CBT Podcast Ep.7_v23
00:00:00 Speaker: Back pain steals your freedom. Core connection and healthy movement. Bring it back. So before we get started, I want you to strap your walking shoes on. Or better yet, no shoes at all. Grab your headphones and get your body moving while you listen to the insights that helped me climb out of a decade long struggle of debilitating lower back pain and led to the creation of Core Balance Training, which has helped thousands of people climb out of the back pain spiral for good. Welcome to the Back Pain podcast by Core Bounce, where we share practical insights to address back pain at its root. I'm your host, Doctor Ryan Peebles, doctor of physical therapy, specializing in spine and core rehabilitation. Each episode brings you a recording of one of my live sessions with my students. We start with a focused topic on back pain, then move into a live Q&A where I answered real questions in real time. My hope is that these episodes get you on the path to climbing out of the back pain spiral for yourself so you can live life the way that you want to. Let's dive in. This week's topic is acupuncture. The biggest question is does it work? Does acupuncture work for back pain? I have done research into acupuncture and whether or not it works, so I'll be sharing some of that, but maybe not so much going into the literature with you here today. I think that acupuncture is something that a lot of people that have had chronic lower back pain have at least considered, and probably many people have tried. Acupuncture is like a really broad field. It's thousands of years old and they use it to treat everything, and it works mostly with energy flow. I think they try to clear the energy meridians that flow through your body And so it's not so much an orthopedic treatment. So it's not going to make any, you know, physical changes for the most part. It's mostly going to make energetic changes. And I believe that that possibly could help with back pain. And it just depends if it will help for you. Right. That's what everybody's wondering. Will it help for me. And so I think the answer is going to be, you know, what is the cause of your back pain. And so it's going to depend. And that's pretty much always the answer. Right. It depends. And it's the most boring answer. And the last answer everybody wants to hear. But it's often the truth. So I'll tell a bit of a story with my experience. I've had several acupuncture appointments. I think it was pretty spread out over my body. You know, one in my forehead, one in my earlobe, one in my foot and my toe along my back, and I found it to be a really calming, peaceful experience. But it definitely didn't cure my back pain and I wasn't really sure or not whether it helped. So that was probably the majority of my acupuncture experiences are are kind of like that. I'll share what I found in the research in the literature where they do clinical trials. I found that the biggest factor in whether acupuncture works or not for chronic lower back pain. The number one factor is whether the patient believes that it works or not. So it's kind of the power of the mind, and you could maybe compare it to the placebo effect. I'm not saying that acupuncture is placebo, because I do believe there's merit in two thousand plus years worth of wisdom, and I think they have it down to a science, and I believe they have twelve or fourteen meridians that run along the entire body, and they're targeting along those meridians to clear blockages in the channels of energy flow. And I know for certain that energy flows through our body. Electricity literally flows through our body. And so it's good to have good, you know, conduits, good connection, good flow. And we do a lot with that in core balance training. So I'm sure it does help. And so I'm going to kind of break it down into the different categories of the causes of back pain. If you know the cause of your back pain is more stress related and is kind of like psychological emotional, then I think acupuncture could potentially be highly effective. And if the cause of back pain is more physical lifestyle. Too much sitting, stuff like that. I think potentially it could have a positive effect, but it's definitely not going to correct the muscle imbalances that result from chair laden lifestyle. So that's kind of where I stand. I wanted to introduce another type of needling that is orthopedic in nature is very similar to acupuncture, but it's targeting specifically parts of the body from an orthopedic viewpoint. They use the same type of needles. It falls under the umbrella of physical therapy. And it's within our scope of practice. And it's called dry needling. Kim, I see you just showed up. Welcome. Good to see you again. Acupuncture helped you psychologically boosted your energy, raised your drive to stand up and you got a natural high. That's really awesome to hear. That's the kind of effect that I would expect people to have, you know, those kind of benefits. That doesn't surprise me that it helps. It can help someone clear their mind and get more energy. And like you said, more drive. So it makes a lot of sense. If you're clearing blockages in energy flow throughout