Does your back hurt in the morning? Putting on pants and socks difficult and painful?

Or maybe pain wakes you up when you roll over in bed during the night.

If so, you may be suspicious that your bed is causing your back pain.

"Maybe my mattress is too old, or I'm sleeping in a weird position."

But here's the thing: because we're just laying there all night in bed, mostly not moving, it's virtually impossible to injure yourself.

You may have a ton of pain, but you can rest assured that it's not your bed's fault.

Why we have pain at night or in the morning

Of course there are many things that can cause pain. And if you're unsure about your health status, it's important to get checked out by your doctor -- just to make sure there's nothing scary causing YOUR pain.

But you can rest assured that the "scary" potential causes for back or spine pain are quite rare.

And for the huge majority of back, neck or shoulder pain, there may be zero actual damage inside you. Meaning, nothing's torn, ruptured, fractured or dislocated.

You just hurt.

And as to why it's so common to hurt when laying down or waking up, here's why I think that happens.

If your back, shoulder or neck are already "unhappy", literally ANY activity can make your pain spike. I call these "triggers" for pain.

Pain "triggers" aren't the actual cause of your back pain, but they are activities or body positions that aggravate the pain you may already have.

For example, common triggers for low back pain include getting up/down from a chair, rolling over in bed, getting in/out of a car, bending forward at the waist...there are more. None of these things are dangerous, but they're famous for triggering pain.

If you've noticed that any of these activities hurt when you do them, it may simply mean that your back is "unhappy", and complaining in the form of pain while you do these things.

The best bed for spine health

There's a simple answer to this one.

The best bed for YOU is the one you sleep best in.

The one that feels best, is best.

Now if you're wondering why the bed that always felt great to sleep in, suddenly now hurts when you're laying down, it's often because you have something else causing your pain, and until we resolve it, ALL movements may hurt.

So addressing the underlying cause for your pain is the likely solution -- NOT going out and buying a new mattress.

If we can resolve the actual cause for your pain in the first place, very often the same mattress you've been using suddenly becomes comfortable to sleep in again.

But wait, you may ask -- should it be a firm mattress? Soft? Medium? How about pillow-top, or memory foam? Do any of these matter?

No!

As long as you're able to:

• Sleep through the night, and not be awakened by pain
• Wake up without feeling worse than when you went to bed

You've got the right mattress. No matter what firmness or density it has.

When it comes to sleep, comfort is king! What feels best, is best.

What to do if you hurt at night or in the mornings

Job #1 is to find out why you're actually hurting in the first place.

Getting checked out by me or another qualified healthcare provider is often the best first step.

Then, once we know what's causing your pain, we can address it with the right therapies or lifestyle modifications, so that sleep becomes restful and comfortable again.

Typically we can figure these things out quickly, which is nice.

If you're having trouble sleeping due to pain, or having lots of pain in the mornings, that gets old pretty quickly.

If you're in the Austin area, give us a call. I'd love to help you get back to feeling great again!

If you're like most people, you may feel like you should be stretching more. Patients tell me this all the time.

"Ugh, I know I should be stretching. It's just so confusing, trying to figure out which stretches I need, and I never know if I'm doing them right."

But first, let's answer the question: "What does stretching actually DO?"

Stretching is a tool, and like all tools, it has a specific usefulness. And if we don't know what this tool does, we'll just be guessing about when it might be useful.

I see stretches as a mobility tool. Meaning, if your hip should be able to bend 90 degrees in a certain direction, but instead you can only bend 30 degrees -- stretches can help restore your missing flexibility.

Or as I like to say, stretches "loosen tight things". They increase your range of motion.

Can tight muscles cause pain?

I consider a lack of flexibility to be the number one cause for all "body" pain -- that is, pain we have in our moving parts.

This includes low back pain, knee, hip, shoulder, neck, ankle -- most of the pain that brings people in to see me.

Here's why I believe "stiffness", or lack of flexibility, can contribute to body pain.

We have about 350 "moving parts". And each one has a normal range of motion it should be able to move through. Your elbows, hips, knees -- all need to be able to move freely, in order to do our daily life activities in a safe way.

