Three Questions with Meghann Koppele Duffy

Lower Back Pain

• Meghann • Episode 4

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Lower back pain isn’t a mystery - it’s a puzzle waiting to be solved.  In this episode of Three Questions with Meghann Koppele Duffy, I’m exploring how overlooked sensory inputs and motor functions, from foot pressure to eye mobility and breathwork, are intricately linked to your back’s health.  You’ll hear insights as to why your everyday habits may be contributing to your low back pain as well as practical exercises to assess and address your discomfort.  Whether a movement professional or someone with low back pain, this episode will provide valuable tips to help you manage and alleviate pain through critical thinking and targeted strategies.

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Meghann Koppele Duffy: Welcome to Three Questions, where critical thinking is king and my opinions and research are only here to support your learning and understanding. Hey, I am your host, Meghann, and I'm so honored you clicked on Three Questions today so we can get into lower back pain. So, before I ask you any questions, do you have low back pain?

Have you had it in the past? Or do you work with people or love people who have low back pain? Now, a lot of the time, it's easy to blame the back, but it is more complicated than we think. So today's three questions are to help you critically think and fill in the missing pieces of to maybe why you or your loved ones are experiencing low back pain.

Question one, can you feel your feet? Might sound like a stupid question, but people's answers never cease to amaze me. So, can you feel your feet? What do your feet feel like? What part of your feet do you feel? Do you have a lot of calluses? Do you feel where those calluses are? Can you determine the sensation or the difference between your fourth toe and your third toe?

I mean, come on. Sounds impossible, doesn't it? But why the feet are so important is that's what connects us to the ground. Okay, obviously, well, unless you're walking on your hands, but most of us walk on our feet. And so every step we take, our brain is going to determine how the rest of the body reacts and responds based off how that foot hits the ground.

Now, something that's super interesting to me is that nobody ever takes a perfect step, and usually every step is a little different. And it's up to our brain to determine how we're going to move through that step or how we should respond muscularly. Based off the sensory input at our feet. This will make more sense if you think about maybe your grandparents, or parents, or, uh, older person you know.

Unfortunately, a lot of them might break a hip as they age, and that could lead to, you know, not to be kind of blunt, but death. You know, if we stop moving, body sucks, stops moving, we get, the body gets a little dehydrated, stiff, basically like aging is a drying up process. So we want to keep moving. But what happens with a lot of people is they fall and break their hip.

But they fall because of a balance issue. And that balance issue could be their inner ear, their eyes, or proprioceptive. Mostly because their brain has no idea where their feet are in space. Now think about your grandparents shoes. Do people's shoes get sleeker, sexier, smaller, thinner as they age? Or do they become more box like and cushiony?

Now I'm going to piss some of you barefoot people off, but barefoot is not best for everybody. Older people like those cushiony shoes because it gives more structural support and feedback to the brain. So I am not here to tell you that barefoot is the way to go or not. What I want you to decide is what do you feel and what do your feet prefer to feel?

And how can we utilize that information to teach our brain to better respond? Let's try something. So I want you to stand up when you're in a safe place to stand. If you're driving, obviously don't. But what I want you to do is just kind of shift your weight right to left. And notice, what happens at your feet?

So let's say let's just shift to the right. I want you to go and notice where the pressure increases when you shift to the right. Just notice. And you don't have to be super specific, just think of, feel that spot. Okay? Then what I want you to do, go to where the pressure increases the most. Stay there. Now, try to shift back to the left without decreasing the pressure at that spot.

I'll give you a chance to try it. Okay? How did that feel? Did you feel your hips activate? Did you feel some spasms? Did you feel pain in your lower back? Now what I want you to do, come back to center, shift to where you feel that increase of pressure. Then shift back to the left only till you feel a slight decrease.

Okay? Then I want you to shift back to the right without increasing the pressure. So go to where the pressure is the lightest and then try to shift to the right without increasing it. How did that feel? Now what I just assessed on you is your hips and the rest of your body to respond to various foot pressures and positions.