the body, then the energy is flowing better and you should have more energy. So that's a great share. Thank you. Kimberly, I have not had an experience like that, but I'm just one person. I remember loving going to my acupuncture appointments. I think I've probably been to about ten in total if you add them all up. And I remember just really enjoying going and laying down and feeling the warm lamp and the music, and it was like meditating for an hour and extremely peaceful, and I felt at peace. And I when I left, I felt nice and I felt good. I was a lot younger than I am now. I probably didn't have a strong like effect of like whether I believed acupuncture worked or not. I was kind of like, I don't know. So I'm testing it out. And so whether it worked or not on me was not impacted strongly by my belief in it or my disbelief, I probably was more of a neutral party. So yeah, that was my experience of it. I was going to it specifically for my back pain. I was probably like twenty between twenty and twenty four years old or around that age range, and I had chronic back problems. And so that's what I went to. All the treatments that I went to was to heal my back, and in my case, it did not solve my problem. I don't even know if it helped in the long run, except maybe that it made me feel more peaceful. But had I been going to acupuncture for a different reason, like energy, uh, or just like mental health, then I could imagine that it would be highly effective. And mental health and stress can cause back pain if that's the root cause of your back pain. And then you're addressing the root cause, you're addressing your mental health and you're addressing stress, then it could potentially, I would imagine, have a very effective result. I, uh, was getting into introducing dry needling. So I'm going to talk a little bit more about that. So the background of dry needling is we're using the same types of needles, dry needling needles. So it's exactly the same type of needles. But the approach is more western. It's orthopedic. It's based on the anatomy, not based on energy flow or meridians. So what they're targeting with dry needling is trigger points. The trigger points are the things that form when energy electricity becomes stagnant in the muscles. Every muscle in the body has electricity flowing through it all the time. And sometimes that electricity becomes trapped. It becomes stagnant. And when it gets trapped, it forms like this little ball in the muscles. We commonly call that a knot. Everybody has a knot in their upper traps, and dry needling can be extremely effective for releasing trigger points, for releasing knots in your muscles. And so they're not in any way targeting energy flow along meridians as in acupuncture, but they are releasing stagnant energy by targeting trigger points. These knots. A lot of people have one at the bottom of their foot and upper traps. Quad muscles. Calf muscles. The gulf for dry needling is to get the needle right into the middle of that thing, where the electricity is trapped, and somehow it releases the electricity and the knot. You'll feel it when they hit it. If you've ever had it. And I see, Kimberly, you said that you had dry needling. The knot will go and then release like that. And so you can instantly get rid of knots in your muscles. And so this happens instantly to a type of muscle, you know, tension a type of stiffness basically in your muscle. That could take ten massage sessions to release. You know, deep tissue massage for a long time would get rid of these things when a needle can do it pretty much instantly. So I find this to be from a Western orthopedic perspective, extremely effective for temporary or instant, but not permanent relief because trigger points and knots form in your muscles for a reason. And so if you don't remove that reason why they formed in the first place, then just treating them to get rid of them is not a permanent solution. They're going to form again, but as a temporary form of relief. It's extremely effective and you can get this done by a physical therapist. I believe those are the main people that do dry needling. So the goal of acupuncture is to restore balance, qi or prana, and the flow of energy through the body. The goal of dry needling is to release painful or tender muscle trigger points. And so totally different approach, totally different goal, same tools, pretty much the same exact needles. I've had four inch long needles stuck into my hip flexors because the hip flexors are very deep, and I've had basically a long term battle with my hip flexors over my life, and I've had them released by dry needles and it was insane. It was a crazy experience where my body felt so loose that it actually felt like bad. Like my spine felt so unstable and loose after I had these four inch long needles stuck into my hip flexors. They went in through not only through the front, through my abdomen to reach the hip flexors. They also went through the back past my spine. So if the vertebrae are like this, they went through the vertebrae into the hip flexors, which are on the front side of the spine, and release them. And my body had been so used to being basically held up by my