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Feldenkrais Method
Low Back Pain

Anatomy Overview, Discs Bulging/Herniated, Degenerative Joint Disease (DJD), Spondylosis, Sacroiliac Dysfunction, Sciatica and Treatment Strategies

No one receives an instruction manual for their body when they are born. Too bad, because if we knew how to use our back when we began grade school we could eliminate the habits that lead to so much back trouble as adults.

Anatomy Overview

When our spine is upright, 3 normal curves are meant to be balanced.

Ideally there is a small inward curve (lordosis) in our cervical spine; a medium sized outward curve (kyphosis) in the thoracic spine and a medium inward curve in the lumbar spine. (See ill. 1) These curves give our spine strength under compressive force similar to the coils of a spring, which absorbs forces better than a straight rod. The discs in between each bony vertebra are also shock absorbers. They are comprised of firm, dense concentrically layered cartilage with a soft center (nucleus pulposa) that acts as a hydraulic cushion. (See ill. 2, 3, 3.5)

Garden-variety back pain begins with strain of the muscles and ligaments as a result of over-use or overstretching.

When we are young, rest is usually enough to heal the strain. Repeated strain and poor posture over time begins to degrade the deeper tissues of the back.


There are many theories of disc mechanics but one fairly well accepted theory is that when one rounds one's back the disc is subject to wedging force. The wedging causes the front of the disc to be crunched while the back of the disc is overstretched. (See ill. 4) Sideways wedging of discs can also occur. (See ill. 4.5) Our body is designed for all sorts of flexible movement. The problem arises when our spine is 1) placed in a rounded and or side bent position for long periods like during sitting or bending forward for work

2) rounded when lifting or pushing a load.

A repetitive, sustained or forceful rounding of the low back will cause progressive deterioration of the disc. Fibers in the back of the disc soften over time. The once-centered nucleus is pushed backwards and the disc begins to bulge backwards pressing on nerves/spinal cord. A bulging disc is like a tire ready to blow. When the soft nucleus actually extrudes out of the disc it is considered herniated and causes irretractable pain and pressure on nerves/spinal cord. (See ill. 5 disc viewed from above)

Discs of younger persons are more elastic and prone to bulging/herniation problems.

Older discs tend to be drier so they are more likely to flatten after years of excess compression, rather than become herniated.

Degenerative Joint Disease (DJD) of the Back

The inter-vertebral discs, vertebral body, facet joints and sacroiliac joint. These are the four tissues in the low back where we tend see degenerative changes. As a person ages their discs become firmer, more dehydrated, compressed, thinner, and the spine can become less mobile. (See ill. 6, 6.5) Excess compression is then transferred to the bony vertebrae. Bone responds to excess pressure by building up more bone around the edges of the vertebrae.

Spondylosis, this bony build up around the vertebrae, sometimes called "lipping", acts to limit motion further. (See ill. 6.75)

The vertebrae also have two pairs of facet joints on each side. These are true joints having hyaline cartilage lining each bony surface and are sealed by a joint capsule. One set of facet joints connect one vertebra to the one above, the other set connect to the vertebra below and are responsible for guiding and gliding motions of the vertebrae. (See ill. 7, 7.5) The facet joints are not primarily weight bearing joints. When discs flatten, facet joint surfaces undergo excess compression and over time the cartilage can wear down.

Once worn the cartilage becomes rough, causing true degeneration of the joint often accompanied by inflammation (arthritis). Because facet joints are on the back and sides of the vertebral bodies they are under pressure when a person does a backward bend. Excess arching of the back can lead to facet joint DJD. When a person has facet joint wear, arching of the back often worsens the pain, while slight rounding gaps the joints and gives relief.

The inflammatory response in any joint, including the facets, can accelerate calcification and bony build up may result. These bony spurs are call "osteophytes".

They can begin to encroach on the areas where spinal nerves pass, or around the spinal canal, causing pain and sensory/motor problems in the legs. When this occurs it is called spinal stenosis. (See link)

Sacroiliac (SI) Dysfunction

The sacrum (sacred bone) is a roughly triangular bone, (See ill. 8 side, 8.5 back) which sits between two pelvic bones (iliac). (See ill.10) The surfaces between the sacrum and iliac are covered in contoured cartilage that mesh together like intimate fitting gears. When correctly in place the joint does allow some detectable movement. When out of place the joint can become locked, painful and incongruent rubbing can cause cartilaginous deterioration.

