• ESTHER SMITH BACK AND NECK (1)
TBP 085 :: Esther Smith – Neck and Back Injuries in Climbers 2017-12-10T11:37:27+00:00

Project Description

Date: August 17th, 2017

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About Esther Smith

Esther Smith is a Doctor of Physical Therapy, a Nutritional Therapy Practitioner, and the owner of Grassroots Physical Therapy in Salt Lake City. She is a 5.13- climber who’s reaped the benefits of her own physical therapy practices, having healed a shoulder injury, a finger injury, a recent foot injury, among others with exercises, stretches, and alternative therapies.

She works almost exclusively with rock climbers, which is rare for a physical therapist. For a complete bio and list of certifications and qualifications, please visit www.grassrootsphysicaltherapy.com. This is my fourth interview with Esther, and here’s a list of the other interviews I’ve done with her:

This interview is all about back and neck injuries. We talk about the most common back and neck injuries among climbers, why we get them, what they feel like, how to get a proper diagnosis, and mostly… how to make the injuries go away.

During the interview, you’ll hear Esther talking about the videos she created to help you understand what she’s trying to explain. You’ll find all those links below. If you have shoulder, neck, elbow, or other injuries, she also has video tutorials for sale on her website, www.selftreatment.com, which very well may make your pain go away without the help of any practitioner.

In fact, I’ve had at least 10 people approach me at crags or at the gym and tell me that these interviews with Esther “fixed” their (insert body part here), so we’re extremely happy that these interviews and Esther’s videos are helping people around the world.

Esther Smith Back and Neck Interview Details

  • Update on her foot surgery and recovery
  • Most common back and neck injuries
  • Dry needling for injuries
  • Using drugs for pain
  • How neck and spine affects shoulder health
  • How sitting affects spine issues
  • How to strengthen neck
  • How to strengthen back and core (back and front)
  • Pilates for core and back health
  • When to strengthen and when to seek pain relief

Self Treatment Videos

These are trailers of video tutorials that Esther Smith and Eva Kauffman created to help you heal your back and neck pain. They each cost $14.99, but that is a very small price to pay to potentially be rid of your pain.

Healthy Neck Video (Trailer)

 

Get The Video

Healthy Low Back Video (Trailer)

 

Get The Video

Low Back Pain Extension Preference Video (Trailer)

 

Get The Video

Low Back Pain Flexion Preference Video (Trailer)

 

Get The Video

Esther Smith Links

Training Programs for You

Do you want a well-laid-out, easy-to-follow training program that will get you stronger quickly? Here’s what we have to offer on TrainingBeta. Something for everyone…

climbing training programs

Please Review The Podcast on iTunes

Please give the podcast an honest review on iTunes here to help the show reach more curious climbers around the world.

Transcript

Neely Quinn: Welcome to the Training Beta Podcast, where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn, and today we are on Episode 85 of the podcast, where I am talking with Esther Smith. Esther Smith is a physical therapist- you’ve heard her on the podcast three other times potentially. She and I have talked about shoulder injuries, and then we talked about elbow injuries, and then we talked about finger injuries. Today we are going to talk about back and neck injuries. Then we are just going to keep on going down the body, because she seems to be extremely helpful with people, with climbers in particular, with these injuries. I go out climbing or to the gym, and people will come up to me and be like “Thank you so much for your Esther interview on fingers or elbows or whatever”, and they will tell me that they are fixed because of what she said, the because of the videos that she created to help you guys treat yourself at home. She has a website called selftreatment.com, and on there she sells videos that are an hour long. They are tutorials on what exercises to do for which injuries, and they cost a little bit of money, but it’s $15, and comparing that with a massage therapist or a physical therapist or whatever, it’s super cheap. I high recommend, based on the results that other people have gotten, that you go over to selftreatment.com, or see her in Salt Lake City if you are in the area, and she can help you out with any injuries you have.

Today we are going to focus on back and neck stuff. I don’t know about you, but I definitely have neck stuff. We will talk about what kinds of injuries are common among climbers, how we get them, and how we can rehab them. So I’m just going to jump right in- here’s Esther Smith, enjoy.

Neely Quinn: Welcome back to the show Esther, thanks very much again for being with me.

Esther Smith: Thank you Neely, happy to be here again.

Neely Quinn: So before we get into it, I am sure that there are some people who are wondering about your foot thing that happened, and how you are doing. Do you want to update us?

Esther Smith: Sure, yeah, some good updates. It’s been four months since we talked, and that was right before I had surgery. Just in the last week on Monday morning, I got the hardware removed out of my foot- out of my arch. After the injury, what happened was I dislocated and fractured the bones of my arch. To reestablish the integrity of the structure, they had to put these giant screws in there to kind of connect things back together. For the last four months I’ve had these kind of bolts in there, and they had me non-weight bearing for a couple of months, and then I progressively have been able to walk a bit, leading up to getting the screws out. So yeah, this last Monday was a huge milestone to get those out, and now I basically have my foot back and am able to progressively start to walk, climb, hike, ski, bike, all those things are going to be available to me now. But for the last four months, I was in a tough place, because you know- I went from kind of 100% to 0 it felt like, in an instant, so that was super challenging personally and even professionally.

Neely Quinn: Yeah. And can you just remind us what happened?

Esther Smith: Yeah, so I was just at the climbing gym belaying my husband, and he took kind of an average fall, but without any friction or anything in the gym, I got zippered, sucked into the wall. I stuck my bare foot out and it impacted around a big, globular hold that was sticking out. My arch basically just slammed around that hold, and in that instant I experienced all that trauma. Then it took a couple of weeks to get it diagnosed and assessed as this Lisfranc fracture dislocation, which are kind of rare, and then get into surgery and get that repaired by a really good surgeon.

Lessons learned there- one I think everyone should be belaying with shoes on whether inside or outside, because if I had good footwear on, I probably wouldn’t  have dislocated or fractured. Then I was stepped reasonable away from the wall to see him on a steep route, but I could have been probably better positioned more under that first bolt, so that I didn’t get that horizontal pull so forcefully. Now I think we are going to reconsider, when we do climb together, definitely having some sort of traction device- try out that Ohm device. Then being really careful about clipping that first draw at the gym or if we are outside, just looking at those angles and vectors and thinking- you know, I never expected that that was the way I was going to get hurt climbing, standing on the ground at the gym.

It was a big surprise and I hope it can be a lesson for everybody so that nobody else has to go through this. We should probably be more respectful of that as a potential for injury, and just making sure that everybody stays safe. Just looking around, wearing shoes, and just making those calculations so we protect belayer and climber.

Neely Quinn: Yeah, it’s such a freak accident. I’m glad that you are on the mend.

Esther Smith: Yeah it was super freak. But in the end, after all this time, I’ve learned a ton and have built a lot of character, and I have a ton of empathy for people that are going through that level of disability. To lose your foot for four months basically was super challenging for me, but it’s given me new perspective, compassion, and empathy for people in similar situations. Just in general, as an injured athlete, it was pretty wild to experience the chemical changes that occur when you are getting out there, and kind of getting the fix that you are used to. Going through those lulls, and realizing that it was really just a result of imbalances because I wasn’t producing the same chemicals in my brain.