chronically tight hip flexors that when they got released, this treatment is so effective that I really lost a lot of stability and support for my spine, and I hadn't replaced it with training my deep core muscles. So this is all going to come back around no matter what to, you know, providing support for your spine with the muscles that are designed for that, the deep core muscles, so that these other muscles that are forming knots and trigger points don't have to overcompensate, because that's why I believe trigger points happen is because muscles are chronically tight. They're chronically working, overworking, not getting enough blood flow or oxygen, and then they eventually lock up. And so if we can help them out by providing support around them and allow them to let go a little bit and do less work to less compensation than I believe we're addressing the root cause of the trigger points. And so that's where something like dry needling could be a great complementary treatment for other things. You know, you're also doing the core training, along with the dry needling. That could be a perfect combination to kind of speed up your healing process, speed up your process of achieving balance in your body. So I think that's really the main things I wanted to share today. My personal experience was it was nice. You know, I it wasn't just one attempt. I had several visits with acupuncturist and it didn't solve my problem, but I also didn't have any problem with continuing to go because it felt like it was benefiting me a little bit somehow. I'm going to switch gears and get into answering some questions that were in the program. I got a question from a student who's in the coaching hub, and I wanted to address it here because it's going to be a little bit of a longer answer. So this is Nick. He says, hi, Doctor Peebles, I watched your sitting cross-legged video, and I've not been able to comfortably sit cross-legged since I was a teenager. He's in his forties now. It's something I'd love to be able to do, but for over a decade now, I've not been able to find an exercise or a yoga or stretching practice that I can see any gains from. I need to use my hands to hold myself up, and I really need to engage my core highly in order to reduce pressure in my lower back. My left leg doesn't seem to want to drop, my left hip is experiencing pain, and my left ankle also feels like it's not being as flexible as needed and is also experiencing pain. So I thought it may be. Maybe it was my hip mobility, but I can actually squat pretty low with very little issues in regard to pain and only slight discomfort. And generally I have a lot of muscle tension in my hamstrings, traps, and lats. My shoulders have terrible mobility and I'm unable to lift my arms directly above my head without putting uncomfortable pressure in my lower back, which is one of the things that led me to your training program. I guess my question is, do you know if this might be a muscle imbalance issue, and are there any exercises you'd recommend for properly balancing, other than the hip opening exercise you provided in the video? Or do you think it's possible that continuing to focus on strengthening and balancing my core might help alleviate my general muscle tension all over my body, and potentially help me see gains in being able to sit cross-legged. So I wanted to address this here because I think it's relevant to a lot of people. It's certainly relevant to me and my general body type. So Nick and I kind of have a similar, like, genetic makeup, let's say, where we're not flexible. And some of the things that he shared, like his tight shoulders, his tight lats, inability to reach overhead without straining the back, those are all things that I can relate to. I've always had trouble sitting cross-legged like this, and so I just would put us in the same category. And so I'll share my knowledge and experience with living in a body like this. And I'm imagining there are other people out there, probably in the program who can relate to this as well. So hopefully this helps some other people too. So the question kind of is has my answer in it generally, which is do you know if this might be a muscle imbalance issue, or do you think it's possible that continuing to focus on strengthening balancing my core might help alleviate my general muscle tension all over my body? Okay, so yes to that. You do have general muscle tension all over your body. All of us do. But some have more than others. And so this would be a case where there's in specific areas of the body is really tense, really dense tissues. And even I would imagine if Nick stretches them, maybe they feel a benefit of being stretched for maybe a couple hours, but they tighten right back up. And that's because the body for some reason, wants to be tight. And so we want to get underneath this cause and not address it on the surface by just stretching the tightness, but understand why the muscles want to be tight and address that reason. And typically, from my experience, and just having done this for so long, is my belief that the muscles tighten up to protect, and they protect when they feel like something is unsafe If and when the