And if our range of motion is limited (by, say, tight muscles), that means we may be prevented from moving in a safe way -- and forced to move in a less safe way, that can hurt.

Imagine if you were throwing a baseball, but your elbow joint was fused -- you couldn't bend it at all. Trying to throw a ball would be very awkward, you wouldn't be able to throw very hard or very long, and you'd probably start getting shoulder pain from being forced to throw so weirdly.

I believe the same thing can happen with ANY joint that's too stiff.

Just because you have some stiffness is no guarantee that you'll hurt, but I see stiffness as making the risks of injury higher. If you're forced to move less naturally, over time, this can lead to hip, neck, back or knee pain.

And stretches are a perfect tool for restoring your normal flexibility (along with massage, which we'll talk about in another post).

How to tell if you need a stretch

Since stretches restore flexibility, first I check all your "moving parts", to see if any of them are too stiff (can't bend as far as they should).

If we find some stiff things, we simply "plug-in" the stretch that fixes that thing.

Tight hamstrings, can't touch your toes? Hamstring stretch.

Can't pull your heel to your butt? Quad stretch. And so on.

Finding the tight things is easy, once you learn how. Then, we'll give you a stretch that restores that missing flexibility -- usually over a week or two at most.

My rules for stretching:

There are 3 elements to a stretch, and all 3 have to be done right for the stretch to work:

• How aggressively you hold the stretch
• How long you hold the stretch
• How often you hold a stretch

If any of these elements isn't done properly, your stretch may have no effect. Meaning, you won't get any more flexible over time.

If you've ever tried stretching, and you feel nice and loose today, but then tomorrow, you're just as stiff as you were before...this is usually why. Some elements of your stretch were missing.

Here are the rules I give my patients for all stretches:

• Make the stretch "barely tolerable". Meaning, you can handle it, but you're a little miserable
• 1-2 minutes per stretch. Holding a stretch long enough means you get more flexibility from it
• Stretch daily. Stretching once a week isn't often enough for most people to see steady improvements in flexibility

Following these rules helps us achieve the goal of stretching -- to gain a little more flexibility every day you do them.

Then, once your flexibility is normal (within a week or so), you're done! You don't have to stretch every day, since you fixed that problem.

Then, just check your flexibility every so often (maybe once a week) to make sure you still have the normal range of motion.

This way you'll catch stiffness just as it's starting, and "touch-up" your flexibility for life.

And this is the easy part! I spend about 10 minutes per week stretching. That's it. Not hard to do at all.

Choosing the right stretches for you

With my patients, checking mobility is one of the first things we do.

Then, based on what deficits we may find, I'll prescribe a stretch that addresses their specific deficits.

There are literally millions of stretches (which you'll find on Youtube and Instagram!), but it's a very short list of stretches most people actually need.

And once we find the ones you need, they'll be the same ones you need for life. Rarely do I see patients who develop NEW tight spots in other muscles.

Typically we all have our own unique "problem areas" that, once fixed, we only have to "touch-up" occasionally for life, to stay active & pain-free.

I hope this helps! If you're hurting -- even for a long time, or you're in severe pain -- I'd love the chance to help you get back to 100% again! Just give us a call.

One of the first things my patients want to know is, “Why did my back start hurting all of a sudden?  I wasn’t doing anything crazy or dangerous, then out of nowhere it hit me, and now I can barely get up from a chair!”

In this post we’ll talk about what I believe triggers most back pain in the first place, the underlying causes, and how the right therapies can fix them.  

First thing to know is, you don’t need a big injury to cause back pain.  In fact, most people have no idea what caused their pain – they just woke up with it one day, or felt a sudden “jab” of pain after bending to pick something up – even though they’ve done the same thing a million times, and it never hurt before.

And this is how most back pain happens – the huge majority, like 90%.

But even though the pain may feel like it “came out of the blue”, there’s always a reason. 

The most common cause of low back pain

The biggest reason that I see is lack of flexibility. Especially tightness in hips and legs.

Now let me be clear – there is never just one cause for pain, always multiple *contributors* to it.  Meaning, if for example you’re dehydrated, or low on sleep, or too stiff, or too weak – all of these things can make it more likely for back pain to happen.