Nutritionally I sought out things that would help to build up those neurotransmitters that weren’t coming from exercise, so having things like tryptophan and tyrosine and thinking about supplements and stuff that I could take to build those neurotransmitters that I wasn’t producing through exercise. Strategizing that way, figuring out all the good things that I could do that would bring balance, that were outside of my typical athletic pursuits. It was kind of an interesting journey to experience all that, and then be able to counsel people on that moving forward.

Neely Quinn: Yeah, you learned a lot for yourself and your patients.

Esther Smith: Yeah, yeah.

Neely Quinn: Were you able to do anything training wise, or did you find any other fix that didn’t involve your foot?

Esther Smith: Yeah, I’ve been- pilates was amazing. I’ve actually- so I started this teacher training program with Streamline in Salt Lake, like a month before my foot was broken.

Neely Quinn: For pilates?

Esther Smith: For pilates, so that I could become certified in it. So I’ve been a student of pilates during this whole time, and it’s amazing how much you can do in pilates, whether its mat work or equipment work, that is resisted and even cardiovascular exercise that is awesome, and is an amazing way to stay fit and train and stay mentally balanced. You can do so much of it with one foot, or zero feet. So that was a total saving grace for me, definitely. Then when I could start to weight bear but not walk much, not run, not bike, not swim, I did start some strength training with a trainer here, and we have been doing a lot of stuff like going through lifts, intervals, and stuff that we can do. That has been awesome as well.

So yeah, between pilates and a little bit of strength training, that’s what I focused on. I didn’t any climbing specific training- a lot of people were like “You should go hangboarding and campus and get super strong”, but I usually train for climbing to climb, and climbing is still a little ways out for me. Mentally I didn’t really want to put myself in that scenario where I would be training for something that I wouldn’t really be doing, and kind of have these expectations and then not be able to have goals or performance to put towards those. I just stuck with staying away from climbing, because that’s still a little ways out, and then just focusing on other training aspects and general fitness.

Neely Quinn: Cool, it will be interesting to see how climbing goes for you, and how hard or difficult it is with your foot to get back into it. But you are going to Spain in a month, right?

Esther Smith: I am, yeah. So I’m excited about that, so I’ll see where I can get myself in the next few weeks. But again, I think it’s important as an injured athlete to just readjust your expectations and not put that stress on yourself. I think the focus, when you are injured, should be to heal, and then slowly get back to what we love and what we want to do. But it’s important for our mental health to just kind of chill a little bit on some of those things. I’m a pretty goal oriented person, so it’s been hard for me, but it’s been a good lesson.

Neely Quinn: Good, well, again I’m glad you are on the mend.

Esther Smith: Thank you.

Neely Quinn: Today we are going to be talking about back and neck stuff. We have covered a lot of body parts now. We’ve done shoulders, elbows, fingers, and wrists. Now we are gong to do back and neck. This is actually something that is kind of your specialty, right?

Esther Smith: Right, yeah. I have a ton of training in treating the spine. My certification as a mechanical diagnosis therapist- the MDT or McKenzie training- is really focused on treating the spine, back and neck pain. Then I worked in a spine clinic for the first four years out of school, and so I saw hundreds and hundreds of cases of back and neck pain, over those first four years, and then have continued to have that practice with my new practice at Grassroots. I’ve had a lot of experience kind of in the trenches working with that. It’s a passion of mine, and I really love talking about it, and I love treating it, because people have a tendency to lose hope when they have chronic neck and back pain. There is so much you can do to get people better, so I kind of want to share some of those tactics with you guys.

Neely Quinn: Yeah, and before we get into it actually, I wanted to just mention how many people have been coming to me and saying “I listened to your Esther podcast about fingers, or about elbows, and now I’m fine- my injury is gone”. I’ve probably had ten people say that to me, and then more people e-mail. So if you guys haven’t listened to those and you have elbow, finger, shoulder, whatever issues, definitely go back into the podcasts and listen to those.

Then on the topic of neck stuff, I wanted to mention that- because I’ve worked with you, and one of the things you told me for my neck issues, which I have struggled with for the last twenty years, is do to this one simple exercise. I used to crack my neck all the time, and you saw me do it one time, and you were like “Don’t do that!” [laughs].

Esther Smith: Right [laughs].

Neely Quinn: And you told me to do this simple- and maybe we can talk about the exercise where you are standing up and you put your chin in and you put your head back. I do that now, and I have no cracked my neck since that conversation.

Esther Smith: That’s awesome, that’s so good.

Neely Quinn: Which is huge, because I thought that I would have to be cracking my neck for the rest of my life, because it was so uncomfortable. That for me, gave me hope and hopefully we can do the same for some other people today. So where do we begin?

Esther Smith: Good question.

Neely Quinn: I supposed I’m the person that should be… [laughs]

Esther Smith: Yeah you’re gonna have to lead this one.

Neely Quinn: Okay, so for climbers, what is the most- because you see a lot of climbers in your practice. What are the most common injuries concerning the back and neck that you see among climbers?

Esther Smith: Well I supposed to start out with that it’s important to recognize that most neck and back injuries happen outside of trauma. It’s not a car accident, a big fall or some traumatic event. Most injuries occur for no apparent reason, and we call them insidious. They kind of sneak up on you- you can take a very fit, athletic person, and they’re just bending over to pick up a pen, and that’s when their back goes out. So I think it’s important to understand that back and neck injuries happen in this insidious fashion, and the challenging part about talking about these various injuries is that they can present in so many different ways. For instance, if you take any joint, like we’ve talked about before, whether it’s your shoulder, your elbow, your finger or your spine, there are syndromes that occur.

In the spine, the most common one that results in kind of pain, stiffness pathology, is that derangement syndrome that we’ve talked about before. We’ve talked about it in those other joints- the shoulder, the elbows, and the fingers. What happens in a derangement is that there is just displaced tissue within the joint, so it feels like stiffness, pain, lack of range of motion or you can get pain that radiates. The most common injury is derangement syndrome, by far, in the spine, whether it’s your neck or back.

The cool thing about derangements, which is probably what you had Neely, is that they respond to certain directions of motion, certain directions of therapeutic motion. So your chin tuck plus neck extension exercise was a motion that I gave you that helped to restore your range of motion. It helped decrease your stiffness and decrease your pain. You were treating your own displaced tissue, you were treating your own joint displacement. That’s what’s so cool about treating the spine- you can give people simple tools that are incredibly effective, and people are really surprised, because the spine is scary and it seems like it’s going to be this complicated thing. You’re going to have to have all this therapy and these procedures, and I’m like “Maybe you should try tucking your chin ten times, or doing these lumbar extensions”, and you can get these profound results. They’re not only profound in that instant, but they can be really lasting and restorative.

Basically what you are trying to do with these injuries, these derangements, is restore a neutral resting position of your joints, regain your range of motion or function, and decrease or abolish pain. With that comes a return of strength, too. So people often with neck injuries, back injuries, they feel weakened. They can’t perform, and maybe their neck feels super vulnerable, right? Or their low back feels vulnerable. When you address the problem at the joint itself,  your muscle engagement and recruitment in your nervous system comes back online. That’s another really cool part- you get this reboot.

