In this chapter, we’ll focus on how these key concepts are related to your physical body. For most people, it all starts the same way. You use your body in an unbalanced manner, likely without being aware of it. For example, you may sit in a chair or car seat 10 hours a day, but stand or walk only an hour or two.
Next, one of two things happens.
Some people develop tissue-based pain, which originates in the muscles, tendons, ligaments, or joints. Others suffer from nerve-based pain, a result of taut muscles pressuring a nerve or pulling the body out of alignment so the bones in the spinal column (or a joint) compress or pinch a nerve or force a disc to bulge or herniate. Often, people suffer from both types of pain at the same time.
Let’s examine how these situations can develop.
Muscle Imbalances:
The Tug of War Inside Your Body
Human beings are born with well-balanced bodies, but rarely do they stay that way. Throughout our lives we learn to use our muscles to master various activities, but because we tend to favor one side, or do some activities over and over again, we work some muscles too much and others too little.Take our modern-day sedentary lifestyles, for example.
Most of us sit far more than we stand or engage in activity.
We sit at the computer, in a plane, in meetings, while watching TV, and while eating, driving, and visiting. If we were to log the hours we spend sitting, as opposed to other activities, we’d probably find that sitting takes up the majority of our time. We’re a society of “too much” sitting—especially compared to 50 or 100 years ago.
Sitting, however, isn’t the only way we use our muscles too little or too much. Consider the course of your own typical day. Most likely you use one hand more than the other to brush your teeth, style your hair, write, and eat. That hand and arm also are probably more prominent in activities such as cleaning, cooking, and doing laundry.
When you drive, you use the right leg for both pedals, while your left does nothing, unless you’re operating a manual transmission. Since you do these activities most every day, these muscles are used over and over again, while others—like your left leg when driving—are hardly ever worked. You can imagine how the stronger muscles on one side of your body—with little counterbalancing resistance from the weaker ones on the other side—can pull your spine, hips, and other joints slightly out of alignment.
The same thing can happen with your forward and backward movements. Many people tend to lean forward more than backward for activities such as driving, reading, mowing the lawn, woodwork, crafts, playing games, and, of course, working at the computer. You lift heavy items by leaning forward, not backward. For sports such as skiing, running, cycling, soccer, and baseball, you’re almost always leaning forward.
If you’re not performing backward-type stretches and exercises to counteract these “bending forward” habits, the muscles in the front of your body will become stronger and shorter, while the muscles in the back may weaken and stretch out. Again, when the front of your body is much stronger than the back, you can imagine how such unbalanced forces can subtly distort the natural curve of your spine.
There are many more examples of how we use our muscles unevenly. You may prop a telephone on one ear while doing other tasks, using just one side of your neck. Carrying a heavy purse, laptop bag, or backpack on one shoulder may cause you to lean to one side to support the weight while sticking your hip out on the other side to counterbalance it.
A similar thing happens if you have young children or grandchildren and carry them on one hip. You jut out that hip to support the extra weight—without copying the action on the opposite side.
Another example: If you have a wallet or cell phone in your back pocket all the time, it tends to tilt your hip and the rest of your body to one side whenever you’re sitting. The result of all this uneven body use is that certain parts of the body grow strong while other parts weaken, creating a literal tug of war—where both sides lose.
Common Muscle Imbalance Examples
One of the most common examples of a muscle imbalance that causes back pain occurs in many people today who work in sedentary positions. We call it “forward-tipped pelvis.” All that sitting tightens the hip flexors (fronts of hips).Meanwhile, the stomach (abdominal), hamstring, and buttock muscles become weak from being underused.
The tight muscles pull the pelvis down and forward, creating an excessive curve in the lower torso and causing the abdomen to protrude forward. The resulting pressure on the lower spine can eventually cause dysfunction and injury, such as sciatica, a herniated disc, or a muscle spasm.
Another widespread muscle imbalance is one we like to call “forward head and shoulders.”
This occurs frequently because people spend so much time hunched over computers, steering wheels, office desks, stoves—almost every activity we do requires us to lean forward.
This causes the muscles in the chest and at the base of the neck to tighten up, while the muscles in the upper back and shoulders weaken and stretch out, putting pressure on the upper spine and causing upper back and neck pain.
There are other common muscle imbalances, but perhaps you can begin to see how our everyday routines work our muscles unevenly, create bad posture, and eventually lead to pain.