The job of the sacrum is twofold:

It is like the keystone at the top of an arch as it accepts the weight of the body from the last vertebra above it and then transmits this force down through both halves of the pelvis. (See ill. 9) When one is sitting the pelvis transmits the body weight to the seat of a chair via the sitting bones. When standing the pelvis transmits the weight to the hip joints and down the legs to the floor.

The sacroiliac joint gives the pelvis mobility and some twist. For years motion between the sacrum and the pelvic bones was though to be absent.

You can feel the movement of one half of your pelvis if you lie face up on the floor. Put each hand on the corresponding knobby bit on the front of your pelvis. Start with both knees up then feel what happens when you place one leg flat, while leaving the other bent. Can feel the pelvis tip forward on the side you are lowering your leg? The pelvis on your bent leg side stays in place. Reverse the legs and feel the movement.

So what causes SI dysfunction?

Childbirth: During delivery the pelvis must expand to allow the baby to exit. There may be uneven spreading, and/or the sacrum may not return to exact midline after delivery.

Often adding insult to injury, mothers find themselves multitasking while holding their babies on one side or on one hip causing uneven pressure through one hip and SI joint.

Jumping hard, or repeatedly, onto one leg can cause enough pressure on one half of the pelvis to push it upward out of place in relation to the sacrum. This is called an up-slip.

Falling on one side or on one's bottom can injure the SI joint.

Sitting and Standing Habits are one of the most common causes of strain and overstretching of the sacroiliac ligaments.

Frequent or prolonged sitting with one leg crossed will pull that side of the pelvis upward and forward causing overstretching of the SI joint. Sitting on the floor consistently on the same hip will overstretch that side's SI joint. Often these habits cause problems in the back, hip and SI joints. People often sink down through one leg and allow their opposite hip and pelvis to jut sideways. This causes overstretching of ligaments of the hip joint as well as weakness of the muscles around the hip.

A Short Leg either from structural or functional causes will create asymmetrical pressure on the SI joint. (See ill. 9.5)

Anyone with severe, re-occurring or persistent sacroiliac pain should consider seeing a NUCCA practitioner for structural correction and maintenance. (See links and

For an in depth, highly technical article on the SI joint and exercise by the "Grandfather of the SI joint" Richard L. DonTigny, PT, view this link, exercises are towards the end: (PDF file).

"Sciatica" is the term used for pain that runs along any portion of the sciatic nerve. Because the sciatic nerve branches off, becoming the tibial and peroneal nerve lower in the leg and foot, pain along these nerves is also part of the syndrome.

A disc that is either bulging or herniated presses on the spinal nerves, irritating them down into the buttock, into back of the thigh, into the calf and even into the foot/toes. Sometimes the pain runs a clear path from back to the buttock, leg and foot. Sometimes pain may be present only in the foot, calf, back of the thigh or low back.

Pressure on the sciatic nerve as it passes through the buttock may also irritate the nerve. (See ill. 10) Tight hip musculature can cause this pressure. Even an object, such as a wallet in one's back pocket day after day, can irritate the sciatic nerve. Police who wear a lumpy belt with many compartments may also cause sciatica.

Treatment strategies:

In cases of trauma or work related injury always see your family doctor, or an Orthopedic/Osteopathic physician.

For low grade strains:

Rest: If you can, take the day off. Spend as much of your day lying on a firm surface like the floor in the rest position, knees either bent on a chair, or knees bent, feet flat. Avoid sitting for more than 5-10 minutes at a time.

Try to minimize any activity that creates pain and moves the back much. This means:

No lifting, bending, carrying much more than 5 pounds, no sit ups, no weight lifting at the gym, no sexual intercourse. Do wear slip on shoes to avoid bending down to tie laces. Use a reacher to pick up items off the floor.

Sit only in good firm supportive chairs. If you do not have a good firm chair get a Better Back support to place in your chair or sofa. When sitting in deep chairs use a large pillow behind you for support.

If walking does not increase pain, go for a short gentle walk 10-15 minutes. Allow your arms to swing freely and gently without anything in your hands (leave the dog at home).

Anti-inflammatory medicines, allopathic or homeopathic.

Thermal Therapy: Cool pack for 20 minutes 2-3 x a day for the first day (ice is not ideal for lying on). Warmth pack if there is no swelling and pain is not as acute.