So to answer your question, most common injury, if I had to classify it, we would call it a derangement problem- these displaced, off-track joints, and it can be more than one, certainly, in the neck and back. The way we wold go about that is we have to do a mechanical assessment, see what’s up, and then really get going on tailored strategies that work on people.

Neely Quinn: What’s a mechanical assessment?

Esther Smith: That’s a screening, like I did with you, where we look at your range of motion, we look at any neurologic issues. If you have a pinched nerve, which a lot of people do in their neck and back, it can present as pain that radiates in your arm or any location, if it’s neck. In the low back, it can go down to the leg and buttock and stuff. So you look at any signs that there is nerve compression, range of motion, functional tests, and then the assessment, what’s cool about it, is you start to use these repeated motions and these loading strategies and you can see how much you can change in one visit. You do test re-test. If they have these baseline problems, then you load their spine through their own motion or through manual therapy, and then you go back and you see if it changes. With derangements, that being the most common thing, they change fast- they change rapidly. You can expect pretty profound results in a session or two.

Neely Quinn: Hmm- a session or two?

Esther Smith: Yeah, yeah.

Neely Quinn: What if a person has what you were talking about- the nerve pain radiating down. Is that something that can do away really quickly?

Esther Smith: It can, it can indeed, but it gets trickier when it gets that bad. People who have pain that either radiates down their neck into their arm, or down their spine into their lower extremity, you know, it’s important that you are seen and assessed by a qualified person. You don’t want nerve compression to stick around. Nerves are really slow to heal, they get really pissed of easily. If they are really bruised or really damaged, sometimes it’s irrecoverable, and sometimes it results in persistent, lasting weakness or nerve dysfunction, and you don’t want it to get that far.

A lot of time pain starts centrally, and then as it gets worse it migrates out into the extremity. If that’s happening, you definitely want to nip that and you want to be seen by somebody and get this mechanical assessment, or start to go through your own self-treatment as such as you can. One of my goals with selftreatment.com, originally was to create videos for the neck and for the low back that help to walk somebody down that pathway a little bit, of self-assessment and self-treatment to a degree that is generalizable. Again, these injuries can be super specific and some people end up needing surgery. By and large, most people can get better with conservative management. You want to try and recognize patterns, and then kind of treat in as tailored of a fashion as possible, but there are general strategies for treating that more basic neck pain. Same with the low back, which we can talk about a little bit more.

Neely Quinn: Before we do that, I would like to go back to the extreme area of all of this. If you do have an injury or you start to get pain, which I have had a couple really bad neck injuries- one of them was from a car accident, and one of them was, like you said, from holding a phone between my ear and shoulder for a while. All of a sudden I couldn’t move my neck for two months. So in that situation, I was in so much pain, that I ended up going to the doctor, and he had me do an MRI, and then he said “I can’t do anything for you, here are some painkillers”.

Esther Smith: Yeah.

Neely Quinn: But alternatively, you could be Alex Puccio, and have nerve pain and neck stuff happening, and then you go to the hospital and they’re like “We need to get you in surgery right now”. So I guess my question is, how do you know when to go see a doctor about it?

Esther Smith: That’s a good question. If you had any trauma, if your pain or injuries are a result of trauma, you need to go see a doctor about it. You should get that screened. So that car addict episode that you had, that would be an immediate reason to get that checked out by a physician, to make sure that if you need imaging, you get any sort of fractures ruled out, that kind of hardcore injury-

Neely Quinn: Sorry, just to be clear- the second one, where he gave me the painkillers, was from having the phone in-between my ear and shoulder.

Esther Smith: The phone one- and that’s not uncommon. In that case, I think you did the right thing. You had extreme pain and limitations- you went to go see a doctor and head down that route. You knew that was probably severe enough that that felt like the right thing to do. I think people just need to be cognizant of that. When you are dealing with the spine, you should really respect it, and not let injury fester. and then get to a point where suddenly now you have this emergent problem. If you have trauma, I think that you should go see a physician, and you should look into that course of treatment where you might get imaging, et cetera.

You also have other resources going to a really skillet chiropractor who you trust and is good with mechanical assessment is an option, when you are having significant neck or back pain. Going right to a physical therapist if you have direct access in your state, I think is probably where I would go first. Then certainly your family practice physician or an orthopedic physician, those are all kind of options for immediate treatment.

Neely Quinn: I think a lot of people unfortunately balk at chiropractic. We’ve had a lot of chiropractors on the show, or having written stuff for us, and we get a lot of negative comments about them. Do you think that it is possible that a chiropractor can make something worse if they don’t know what is going on, if there hasn’t been imaging going on?

Esther Smith: Yeah, yeah, and so could a physical therapist, right? If we start putting our hands on people and we don’t have a good idea of what is going on, add force to the situation or anything like that, there is a potential for making things worse. So that’s why you gotta go to a trusted, good, qualified person that is going to do a good assessment, try to get down to the source of the problem, be super respectful of that and only apply strategies that are safe. Chiropractors can sometimes get a bad rap, because there are certain clinics or shops that you can go into, and they just crack you like you are just a part of a whole assembly factory line, right? And they aren’t necessarily doing a good evaluation and assessment of you, and that’s where things might be dangerous. But a good doctor of chiropractic work will, I think, be a good person to- and I work with a really great one here, who I send people to. Then they have the opportunity to order imaging as well, and they have the opportunity to do intervention, whereas your family practice doc, the thing that they are mostly likely going to prescribe are meds, rather than an actual physical intervention.

Neely Quinn: And what do you think about that? Doing meds?

Esther Smith: Well I think that if you are having extreme pain and you get a muscle relaxer and that helps, then that’s not a bad thing. But it’s not going to treat the reason why, you know, you have the problem. You really need to understand the problem mechanically and treat it with mechanics, not with chemicals. Chemicals will deal with the inflammation, the muscle spasm and all of that, but it’s not going to treat the mechanical problem, and neck and back injuries are mostly mechanical. That’s where a chiropractor or physical therapist is going to be awesome on your team, because they can employ those strategies.

Neely Quinn: So you probably think that physical therapy and chiropractic might go hand in hand?

Esther Smith: I do. I think it should, and I don’t think they should be in competition. I think both fields should be respected, but you have to go to people who are doing a good job, so it’s just a matter of finding those folks in your area.

Neely Quinn: Do you do dry needling? You do.

Esther Smith: I do, and that’s awesome. I use it all the time now, and dry needling taps into the neuromuscular system. It taps into what the brain is doing to the muscles, and it taps into how the muscles might be caught into this state of spasm, or trigger points. You can go right in, very specifically, and release bound tissue. You can go in and you can recruit tissue that’s kind of sleeping, or not well innervated or well activated. Dry needling is super awesome. And that brings me to another point- acupuncture and gong to see an awesome acupuncturist if you are having a bout of neck or back pain is also a great strategy. But they’re just kind of working with a different lens on than I might, if I see somebody and I employ dry needling. So an acupuncturist is also a great person to see.

Neely Quinn: So on that note, and I know we are being a little bit tangental here and I have a bunch of other questions for you- but there are some acupuncturists that don’t think that dry needling is a good idea, and/or they don’t think that people who do dry needling have enough training in it. What do you think about that?

