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The BRACING Series: No. 3

By Sean M Wheeler, M.D.

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

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

Let me start with a story.

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

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

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

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

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

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

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

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

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

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

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

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

Proper bracing muscle stability allows action muscle strengthening without injury.

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

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

Stability Exercise #3: Deep Bracing Muscles of the Spine

This exercise is for the bracing muscles of the spine.

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

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

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

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

Good luck.

Published in The BRACING Series

The BRACING Series: No. 2

By Sean M Wheeler, M.D.

Spine stability is an inherent component in the design of our bodies.  

We gain spinal stability throughout childhood and early adulthood.

As infants, we can only stand once we achieve the stability to do so.  As toddlers, we crawl until we gain the strength in our bracing muscles to walk and then to run

With spinal stability comes a smooth daily coordination and balance for each of us, that demonstrates the power and inspiration of the human body, similar to the awe many experience in watching a professional athlete.  Our ascent to stability continues until derailed by injury or by a shift from an active life to one that is more sedentary.

Back pain often accompanies a sedentary lifestyle. In a futile attempt to sidestep the pain,  we stand and walk differently.  We avoid using the very muscles designed to stabilize the spine - the bracing muscles

And now our back hurts. 

Once the bracing muscles are no longer doing their job, they rapidly atrophy.  These muscles weaken, the spine destabilizes, and the spiral of chronic back pain deepens.  

In research studies observing the effect of weightlessness in outer space on different muscle groups, astronauts were tested for muscle strength before and after a two-week trip into space.  Researchers found that, during those two weeks in space, action-muscle strength (the muscles that move us) decreased by 5 percent in the arms and 7 percent in the legs, while bracing muscle stabilization of the spine (the crucial endurance muscles) decreased by up to 70 percent.  

While in space, astronauts continued to exercise their action muscles daily, but they couldn't consistently utilize their bracing muscles because of the absence of gravity. 

Bracing muscle strength is easy to lose but challenging to recover.  As adults, we can't reproduce the conditions and movement patterns of childhood development.

To repair our bracing muscles in the aftermath of injury or atrophy we need to target them with site-specific strengthening exercises, which is the purpose of the STABILITY Series.

Stability Exercise #2: The Hip Hiker

The bracing muscle exercise viewed above is called hip hiker.

In this exercise, keep both legs straight with your knees locked.  It's important to understand the hip being strengthened is the one that stabilizes as the other hip moves. 

Do 25-50 reps on each side. As the STABILITY Series continues, remember that you do not have to do all the exercises at once.  Do a couple of different exercises for your bracing muscles each day and become expert at each exercise.

I will introduce another exercise next week.  

Published in The BRACING Series

The BRACING Series, No. 1

By Dr. Sean M. Wheeler, M.D.

I have seen some strong patients in my twenty years of practicing medicine: bodybuilders, professional athletes, Pilates instructors, laborers and others who depend on strength for their work.  

"Weak" is not a term we would associate with them, but the longstanding back pain they suffer is the result of a weakness in a particular set of obscure muscles.  The weak muscles in these very strong patients are the bracing muscles, which are unique muscles that require a particular approach to strengthen. 

I introduce the concept of bracing muscles in my book, UPRISE--Back Pain Liberation by Tuning Your Body Guitar, which will have a major impact on the future care of back pain.  In my book I promise to develop a set of exercises targeting these muscles that can improve the stability of everyone, not just people with chronic back pain. 

Over the coming months, that promise will be fulfilled here as we release a series of videos to demonstrate these exercises. 

In a few weeks local gyms will fill with new members on a New Year's resolution bender, trying to get in shape for that spring vacation they've already purchased.  Many will focus on "core" training, which has become an industry in itself.  And yet an extraordinary number of people who are working on their core still experience back pain. 

This is because you have to get the spine stabilized before you can "get in shape."  

Six-pack abs boost your ego but not your stability.  Stability is the role of bracing muscles. 

Trying to exercise heavily when your spine is not yet stable is like trying to build a second story on a home with a cracked foundation.  It is an invitation to injury.

So which muscles are the bracing muscles? 

Truthfully, they can be hard to find.  They aren't muscles you can flex and impress yourself with in the mirror.  Exercising them doesn't build their size, it builds their endurance and circulation. 

There are six bracing muscles that pull your hip into a stable position in the socket, which collectively I call the gluteus stabilizers.  They work in conjunction with the psoas muscle and the pelvic floor muscles to suspend the hip in "mid-air" inside the hip joint, providing stability while allowing movement. 

When these bracing muscles weaken, the psoas spasms, the hip is pulled up into an impinged position and the pelvic floor weakens, leading to pain and dysfunction.  That's the theory, anyway.

Stability Exercise #1:  The Clamshell

The first exercise appearing in the video above is called a clamshell. 

The important points of technique are to keep the body rotation closed, stay leaning forward, and to keep the knee low.  As with any exercise, rushing through it is not helpful. 