But the way we make it simple is by looking for the biggest contributors to YOUR back pain, then attack them first.  That way we can get big results, fast.  Then we can always address some of the smaller contributors later.

And in my experience, tight hips and legs are the #1 reason for the huge majority of the back pain I see and treat every day.

By tightness I mean, muscles that are shorter ropes than they should be.  And the reason tight muscles matter is because they limit how far you can move.  If they were too stiff, you’d just be locked in place.  So you need stretchy muscles to allow normal movement to happen.

If you’ve ever had trouble doing a toe-touch, for example, it’s often because muscles in your legs are too tight, and preventing you from bending forward very far.

A muscle is basically a “meat rope”, if you think about it.  And that meat rope needs to have some elasticity, some stretchiness, so that we can move our bodies. (walking, bending, squatting, lifting, etc.)

And if they’re stretchy enough, it means that we can move safely.  But if they’re too stiff, they limit our movement, and it forces us to do life in a less safe way, that can hurt.  

Also, tight muscles can pinch nerves!  All of the nerves in your legs come from your back.  And if there’s not enough room for the nerve as it runs down your leg, it could be getting pinched, and giving you pain that runs down your leg – like sciatica.

The reason tight hips & legs matter so much to low backs is because, if your hips aren’t flexible enough to “help out” when you squat or bend, it forces your low back to do all of the work.

And that’s why tight hips and legs can “overwork” low backs, and cause all of our pain.

Back pain can be excruciating, with ZERO damage.

Interestingly, most of the pain you feel when your back hurts isn’t from “damage” at all.  Most of the pain is from our body’s “overreaction” to a perceived injury.

What I mean is, if you “tweak” your back from bending in a weird way let’s say – not even any actual damage – but your body senses there’s something not quite right with your back, your body tells the muscles around your back to tighten up protectively.

It’s trying to help you by immobilizing your back.

But the problem is, cramps hurt – and they DO immobilize you.  And those cramps can hit you suddenly – like an electrical shock feeling, running up your back, or down into your butt; or they can slowly tighten up and make your back super hard to bend and move.  Or it could just feel like a knife jabbing you back there.

And guess what – all of these are the most common symptoms you’re likely having with your back pain.

And all this pain is not even from being “damaged” – it’s from your body overreacting and giving you tons of that “protective” cramping.

But – if we remove the cause for your body’s concern (by improving your flexibility), it figures out hey – everything’s actually okay – and it releases the cramping, and your pain goes away.

Back pain can SEEM scary, even when it's not.

I routinely see patients who are “crooked” – leaning off to the side, or slightly bent forward.  And it’s very difficult and painful for them to straighten up.  This can freak people out.  But it’s not a scary thing.

What often happens in these cases is simply that the muscles on one side are cramping harder than the muscles on the other side, and the tighter ones pull you off to one side.  

Patients will say, “Doc, I looked in the mirror today and one of my hips is clearly higher than the other one.  And it feels like my hips aren’t even, like one of them doesn’t work the way it’s supposed to.  I feel crooked.”

Seeing this “crookedness” in yourself – especially when it was never there before – can be very disturbing.  Make you worry that there’s some structural problem inside you, creating this “deformity”.  

But don’t worry – this is super common, and not a big, scary thing!  Just one of the things that can happen if you have regular ol’, plain-vanilla back pain.  I see it all the time with my patients in clinic, and see them get over it with no issues.

But what if your pain…moves around?  Or what if it changes from day to day, or even during a day?  This is also extremely common, and not alarming.

For example, let’s say that today your back pain feels like sharp jabs, it takes your breath away if you make a wrong movement, even a small one.  But tomorrow, it’s not sharp anymore, it feels like a dull ache, or maybe stiffness.

What if your pain is usually on the right, and then one day it’s on the LEFT.  What does that mean?  Nothing, actually!

All of these changes to the character of your pain (like dull, shooting, sharp, sudden, stiff, sore, electrical) – really don’t mean much.  I call them the “noise” that goes along with all back pain.

If your back isn’t happy, it’s totally normal to feel it change over time, whether that’s your pain moving from right to left, or going from dull to sharp, or moving from your back down into your glute – all of these are just the kinds of things I would expect to see with anyone who has back pain.