predictable pattern occurs, where the deep core muscles tend to shut off and they're not supporting the spine, that's a really common reason for the body to feel unsafe. And so what happens is these big outer muscles, typically the ones around the hips and the shoulders, because those are the biggest, strongest muscles in the entire body. Overcompensate. We tend to overuse these muscles generally in life. Anyways, to get up and down from a chair to do things, we're using our arms and our legs. We're overusing our arms and our legs and we tend to underuse our our core. And so these muscles are very strong, very overused. And they are very active. And they're used to doing this. So they they become our dominant source of everything. And so they turn on even more to protect because their protective muscles. And then we get this chronic tightness. So yes, stretching can be beneficial temporarily, but not so much in the long term because like I said, these muscles want to be tight and they just decide to tighten right back up. So there's going to be more than just muscle tightness going on, Nick. There's going to be more than just muscle tightness in your case. And that's because this has been going on for so long. You mentioned that this has been this way since your teens. And so when that happens, when joints are not used to functioning in their full range of motion for a long enough period of time, then it not only becomes muscle tightness, but it's also joint stiffness. So the tissues, they're more static tissues around the joints, like the joint capsule and the ligaments and even the tendons they become stiff. And so you can stretch your muscles. But that isn't addressing the whole problem anymore, because there is stiffness inside these really static, really strong tissues in the joint. And that would be a scenario where like manual therapy could be beneficial. Having a hands on physical therapist who could manipulate your joints and just get movement in those joints, but you don't absolutely need that. I'll talk about a solution that has worked for me. I have been able to improve the mobility in my hips and my shoulders, and especially if I'm working on it actively, I can maintain that mobility. But I think because of just my genetic makeup and maybe yours too, we tend to move back towards less flexible and less and Unless I'm actively working on it. So the things that I found are effective are not static stretches, but active stretches. One thing I'd like to clear up, actually, is you mentioned you thought it was your hip mobility. You thought it was hip tightness that was limiting this. But you actually have good hip mobility. You can do a deep squat. There's the hips move in all different planes of motion. And so sitting cross-legged would require hip rotation hip external rotation specifically. And so that can be really limited. But you could still have great hip flexion mobility which is what it requires to do a deep squat. And that's extremely common. That's the case for me to where I have a good deep squat but very limited hip rotation. So it is hip tightness. It's hip tightness. There's tiny little muscles in your hip that are responsible for rotation and they get tight. There's six deep hip external rotators. And so they are responsible for rotating the hip out like what you're doing in a cross legged seating position. But this range of motion, this cross legged sitting would actually be limited by tightness in the hip internal rotators. So there's several hip internal rotators as well. And so those are the ones that would need to be stretched in order to improve sitting cross legged. I don't like to get too much into the names and the anatomy of the muscles, because it doesn't really matter to know them. What matters is that you do the right movements and that you do it in an active way. So active stretching involves not just pulling a muscle to its full length, but actually training the muscle while it's in that full lengthened position. And we're going to get into this a lot in phase three. So if you stick with the program until phase three, we will be addressing this issue directly in several lessons. One would be the typewriter squat. One would be the hip rotation active stretch, where we get down on the floor and do hip internal and external rotation stretching in an active way. And I will show you exactly how to do that in the lesson. And then we have a standing exercise called hip rotation motor control, which I'll teach you how to develop control of these tiny little muscles that live in your hip and know how to rotate your body from your hips rather than from your spine. And so you can do sports and do higher level movements where you're not twisting your spine in order to be agile, but the rotation comes from your hips, which is where it should come from, which is where the hips are designed to be the strongest, most mobile joint in the lower limb. It's the second most to the to the shoulder. So as far as mobility. So they should be able to rotate. And so my best advice Nick, is to yes, continue to develop your deep core and your spinal stability and really build that up. And the reason that we put the mobility stuff at the