Try to do 30-50 reps on each side every day for the next week until I introduce the next exercise. 

Good luck.

Published in The BRACING Series

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

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

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

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

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

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

Pope enthusiastically insists:

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

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

Pope recommends incorporating a HIIT workout three times a week.

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

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

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

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

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

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

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

[Image Source: Aurora Bootcamp]

Published in Back Pain Relief

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Why is chronic back pain such a global problem with no widespread treatment moving us any closer to solving the condition?  
For the answer, consider these reasons:
  1. We work harder, longer, and play outside less and less.  Look around your office: it's a safe bet that most of your coworkers are sitting, including yourself. As a society, we're only starting to explore how destructive sitting is for our bodies.  
  2. We live in a world where exhaustion rules as a status symbol.  A person will answer the phone only to tell you for five minutes how busy, tired and stressed he or she is.  If we have back pain, we buckle down and keep moving.  
  3. Preventing disease and muscle weakness is a different type of work, the kind of which slips under our general awareness.  We don't get patted on the back for taking time off to work out over lunch or for breaking social norms like sitting at work. 
  4. It's easier to respond to urgent problems as they occur.  It remains far less common to be proactive and deal with important issues before they become problems.  In health care, this can be seen in the lack of focus on prevention.  Instead, current medical communities focus on what it can diagnose or treat.  
  5. Back pain progresses stealthily under a cloud of injuries, spine instability, and poor posture.  Additionally, your body compensates for weak bracing muscles (the ones you need to keep your spine stable and pain-free) like no other part of your body, making recognizing the root of back pain even more difficult.  We have nothing to compare it to, which means we need a new way to recognize causes and solutions.  
If you struggle with back pain and rely on customary medical advice, the odds are stacked against you.  Research results produced most recently essentially say nothing works when it comes to treating chronic back pain.  Our medical community's algorithms for treatment are flawed and failing.
Chronic back pain is a real problem for many of us, but there is a solution, which while simple in concept requires discipline.   
First, let's rewrite our understanding of what causes chronic back pain.
Second, as a patient, one must understand what to expect in treatment, and what works and what doesn't.  To instill your self-care discipline, seek a trained expert to show you how to care for our back to prevent chronic low back pain.
UPRISE: Back Pain Liberation, by Tuning Your Body Guitar, by back pain expert Dr. Sean Wheeler, offers the starting point for a new global conversation of chronic back pain treatment and relief.  
[Image Credit: The Lancet, Source: The Economist]

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

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

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

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

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

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

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

As characterized in the study:

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

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

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

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

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

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


Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary in aid of understanding the cause of back pain, and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 


Published in Medical Research

Tiger Woods getty imagesTiger Woods For the third time in his past nine tournaments, Tiger Woods withdrew from further play due to back pain.

Woods made it to the green on his 12th hole of the first round at Torrey Pines North Course before withdrawing from the 2015 Farmers Insurance Open.

As reported by CBS Sports, Woods described his difficulty:

"It's just my glutes are shutting off. Then they don't activate and then ... it goes into my lower back. So, I tried to activate my glutes as best I could, in between, but they just never stayed activated." [emphasis ours]

Woods also says about the Masters in April:

"The whole idea is to make sure that I'm ready for Augusta, so I got a lot of rounds to play between now and then. That's what we're building for..."

Based on how Woods publicly describes his physical condition, ready to compete for The Masters championship he will not be.

Here's why.

Glutes are your butt muscles. They are a key component of your body's power center, as they unleash the strength of surrounding muscle. They're especially important for athletes, because hip extension is a primary source of explosion in many sports, including golf.

To fully understand what Woods is today experiencing, 10 months ago at age 38 Woods had a lumbar microdiscectomy, a surgical procedure of the low back to address a pinched nerve, a source of pain for several months.   

With this context, Woods' explanation of why his glutes would "shut off" and not "activate", telegraphs that Woods misunderstands the orchestration of his body, according to sports medicine and back pain expert Dr. Sean Wheeler.

Dr. Wheeler, who knows the stresses the sport can place on the body, counts among his former patients Byron Nelson, for whom he served as physician for a brief time during 2005-06.

Dr. Wheeler offers this perspective on Woods' pain difficulties:

"With Woods, if his gluteus muscles will not fire and contract, there is an unexpected reason for his pain rather than "my glutes won't activate."

The likely answer is that his glutes are fatigued, in other words, they are incapable of contracting properly."

For an iconic athlete as vibrant and physically strong in so many ways as Tiger Woods, how is this possible? After all, Woods hits the gym often for strength training, with an obsession for weightlifting.

Dr. Wheeler explains:

"For Tiger Woods, as with most everyone athlete or no, the answer to solving his pain woe is counterintuitive

Strength training will NOT improve his recurring low back pain problem.

Instead, based on the pain he describes, Woods should redirect his efforts to circulation training®.