Esther Smith: I totally respect that opinion, and I have dear friends and colleagues that are acupuncturist. I battled with taking the training, and using it as a tool in my practice, but it is such a powerful tool for a physical therapist to be able to use. I took a training that is really, really good and made sure that the training- because not all programs that teach physical therapists dry needling are the same, or I don’t think maybe a high enough caliber, or are teaching it appropriately. So we’re not trying to do acupuncture or say that we are doing acupuncture at all. We’re just using the same tool, but with a different aim, and it’s really for functional changes. I try not to step on their toes, or to really be on their turf, and just use the needle as a tool to direct change at the neuromuscular system. It’s awesome for us to be able to use it, and I think that if we can all kind of work together and share these tools, just like a chiropractor might use exercise, right? But they’re not a physical therapist. If they are doing that well, and the are using it as a tool, I don’t really have a problem with that.

I think there is a safety issue with dry needling, right? And we want enough training to be very, very safe so that we aren’t causing problems. I think that under certain educational school, we’ll get that. And then just making sure that we aren’t saying that we are doing acupuncture. Acupuncturists go to school for four years plus, and I was able to do dry needling in a total of eight days of training or less. It’s a completely different thing, so we just have to be respectful of that.

Neely Quinn: Well is there any way to know if your physical therapist or whoever is doing dry needling is properly qualified?

Esther Smith: That’s a good question. You can ask what program they were trained under, and I was trained under KinetaCore. I think that you can expect that if you asked the therapist if they were trained with KinetaCore that you can expect really good, effective care. I can’t speak to the other trainings to say that they are not good enough, you know what I mean? But you can look for one that is trained by KinetaCore. And I think just word of mouth is the most powerful thing. Talk to people, see who is there in your area who is doing good work, and try to go that PT that everybody else has had good success with. That’s probably the safest bet.

Neely Quinn: Yeah. Okay. I’m going to switch gears here, because we have a lot of questions to get to. Tell me about why a healthy spine is going to help a climber be a better climber, in general, and then we will go from there.

Esther Smith: Okay. So your spine is the center of you- it’s your central column. We call it your axial skeleton- so your skull, your neck, your ribcage, your spine, your low back, and your pelvis. Everything we do as climbers comes from the center, right? Our arms and our legs are attached to this axial skeleton. If we don’t respect our spine and produce a really healthy and maintain a really healthy spine, then I think we are going to be more vulnerable to injuries out in our extremities. Having a really healthy neck sets us up for a healthy shoulder and arm. Having a healthy low back sets us up for healthy hips, SI joints, and legs. Since we depend on these powerful extremities to move us, we have to reference our spine as being the foundation and center of all of that. And it’s at our spine that our core attaches- all of that amazing musculature where we are able to produce all of this power, upward lift, and suspension- it comes from the core being strong and healthy, and that comes from the spine being strong and healthy.

Sometimes I worry that we don’t give enough credit to the spine, and if we do, if we aim our attention there and we look at optimal alignment, function, and organization of our central trunk, we can produce better performance and better efficiency on the wall as climbers.

Neely Quinn: Okay. So lets talk about maybe shoulder stuff, because we can start at the top and maybe go to the bottom. How could your neck affect your shoulder or spine?

Esther Smith: Well if you imagine your anatomy- you have the neck and upper back, which is really where our ribcage starts, and so that is our thoracic spine. Our shoulders live on our ribcage, starting on that joint that is formed with our scapula on our ribcage, called the scapula thoracic joint. That is really how our arm attaches to us, right? It’s the scapular on our back, and then this tiny little collar bone that attaches to the front of our sternum. If we don’t have a healthy set up there, at the cervical spine and the thoracic spine, then it’s going to absolutely effect the connection of our shoulder to our trunk.

Also, neck issues can manifest as shoulder pain. A lot of times we get people in here who are like “My shoulder hurts, it hurts by my scapula, it hurts in my elbow, and my hand or wrist”, or any place down the arm, and it’s actually a neck problem. It’s not a local problem that they thought it was, it’s just that that’s where the pain is showing up. So often when people come in with a shoulder complaint, we look at the neck, we do that mechanical assessment, and we uncover that at least part, if not all, of their issue is stemming from that centerpiece, that spine, whether it’s the cervical or thoracic.

So the other thing is that the strength of our shoulder and arm comes from the organization of that connection of our arm to our trunk. When we do all of these antagonist exercises, rotator cuff strengthening exercises, we are really in a sense creating that optimal connection between spine and arm. I just don’t think that we reference it back centrally enough. Climbers, with the posture that we generally have, being kind of that forward head and a little bit hunched forward posture- that affects our spine negatively at that upper back-neck connection. That postural set up and our alignment there as climbers, in general, sets us up for those pain syndromes out into the shoulder and out into the arm.

The more that we can trace back and say “Look, if we start centrally and we stack up really well and we get rid of any derangement problems, displaced, maligned issues at the joints of our spine, then we are going to have healthier shoulders, healthier arms. And another thing is that we don’t really strengthen our neck much, but it’s important to have strong local neck muscles to support that part of our spine, because we are dealing with this really heavy head- this bowling ball on a little pedestal. Then as climbers we are in these steep positions all the time, we are looking up, we’re belaying, and we are having this bowling ball interact against us, with and against gravity. It’s also super important as climbers that if we are talking about strengthening, and doing antagonist exercises, and if you’re having shoulder problems and arm problems and neck problems, you need to look at actually just isolated strengthening of the neck too. Those are muscles that nobody really thinks about.

We created a video called “The Healthy Neck”, and a half hour of that is local neck strengthening that is super awesome, and important for climbers to recognize that if you are having nay of these upper extremity issues, that you should trace it back, and you should maybe take a look at this Healthy Neck video, or work with somebody in your local area where they can start to identify these imbalances. It’s pretty profound the changes you can get throughout the whole upper quarter.

Neely Quinn: Can you give me a couple exercises that, in general, might benefit people’s necks?

Esther Smith: Yeah, so the one that you started with Neely, and you were kind of wanting me to reference. You’re standing or sitting, and you sit really tall, or you stand really tall, and you try to have this really nice, organized, stacked, vertical posture. What you did with your neck to begin with, is you just slid your head back, and you tucked your chin straight back- like you were sliding your head back on a shelf or little ramp. That’s called cervical retraction, or a chin tuck. If you can imagine, as a population, how we kind of have this forward head and that hunched forward posture, just doing those little repeated chin slides back  is one exercise that most people can benefit from. It helps to realign and stretch and mobilize that really stiff junction area, where our upper back ends and our upper neck begins.

Chin tucks are great, but not for everybody. If you are having certain issues, chin tucks can actually be aggravating. It’s a little hard to be super general, but that retraction chin tuck is awesome, and people coulee be right now sitting or driving or whatever, and you just kind of press your head back into the head rest. Do that ten or fifteen times, it’s strengthening, mobilizing, and can be very relieving of pain.

Neely Quinn: Okay.