end of the program is because you want to create that stability first before you remove the stability by lengthening and stretching the compensating muscles. Because what would happen if you did mobility work first like it's almost similar to the story where I got dry needling done in my hip flexor, and my whole body felt extremely loose, and my spine felt bad because I removed all the stability from my spine with the dry needling, and I had nothing to replace it. And so, of course, my body tightened back up over a matter of hours. And that's what would happen if we do mobility training and we don't replace the stability that the muscle tightness was providing with some internal stability. So that's my best advice. Continue with the program. Work on getting the strongest core and deep core that you can. And then in phase three we'll start attacking mobility, especially in the hips. But in the short term, you know, the short answer is active stretching is what lasts. So you want to train. So you're going to stretch your hips. You want to train those muscles with contracting them with actively using them while you're deep in the stretch, and there's a thousand different ways to do that. And so that's something you can look up or you can wait to learn in the program, we have pretty much an entire week on active stretching shoulders and hips. So it's the same story for the shoulders. So hopefully that helps. And then Nick I wanted to address one other thing you mentioned. You said that you don't come up any higher into the bridge because you lose that posterior tilt. You lose your pelvic stability. And so that is the tug of war. You mentioned that one of your concerns is that you don't quite feel the stretch in your hip flexors while doing the bridge, and so you're wondering if you should be feeling that. Well, I think what's happening for you, Nick, is that your hip flexors are probably extremely tonic, extremely tight. And so when you come up into the full bridge, you get to the top level. Like imagine they're like ropes and you make those hip flexors ropes taut. You get to that point of the tug of war, and if you go any further, that rope pulls your pelvis into an anterior tilt. And so you back off. Right. But if you were able to kind of like wear down that muscle a little bit. And so you instead of that rope pulling your hips into anterior tilt, actually the rope was able to stretch a little bit. Then you would feel that stretch. But it's possible, I'm guessing that your hip flexors are so tonic that they're not stretching. They're just acting like a static rope. And so it's going to take extra concentration and focus for you to gradually play that game of tug of war and push further up into the bridge and really focus, even put your hands on your hip flexors and, like, massage them and just encourage them to relax so you can actually get a stretch into those muscles rather than them pulling on the pelvis and you losing the tug of war. You want to still win the tug of war and also be stretching those muscles as my best guess of what's happening. Because I also noticed, you know, when I first watched your video that it didn't look like you're coming up quite all the way, and it looked like you had a little more room to come up. This question was, I believe it was from Heidi and this is about the day five get fat concept in week one. Module one Heidi has been commenting every day and sharing that she's been making progress and feeling the connection. Today. She says this one was a bit more complicated for me to grasp. I'm getting the back anchor. When I take my fingers and push in, I can feel that fat feeling, but when I push out into my fingers. I feel like my six pack abs want to take over when I come up into the bridge. So when I'm up in the bridge, my glutes are activated. But I feel that my front abs are flat and strong. Is the intention for the six pack abs not to take over as much and let the deep core muscles get the get fat area take over. So I think what you're asking is, is it okay that your six pack abs are really active? And the answer is yes, especially in the bridge. Like if you're in the full bridge, your six pack abs are going to be very active. I hope they will be. They could be totally turned off for a lot of people. They would be. But in this program we're training them the core to be active. And so if you're pulling up on your pubic bone with your abdominals, then your six pack abs are going to be very active. And so that's okay. The goal of the Get Fat concept lesson is to make sure that you're not leaving behind the deep core, because the six pack abs are not part of the deep core. So we want to include the deep core. We want to make sure they're part of it because they are part of the back anchor connection automatically. They are part of the push away the back anchor progression automatically. But once we get off the ground and we no longer have that back anchor connection to the floor, then it's possible that we can lose connection to them. And so the Get Fat concept is a way to check and make sure that they're still on. And so the goal is not for them to be the dominant muscle group. And the goal is not for the six