Changing postural habits: Learning how to sit, stand and move well is key to pain prevention. Any activity that either adds compression or excess stretch may worsen your problem. Pain is one of the best guides to movement and activity. Don't tough it out, there is little to gain by creating pain. Alexander work is key to learning good use of one's back for long-term maintenance of back health.

Using the lunge to bend and reach is helpful. (See ill. 11)

Kurashova Tissue Re-education Techniques are effective in reducing swelling, normalizing muscle tone around the low back and improving circulation for tissue healing. Kurashova techniques normalize muscle tone by use of gentle vibration rather than deep pressure. For sciatica there are special techniques for calming the irritated nerves. These are unique and extremely effective. Caution must be paid when treating a low back. Deep pressure on the low back, in the name of relaxing tight muscles, can irritate a swollen bulging or herniated disc.

Exercise: During recovery from back pain, exercise should only be done after pain has subsided. I usually recommend doing a pelvis balancing procedure (see On the Level) before exercising, as once your pelvis is balanced there aren't asymmetrical pulls created by other exercise. Most people tolerate Alexander "lying on the books" and it is a great break from gravity because it decompresses the back.

There are some exercises that can be done without putting strain on the back. A good diagnosis and understanding of the back problem can help determine what exercise is best. I do not advise doing preprinted standard back exercises without the guidance of a trained therapist. I give only exercises that do not produce pain.

By trying one or two exercises that are well tolerated to start, it is easier determine if they are well tolerated over time. Occasionally pain worsens after days of exercise and may need to be modified or eliminated. Caution should be taken in doing Williams Flexion exercises. (See link When there is a large bulging or herniated disc, Williams Flexion exercises can cause more protrusion, further bulging and pain.

If there is an early stage bulging disc, extension exercises may be helpful in pushing the bulge back in.

However, if a disc is very irritated, there is swelling or moderate disc bulging, an extension exercise may actually pinch the inflamed tissue and worsen the irritation. Do not push through pain.

For an older person with possible osteophyte formation in the spine, these spurs can pinch the already encroached nerves when the back is extended so extension exercises may be contraindicated. Flexion exercise may be better for an arthritic back that needs to gap the disc space to reduce osteophyte encroachment.

One good rule of thumb is that the exercise should not provoke more pain, either during exercise or the next day.

Treatment for Chronic pain caused by Hypermobility.

Once an area of the spine or sacroiliac joint is overstretched or injured multiple times to the degree that the ligaments have lost their firmness, pain can become chronic. Structural asymmetries can contribute to the continuation of one-sided strains. Therefore I recommend a NUCCA practitioner be consulted to establish good first cervical symmetry for at least 1-2 months, then Prolo (proliferative) Therapy. This involves multiple injections of an irritant into ligaments that help stimulate the formation of new collagen fiber. These injection plus nutritional supplementation helps grow new stronger tissue.

A series of injections are generally given about a month apart and may involve 3-6 months of treatment. See link to Dr. Hauser's web site:

Back Supports

Doctors and therapists generally agree that the continual use of a corset or back brace leads to weakness of the back muscles hence is not advisable for long term wear. (However in cases of compression fractures or post-surgical healing they may be indicated for immobilization.) Most "cloth with stays" type corsets are traditionally worn around the low back with the aim of giving compressive support around the abdominal wall and low back.

It also provides a reminder not to do much bending but does not restrict movement entirely.

Suggestions for wearing a back support (except for after fracture or surgery):

Make sure that your pelvis is balanced every time you put on the support.

Wear the support lower around your pelvis.

If pain is acute then wear the support throughout the day when you are sitting or standing/walking. Loosen it or remove it when lying down. (You might need it on and off for 3 weeks during a healing episode.)

When pain is less acute wear the support only when sitting or during upright activity of any sustained duration. This will be an individual matter, let your back tell you.
Wear your support preventatively, if you will be lifting, kneeling or tackling household projects.

If your pelvis is asymmetrical your low back and sacroiliac joints will be strained. Wearing the support while your pelvis is asymmetrical will only squeeze the sacroiliac joint with its joint contours misaligned may cause more pain.

I recommend the Sports-All support. It is a soft support that is attached to soft fabric shorts.

Velcro attaches the support to the shorts wherever you place it and the support won't ride up with activity like regular supports usually do.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area