Esther Smith: So that’s one. And then simple, little neck strengthening exercises. The simplest thing you can do that starts to strengthen your deep neck flexors, is to lie on your back- you can have your knees bent and your feet just on the ground and laying flat with nothing underneath your head, and literally just having your head be flush- or your face- perpendicular with the ceiling- or parallel to, sorry. Just barely lift your head up off the floor, like a piece of paper is being slid underneath your head, and you just hold it there for ten seconds, with just a little bit of a chin down orientation. Just those little head lifts, without letting your chin pop up towards the ceiling, are really, really good. You’ll feel all this work in your deep neck, and the front of your deep neck, and that’s an awesome thing to start strengthening for climbers as well.

Neely Quinn: Yeah because one of the reasons I don’t like climbing on super steep stuff is because all of these neck issues. It seems like that would strengthen my neck in order to be able to do steeper stuff.

Esther Smith: Exactly, yeah. A lot of people with neck problems have a lot of vulnerability feeling, where they don’t want to look up, right? Like you said, you don’t want to throw that bowling ball back behind you because it causes pain or stiffness. If that’s going on, then something is happening where all of that range of motion should be available to you. Maybe you do some chin tucks, and then you retest your comfort with looking up, and you see if if you can get more extension, more of that range of motion established through doing some of those retraction chin tucks.

Then another piece of that is, I don’t feel strong enough, or I feel vulnerable, or my neck feels weak. Lay down on the ground, do those tiny little head lifts, ten second holds, and you’ll start to develop some good strength in those neck flexors. Usually it’s a combination of mobilizing and clearing any kind of stiffness restrictions in your range, and then strengthening right around that part of you anatomy. We don’t know these exercises that well, right? So they’re a little bit foreign to us. We know how to do some stuff for our shoulder or whatever, but the neck is a little more obscure. That’s where that Healthy Neck video is pretty awesome, because we go through a whole routine, and it’s really awesome.

But, in general, those are kind of some simple ones. Then for people with neck pain, usually there is a strong connection feeling tension all the way down form your neck to your shoulder, right? Like upper trap tension, where you’re always kind of like “My neck is sore and tight”. So doing shoulder mobilizing exercises, where you are moving your shoulder blades on your ribcage, loosening your upper trap, loosening those big muscle connections from neck to shoulder, are great as well. A lot of the stuff that I have given you already for other things, like the shoulder stuff from our first podcast- that can actually be really helpful for the neck. So people can cycle through those floor angels, pec stretching and lat stretching, and waves of stretching the upper trap and mobilizing that joint of the scapular thoracic. Those can be super helpful at relieving neck tension.

Neely Quinn: Okay, it seems like there are a lot of things that people can do in order to avoid neck tension. For instance, my friend, she just started training again for climbing and she started doing Is Ys and Ts, which are fairly common shoulder exercises as we all know. She was doing them incorrectly, so she was using a lot of trap and neck muscles to get the weights up, and she started having neck pain and tension headaches. Can you talk a little bit about proper form?

Esther Smith: Yeah, and that’s in that video I have. It’s a free video on YouTube which shows me working with Brittany Griffith doing the Is Ys and Ts. She says in the video “I feel it all in my upper trap”. So that’s super common, and part of that is because that’s the muscle we are used to using to raise our arm. We need to change our strategy when we are in that position, like laying on our tummy and doing those over a ball or over a bench, doing those Ts Ys Is, or whether we are standing and doing them. We need to use other muscles that help to lift our arm up against either just gravity, or if we have weights in our hands, and start to access the ones almost under our armpit more than on top of our shoulder.

To decrease the upper trap tension, you want to think about your shoulder blade doing this upward spin on your upper back. It almost does this down into your back pockets, plus swoops wide and around, and that helps to raise your arm in a way that doesn’t recruit the upper trap so much. I think it’s important, what you have to figure out, is what other muscles can I use that I’m not currently using?

Neely Quinn: Right.

Esther Smith: And access those. It’s hard- it’s a super hard thing for me to even teach with somebody here for me to get them. I’ll literally be tapping their underarm- there is a muscle called your serratus anterior that does a lot of that upwards swoop of the shoulder blade. That is super important to recruit. Your middle and lower traps are the muscles that you want to focus on feeling being used when you are doing the T Y Is. It’s kind of like you just have to position yourself, take weight off, and maybe start to do them in less of a position against gravity. Maybe you just practice doing them standing or seated, with no weight, and then you slowly will be able to go onto your tummy, where gravity will be more of a force against you- still no weight. Then when you are really good and not feeling any trap tension, then maybe add a couple of pounds to you hands, but there really shouldn’t be a lot of resistance in those exercises, because your upper trap will want to do all the work.

Neely Quinn: Yeah. In my shoulder rehab a lot of my exercises- well they are shoulder exercises- but a lot of the time I was just using my trap to get my arm up. I do most of my exercises in front of a mirror-

Esther Smith: Yeah that’s great.

Neely Quinn: That really helped a lot and I think it could benefit all of us honestly.

Esther Smith: And that’s the number one thing I’m teaching people. When they come in with neck and shoulder issues, or just shoulder or just neck, is changing our muscle recruitment. It’s the same for when you want to do a proper pull-up. You don’t want to do that from the top of your shoulder- you want to do it from these strong under arm muscles, your lat, and these guys that really support the shoulder blade on the back. It’s just part of what we’ve done culturally or something, where we have this dominance of our upper trap. Doing it in front of a mirror and starting to do these exercises to change our motor programming. You don’t have to add weight for that, you can be very low resistance and start to change the pattern versus trying to get strong fast.

Neely Quinn: Yeah. So I want to make time for the mid back and lower back too. Do you want to talk any about the mid back?

Esther Smith: The mid back, yeah. It’s less frequent that people have issues there, because it’s a very rigid part of our spine so derangements occur less. People do come in with ribs that are out, and certainly come in with their thoracic spine being off. I think with the thoracic spine, the main thing there for climbers is that we don’t want to get too stiff there. Stiffness and that severe, cage like presentation of that in some of us can lead to shoulder problems, and can lead to issues locally there. Then our posture, in general, facilitates our spine being more curved, hunchback style. You don’t want that steepening curve of our mid back. All those things we just talked about- the strengthening for the under arm zone, your rotator cuff, and those scapular stabilizers, mid to lower trap rhomboids, all of that is really really nice for maintaining a healthy thoracic spine.

Then doing things like all of the shoulder mobilizer exercises, whether it’s foam rolling in and around that area, and just kind of creating some dynamic suppleness about that area, that’s probably the most important thing to maintain a healthy thoracic spine. And then just really watching our posture, making sure that we aren’t hanging out, belaying, and then sitting in alignment that compromises us. Having that tall, vertical, stacked alignment is really important.

Neely Quinn: You probably think that belay glasses are good?

Esther Smith: Yeah, they’re excellent. Super, super good. We are lucky to have had somebody figure that out for us.

Neely Quinn: I know right?

Esther Smith: It’s saving a lot of people. I use them all the time, it’s so much better. And we are climbing steeper and steeper, so they’re becoming more important right? Before maybe climbing didn’t really go there, but not these long routes that are super steep, and the poor belayer having to look up all that time. So yeah, they’re great.