Now, it's not wrong or right to increase or decrease the pressure in your feet, but there's so many joints in the foot that if our brain only thinks like one of those joints is available, it's gonna keep dumping into that joint. So where you felt that increase of pressure is often where you're kind of dumping.

So if I said to your brain, hey, try that shit again without dumping there, I'm testing your brain's ability to find another pathway and see if it could stabilize at that spot and mobilize another spot either up or down the chain. Okay, a little technical there. But really simply, I'm looking to target a part of your brain called the cerebellum.

And that part tends to, you know, jump in when there's an error. Okay? So if like you were trying to move without increasing the pressure. And your brain was like, oh shit, I wasn't able to do that. Your cerebellum is going to kind of go, oh, can we do it another way? Okay, now why this is important is we want our cerebellum jumping in when it needs to, and being able to filter the information to give our brain another pathway.

In our previous episode, I talked about how important compensations are. That's why kind of humans are fascinating and, you know. Don't die all the time because we're able to compensate. So don't be pissy about your foot or your hip right now. I want you to start thinking, can you start training your feet in weird ass positions?

Can you try to do a deadlift without increasing the pressure in your right foot? Or going to where that pressure is heavy as hell and maintaining it? I want your brain, especially your hips, to respond no matter the sensory information at your feet. And here's the bad news. What if you don't feel any pressure increases?

What if you don't feel any sensation? What if your client has neuropathy? What if you had a broken foot and your brain map down there is a shit show? Well, maybe the bottom of your foot isn't giving enough information. But we can use the top of your foot and or a shoe to help the brain know where it is in space.

If you've watched any trainings or videos with me, I use kinesio tape a lot to basically just bring sensory information. to the skin, so the brain knows where that body part is in space. Okay? So right now, I want you to walk around and notice if you feel pressure changes at the bottom of your feet. And then put your shoes on.

And notice if you feel pressure changes when you do your deadlift or squat. Maybe you feel a lot of pressure on the side of your foot. Or the top of your foot. What about your shoes? Do you get any holes at the top of your shoes because your toes are poking through? These are all important questions you need to answer to help your hips better respond to your feet.

And why that is important, my friend, is I've never met a person who I'm like, Ooh, you move your pelvis around your leg really well. Now, I've met a lot of people who think they're moving their pelvis around their leg really well. Not because they're idiots, but because it feels like they are. But in actuality, they're shifting at other joints.

So before I go on to question number two, next time you're doing maybe like a stiff legged deadlift or you're doing maybe a hip hinge, pin your femurs and or tibias and feet in a specific position. So I think it's just easier for me to describe with straight legs, okay, I want you to look at yourself in the mirror and kind of do like a good morning forward and back, but do not change the position of your femur and tibia.

I am a cheater at the ankle. So even when I'm kind of deadlifting or trying to do a stiff leg, I will shift my tibia forward and back so it's kind of a dorsiflexion pattern. And by doing that, because I'm not stabilizing my foot and ankle, I'm not going to get as much mobility of my pelvis around my leg.

Right? So watch and see what you move when you do a deadlift. And then try not to move those parts and see what happens. Now, if that last bit about the ankle or the tibia totally was like, through you, well, chill, work on your feet first, answer those questions, and think, when you are ready, we can move up the chain and bring our margin of error in, so we can really fine tune and differentiate other parts, okay?

It's all good, because if your brain doesn't sense or feel a problem, it doesn't really matter to it. We've got to make it matter. Which leads me to question two. How is your eye mobility and stability? Okay, in the previous episode we talked all about the eyes, and if you did not listen to that episode, please go back.

Nobody gives a shit about their eyes until they have a problem with their eyes. But let me tell you, a lot of your strength and mobility issues are a disconnect to your visual and vestibular system. Yeah, meaning you're moving your body in one direction proprioceptively, But your visual vestibular system might be moving in opposition or too far in a different direction.

