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You Should’ve Listened To Your Mother!

December 12, 2012

Greater than 80% of the population will experience low back pain (LBP) at least once in their lives.  The number one predictor of LBP is a previous episode, meaning; once you experience LBP you are 4-5 times more likely to have a recurrence.  As back pain becomes more frequent, episodes can last longer and intensity of episodes can increase as well.  Taking a proactive approach to episodic LBP will help decrease your risk for injury and decrease the need for medical expenses such as medication, doctors’ visits, etc.

Proper sitting posture is typically a position that most of us don’t EVER attain.  One big reason is the type of surfaces in which we sit and the amount of sitting that we do.  For example, soft sofas, recliners, desk chairs, car seats, plane seats, etc. tend to encourage a slouched sitting posture.  Flexion activities or movements in which you bend forward at the waist increase pressure on the lumbar discs by 85%.  Slouched sitting IS a forward bending activity.  So if you are sitting at a computer all day in a slouched position, you are creating a significant amount of force on the discs of the spine.   Below are pictures that depict how forward bending/slouched sitting affect the biomechanics of the lumbar intervertebral discs.

On the left, properly aligned vertebrae evenly distribute the pressure on the intervertebral disc. On the right, slouching leads to squeezing of the front side of the disc and stretching of the back side, which could lead to tearing, rupture, or a herniated disc. Thanks to Donald Corenman, MD for this image.

Posture can be a large component of low back pain.  And as you may think, proper sitting posture is very difficult to maintain.   Poor posture over time may cause structures in the spine to be irritated or damaged.  Frequent standing and walking and can help mitigate these effects.  But if you are sitting, maintaining proper sitting posture is essential.  If you are reading this and have low back pain, sit up straight and arch your back a little so that you are sitting on the bones at the base of your pelvis.  50% or more of you will experience a reduction in pain.  You now have the power to effectively reduce your own pain!  You have control!

Poor Posture Proper Posture

Without a doubt, correcting posture is the most difficult activity for my patients to do.  With this in mind, I use the Level Belt to encourage correct sitting posture and also to remind my patients when their posture has deteriorated.  Because let’s face it, we lose focus on our posture when we are focusing our attention on something else and we go right back to that slouch, slumped posture that has become our “normal” sitting position.

Too much arch

Too much arch

Just right

Just right

Too much slouch

Too much slouch

I use the Level Belt with my patients to 1. Educate them on what neutral sitting posture is, and 2. Provide continual feedback to help them maintain neutral posture, thus ultimately reducing their pain.  And from the patient’s point of view, it’s something that they can do independently. This is the first step in starting to take control of your pain.  The Level Belt is a great tool to assist you in your pursuit of a pain-free status.   And most importantly, not having to rely on someone or something to “fix” your painful back is a very empowering experience.

Kristy High Pottkotter, PT, SCS, Cert MDT
Wexner Medical Center at The Ohio State University
Special thanks to Kristy Pottkotter for being this week’s guest columnist.


Western riding with the Level Belt

December 5, 2012

Those of you who ride Western, the Level Belt can help you too! A few weeks ago we blogged about using the Level Belt for dressage training and posted a couple of videos on our YouTube page. Now we’ve done it again with a friend riding Western!

A few features that you riders and trainers out there might find useful:

  • Sue can get immediate feedback when she slouches too much (high tone in the video) or arches her back too much (low tone in the video). Getting high tones for arching the back instead is as simple as flipping the belt over so the iPhone/iPod’s Home button is on the other side.
  • Biofeedback can be started and stopped at any time using a standard plug-in headphone with remote built in to the cord, so you don’t have to reach back and tap the button or have someone else walk up and tap it
  • When combined with a bluetooth external speaker such as the HMDX Audio HX-P230RD JAM Bluetooth Wireless Speaker (available in lots of colors) you can either get louder feedback without wearing headphones, or the trainer can listen to the feedback even as the rider and horse walk away. Isn’t that cool?

Riders and trainers, please let us know how you are using it to enhance learning of proper posture during horseback riding!