Neely Quinn: I honestly wouldn’t be climbing if I didn’t have them, because it hurts my neck so much. No I just wouldn’t be belaying, actually, which would suck for my partners [laughs]. One other thing I wanted to mention about the mid back- I actually worked with Jared Vagy also, and he told me to lay on the ground, on my back, and to keep my upper back sort of flush with the floor- like stuck to the floor basically- and then just raise my arm up over my head, and to keep my back stuck to the ground. He said that would help with loosening up that upper back. What do you think about that?

Esther Smith: Yeah, and did you feel a big stretch in your lat and under arm when you did that?

Neely Quinn: Yeah, I mean it was hard to do.

Esther Smith: Yeah it’s super hard. What ends up happening if we don’t have that parameter of keeping our ribs stuck to the ground is they will just pop up with us. So if you keep them down and then raise your arm over head, you are really asking your lat in particular to be long and stretchy and mobile. That muscle goes across our whole back, and is a powerful muscle at our shoulder. I think that’s an excellent exercise. Basically, like I said, if you can free up your shoulder, free up your neck, free up those connections of shoulder blade on back, it’s going to help your thoracic spine. Helping your thoracic spine is going to help your neck big time. So the stiffer we are there, the more curved and hunched, the worse we are at our neck and shoulder. Exercises where you are doing windmill, swoopy motions with your arm, twists, wringing out of that area, or like you were doing, laying on your back and going arms over your head and stretching those big muscles that are short and tight, that’s a great avenue.

Neely Quinn: Okay. What about core exercises? It seems like a lot of times we are strengthening to front of our core area, but not the back. Is that true, and what should we do about that?

Esther Smith: We should strengthen circumferentially. Our core, if you really think about it, is our entire trunk. It’s everything that our arms and legs attach to, including our hip muscles and our buttock muscles. We can’t just think of it as being our abs, and if you think about the low back and the core, it’s the muscles that form our abdominal wall. The reason it’s so important to be strong all the way around that is because our lumbar spine sits in the middle of that, and it sits in the middle of a heavy, rigid pelvis, and a heavy, rigid ribcage. Then you just have this pedestal of your lumbar spine, right? The only thing that really decompresses that and keeps that protected is a healthy, strong core all the way around. If you’re really dominant, short, and kind of crunchy, you know? Meaning you strengthen in ways that are constantly doing sit ups and crunches, that way- you’re not appreciating the fact that you need to create lift and decompression all the way around. Thinking about doing exercises that strengthen the muscles on the back of the spine, and the sides- your obliques and your transverses abdominis, and then of course the rectus, the six pack muscle in the front, but then also think of your core as being those shoulder stabilizer muscles. The lats, the middle trap, the rhomboids, all the way up to the shoulder and then even those glutes.

Climbers are often quite weak in their glutes and their hips, and that is part of our core too. The more we can be strong in those muscles, like our powerful hip extensors, the more powerful we are going to be on the wall. It’s so much more than just our six pack and just the front of our core, it has to be 360.

Neely Quinn: So if you were training somebody and you wanted to train the back of their core and their upper core- all around their core- what are some exercises that they can do?

Esther Smith: Well first of all, Pilates in general. That is what it’s all about. Joseph Pilates called that area the powerhouse, and so Pilates is all about strengthening that all the way around, and then connecting your core to your limbs, so that you move from center. Easy things that people can do, and we’ve all heard about, is simply planks, right? So you can do a plank facing down, you can do planks facing on each side, and you can even do versions of planks where you are face up. If you did one thing- they’ve done studies for the biggest bang for your buck core strengthening exercises, planks are actually really, really great, and they are simple. What’s also kind of cool about them is that they are done in neutral. You’re not bending, crunching in any one way. You’re just maintaining a neutral spine and strengthening around it.

That’s kind of a bit of the essence of our core- it helps to organize us and keep our containers of our trunk organized, lifted, and then from that trunk our arms and legs can function really well. A lot of core exercises you’ll see that it’s the trunk, you want to maintain neutral. If you’re on your hands and knees, and you do that one arm lift one leg lift- the opposite sides. Have you done that one, called bird-dog?

Neely Quinn: Mhm, yup.

Esther Smith: That’s a really popular core strengthening exercise that gets those back muscles. It’s excellent, actually, for the little paraspinal muscles, and then your glutes and everything. That’s a big bang for your buck one too. Just on your hands and knees, find a neutral table top position with your spine, and then raise one arm out and the opposite leg back behind you, and try to image that you’re not tipping a glass of water if it was on your tailbone. You’ll find that a lot of core exercises keep your spine in neutral and then you do something fancy with your arms and your legs, and you use the weight of your arms and your legs to be your resistance, and it’s enough. People get a lot of benefit out of that, and it’s plenty of work. When you are strengthening your core it’s more infrequent that you need to load it a lot, there is so much you can do just at body weight.

Neely Quinn: So what if people have pain and they are trying to do these things, in their upper, middle or lower back? What are some guidelines?

Esther Smith: You have to get that pain addressed. I think that’s what I want to have the message be, is that for these insidious, no apparent reason injuries outside of trauma, most of the time that pain can be abolished if you can figure out the right tools and strategies. Just like you said, people have called in and said “I don’t have pain or problems anymore after listening to the podcast or checking out these videos”. It’s because most often, it can be simple strategies and people can get better. Neck and back pain, sometimes it seems like people really let that go chronic, and they just think it’s part of them, or they’ve been told they have arthritis or whatever. Even still, more often than not, people can have complete resolution.

I’d say if you have pain, you want to try and seek and destroy that, and then strengthen. People come and they have low back pain and they’re like “I need to do core strengthening exercises”, but they hurt. So I say “We need to get the pain gone”. Usually that’s where that mechanical assessment comes in, and we find strategies that are meant to change their symptoms, and then strengthening is kind of phase two.

Neely Quinn: Okay.

Esther Smith: Because if you have pain Neely, you’re muscles aren’t going to be strong in that area. They will be inhibited to some extent, and they’re not at their appropriate length-tension relationship, so they’re just going to be weaker. Until you deal with that pain signal, and likely the problem more locally at the muscle or the joint, you’re not going to really accomplish much by trying to strengthen.

Neely Quinn: It seems like a lot of people have pain because they are weak in some area. Is that not true?

Esther Smith: Yeah, it’s a little chicken or egg on that question. I agree, yeah, but why are they weak? I would say they’re weak because the central nervous system has a problem with the region. Usually the central nervous system is on alert because there is a mechanical problem. There is restriction, compression or obstruction, and usually that’s happening at the joint center, whether it’s your shoulder, finger, elbow, or spine. You have to figure out the motion segment problem, the joint problem, and get the nervous system on your side again for you to regain your strength.

If somebody has pain, and they are weak, and I just try to strengthen them, usually that does not work. We have to figure out why the pain is there, and usually the pain is there not because they’re weak, but weakness is a symptom- another symptom in addition to pain.

Neely Quinn: What do- okay.

Yeah.

Neely Quinn: I get it.

