Author: Cho, DPT

Here is a topic that in my recent years of practicing realized the SIGNIFICANT IMPORTANCE of teaching my patients on the science of pain-what it is, why it’s happening and what they can do to either to get ride of or to manage it. Keep in mind that the principles of pain the I am about to talk about does not only limit to lower back pain.

I learned about the science of pain after my mentor encouraged me to follow Adriaan Louw a renown author, scholar and a physical therapist on his research of neuroscience of pain. I have to say that after taking courses and reading many research articles, that the way I practiced has only gotten better and my patients were my proof.

It made a world of difference to talk about this and I believe that when you have a better understanding of your situation you feel more hopeful and start to take back control of your body and your life, which is empowering!

Many researches show that when people living with pain learn about the science behind it, it eases their hesitancy to moving again-getting back to activities that you once enjoyed and pain intensity itself can lessen.

So lets start the journey of understanding the science of pain. Trust me it will be eye opening and I get so pumped about talking about this. So lets begin shall we?

The first thing I would like to say is that pain is normal and very real, it is our body’s system of protection and very critical our survival. We need pain and here’s why.

Lets say that you accidentally step on your kids Lego on the floor and quickly you jump off the Lego muttering a 4 letter word. It’s your brain that tells you, “Hey, take your foot off that ASAP or you’re going to keeping hurting yourself!” Another prime example is that instinctive reaction of taking taking your hand off that hot pot you accidentally touched. If you didn’t experience pain, would you continue to burn your hand?

While to experience pain is normal and needed, to live with chronic pain is not. The tissues in our body are meant to heal and they probably have. Surprisingly it isn’t the tissue that are the culprit of pain but the brain and let me explain why.

The brain is the control center where details are assessed, such as the “hows, why and what” you’re physically feeling. Nerves of and surrounding area of the injured body part send “danger signals”, NOT pain signals (there is not such thing as “pain signals”) up the spinal cord to the brain.

Once danger signals reach the brain it is there that the concept of “pain” is actually established and the brain decides the next course of action to protect that area.

So let’s go back to the Lego example. You step on Lego that your kid left in the middle of the floor. That pressure on your foot spikes the nerve electric impulses of that area sending important “danger signals” to the brain. The brain then orders you to take your foot on the Lego and to blurt a 4 letter word(s), all in the matter of milliseconds. Once you remove the foot, the electrical impulses return to normal, low and steady state.

The problem lies when the nerve impulses don’t calm down to it’s normal state even when the object that caused danger signals is no longer there.

High electric impulses of nerve = constant signaling to the brain”danger, danger, danger x100.” The is overwhelming to say the least.

Over time, the impulses that stay high become extra sensitive. That extra sensitivity is what leads to not wanting to move as much, release of stress hormones, emotional and psychological changes because of frustration, lack of sleep, etc. All in all, your quality of life starts to diminish.

So you see, prolonged pain does not necessarily mean that your tissues are more damaged because tissues heal! Rather the nerves in the area and surrounding areas are overwhelmed.

Also know that nerves have all these cool characteristics about them. For example, does your pain get worse in cold weather? Can you not move as much or as well as you did before? Does you pain level go up when you’re stressed out or when you’re sick? There’s an explanation for all this.

Nerves are made up of different sensors detecting temperature changes, stress hormones, physical movement, immunity and blood flow constantly relaying info to your brain just to let it know how it is doing.

But if your nerves are already on high alert, these sensor also stay on high alert very attentive to temperature, movement, stress, etc as you have probably noticed.

I know what you’re thinking. You’re asking, so what can I do to desensitize my nerves? I would suggest 2 things but in the book you can find Louw suggest various things.

First, read Why Do I Hurt by Adriaan Louw. He does a PHENOMENAL job of breaking the science of pain and provides with much more details that are very relevant to your pain . THIS IS A MUST READ! It will be 30 min well spent!

Check it out on Amazon.

Second, consult with movement specialist to getting to back to moving again! You want to make sure that you get back to moving safely and correctly.

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Happy Monday, I hope everyone had a great Thanksgiving. Ok so let’s get down to business. In my last blog I gave you the 411 on importance of sleep and now I am here to guide you through them. Here they are…3 BEST sleep positions for lower back pain so grab 2-3 pillows and follow along.

#1 Sleeping on your back 

Ok, so the 2-3 pillows you have are going to be supporting your legs. Place the first pillow up to your gluts, not under your gluts horizontally. Then the second pillow goes on top of the first pillow but starting mid thigh, again horizontally. Last, the third pillow goes under the knee fold. Some people like the added height of the third pillow while some feel comfortable with just two. Generally you want to use at least two pillows, one pillow doesn’t seem to be enough. Play with it the number of pillows to see what feels most comfortable to you.

#2 Right and/or Left Side Sleeping

You will definitely need 2 pillows or a body pillow. If you have 2 separate pillows try this. First, place a pillow between your legs vertically supporting from mid thigh to feet. Then depending on which side you are laying on, you are going to place a pillow under the arm. For example, if you are laying on your right side, you left arm hugs on the pillow.

Why the pillow under the arm? It there to limit rotating your top shoulder and trunk towards the bed as the night goes on. When your upper body rotates or leans forward it can contribute to the lower back rotating as well, adding unnecessary stress. Remember when your body is in pain, your body is more sensitive to minor changes.

