top of page

Do you have pain in your lower portions of your lower back? Or in the neck area, across your shoulders, between your shoulderblades?

If you answered yes to one or both of the questions above, the following pages are for you. 

This entire section is written by Dr. Ara Chitchyan who owns exclusive copyrights on this intellectual property. Anyone found misusing, copying or in any way abusing this free resource are subject to the harshest penalty that Dr. Chitchyan has ever been known to apply - given stern look of disdain, finger pointed at them, head shaken in addition to most harshest one - silent treatment.

humanoid robot standing next to a handle

01

Pain - functional anatomy lessons

Our bodies are more complex than anything you can think of. Yet most of the complexity is hidden from our awareness. The more we try to understand it the more layers of complexity we discover. One of those layers of complexity is pain. Why do we feel pain? What is pain? Why we NEED pain? Why is it that the problem might be in one part but the pain is felt in totally different part of our body? If you are a patient of mine, you are aware that I rarely pay attention to what other doctors diagnosed you with. In fact if you tell me you have a disc herniation and that is what you need to be addressed, I will go on for hours or until you give up - whichever comes first - explaining why is it that disc herniation is not the problem. If you have walked into our clinic, you will remember judging looks at the way you walk, at your posture, shaking of head, and eventual eye roll. Jokes aside, ability to maintain good posture is not just, you know - good for you - but also is a sign of healthy musculoskeletal system as well as it is a sign of having good body awareness. And as you advance along your recovery and that ability to maintain posture returns - it usually coincides with resolution of symptoms of majority of "garden variety" of musculoskeletal issues. That is why most of exercises that you will see on this and following pages are postural, designed to allow your body to maintain static and dynamic stability. 

So quickly before we go any further - remember, we spent our early development curled in a fetal position, then we usually roll on our back then we develop ability to keep our head up and turn on our stomachs; followed by bringing our upper body off the ground and crawling using our hands then assisting with legs. After that we learn how to get up on our hands and knees and only then we learn how to pull ourselves up to standing. This is promptly followed by falling down. Learning how to catch ourselves and prevent that fall is how we learn how to walk. So - and this is super important - walking is a perpetual falling off of one leg and catching yourself with the other. Now think about that. Did you subconsciously started thinking about your walking? Or better yet - started walking? Paying attention to what is happening with your body? If you answered yes - good, you may proceed. No - really? Eyeroll. Moving on...

02 do this exercise correctly and you will have guaranteed reduction of your lower back pain

Ballerina Exercise
(see this exercise and more in member's section)

Ballerina2.jpg

“Ballerina” Exercise

  1. Stand next to a wall or a door with the opposite side of exercised leg closer to the wall, feet shoulder width apart

  2. With the arm opposite of the exercised leg, brace and stabilize yourself against the wall or door.

  3. Shift your weight onto the leg that is closer to the wall. Hike your hip on the exercised side so that the foot does not touch the floor. At this point make a mental snapshot of your spine - neck to the lower back. Benefit of this exercise increases if you keep your spine in the same position throughout the exercise. In fact, if you attempt to assist the movement that follows with your spine muscles, you are risking further injury!

  4. Position your foot at externally rotated and plantar flexed position (your toes may touch the ground). Your spine should be upright.

  5. Make sure you pay attention at the state of your lower back. From now on your lower back should not move at all. (muscles may be active)

  6. Plane that your will be moving your leg is out and back from your body at a 45-degree angle - as if you are trying to kick someone who stands on your side but behind you.

  7. Abduct your leg as much as you can without changing the position or muscle activity of your lower back. This is extremely important to isolate muscles that you need to exercise. If at any point you feel that muscles of your lower back are either too tight or performing the movement – stop and reset your position so that muscles of your lower back are not moving the leg. Ideally you would like them to be relaxed.