But your brain doesn't realize. So I'm not going to do the same strategy I used in the previous episode. Go back and listen to it. There's a little cookie. You want to learn? Go back. But I do want you to think about where are you looking when you're moving? And if you're trying to stabilize your spine and isolate limbs, well your eyes should be stabilizing.

If your eyes are moving all over the place, that could be an indication that you're not getting enough sensory input. Yep. And if your eyes are moving all over the place, what's your tongue doing? Right now my tongue's moving because I'm talking. But a lot of people are moving their tongue all around in their mouth, and that can create some instability in your cervical spine.

Okay? Doesn't mean we're all doing shit wrong. It's just a question. So I want you to ask yourself, if you are able to isolate and mobilize your eye, mobilize your eyes, easy for me to say, without moving your head. Try it right now. Put on your phone. Put on a video. Don't look at the video. And I want you to try to move your eyes.

And I want you to notice, is your head moving? I'll see clients all the time, they think they're doing eye tracking. But they move their head a little bit. Now, nobody's going to die from moving your head when you're trying to isolate your eyes. But it is going to inhibit your full ability to mobilize your eyes, which is going to affect their ability to stabilize.

So if you don't think eyes matter, you are missing out on some serious strength and mobility. And if you want to learn more about the eyes and why this question matters, if I haven't said it twice, I'm going to say it a third time, listen to the previous episode to learn more about your visual system and to learn three questions that will dictate where you might want to start.

Now, last question, which is going to tie everything together in a beautiful bow is, are you breathing? Hmm. It's a weird question. To quote a friend of mine, Shanté, she's also known as The Movement Maestro. She taught a course on breathing. And it was the, my favorite opening to a workshop ever, because she said this, If you're alive, you're breathing correctly.

Now, can we optimize breath? Yes. But we all need to chill for a minute about the breathing. And why I love that, it just kind of was like, Alright, if you're alive, you're breathing. So, you have enough diaphragmatic mobility to stay alive to breathe. Now, if you have some breathing issues, that's going to tell us there are some other things going on.

Now, I am not a pulmonologist. I'm going to stay in my lane and talk about movement. But something people don't realize is the inability to reflexively stabilize in your upper quadrant, so the shoulder girdle, we kind of have two shoulder girdles on either side, has a direct effect on your diaphragm's ability to mobilize.

Also, your eyes, and spine, and jaw, and tongue, their ability to stabilize could have an effect on your breath. Because the brain thinks safety first, and if there's a lot of inmo, um, instability up here, well the brain's gonna be like, Uh, we're not stable to move that diaphragm that much. So all that deep breath technique you're doing might actually be aggravating your nervous system and not calming it down.

How do you know? You know. Do you feel good when you meditate? And I always say this to people. If you don't meditate, it's because it's not helping you. Notice I didn't say meditation is bad, or meditation's not helping you. Uh, uh, uh, uh. How you're doing it is not helping your nervous system. Good meditation, how I like to meditate, is in specific body positions where I know my upper quadrant and or my tongue and or my spine and or my jaw can stabilize when needed.

Now, I don't want to get everybody upset. All those things don't need to be stable at the same time. Depends on what you're doing, but if there's too many instabilities. You know, like, I've had post concussion, or maybe you've had post car accident, or you're an ex football player, or a soccer player who's had multiple concussions.

Those instabilities can create a safety problem for the brain. So, if you're not doing your breath work, if you don't like how it feels, I'm not going to blame meditation and breath work. I'm going to blame the environment and you, if you can't settle in and deep breathe and feel good, don't be mad though.

But you're going to have to look deeper at some of these areas of neurological instability to create more safety, okay? So if you're hearing this right now and being like, oh, that's why I hate meditation, it's all bullshit. Well, you're not listening. It's not bullshit. What I'd like you to hear is, if it's not working for you, there's things that we can do to help our body to make meditation more successful for you.