Circulation training, rather than strength training, is needed to improve the endurance of his gluteus muscles, which we label bracing muscles®."

Why is circulation training necessary, and what is it?

The answer should prompt us all to unlearn what we know—and what we believe—about our bodies and back pain, letting go of our assumptions to learn a new way of thinking about pain, in particular low back pain. 

Dr. Wheeler offers a primer revealing the answer:

"Bracing muscles, compared to what we label action muscles®, each perform as their name implies.

Action muscles move—they prompt action—wherever located within your body.

Bracing muscles stabilize—they brace—without moving the body structure they are intended to support whether, for example, your spine, neck, or feet continually throughout the day

Each of these two types of human muscle offer different performance characteristics requiring different care throughout one's lifetime.  

Action muscles are maintained and, if desired, made even stronger through strength training, by use of movement and resistance.

In contrast, as bracing muscles provide all-day stabilization, they require the constant flow of energy achieved through blood flow. Maintaining this blood flow to the low back and gluteus bracing muscles, through circulation training, becomes ever more important as these muscles must maintain their endurance—and bracing capability—as blood flow naturally begins to decrease to our spinal discs as we age, typically in our mid-30s. 

The differences come into sharp relief: 

"Strength training is about pumping iron and building muscle mass for action muscle power. 

Circulation training is about pumping blood for bracing muscle endurance."

Every human being needs both strength training and circulation training for a healthy, sustained life.

Yet, in today's medicine, too often circulation training is overlooked and the obvious benefits not embraced—by physicians, health insurance carriers, and patients. 

Bracing muscle endurance is the single most important key to achieving freedom from back pain, pointing to the counterintuitive answer of how Tiger Woods can be liberated from his chronic low back pain:

Rather than strength, Woods must build endurance in his bracing muscles—those of his low back and his glutes.

For the lumbar spine and gluteus bracing muscles to contract—and brace—they must possess ample endurance.

The importance of the gluteus bracing muscles is that they stabilize the hip. If these muscles fatigue, the hip is unstable. 

psoas-musclePsoas MuscleIF these bracing muscles lack endurance, action muscles spring into—what else?—action, to compensate for non-performing gluteus and low back bracing muscles. As Woods' nearby action muscles—in this instance psoas [soh-uh s] muscles—are likely very strong given his strength training habits, these psoas action muscles attempt to compensate for his lethargic bracing muscles.

Psoas action muscles cross the hip joint, on both sides left and right, and attach to the lumbar/low back region of the spine. Because of where the psoas attach to the low back, when forced to compensate for weakened bracing muscles, psoas action muscles can go into spasm and cause back pain.

Says Dr. Wheeler:

"If the psoas action muscle spasm, the bracing gluteus is unable to contract, as the two muscles compete. The result creates an inescapable, repeating cycle similar to traversing the impossible Penrose stairway; one may ascend or descend the stairs forever yet end up back at the same spot every time.

Fatigued gluteus bracing muscles cause psoas action muscles to spasm which cause the gluteus not to contract, leading to less endurance of the gluteus bracing muscles, repeating the cycle.

Without breaking the cycle, the consequence is sustained low back pain."

But again we are talking Tiger Woods, he with access to the world's best strength training equipment and trainers. Why would his psoas action muscles be forced to compensate for his low back and gluteus bracing muscles?

There could be many reasons, but the most likely is Woods' back surgery of 10 months ago at age 38. 

Woods seeming propensity to focus on strength training benefits his action muscles, yet without sufficient post-operative, restorative circulation training as he ages, Woods' bracing muscles are likely unable to properly perform.

Once one loses endurance in the bracing muscles of the low back, a 180 in 180® is required—a 180 degree refocus in how to care for your back—requiring 180 days to unlearn what you think you know about your body and low back pain, and to develop the good habits needed to restore bracing muscle endurance.

Woods must give himself adequate time which, depending upon his schedule and focus, could be as much as 180 days to restore his low back and gluteus bracing muscle endurance.

Knowing what he means to the world of golf, we trust Woods returns to form soon, after his low back and gluteus bracing muscle endurance is restored.

[Tiger Woods image credit: Getty Images, Source: CBS Sports]

Watch as sports medicine and back pain expert Dr. Sean Wheeler introduces a new medical termBracing Muscles — and why understanding the function and care of your Bracing Muscles is so important in the treatment of chronic back pain, and how caring for them properly achieves back pain emancipation.

Based on an examination and critique of established medical practice, Dr. Sean Wheeler's new bookUPRISE, offers a new understanding of the body as the finely tuned instrument it is – as not only your body, but as your Body Guitar, and a medical innovation to achieve back pain emancipation.

Bracing muscles located in your low back play a crucial role in this emancipation, to assist you in reaching pain freedom.

Dr. Wheeler's new understanding of treating chronic low back pain required the creation of new labels in aid of understanding. A glossary of this new terminology appears here.

Published in Dr. Sean Speaks

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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