than several minutes causes poor elbow mechanics and clenching. If you know you are going to be on longer than a minute or two, use your headset!

Gum chewing- skip it, or do it very minimally, for a very short amount of time. Repetitive chewing mimics jaw clenching and teeth grinding which produces major tension in the jaw, neck and shoulders.

Jaw clenching- this is a bit trickier because it is less noticeable. For starters it is helpful to realize that unless you are chewing up your food, you should always have space between your teeth (all of them). The lips can be closed, but the top and bottom teeth should have space between them at all times. It may help to use a rest break software that can help to remind you to relax and release your jaw.

Nail biting- this could, by far be the most difficult to tackle. I'd recommend designating two 5 min nail biting times during the day- say 11 am and 3pm. Outside of those times do not bite- and when you catch yourself biting stop and remind yourself of your biting time. Set an alert to notify you it's time and bite away. Over time you may find that you no longer have the desire to bite.
If this doesn't work I would recommend doing some research, and possibly looking into some cognitive behavioral therapies for suggestions on how to break this habit. Nail biting also has a negative impact on jaw, neck and shoulder tension, because, like gum chewing and jaw clenching you repetitively engage and stress these muscles.

Shallow breathing- this clenches the muscles between your ribs and compresses all of the soft tissues of the torso. Learn to take full deep breaths (see previous post on breathing techniques).

Aside from these detailed tips, here are some general recommendations to keep your body happier:

• Seek out stress reducing activities that you enjoy like Pilates, Yoga, Meditation, or maybe running.
• Take breaks regularly. I've mentioned there are software options that will remind you when a break is needed http://www.workrave.org/
• Make time for physical activity, don't "try and find it", because it will not magically appear, you have to make it happen
• Take a walk around the block, or try taking the stairs
• If you have difficulty staying motivated, schedule regular workouts with a trainer. If you have it on the books and are accountable to someone else, you are more likely to actually follow through.

You can take it with you- Pilates Anywhere in 10 Min

Summer is upon us, and for many of us that means vacations and long weekends away, relaxing, soaking up the sun, eating exotic foods... what's not to enjoy? That's why I'm often surprised, pleasantly so, that many of you express concern about going without Pilates while you're away. I thought I was the only Pilates Geek who felt this way, I now stand corrected. So here I am, the geek of all Pilates Geeks offering you a simple solution- take it with you!

5 simple Pilates Mat exercises, in just 10 minutes, anywhere!

Bridge targets: core, hamstrings, glutes and spine
Set up: Lie on your back, knees bent, feet hip-distance apart, arms by your sides, palms down
Movement: Lift butt and spine off the floor maintaining a neutral spine position, coming all the way up onto your shoulder-blades, then lower down maintaining a neutral spine and neck throughout the movement.
Reps: 5

Chest Lift targets: core
Set up: Same as above, with palms interlaced behind your head
Movement: Slowly peel your spine off of the floor one vertebrae at a time, until you reach the bottom tip of your shoulder-blade, slowly roll down, keep some space between the chin and the chest and keep elbows very still, refraining from pulling with the arms
Reps: 10

Criss Cross targets: core
Set up: same as above, with legs in table top
Movement: Roll up slowly and cross your right shoulder towards your left knee, lower and repeat on other side, keep elbows still, do not pull with the arms
Reps: 10

Plank targets: whole body, a slim core and Pilates arms await you
Set up: Kneel on all fours, 90 degree angle in hips and shoulders, hands shoulder distance apart, fingers wide apart, middle finger forward
Movement: step one foot back and then the other, until you are in "push up" position, draw heels back and spread wide across your upper back, keep head in line w/ shoulders (not above, not below), hold pose.
Reps: 10 breaths
Variation: Add leg lifts, lifting from gluteal fold only, 5/leg
* to master your plank, see my blog post on the Perfect Plank in 10 Simple Steps

Reverse Plank targets: whole body, great for correcting computer posture
Set up: sit down with bent knees, feet on floor, hands behind you, fingers face forward
Movement: Push yourself up until you resemble a table (90 degree in knee and shoulder joints), stretch the chest open and extend legs out until they are straight, hold pose.
Reps: 10 breaths
Variation (+ challenge): Leg lifts 5/leg, keep spine stable
Modification (-challenge): Keep legs bent

And that's a wrap! Hope you enjoy your guilt free, strong, sexy, geeky vacation, and rest assured, knowing that your body has been worked from tip to toe.

The Perfect Plank in 10 Simple Steps

Plank pose is an amazing core exercise that prepares your body for advanced exercises, however many people cannot get past the barriers of wrist and/or low back pain. Below we are going to go over the steps for building a proper Plank. *If you have Carpal Tunnel Syndrome please perform the Dolphin variation of Plank at the end of this post.



10 Steps to a Better Plank

1. Start in a quadruped position on the floor, shoulders directly above wrists

2. Middle fingers should face forward, fingers should be separated slightly with an L shape between the thumb and index finger

3. Step one foot back at a time to come into Plank, your body should be at a diagonal incline

4. Pull your shoulder blades apart and down in the direction of your hips

5. Keep your collarbone wide and gently pull chest forward

6. Press all points of your hand and all knuckles into floor (especially thumb and index finger knuckles)

7. Now rotate the inner part of your elbows to face forward- further drawing the shoulders down the back (keep the thumb and index finger knuckles pressing into the floor)

8. Pull your belly button up and in towards your spine (this is crucial for protecting your lower back)

9. Reach your tailbone back towards your heels

10. Pull your heels back and the top of your head forward like you are pulling two ends of a string in opposite directions.