-Ajit Chaudhari, Perfect Practice

Dressage: Equestrian Training with the Level Belt

November 8, 2012

Last week I had the opportunity to visit and observe Jodie McKenzie (no relation), a local Dressage equine instructor at Mac Meadow Farm here in central Ohio. Jodie had heard of the Level Belt and was interested in trying it on herself and to help her clients.

Dressage dates back more than 2000 years ago as a style of horseback riding. First used by the Greeks in preparation for war, its benefits included free flowing movement between the rider and the horse promoting mobility and agility. Two qualities found very beneficial when attacking and evading enemies.

Today dressage has evolved into a popular equestrian sport featured in Olympic, professional and amateur ranks.

According to Jodie, “all work in dressage should be free, light, and aesthetically beautiful to the observer.” To help achieve this, the rider most have great postural awareness and control while resolving undue muscle tension to more easily “receive” and follow their horse. Muscle tension is the main culprit causing extraneous movement in the rider, resulting in significant point reductions in dressage competition.

With Jodie and her horse Angus’s approval, we applied the Level Belt to Jodie’s low back and started our evaluation.

Jodie began by actively engaging and relaxing her trunk and posture muscles. As anticipated, the Level Belt sounded appropriately with each posture change. It was obvious that the concept of pelvic tilt was nothing new to Jodie. According to her, this concept is one of the most necessary to learn in the equestrian world. While this is a desired concept, most students struggle with learning and understanding of how to move and control the lumbo-pelvic spine. Jodie concurred that this is often an issue which requires regular reinforcement during her training sessions.

The Level Belt was found to be very effective during both the walk and trot activities, sounding with appropriate biofeedback when good postural control was lost.

Jodie also offered an additional insight specific to riding that we have not noticed with other activities. She noticed that when she applied over-tension through her legs, something she has been working on reducing to improve her own dressage skills, she would also receive a biofeedback tone from the Level Belt alerting her to the riding error and promoting her correction.

As with the other activities we have featured and will feature in the future on our blog, good posture can really help with performance and injury prevention, and the Level Belt can help you learn to avoid poor habits affecting postural tone and neuromuscular coordination.

I encourage you to become aware of your own posture and muscle strategies, allowing you to get out of your own way and begin moving less restricted and more efficiently.
I would like to thank Jodie and Angus of Mac Meadow Farm for their time and contribution to this blog.

-Chris McKenzie, PT, AT, SCS

Training Core Stability During Dynamic Movement

September 18, 2012

Whether an athlete is getting ready for baseball, golf, basketball, hockey, figure skating or any other athletic activity, our goal is always to make that athlete as capable as possible during dynamic movements at game speed. But how does one accomplish this? Over the past several years, I have often been asked how it’s possible to train pelvic stabilization during dynamic activities such as throwing, swinging and hitting. Should we focus on getting the entire dynamic activity “correct” all at once or break it down into sub-components. And if we should break it down, what is an effective way to do it?

The first step to training pelvic stabilization or trunk control during dynamic skills is to be successful in performing controlled postures and drills. Using the correct muscles to stabilize and control the trunk is essential to applying their potential to more dynamic activities. For this reason the exercise progressions I’ve developed around the Level Belt biofeedback technology begin with controlled postures and advance into more functional postures.

In a supine position, raise and lower medicine ball while maintaining pelvic control with biofeedback on pelvic position from the Level Belt app


Toss medicine ball back and forth while sitting on a physioball, maintaining pelvic positional control

Unstable Sitting

Toss medicine ball back and forth while maintaining pelvic positional control using the Level Belt


Training pelvic stabilization during high-level dynamic activities requires one to break down the activity into its more segmental parts. By training control of the pelvis under the spine during the segmental components of the dynamic movement, the user learns what stability feels like. This newly learned stability can then be applied to the dynamic movement as a whole.

Before Perfect Practice developed the Level Belt technology, we either watched our clients with our own eyes, asked them to watch themselves in a mirror, or recorded video to play back. There are other products out there like a motion capture laboratory, but that takes too much time, is too expensive, and oftentimes just isn’t available. And the other clinical products out there just didn’t allow us to get our clients into sitting or standing positions. Now, with the Level Belt, we are not limited to supine exercises on a table, “standing” exercises pressed up against a wall, or 3D motion capture in a laboratory—we can get the biofeedback we need in the clinic or out on the field.