None of them mean you automatically have a “difficult” kind of back pain, that might take longer to heal, or require some kind of fancy surgery or procedure.

Fixing low back pain can be simple and fast.

So just as a summary – 90% of the back pain I see is because of stiff hips and legs.  Which is great, because these things are super easy to fix, and quickly.

And the most powerful fixes for tight hips and legs are: stretching, and massage.

We’re familiar with stretching, and in this course I’ll be showing you the the exact stretches I give my patients.

And you don’t even need to see a massage therapist – you can do the massage yourself, using a foam roller or a softball (I’ll show you how), and we’ll even be going over some “buddy” massage that you can have a friend or spouse do for you – and don’t worry, it’s super easy!

In this course, we’ll go step by step over how to check yourself out, find the biggest contributors to YOUR back pain, then “plug-in” the most effective therapies to fix them.

And once you’re feeling better, then you only need to do occasional “touch-ups” to keep your pain from coming back.  That’s the BIG win – because it takes very little effort or time to maintain your flexibility for life.  All the hard part is in the beginning.  Then it gets easy.

Interestingly, science and research have no idea why back pain happens. In fact, doctors call it "non-specific" low back pain -- meaning, they don't know what causes it, or how to fix it.

Which is why I decided to figure it out on my own.

With my patients in clinic, and in these blog posts, I explain my theories about why pain happens, and how to fix it. And even though science may figure out WHY this approach works sometime in the future, until then, I'll keep using this approach, since it beats the pants off every other method I've found.

If you're tired of hurting, come see us! I'd love the chance to get you feeling great again.

Hip 'flexion' is a movement we're all designed to do.

If you're standing, then raise one knee in front of you, that is 'flexion' of the hip.

The main muscles that make this movement happen -- the hip flexors (psoas and iliacus) -- routinely get accused of causing low back pain and other problems. But I don't think they deserve that blame.

Why don't I care about hip flexors? Because I ignore them, and patients get better anyway. Which suggests they weren't that big of a deal in the first place.

Hip flexors attach to each of your lumbar vertebra, then run down the inside of the pelvic "bowl", attaching near the groin. When they contract, they raise your knee.

And because of their location (attaching to the low back), that often makes chiropractors and physical therapists suspicious that they may be contributing to lower back pain.

I disagree. And we see literally thousands of patients with low back pain get better -- even though we've ignored their hip flexors. Which suggests the problems causing their pain were elsewhere.

Have you ever tried hip flexor stretches or massage?

You'll find thousands of videos on social media recommending these stretches, and special tools that are supposed to "massage" or "release" the hip flexors.

But if you've ever tried the stretches, they're super awkward to do, it's hard to tell if you're doing them right, and sometimes (if your back is already hurting) you just may not be able to do them period -- because the position is too painful.

And, if you've ever had a massage therapist "work" on your hip flexors, it's often extremely painful -- digging deep into your belly muscles, trying to reach them.

But research shows that we can't even *touch* the hip flexor from the outside of you -- let alone massage its whole length. Imagine a 10-inch muscle, and we may be able to *barely touch* the last half inch of it.

How much good could that possibly do? Not much.

So if the hip flexor stretches are too difficult and awkward to do, and you can't tell a difference from doing the stretches...and the massage is painful and ineffective...why should we care about hip flexors at all?

Personally, I don't.

And as long as we're seeing steady improvement in your back pain from addressing the other, REAL causes -- it means we made the right decision to ignore them.

But what if I have pain in the front of my hip?

Doesn't that mean my hip flexors may be causing it?

This would make sense, right? But here's the thing.

Pain is famous for happening where the problem ISN'T.

Meaning, just because you may have pain in a certain area, it doesn't automatically mean the pain is CAUSED by that area. In fact, it's my experience that almost ALL low back pain isn't a low back problem at all -- it's caused by tight glutes and legs.

I'll explain this in more detail in another post, but the takeaway here is that pain in the front of your hip doesn't automatically mean you have tight hip flexors, or that they're a problem in any way.

So, what IS causing my low back pain?

If it's not my hip flexors, what is it?

The short answer? I find that it's tight glutes & legs.