Your Muscle Strength: Use It or Lose It
The body is truly an amazing machine. The more you work it, the stronger it gets. In contrast, if you drive your car for thousands of miles, it’s not going to drive any faster or get better gas mileage. If you play your upright piano for years, it’s never going to grow into a grand piano. The human body, on the other hand, responds to work by becoming stronger and more efficient—especially in the muscles.As you go about your daily routine, using one hand, arm, or leg more than the other, that part of the body becomes stronger. Imagine if you lifted weights with only your left arm for several months and did very little with your right arm.
Pretty soon you would notice a definite difference between the two.
When you exercise or use a muscle, the fibers are stimulated, stressed, or slightly “damaged.” This is why you may feel sore after a particular activity. During rest, the body repairs the muscle, building it back up to withstand similar work in the future. The fascinating thing is that the body goes the extra mile in reconstruction, building the muscle up stronger than it was before, so you can handle the same
activity with greater ease.
However, the opposite also is true: When you don’t work a muscle, it not only doesn’t grow stronger, it actually grows weaker, sort of like a basketball that isn’t inflated regularly. If you’ve ever had an operation on one leg or arm and had to build the muscles back up again, you know this fact well! Or, if you’ve ever been confined to bed for a week or two due to a medical condition, you’ll remember how wobbly you felt when you tried to get up again. This is because your muscles had already started to weaken from inactivity.
So, how do these uneven muscles result in a tug-of-war inside your body?
Striving for Balance
When we think of balance, we often imagine two things working in opposition to one another. We may visualize two children on a teeter-totter, for instance, or the two ropes that lift and lower a flag on a pulley. Muscles work much the same way—in twos. In order for you to be able to move forward and back and side to side, each muscle needs a partner muscle to pull the opposite way.If you bend your elbow to touch your neck, your biceps (the muscles on the front of the upper arm) pull, or contract and shorten, and the triceps (the muscles on the back of the upper arm) relax and go into a stretched position. If you didn’t have the triceps muscles to pull your arm back out, it would remain bent. Fortunately, when you’re ready, the triceps contract while the biceps relax to straighten your arm again. This is why it’s so important to keep both muscles in an opposing muscle group balanced.
I’m not saying here that both muscles need to be of equal strength, as some muscles are naturally designed to be stronger than others.
Rather, each muscle should maintain the state of strength and flexibility that keeps the nearby joints functioning optimally. This allows you to move easily in all directions in the way the body was designed to move.
When it comes to eliminating and preventing back pain, the goal isn’t necessarily to have muscles as strong and flexible as possible—though that certainly helps. The goal, as we said in Chapter 3, is balance: Your muscle pairs need balanced strength and flexibility to support your body height and weight and allow for normal movement.
Unfortunately, for most of us, keeping all the muscle pairs equally balanced is a tall order. Not only do we suffer from working some too much and others too little, we suffer from stretching some too much and others too little. But the even bigger challenge is that most people aren’t even aware of this. While this basic understanding of how our bodies work should be common knowledge, it isn’t, and that’s why so many people struggle with nagging aches and pains.
“I Can’t Touch My Toes Anymore!”
Many of us, as we get older, become less flexible. When we were children we could probably touch our toes, do somersaults, and even perform splits. But as we get older, our muscles seem to tighten up like boards. You may be surprised to hear that age isn’t the main culprit.
A muscle’s natural reaction is to contract. Just like a roly- poly bug that curls up when you touch it, the muscle—when you ask it to work—will tighten.
Think of what happens when you touch a hot burner by mistake. The muscle contracts to pull your hand away, sometimes before you even realize what’s happened.
Similarly, when you perform an activity, the muscle contracts to help you perform it. That means for every activity you do, some muscle, somewhere, is pulling or contracting.
Do the activity frequently and for extended periods of time, and the muscle is required to stay in that short, contracted state.
If the muscle is stretched during a resting and healing period, it most likely will return to its relaxed, elongated, and more flexible state. (This is why most fitness trainers, like me, recommend stretching after exercising, to elongate the muscle again after it’s been tightened from physical activity.) If it’s not stretched, it will stay tight, and at the end of the healing process it will remain a little shorter than it was before. For most of us who do certain activities over and over again, but fail to adopt a regular stretching routine, this is how we lose flexibility.
Gradually, our muscles get so used to being in a contracted, tightened state that they tend to stay that way. Suddenly, we can no longer touch our toes—or for some folks, even our knees!