Focus on core stability and pelvic control during one phase of the movement at a time

Golf: working on takeaway

Challenge trunk control with increasing weight while maintaining proper posture

Pitching: rotate pelvis without tipping

Adding an unstable surface and multiple distractions make the pelvic control task even more challenging

Basketball: maintain control with multiple challenges and distractions

So how do we use the Level Belt for a pitcher?  We train trunk stability in the cocking phase, the acceleration phase, release phase and follow through phase in each of their individual postures.  We utilize tools such as Therabands®, med ball throws, BodyBlades® and manual resistance to challenge the trunk’s stability during upper extremity activities.

Release phase with a BodyBlade--focus on maintaining pelvic control while shaking blade

Maintain pelvic control during shoulder exercise

Biofeedback from the Level Belt helps pitcher maintain pelvic position during ball tosses

Once the client is successful at minimizing errors in trunk control at one level we select the next more challenging level available on the Level Belt app, enhancing the user’s motor learning. Enhanced stability at the trunk results in improved performance and reduced risk of injury. These benefits extend beyond the trunk to the upper and lower extremities as well.

See how the Level Belt will benefit your clients and please share your feedback and videos with other Level Belt users via the Perfect Practice web site and Facebook page!

Chris McKenzie PT, SCS, AT, CSCS;

Get moving (the right way) to beat Low Back Pain

September 4, 2012

Since starting my career as a physical therapist, some 20+ years ago, I have always been amazed at some of the accommodations we as humans take to remain operational in life. There is no injury, pain or dysfunction that cannot be compensated for.  But these compensations often result in additional issues we must deal with even after the immediate limitation is resolved.

Thankfully, most primary injuries are resolved quickly allowing us to return to our previous level of function, but one particular area of the body is not as fortunate—the low back. Musculoskeletal injuries (muscle joint ligament and tendons) typically result in inflammation swelling and pain. After initial care is performed to protect the injured site, early motion is typically prescribed as the next important step for recovery and return to full activity. The use of casts, splints and immobilization braces are being replaced by stationary bikes, continuous passive motion units, and therapist assisted movement, as early as immediately post injury and post operatively. Scientific evidence supports early motion as a benefit to healing, improved blood supply and reduction of unwanted scar tissue. Despite this evidence, injuries to the low back continue to receive prescriptions of bed rest, splinting and bracing. While low back injuries require their acute status to be resolved first, as with all musculoskeletal injuries, patients with low back injuries are far more likely not to break free of that limited movement pattern—resulting in future re-injury, chronic pain, and chronic dysfunction.

Low back pain is the second leading cause of patient visits to their primary healthcare provider, behind only the common cold. Costing more than $86 billion in the US alone, low back pain continues to grow as a leading cause of work loss and productivity expense. According to the National Institutes of Health, in a three month period one quarter of all US adults will suffer at least one day of low back pain. With these facts and growing statistics it is apparent that our current methods of prevention and resolution of low back pain are far from successful.

While I certainly would not suggest that all low back pain can be resolved by simply increasing the amount of motion, an increased emphasis on (proper) movement may provide big gains in avoiding the long-term dysfunction, compensations and disability that too often result from low back pain.

The low back and pelvis provide a unique connection between the lower extremities, trunk and upper extremities. Through coordinated movement the low back and pelvis provide the necessary posture and stability to sit, walk, run and perform almost every functional activity we do. Research now links the trunk not only to performance but prevention of injuries involving both the upper and lower extremities. No longer can we assume that low back pain only affects the back. We must appreciate the true dysfunction low back pain can have on the entire body.

Anterior Tilt Neutral Tilt Posterior Tilt

Once you understand the encompassing role of the lumbo-pelvic spine, one can appreciate the need for maintaining and developing the ability to position and stabilize movement around it and through it. It is for this reason that Perfect Practice was established. We are dedicated to creating tools that enable the patient to learn and improve lumbo-pelvic mobility and stability. Utilizing common technology and scientifically proven findings, Perfect Practice will teach you how to reengage the neuromotor control needed to move the lumbo-pelvic complex through its full range of motion. Once you have achieved your essential lumbo-pelvic mobility, Perfect Practice will use the same technology to guide you through a progressive trunk stabilization program to enhance your daily function by reducing unwanted stress to your low back structures.