The same principles apply for body pillow. You place it between the knees and hug at the arms, like the picture shows.

# Stomach Sleeper

Again, for sleeping on your stomach you can use 2 pillows or a body pillow. I generally find body pillows to be more comfortable and supportive.

The main difference between sleeping with pillow support in sidelying vs. on your stomach is your leg placement. When you are sleeping on your side, the legs are stacked on top of each other with a pillow in between whereas sleeping on your stomach, the bottom leg does support the top leg. The top leg is only supported by the pillow.

I promise for a picture to come for visual assistance. None of the pictures did the positioning justice.

So try this if you have 2 pillows or a body pillow. Just like in sidelying you are hugging the pillow at the top arm and the top leg is supported by the pillow placed vertically as much of the leg the pillow allows. The bottom leg is positioned naturally and comfortably.

KEY POINTS TO REMEMBER

• Do not try to change your favorable sleep position. Try the giving your body more of a pillow support then if that does not work then trying a new sleep position.
• It should take you less than a few minutes to get comfortable once you get your self set up. If you takes you longer than that, having someone like your friend or significant other look at your alignment. Sometimes having someone else see you in different views help make alterations that you may not notice.

• These sleep modification are designed to help you sleep better with less frequency of waking up in the middle of the night, help you fall asleep quicker with less discomfort, or help you wake up with less pain.

Hope these tips helped. If you have any comments and or questions please leave me a comment.

This is a HOT TOPIC! Sciatica during pregnancy is probably one of the most common, if not the #1 complaint of lower back pain when pregnant. Fear not, I am here to provide some solutions as best as possible. There are things you can do such as as core stabilization exercises, sciatic nerve stretches (or some may call sciatic nerve glides), hip stretches and improving posture to address sciatic nerve pain so keep reading.

Sciatic nerve pain during pregnancy can occur either on the right or left side of the buttock with sharp, burning and or even shooting pain down the back of leg. It is most common in second and third trimester. Why does this happen you may ask?! Without getting too technical, sciatica occurs because the nerve is compressed.

Still not sure, if you’re pain is due to sciatica other than the fact you have pain in the buttock and down the leg, try these two things.

#1 – Push your glut region where you feel the pain. Does that reproduce the pain down the leg? Likely, you are pushing on the piriformis muscle where the nerve can commonly get compressed from.

#2 – I am going to guide you through the sciatic neural tension test to further confirmed that the nerve indeed is affected.

First step, find yourself a bath towel, a long dog leash or a belt .

Second, lay on your back with both knees bent and feet on surface that you are laying on. Don’t worry, I know laying on your back is uncomfortable but you’ll be there for another a few minutes. While in this position, loop the belt/dog leash/bath towel behind the of the painful leg.

Third, you are going to pull the weight of the leg with the strap with both hands and pull that knee towards you, letting go of all the weight of the leg in the strap.

Forth, straighten you knee. What do you feel? Do you feel the exact pain that you complain of? If so, you are screening positive for sciatic nerve irritation. If you are not sure than  continue to the next step.

Fifth step, complete # 4 again and add pointing your toes towards your nose. What do you feel? The exact pain that you complain of? If yes, then again confirmation of sciatic nerve involvement.

If you are testing positive for both screening or just one you, are likely having sciatica.

SO NOW WHAT? Ok, here comes the good stuff, symptom relief with piriformis stretching and nerve glides!

Piriformis stretching can be completed a a few different ways. Check out my video on various stretching performs stretches.

Then you have the neural tension test you completed above. Use those exact movements to gently stretch the nerve for relief. Watch me!

For the nitty, gritty details on sciatica, visit my sciatica page.

Hello everyone! This is a FANTASTIC day to talk about sitting posture. Want to prevent lower back pain while sitting at work?! Here are 4 best ways to improve your sitting posture and decrease your lower back pain.

#1: Get up every 30-45 minutes, this is very, very critical! Set an alarm on your cell phone and after 30-45 minutes alleviate the pressure throughout the spine by standing, stretching and or walking for 1-2 minutes then get back to work. I understand, you can get so caught up in your tasks throughout the day then not realize that you have been sitting for so long but that is what the alarm is for.

#2: Adjust your seat height so that your hips are angled slightly higher than you knees while being able to maintain both feet comfortably flat on the floor. You can do this by playing with the seat height- adjust that lever under that seat or investing in chair wedge.

#3: Adjust your computer monitor. Most of the time I have to suggest making minor adjustments to the computer set up itself. First see if your eye level naturally and easily is positioned to middle of the computer screen. Next see if your shoulders are nicely relaxed with hands on keyboard. Your shoulders should not bee shrugging toward your ears. If this is sounds like you, you may have to raise or lower your computer monitor, or adjustment of the seat height without changing too much the position discussed in #2.

#4: Invest in a lumbar support. I have to say that my favorite and what I have recommended to almost all my patients with lower back pain is the McKenzie Super Roll (especially for my bulging disc patients-found on Amazon) to place in your work chair to assist with improving your sitting posture. Remember just because you are using a lumbar support does not allow you to sit for hours without pain. It should be use for support. Sometimes a bed pillow will do the trick too- placed vertically to support the curvatures of the mid to lower spine, taking some stress away from the muscles.

Hope these tips are helpful! Try these out and let me know how it worked for you. If you have any other questions, leave me a comment.