Also, a lot of people meditate when they're sitting. And in a seated position, that can cause a lot of, I'm gonna call it brain muddiness. And what that means is, your brain might have a hard time differentiating your lower back from your hips. So when you go to sit down, obviously we not need a lot of hip mobility.

But, it's a lot easier just to move your lumbar spine. Okay? So a lot of people when they sit, over mobilize their lumbar spine at specific segments. Rather than moving their hips. So going back to low back pain. Your inability to breathe or meditate in a seated position could be making your back pain worse.

So, if you're having trouble breathing, what I want you to think about is can we get the foremost mobile joints in your body, your glenohumeral and your hip joints, to isolate from other nearby joints and stabilize. Just do that, see how that affects your breath. If you're breathing and you can breathe well, I want you to then start doing your lower back exercise or your glute strengthening exercises.

If you cannot take a deep breath while you're doing your prescribed exercises to decrease low back pain, your low back pain will not get better. You are not stable enough in that position or to do that exercise. Notice I didn't say you wouldn't be able to do that exercise. Because we can create easy gripping patterns, I can pull in my abs, brace myself, push a leg down too much, do an isometric, I can trick my brain into stability.

But why that's a bad idea is when you get up and try to walk or move throughout the world, that's when the low back pain is going to get worse. Raise your hand if your low back pain is fine when you're working out, but as soon as you bend over to pick up a damn pen, your back goes out. Well, let's think about it.

When you bend down to pick up a pen, are you feeling where your feet are? Where are your eyes looking? And, are you able to even breathe in that position? Okay, so maybe the next time before you pick up a pen, press down or try to not change the pressure at your foot while you're picking up that pen. Maybe next time you pick up the pen, you don't look at the pen.

Okay? The hand is going to the pen. So think about, if I'm reaching for something, my head's this above. So what if you look right above the pen and move towards that visual target and grab the pen? Okay? Or, maybe if you want to look at the pen, look at the pen and watch your hand grab the pen and as you stand up, don't change the distance between the pen and your eyes, meaning coming back up in the same pattern you went down in.

Last but not least, take a deep breath. If your breath is shitty, maybe don't go down and pick up the pen. Yeah, I know. Figure out a way how you can create safety in your body. Whether it's a lower quadrant strategy, an upper quadrant strategy, maybe just pressing your, keeping your tongue in the same spot in your mouth.

Try to breathe again and then pick up the pen. Because, we need to focus on the things that facilitate the change, not the results. So if you keep focusing on not hurting your back, that's what your brain's thinking of, it's stiffening up the back. Well, the key to not over mobilizing and making your back angry is that the brain knows there's other options.

Foot and ankle mobility, shoulder mobility, moving the head and eyes. That is the key. So, real short episode today. Because all I want you to do is to critically think about where your feet are, how do they feel, can you maintain the pressure, light and heavy. I see a lot of people in the gym only working heavy foot pressure, like, oh, look at how much my glutes activate when I push my foot down.

Good! But also, when you're sitting, there's not a lot of pressure under your foot, can you keep your hips active when there's light pressure under your foot? Think about it. Number two. The inability to mobilize, isolate, and stabilize your eyes could be making your spine work harder than it needs to. And last but not least, breathing.

The breath never lies. If your breath is suspect, just doing more breath work can often aggravate your nervous system. And if you're thinking, um, now breath work has saved my life. Good, you're stable enough to breathe there. Bravo. Keep frickin doing that. But recognize that other people might not be having the same experience as you with breathwork.

Now, you might be frustrated and want more about low back pain. So stay tuned. We'll talk about it in further episodes, but get started with these questions. Comment if you have any questions, any complaints, any exercises that aren't working for you because the goal of this podcast is to help you find answers and not settle for the shit answers, doctors, PTs, Pilates teachers that everybody is giving you.

So thanks so much for tuning in and hopefully one of these strategies will help decrease your low back pain. Thanks guys.