–Chris McKenzie, PT, AT, SCS

What is core stability?

August 26, 2012

This article originally appeared in the German web site in August, 2011.

Scientific evidence for core stability in sport injury prevention

By Ajit M.W. Chaudhari, PhD

Anecdotal data throughout the scientific literature and popular press advocate for improved core stability for injury treatment and preventionof conditions involving the lower extremity as well as low back and upper extremity. However, these interventions are generally assembled using the conservative approach of including every exercise that might provide some benefit. Rigorous scientific studies have not yet been performed to establish evidence-based criteria for the inclusion or exclusion of core stability exercises.

What is “Core”?

The “core” is a vague term that nevertheless has been widely used to describe some portion of the body extending approximately from mid-thigh to mid-chest, including the joints of the lower thoracic and lumbar spine and the hip joints as well as the muscles that induce movements about these joints. Some researchers have focused on the muscles crossing the hip because of their role in pelvic stabilization. These muscles also act as prime movers of the lower extremity. Other researchers have focused on the trunk muscles, those that cross the lumbar spine to generate movement of the upper torso, because of their role in the etiology of low back pain. These muscles may also influence the forces acting on the lower extremity by stabilizing the torso over the pelvis.

What is “Stability”?

“Stability” can be defined as the ability of a system to return to its original position or state in response to an internal or external perturbation. A stable athlete can hold his/her position or continue on the same path towards a goal even when bumped by an opposing player, while an unstable athlete may be thrown off course or knocked into a position where injury can occur. It is extremely important when considering the role of stability that it is not the same as stiffness or strength. Just as a tightrope walker needs to make rapid adjustments to maintain her position on the tightrope, the ability to make these rapid adjustments is as important as being strong for an athlete to maintain stability.

How could core stability prevent sport injury?

Most musculoskeletal sport injuries occur due to excessive forces being applied to at-risk structures. These excessive forces can occur acutely to cause frank rupture, such as in an anterior cruciate ligament (ACL) injury, or they can occur chronically at a level that is just high enough to cause micro-damage that accumulates over time, such as in a tibial stress fracture. For the lower extremity in particular, much of the force experienced is a consequence of the relatively large mass and momentum of the torso. A lack of core stability could therefore potentially lead to situations where the torso leans outside the base of support, increasing forces on the lower extremity. In throwing motions, energy is generated first in the legs, then transmitted across the core to the throwing arm. In this case, a lack of core stability might prevent this energy transmission, potentially leading the thrower to compensate by excessively using his shoulder muscles to generate the desired velocity of the ball. While these theories have not been rigorously proven, they have served as the impetus for the panoply of proposed exercises and equipment to build the strength of the core muscles.

What evidence exists for core stability in sport injury prevention?

Very few rigorous scientific studies have established the role of improved core stability in sport injury prevention. Two recent studies performed at Yale University on intercollegiate athletes investigated deficits in trunk proprioception and trunk neuromuscular control following sudden perturbations, and found that each of these deficits were associated with two to three times greater likelihood of developing a subsequent knee injury across all sports. Other research studies performed in the United States, Canada, Germany and Norway have identified several successful ACL injury prevention programs that include core stability exercises, but it remains unknown whether the core stability component of these programs provides any benefit. In a recently completed study by our group at The Ohio State University, commonly prescribed trunk stabilization exercises including prone and side plank, supine bridge, lunge, and abdominal curl exercises had no effect on core stability or lower extremity joint forces, although they did improve core strength and endurance. These exercises were not as dynamic nor did they include external perturbations to the athlete like the successful ACL injury prevention programs do, which suggests that dynamic movement and perturbation may be necessary elements to improve core stability.


In spite of the wide array of exercise regimens proposed and equipment available for improving core stability in the scientific literature, popular press, and marketplace, the evidence does not exist to make a recommendation to include or exclude core stability exercises in sport injury prevention. Future rigorous evaluation of the efficacy of these existing programs and equipment, including tracking injury rates, will be necessary to determine whether improving core stability provides protection against sport injury.