Muscle Flexibility: Stretch It or Lose It
If you’re a woman who wears high heels, most likely you’ve heard the warnings: Wear them too much and the muscles in the backs of your lower legs—the calf muscles— will shorten. And if you haven’t, here it is now: Wearing high heels is asking for problems, and it’s one of the worst things you can do to your feet and body. You can visualize this effect.Just imagine your calf muscle as a rubber band that extends from the back of your knee to your heel. When you wear high heels, the rubber band contracts (or gets shorter) to accommodate the shorter distance between your heel and your knee. Over time—particularly if you wear these shoes up to eight hours a day, five days a week—the muscle adapts to this shorter position, so that when you take the high heels off,
you feel a pull as the calf muscle tries to lengthen again to set your heel on the floor.
The same thing can happen to the muscles in the backs of your thighs, called the hamstrings. Visually, you can imagine the hamstring “rubber band” at a certain length when you’re standing. What happens when you sit down? The rubber band—in this case, the muscle in the back of the leg— shortens to allow you to sit.
If you sit too much, the muscle will adapt itself to that position as normal and become permanently shortened, again, reducing your flexibility and causing pain when you stand or need to bend over. This shortening of the muscles happens throughout the body, with any muscle that is required to remain in a shortened position for a long time—and is stretched too little.
Lack of stretching and overwork of muscles are a couple of reasons why we lose flexibility. But there is another reason, which you never hear health care professionals talk about: excess fibrin. A more common term for it is “scar tissue.” I’ll talk more about fibrin in Chapter 6, but for now, understand that when you work a muscle, some of the fibers are damaged. This is a good thing, because when the body goes into repair mode, it typically builds the muscle back stronger than it was before.
However, part of that rebuilding process involves producing fibrin or “scar tissue,” which forms a sort of latticework on which the body can build new tissue. (Picture the crisscross framework on a building undergoing remodeling.) To provide maximum structural integrity for your injured tissues and joints, fibrin is a naturally stiff and inflexible material. The more fibrin that builds up in your body, the more inflexible you become.
Typically, once the repair work is finished, a special type of enzymes called proteolytic enzymes come in to complete the job by breaking down the fibrin and whisking it away.
Unfortunately, as we get older, our bodies don’t produce as much of these critical enzymes as when we were younger.
Without these enzymes doing the cleanup job, fibrin builds up in our connecting tissues. This is why, when you turn 40, 50, or 60, you begin to feel stiff all over and less springy than when you were younger.
You can see how our tug-of-war is getting worse. Not only is it going on between strong versus weak muscle pairs, it’s happening between flexible versus inflexible muscle pairs. And guess what’s in the middle of the battle? Your spine— specifically your neck, back, and hips.
Trigger Points
Muscle imbalances are not the only physical causes of back pain. Another source is something known as trigger points or “knots” in one or more of your muscles.When you use your muscles, your body tells them to contract. Long, hairlike muscle fibers lock together, shorten, and draw in. For example, when you lift your coffee cup, all the muscle fibers in your bicep contract, allowing your arm to lift. When you’re done lifting, your body tells these muscle fibers to relax. The fibers “unlock” and allow your muscle to elongate.
When a muscle is overworked (contracted “too much”), it may simply radiate pain, but oftentimes a knot also will develop. (In the case of a tendon or ligament, inflammation or injury may occur.) These knots are really small tangles in the fibers of your muscles.
If you’ve ever had a massage, you’re probably familiar with this. Knots are tender, feel hard to the touch, and can require a lot of pressure to release. If you think of the muscle as a length of hair—since muscles are made of up fibers similar to hair strands—a normal muscle would look like healthy, combed hair, whereas a muscle suffering from a knot would look like you took the hair and twisted it.
This knot slows blood flow through the muscle, causing several problems. First, the waste products produced by your muscle cells aren’t removed quickly, so they settle into the fibers.
Second, the cells in those areas aren’t getting as much oxygen as they’re used to getting—so they’re mildly oxygen deprived.
Third, your blood transports the fuel that powers the “unlocking” mechanism within those last few muscle fibers that are “stuck” together. Without ample blood circulation, these muscle fibers never unlock. This creates a vicious self- reinforcing cycle where a knot causes slow blood circulation, which prevents the knot from releasing itself, which causes the knot to persist even further. (This is a classic situation of your blood circulation moving “too slow” in that specific part of your body.)
These three conditions combine to cause inflammation, tenderness, and pain in that part of the muscle. The result is a trigger point, or what most people think of as a knot, in their muscle.
It’s also important to note that trigger points can develop in tendons, and because tendons are so much less vascular, meaning they get so much less blood flow, they often are much harder to treat effectively.
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