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Pain Expert

I recently had the chance to join Wellness Practictioner Dr. Michelle Robin on her weekly radio show, Small Changes, Big ShiftsWe talked in depth about the motivation behind my new book, UPRISE: Back Pain Liberation, by Tuning Your Body Guitar, a broken medical system that has not made any advances in long-term back pain relief in over 40 years, and the crucial role an understanding of the interplay between Bracing Muscles and Action Muscles plays in liberation from chronic low back pain. 

After the interview aired, we received an interesting question from a listener regarding Pilates, Posture, and Pain: 



GettyImages 460714021 compIn UPRISE, it is by design that I focus on exploring and explaining how the Body Guitar — your unique human back, including the lumbar spine (low back) and Bracing Muscles — can get so out of tune before delving into the readjustment process, which I call Tune Me. Understanding the how — the CAUSE of your back pain — is crucial. Why? Because one kind of pain leads to another kind of pain and causes a cascade of problems throughout the whole system of the body. It is this process that causes the progression of back pain and throws our bodies out of tune. 

When a patient first comes to a doctor complaining of back pain, all too often a one-size-fits-all approach is taken in treating them. By and large, rather than using a more specialized exam to diagnose patients, pain doctors have begun using a highly specialized treatment algorithm. UPRISE explains this in further detail, but know that problems with this treatment algorithm are numerous; it is diagnosis by trial and error. 

 Instead, patients should be properly diagnosed to see exactly what is causing their pain. While the initial cause can vary widely, most manifestations of lower back pain are attributable to one of five problems, which are all part of the same progression of chronic back pain.

  • Muscle Strain 
  • Facet Joint Pain
  • Disc Bulges 
  • Discogenic Pain 
  • Sacroiliac Joint Pain


16PHYSED tmagArticleWhile reading the New York Times this past week I was drawn to this column talking about how runners slow with age, and how strength training may help restore speed as we age, based on a new study published last month in Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine

In approaching age 40, runners begin to lose activation and power in the muscles of their ankles, their stride becomes shorter.  This change accelerates past age 50.

When running, and for everyday mobility, everything starts with the ankle as the ankle is the base of the body.

The lead author of this study suggests that to maintain more of our speed as the years pass, we should consider strengthening our calf and ankle flexor muscles.

Through strength training.

With distance runners and indeed among us all as we age, changes we experience in the ankle flexor muscles are due to a decrease in endurance, rather than solely a lack of strength. 

Understanding this difference — the need for improved muscle endurance beyond strength alone — offers a better understanding of the onset of conditions elsewhere in your body with this similar category of muscles, such as your back, as well as assisting the runners of our world.

What exactly is the muscle category of which I speak?

Muscles of your foot and the soleus muscles in your ankle are of a specialized type labeled Bracing Muscles.

Bracing muscles are unique in the way our bodies use them, rely on them and, as we age or are injured, compensate for them as they become weak and lose the ability to provide us their bracing, stabilizing function within our bodies.

As the label implies, bracing muscles brace high-performance parts of our bodies to provide stability by not moving when another muscle type, Action Muscles, move around them. Bracing muscles are designed to provide our bodies stability all day; they must possess the endurance to function throughout the length of our day.

This bracing stability is so important that when bracing muscles are not performing at their peak, our bodies make drastic changes attempting to maintain this stability:

Our action muscles compensate for them, our joints tighten to compensate for them, our movement and gait changes to adjust for them.

These drastic changes create even more problems within our bodies. Over time the arch changes, the heel cord tightens and our gait becomes even worse. Perceived solutions such as arch supports, new shoes and stretching before runs spiral into a constant losing battle. Eventually the aging runner suffers knee and hip arthritis, a direct result of the loss of bracing function through the ankle and foot.


[Image Credit: iStock, Source: The New York Times]

 As parents, educators, and healthcare professionals, we want the best for our kids. If they are struggling in school, we do whatever it takes to help them succeed. If they are in band, we get them lessons. If they play sports, we practice in the yard. We're concerned with what they do and learn now, and how that will affect them as adults. We're concerned with how they treat their friends, their teachers, and other human beings.

We're also concerned with their habits and their lifestyle choices: sleep, nutrition, internet and social activities, what they watch on TV, what their grades are, whether they're dressed appropriately, and, of course, if they have enough time to simply be kids. We want our children to become confident, caring adults who value hard work and themselves. 

What we don’t seem to worry enough about is a future involving back pain, which could keep them from working or enjoying life at all. Back pain is the leading cause of disability worldwide. A significant number of people will experience chronic back pain in their lives. We don’t seem to worry about this, because we assume that there is nothing we can do about it. But there is. We need to shift our thinking from treatment to back pain cause and prevention. 

My youngest daughter, at 3-years-old, has perfect posture. Her pelvis is in a correct position, her muscles and joints flexible. Her older brothers and sisters, on the other hand, do not have perfect posture. For me, as a back pain doctor (and father of six) who regularly instills the prinicples and importance of healthy posture in my patients, this begs the question: When do these changes begin?

Within minutes of sports medicine and back pain expert Dr. Sean Wheeler's Fox4 television appearance of August 12, we were first contacted by a listener who asked how she might purchase a copy of Dr. Wheeler's new book, UPRISE: Achieving Back Pain Liberation by Tuning Your Body Guitar

As the book was as yet unavailable, scheduled to be published August 18, we sent the listener a copy of UPRISE with our compliments.

This week she called to thank us for the book, and shared the following in reaction to UPRISE:

"A quick read, understandable, and with no hogwash, Dr. Wheeler tells the truth about what causes back pain. He tells us how things really work in your back. After reading Dr. Wheeler's new book, I feel better understanding why I feel what I’m feeling."

Our thanks to Janet Holloway of Kansas City, Missouri, for sharing her reaction to UPRISE: Back Pain Liberation, by Tuning Your Body Guitar.

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Your body is a finely tuned instrument. Like all finely tuned instruments, it must be properly cared for in order to play the beautiful music it was intended to play. Care for your body and use it correctly, and it will play music that is unique to you – your life song.

– Sean M. Wheeler, M.D.

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