There you have it- the perfect plank! You should hold this position for 5-10 breaths at a time gradually increasing strength.

If you still experience back discomfort revisit steps 8, 9 and 10 above, hold for fewer breaths and gradually increase as your core gets stronger.


If you still experience wrist discomfort try the following in succession until there is no discomfort. Once you find the modification that works for you practice it for awhile before challenging yourself with the more difficult variations.

1. Forearm stretch: Kneel, extend arm out palm up, opposite hand grabs fingers, pull straight fingers (no curl) towards the floor. Switch sides. Try Plank again emphasizing steps 6 and 7 above, if you still experience pain try step 2 below.

2. Roll up a mat until it is an inch or two high and place under the heel of the hand decreasing the angle of the wrist. If this does not solve the problem, stay off the wrist and perform Plank on the forearms (also known as Dolphin)

3. Dolphin: Come down onto forearms, elbows shoulder width apart, hands in gentle fists, shoulders blades apart and down the back, chest forward, belly button in, tail back, heels back, crown of the head forward.

Don't give up, Plank is a challenging exercise that has numerous benefits. In time it will become easier, so be patient and enjoy the ride!

Stiff neck, tight shoulders? It may be Disappearing Neck Syndrome

Just because it is not a real syndrome in the technical sense, seeing how your neck will probably never entirely disappear, does not mean that disappearing neck syndrome (DNS) should not be taken seriously. In fact it may be affecting you right now.

How do you know if you have DNS? Answer the questions below to see if you are at risk:

1. Do you work at a computer?
2. Do you use a hand held device?
3. Do you drive a car?
4. Do you experience minor stresses on a daily basis?

If you answered yes to two or more of these questions, you should stop what you are doing, acknowledge that you probably have DNS, and STRETCH! Don't stress (it only make things worse). This will only take a minute- you don't even have to leave your chair!

1. Shoulder Rolls: Relax your arms by your sides and draw small circles with your shoulders to the back for 10, and then to the front for 10.

2. Pec Stretch 1: Sit up tall, reach your arms back and grab the back of your seat behind your butt (fingers point back) lift your chest toward the ceiling hold for 10 deep breaths.
* if you are on a ball, reach to the back of a ball , if you are standing clasp your hands behind your back, palms together and straighten your arms

3. Pec Stretch 2: Turn your chair sideways to the left at your desk, keep your right forearm on desk, then lean forward as your chest sinks toward your thighs. make sure your chest is below the level of your right arm. You should feel the stretch in the front of the chest. Hold for 10 breaths, switch sides.
*To deepen the stretch kneel on the floor instead of sitting on chair.

4. Neck Stretch 1: Reach you right hand down and clasp the bottom of your seat, pull your shoulder blades down your back and then pull your left ear to your left shoulder, slowly nod your head front to back (as if nodding yes) maintaining the side bend in the neck. 10 reps then switch sides.

5. Neck Stretch 2: OK- you may look a little funny doing this one, but if anyone stares, just stick your tongue out while you do it and they'll probably look away quickly and give you your privacy ;)
Sit up tall like you are being measured for height and want to be an inch taller, lift especially high through the back of your head. Now slide your chin in towards the back of your neck like you are trying to make a double chin, then release. This is a slide motion, not a nod. Imagine your chin is on a shelf and you are just sliding it back and forth. Eyes should stay fixed on one point directly in front of you). Hold chin in for 3 counts release for 2 counts, do 10 reps.

Disclaimer: These exercises will work to relieve shoulder and neck tension, herein referred to as DNS, however, people may look at you inquisitively if you mention to them that you have DNS, as it is not really a medical syndrome. On the other hand, they may not even notice, seeing how we live in a society that seems to have an acronym for everything we do that is out of the ordinary (and even some that are not) So, if they look puzzled just give them the test above and refer them to this blog for a little TLC.

Breathe Away Aches and Pains at Work

Sometimes a nice deep breath (or five) is just what we need to relax our shoulder, neck and back muscles at work. This technique is easy to do, only takes a minute or two, and can be done right at your desk...

To perform this exercise while sitting at your desk

1. Sit up properly at your desk (see 1st blog post)

2. Place hands on your lower ribs, fingers lining up with your ribs and pointing in towards one another

3. Take a deep breath in through your nose, imagine that you are slowly sucking air in through a long straw that starts just behind your nose, goes down the throat and fills the lungs. Feel your lower ribs expand out to the sides as your lungs fill with breath (this should take 5-8 counts).

4. There! Now your lungs are full, like a big balloon

5. Picture this balloon in your belly and slowly begin to press the air out of the balloon by squeezing your ABS in, pushing the air up through the straw, and out through the mouth (this should take 5-8 counts as well).

6. As soon as all the breath has been completely emptied give your ABS an extra squeeze for additional transverse abdominal work.

Repeat five times melting tension from your shoulders, neck and back, increasing abdominal strength and fueling your blood and brain with energizing oxygen. Now back to work!

Five Simple Tricks for Sitting Upright at your Desk

1. Locate your sit bones, sit on them (your butt cheeks should be behind you not under you)

2. Lift your sternum (or ribcage) until it sits right over your pelvis

3. Relax your shoulders

4. Lift the back of your head (occipital ridge) up, this will draw the chin in slightly

5. Pull your navel and waist in towards the spine

For more information on proper ergonomics for your workstation check out this informative link
http://www.nicolaellisphysiotherapy.co.uk/page10.htm