Esther Smith: You gotta get to the source. Pain is a signal, so what is pain trying to tell you? Sometimes, yeah, sometimes it’s weakness. But by and large, something isn’t aligned, something mechanically isn’t right, and that’s your feeling. If you take a normal finger right now, and you bend it back too far, you can create pain, right? If I held that on there for a month, your finger is probably going to start to feel weak, right? And hurt. But what if the solution was to take the load off? One, if I just left go of your finger after a month of holding it back too far, you’re going to have relief, and your strength will return. But if I didn’t take the load off, and I tried to strengthen your finger, it’s not going to help right? So what we have to do is unload. It’s under abnormal stress, and so we have to figure out what is that mechanical stress? What’s the load? And then take that load off and relieve that, and then you get relief of symptoms, and your strength gets better, and we have the opportunity to get strength gains rather than be inhibited by the brain and that area being malfunctioning.

Neely Quinn: So how many people do you think have low back pain or general back pain, or pain in general, everywhere, from sitting all the time?

Esther Smith: Oh man, it’s the thing that causes most of our problems in the spine. If you look at risk factors for neck pain, sitting at heavy lifting are the two biggest ones. And then yeah, in the low back absolutely. As a sitting culture, we are not doing ourselves any favors to our spine. One of my number one things that I always go over and that always really does help people is alignment education. Getting people out of chairs, or if they have to be in a chair, supporting them with really good lumbar support. Getting them stacked up appropriately, or getting them into standing desks and standing work stations, which I think you’ve made a change on, haven’t you?

Neely Quinn: Yeah I’m standing right now [laughs].

Esther Smith: Nice. We gotta get out of sitting. For the low back, sitting is an aggravator for a lot of people, so correcting your sitting posture, limiting sitting, and then doing things that address why sitting is problematic. If you take your spine and you kind of slouch it in a seated position all the time, if you think about your discs and the soft tissue in you lumbar spine as being jelly donuts, you’re basically taking a jelly donut between your hands and just low grade, low load squishing that jelly donut out, right? That’s what can happen for people who sit in poor posture. You get this kind of displacement of tissue over time, and then you go to pick up the pen and your back goes out. But really, it was all those little taxes and micro stresses that led up to that event that we call fatigue failure.

Esther Smith: Sitting is such a big deal, because we do it for a long time, and we do it every day, and it’s repeated and it’s low load, and we are just kind of creating these derangements or displacements just based on how we are loading ourselves. It’s not unlike bending your finger back too far, it’s kind of that type of stress on the spine. And it goes right up the chain all the way to the neck.

Neely Quinn: That’s what I was going to ask- what kinds of injuries or pain can come from sitting all the time?

Esther Smith: I would say it’s that derangement problem. You displace your own tissue inside your joints. Whether it’s the disc tissue or your ligaments, things are under stress and strain and we repeat it all the time. Those are the mechanisms for the start of injury. It’s way less about what we are doing climbing and more what we are doing when we are sitting at the crag, sitting in the car, or sitting at work. If we corrected that and we stop doing the negative things, then we have to a lot less therapy, you know what I mean? You can correct and prevent these injuries in your spine, just by respecting your alignment. You want to maintain those beautiful, neutral curves of your spine- the S curve that we have. It’s meant to function like a spring, and be able to endure compression, decompression, and that spring gives us lift and suspension. If we blow out those curves and we shape ourselves like this rounded C, then we’ve destroyed our internal system.

That’s what people don’t appreciate- we were built and designed in a certain way, and that is the way we best function. It’s almost like all of my work is to just get people back to that- back to neutral, and then strengthen them in neutral, and have them function in that neutral, respected position. That’s how they get back.

Neely Quinn: So I know that when I sit down and work for a while, my shoulders are way more painful than if I stand and work. Do you think that people could expect to see elbow issue, finger issues, or knee issues if they are sitting all the time?

Esther Smith: Yeah, it goes up and down, for sure. And it’s translated and expressed in our extremities. That might come from something going on right at the neck that is irritated, and then it shows up as elbow pain. Or your shoulders are painful as a result of maybe your neck position, or simply your shoulder position. Posture and alignment is absolutely the foundation of a healthy spine. We do similar positions a lot- we spend a lot of time in flexion, rounding, bending forward. A lot of times that becomes an aggravator for us in multiple places. For a lot of these therapeutic motions, like the chin tuck for instance- that’s moving you back in the opposite direction a bunch. You end up doing therapy that move you away from what we typically do.

Then in the low back, we call that a directional preference. You might have directions of aggravation. Some people are worse with sitting, or standing, or laying down. They’re worse when they bend, or they’re worse when they extend. What’s cool about understanding your directions of aggravation is that to get better, you have to understand your directions of preference. A lot of times they’re the opposite directions of the ones that make you worse. For the videos that we’ve done for the lumbar spine, we have one that is low back extension, and low back flexion. We get people better by moving them in their direction of preference, whether that is a lot of arching back bending, or a lot of bending and flexing. You can kind of- we made these trailers to help identify which one works for you.

If you go see a McKenzie physical therapist, they are going to be examining that. The thing about the direction preference is that probably 70% of people with low back pain respond positively to extension, which is like cobra, up dog, or back bending. If you think about it, the huge percentage of our population, we don’t go into that motion very much. We are often in the other direction- bent, stooped, flexed. The one that gets most people better is the opposite, is extension. Literally 70ish percent of people respond to that, and same with the lower neck, same with the shoulder, same with almost any joint. If you move joints into extension or straightening out of bending, it helps them.

Neely Quinn: So low back, let’s touch on it a little bit more. I’m standing here, and my low back hurts right now. So are you saying that if I were to do a few sets of cobra or something a day, that might help?

Esther Smith: You could try it, yeah. Jus test it. Literally just get down on the floor, do your up dog cobra or back extensions, stand back up, and see if it feels better. What you are doing with extensions is potentially taking ht load off that finger analogy, right? You’re making it feel better by reducing the displacement, reducing the mechanical stress or strain. The cool thing about it is that you can be your own body mechanic, and you can kind of do your own self-assessment. Try different motions a few times, ten fifteen times, and then retest whatever was painful and see if it’s better. That’s the idea with some of this mechanical testing we do, and with directional preferences. We try to prove whether it actually changes your symptoms and your mechanics. You could certainly do that.

The low back is complicated because you have the lumbar spine, but you also have the pelvic arrangement. You have your SI joints and your hip, and all of that kind of core muscular support. There is a lot of things that can happen there. And for anybody, again, with any radiating pain or numbness or tingling or weakness in the leg, they need to be seen by somebody and probably get imaging to make sure there isn’t any sever nerve compression. That could be permanent and devastating. But for the most part, even if you have that and you see the right person, you can get better, conservatively. It’s a complicated area, but it doesn’t have to be an area that is a complete mystery. There is very recognized patterns that are super treatable, and one of those patterns is the idea of directions preference and loading preference through flexion or extension. That is well described in the videos that we did.

For a healthy low back, you need to try to really create that suspension of that vulnerable lumbar spine that lives between the ribcage and the pelvis, by having a really strong core all the way around, and by having really strong, healthy, well functioning hips too. As climbers, you can imagine a lot of us are kind of stiff and tight in our hips, and that really drags our spine into the mess. A ton of what I do with climbers who have low back pain, is to try to get their leg moving super well, so that when for instance, they bend their knee to their chest, their back doesn’t crumble and go under tension or stress.  It’s like you need all these hinges in our body to work independently and then interdependently amongst each other really well, to have that pain-free situation.

Neely Quinn: What do you mean you get their legs to work really well, what does that mean?