Do this exercise 3 times a day for 3 sets of 20 reps. If you are not able to complete this exercise – do not force yourself and NEVER perform this exercise wrong! Instead go to the easier exercise. (more exercises in password protected area)(to obtain the password - send us a message here)

02

Training

Our bodies are the most efficient mechanisms ever in existence. You think your car does 40 miles a gallon? Our body can perform work for 482 hours nonstop (equivalent of walking for 1600 miles) and consume equivalent of gallon of gas. That's how efficient we are! Let me ask you another question. What activity takes more energy, walking on a treadmill at 10 miles per hour for three hours or being alive for 24 hours? You probably thinking it is a trick question. And you are correct. Unless you are an athlete professionally, we burn most of our energy on breathing and heart beat. Rest - our daily activities - do not really change our individual energy requirement much. But obviously a 250 lbs bodybuilder and 100 lbs grandma do not spend same amount of energy. It is because our body learned over time not to depend on our daily consumption of nutrients. Our liver maintains rather steady supply of same amount of immediately accessible energy - simple sugars and amino acids throughout the day. If we took in more energy than we needed that day, the rest gets stored in our body, for those days when we did not have enough nutrition. Tose days liver assists in mobilization of those stored energy supplies. As we train, our bodies develop short term and long term adaptations. Short term adaptations depend on hormones like insulin, adrenalin, noradrenalin - fast acting but also fast degrading hormones. Their action relies on depletion of immediately available energy storage. That is the reason why if someone who is not specifically trained for a marathon attempts to run a marathon either will loose consciousness from basically exhausting all available supply of glucose or will sustain an injury.  Also, since digestion is an active process, in that state forget about eating - it will be completely useless. Direct IV nutrition is the only way out of that state. Long term adaptations, on the other hand, rely on hormones like cortisol, other steroids, thyroid hormones that create changes in gene expression on cellular level, changing metabolism for a long term results. With those adaptations, your body will be able to access long term energy sources, like fat, to accomplish the goal much faster. Analogy for that is comparing ferrari and Toyota. Fill both of them with same amount of gas. Ferrari although much better looking will get you maybe to the corner store and wont even make it to the gas station. While Toyota will not only get you to the gas station but will also have some extra gas remaining in the tank to come and rescue the Ferrari. Does that mean one is better than the other? Well, it really depends what is your goal. If getting to the corner store at the fastest pace possible is your goal - then Ferrari is the right answer. If your goal on the other hand is to drive for 20 hours non stop without refueling - then Toyota is your answer. And guess what? Our bodies consist of parts of Toyota and parts of Ferrari. Depending on demand it can turn one part on or the other.And that is why most of us can run 5K and feel oh so proud of ourselves and next time sign up for 10K just to find ourself limping to the finish, or better yet - limping to closest bar for some beer.

04

Posture

But, doc, what does this have to do with price of tea in China? Or in our case with neck and lower back pain.

Turns out a lot. As I have mentioned earlier, our bodies are amazing and efficient as well as well designed mechanisms. Did you know that out body is able to remodel bone and cartilage according to the amount of stress that area gets? Muscles can switch their metabolism from one to another as well depending on demand. Positioning of a joint is very important to allow for the forces to be transferred through the strongest points or spread over largest area, while remaining perfectly balanced with minimal effort. It also allows for muscles meant to contract for long periods of time to provide that static support. That is where posture becomes important. With quiet standing, there are only few muscles that are active. They act across the joints that are otherwise totally unstable - ankle joints, shoulder joints, jaw. Soleus plantarflexes the foot - hyperextending the knee during quiet standing. That stabilizes the knee and hip - by creating extension force on both. Shoulder joint stability is important to keep your arm suspended in place. Can you hold 5 lbs of weight in your arm? I am sure you can. How long? An hour? Two? 10 hours? What about for the rest of your life? Positioning of shoulderblade in addition to function of supraspinatus muscle allows your body to do that without ever getting tired. Without that weight of the arm will create significant stretch on neurovascular structures of the arm that will lead to tearing of tissues. Now look at the way your are sitting - rounded shoulders, shoulderblades protracted and rotated.In that position your arm is literally falling off of shoulder blade...

bottom of page