pack abs to not be dominant. They probably will. The six pack abs will be dominant. But we also want the deep core to be included and part of it. So they activate in the beginning with the initiation and they stay active Throughout. And so that's the goal of the day five lesson is to make sure they are part of the movement. Now when you're doing a less intense movement or exercise, kind of like just an average daily movement through your day, whatever, maybe you're doing the dishes that those light, low intensity movements are times when ideally you would want your deep core to be active, supporting your spine. But you wouldn't really want to be using your six pack abs. Those are more of a power muscle. You know you do sit ups with them, but you don't need them to do really light daily activities. And so the get Fat concept can be used to check and just make sure, like I'm sitting here now and just trying to have good posture, that okay, I can check I can feel my, you know, a little. My computer screen won't go low enough, but just feel that my deep core is on. I'm checking on the side. And yes, I'm getting a little feedback when I push in there, there. And so that's a good time to be ideally using the deep core. And if I push in the middle the six pack abs, I wouldn't really want them to be flexing right now while I'm sitting. That's not sustainable. They can't do that all day long. But the deep core can operate all day long. They are a postural muscle. They're low intensity. And so this day five lesson can be very useful for throughout the day type activities as well as we're trying to train our deep core and make it more a part of our lives. So hopefully that answers your question. Heidi and I will have one more question and then we'll be wrapping it up today. This one is from Dee. It says, hi Doctor Peebles, I have stayed on this lesson for several days. This lesson is module two. It is the front anchors progression that she's talking about, and she says, I've stayed on it for several days trying to be sure I have it correct. How long should I be able to do the front anchors together for? So that would be the upper front anchor and the lower front anchor together for I know you can do this for quite a bit of time. I'm not sure when I'm ready to move to the next lesson. Okay, so I admire that you are taking your time through the lessons D and making sure that you have everything down. You have the foundational components, the anchors down before moving to the next lesson. And so, uh, yeah, just honoring you for that first. And it sounds like your main question is how long. And I don't put like a minimum time Anywhere for you to be able to do something, because it's going to be different for everybody. You know, there's all age ranges. And so I'm not going to say that there's a minimum time. But if you're pushing up, pushing away with both upper and lower front anchor and breathing and able to stay connected, and it feels good, you're not overcompensating using your back muscles, assuming you're doing it right with good form. I would imagine that a good five to 10s is sufficient. Yeah, five to 10s. You don't need to be able to do this for five minutes straight, you know, come back down, push away, take some breaths. Allow it push to lower. You know, this is a meditation. It's a flow. And so it was not meant to be strenuous. It's not meant to fatigue you. Although if you are getting fatigued, then that's a good sign that you should be doing this more, because these are postural muscles. They should be able to go all day long without fatiguing. And so we're waking them back up and just trying to get familiar with them, get to know them, connect with them, strengthen the electricity that flows to them. As we were talking about earlier in this stream, electricity is flowing through our bodies all the time. All of our muscles, all the time, even when we're sleeping. And so certain muscles get more electricity, other muscles get less. And so we want to increase the flow, increase the connection to these muscles. And so hopefully that gives you somewhat of an answer. There's no hard minimum like that. You need to be able to do this. For it's just about you being able to breathe fluidly, continuously while pushing away. And that you feel confident. You feel connected. You feel like you're getting familiar with these and you can move on. We're not going to abandon this. When you go to the next module, we're going to build on this. And so everything that you've already done will get further strengthened and reinforced by the layers that we put on top of it. So it sounds to me like you're ready to move forward, but ultimately that's going to be up to you. And yeah, I would say it doesn't hurt to go to the next lesson. If you get to the next lesson and you're like, I'm not ready for this, then there's nothing lost. You just go back to the basics, build up a little more, and then you go back to the lesson when you feel ready. So that's my best advice to you'd thank you for asking and thank you all for showing up for yourselves and keep working at it. Get down on the floor. Give some love to your body that does so much for you and I'll see you next week.