"Stiff" hips -- meaning, muscles that aren't elastic enough to allow normal, safe movement of the hips -- can force you to move in a less safe way, that can overwork your lower back, and cause pain.

I'll go into more detail on this idea in a future post, but it's important to know you can safely ignore your hip flexors, and forego those awkward stretches & painful massage. They're almost certainly not going to give you a full, speedy recovery.

So you can save some money, save some time, and avoid some unnecessary pain by skipping them altogether

And if you're willing to invest a little time and effort to get rid of your back pain, come see us. We're famous for our super short treatment plans, and we have thousands of happy patients to back that up.

Give us a call when you're ready to stop hurting!

The short answer is -- whichever one feels best, is best!

Both heat and ice fall into a category of therapies that don't fix anything, but they can be helpful by making you more comfortable. Neither will speed healing, and there's no danger of accidentally using the "wrong" one, and hurting yourself in some way.

Think of heat and ice as the same kind of therapy as Tylenol. Tylenol doesn't "heal" you, but it can definitely help you get through a rough patch where you're hurting a lot.

If you're having trouble sleeping, for example, and you find that using a hot pack helps you sleep, that's exactly what heat and ice are useful for. Then can help you get through a painful period as you recover, and handle work or daily life with a little more comfort.

With both heat and ice, our goal is that you don't need them forever -- just for a week or so perhaps, when you're hurting the most.

Once you're feeling great again, there's no need to apply either of them.

How heat can help

Heat 'loosens tight things'. Meaning, if you feels stiff, sore or tight, heat can help loosen things up and get you more comfortable.

We've all notice how much a hot shower can make us feel looser and less stiff. This is because muscles are like taffy -- when they're cold, they're stiff and brittle. But when they're warm, they get nice and flexible.

Heat also increases blood flow, which is why you may notice your skin gets a little red when you've been outside in the heat, or after applying a hot pack.

Heat also tends to soothe sore, achy feeling muscles. Heat just feels good!

Heat can be applied all kinds of ways: hot bath, hot shower, hot tub, hot water bottle or heating pad. Any of these can work, and are fine to try.

The effects of heat are temporary, but can give much-needed relief if you're in a lot of pain. As long as you're not burning yourself, it's totally safe to use.

If you feel stiff, tight or achy, try applying some heat for 15 minutes, and see if you feel better. If so, great -- that's what it's for! Use it as it seems helpful.

How ice can help

Ice shrinks swelling and relieves pain.

If you've ever had really cold hands or feet, you may have noticed that they feel a bit numb until they start warming up. This is how ice numbs pain.

Also, if you've ever sprained your ankle and saw it get big and swollen, ice can help shrink that swelling. Doctors often prescribe ice baths or ice wraps after a knee surgery -- both for pain relief, and to keep swelling from getting out of control.

Swelling itself can damage tissue in theory, but it's rare for most people to have that much swelling. A little puffiness around a joint, or a bruised area is typically what we see with most patients. And for a little puffiness, ice can help manage those symptoms well

Ice can be applied with either an ice bath (that you might submerge your foot in, for example), a chemical cold pack (once you "break" it, a reaction occurs in the pack that makes it cold), or just a bag of ice. Any of these are fine to try.

With ice, I recommend having a thin layer of fabric between you and the ice, so the cold isn't applied directly to your skin. It'll still get cold, and protects your skin better that way.

If you have visible swelling or intense pain, try applying cold to the area and see if it feels better. If so, great -- that's what it's for! Use it as it seems helpful.

What if I'm not sure how bad my injury is?

If you're ever unsure about your health status -- especially if you've had a trauma or are developing new or worsening symptoms -- definitely get checked out by a doctor. It may be nothing, but it's absolutely worth it to rule-out any scary conditions that may need medical care right away.

And while both heat and ice are very safe, and can help make you more comfortable during your recovery, do not apply them to open wounds. Your doctor can advise you when & if ice or heat are safe to apply in those cases.

In summary, heat and ice are very useful for managing pain or discomfort, even though they don't "speed healing".

And there's no "wrong" way to apply them -- you can go back and forth between them, to see which one feels best. If one feels better than the other, use that one -- as it seems helpful!