Esther Smith: Well, it’s strengthening through the glute musculature, through that posterior line, we’re often quite dominant, short and tight through our quads, through the front of us, and our soaz. What we need access to is our back line- those spinal erector muscles, and the hip extensors, hamstrings, glutes, and our side hip muscles. What I find is if people kind of have that slumpy, hunchy posture, it’s really hard for them tome their legs well without having back pain or stiffness. You want a clean motion through the hip femur, so that every time you go to move your leg, throwing it up on a hold, high stepping, hiking or anything, that you aren’t negatively affecting your spine. The spine kind of lives in this neutral happy place, and then your limbs move around it really well. That sets you up for a healthy low back.

Neely Quinn: It seems like if you have low back pain, it would probably behoove you to go see somebody like you, that can look at you and know what to do, before you start going and lifting heavy things or something.

Esther Smith: Yeah, it’s super important. And first you need to address the pain, and it’s super helpful to have a guide in that journey. Essentially I work as a translator, you know? I see things different and I am educated in a way that I can understand what pain is trying to tell somebody, and I can help to guide them to abolish that. It’s a hard thing to do on your own, but it’s not impossible if you start with simple strategies like changing your posture, having optimal alignment, doing really good, whole body strengthening, core strengthening, but not having it be with a bunch of weights. Like I said, it could be low resistance, just bodyweight stuff. You kind of establish this decompression suspension system within yourself. You are going to feel better. It’s a challenging area- there is a lot of moving parts and pieces and a lot to look at.

We created a video for a healthy low back, we did one on flexion and extension, so there’s three. We have one for a healthy hip as well, healthy neck, healthy shoulder. We tried to chunk out these regions so that people can invest in a region at a time, and kind of get to know that part of their body. They can understand how it’s meant to work, maybe what they are doing that’s not so great, take away those negative taxes- those things you are doing every day all during the day that make you worse. Then do a handful of things to make you better. Often that is the recipe.

Neely Quinn: Okay last question is about people who- I’m sure that a lot of people right now are, maybe not at work, maybe they are listening to this at work. But if they are at work, I have a feeling that they are probably sitting. A lot of people don’t work at companies who are offering standing desks, and it’s just not an option. First of all, I’m assuming that you do recommend a standing desk, but if people can’t do that, what should they do?

Esther Smith: They should try to get up every thirty minutes and stand and walk for a second, or do some little- have a couple of little balls around your desk, or a little foam thing, and do a cat stretch, roll your foot out, do something to change your position. Sitting is the most inactive, dead thing we can do and it’s not good for any part of our body. The more you can just change your position and do something to liven up your system and activate, that’s super good. If they are sitting, get a really good chair. I recommend a ninety degree, straight up chair, and then a really good lumbar roll behind you.

Neely Quinn: What was the lumbar roll you had me get, what was it called?

Esther Smith: It’s called a McKenzie lumbar roll, and you can order those on amazon, or a bunch of places. McKenzie lumbar roll, that’s the training I’ve done, and they make great lumbar rolls. They make neck pillows too and stuff like that. So supporting yourself because it’s hard to maintain a really good posture- when we are left to our own devices, we kind of slump out of that. Just put something back there, prop yourself up, and make that really supportive. Then when you are not at work, you have options. Don’t go sit slouched in your car, don’t go sit slouched at home or at the crag. Instead, when you have these options, do something different every other part of your day, and do some good restorative exercises. Whether it’s laying down and doing those cobras that feels really good, doing a couple of planks, the bird-dog, whatever. Just mix it up and get out of those routine, sustained, negative positions.

Neely Quinn: Okay. I think we covered everything that I wanted to cover. Is there anything else you want to get out there?

Esther Smith: Um, no I think we did a pretty good job. I just want to have people feel encouraged and hopeful when they are having neck and back pain. Seek out good people in your area, seek out resources online. Do your own tinkering and your own self-assessment, and try to get to the bottom of it. Try to understand what is the load, what are the forces that are making me worse, and what are the things that feel really good? When you find the things that feel really good, do them frequently, and avoid those aggravators. Respect the shape of our spine, and the fact that we have this awesome design, and we have machinery, and the machinery is meant to be used in a certain way- it’s meant to be used in the most aligned way. You can imagine what happens when the wheels of your car are out of alignment, what that does to every other part. The same is true for our body, and so when we stack up from the center and we move from center, we are going to have a healthier center, healthier spine, but we are also going to have healthier extremities. We will function and perform better because we will have this powerhouse we can generate from.

I liked the question you asked about the core strengthening, and even the antagonist work. Let’s get to our back body, let’s strengthen all those muscles that we aren’t used to using. Pilates is a great way to do that, for sure, and you’ll see changes in your performance and hopefully feel better, obviously as a priority.

Neely Quinn: Okay last actual question- how often should people be doing this exercises, or if they are doing Pilates, how often should they be doing it?

Esther Smith: I mean seriously, you could do a little of that every single day. It’s not the heavy load, so you’re not overloading yourself. Mobilizing, stretching, activating, that kind of work can be done every day. I’d say that at a minimum, two to three days a week, you’re kind of tuning into your body, getting inside yourself, and doing some things to kind of restore that neutral position and that balance. Ideally that happens a little every day, but you can certainly do a little program two to three times a week.

Neely Quinn: And where can people find you?

Esther Smith: At Grassroots Physical Therapy in Salt Lake, online at selftreatment.com for all those videos that we have, we have a lot of free stuff on there. And referring back to some of the podcasts that we have done already, would be really helpful if people haven’t listened to those. Feel free to- people reach out to me, I don’t do distance consultations because I can only practice within the state that I am licensed, but I am happy to answer questions to a certain extent if people have them. I think that good resources for people whoa re having neck and back pain would be to go to McKenzie Institute online and find a provider in their area that is MDT certified, and try to build your own healing network in your community. If you don’t have that, then these online resources that we created are meant to at least be a supplement to that.

Neely Quinn: Alright, and I will put links to all of that in show notes so you can find all these great resources. Thanks so much Esther, we really appreciate all your knowledge and wisdom, and the fact that you are really well spoken- thank you.

Esther Smith: You’re welcome Neely, it’s been a total pleasure. Thanks for giving me a bit of a platform for sharing this information, it’s been really fun.

Neely Quinn: Alright, we’ll talk to you next time.

Esther Smith: Thanks.

Neely Quinn: I hope you enjoyed that interview with Esther Smith. Like I said, we are going to continue down the body and do more interviews about knees, hips, and ankles. If there is any body part that we are missing, just let us know and we will try to do an interview on it.

So coming up, other than that one the podcast, I’ll be in Norway starting next week for about three and half weeks, so you’ll be hearing from me there on the podcast. Also follow along with my trip on Instagram at @trainingbeta, and on Facebook at TrainingBeta. Hopefully we will put some good photos and videos up there. As always, if you need help with your training and you’re not dealing with an injury right now, we have all kinds of training programs over at trainingbeta.com, and there is a link up at the top that just says training programs, and there is a ton of them in there. Check those out, hopefully they will make you stronger, and hopefully Esther will make you less painful and less injured. Thanks so much for listening al the way to the end, I’ll talk to you next time.


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