While we have all heard about someone who hurt their back due to lifting something too heavy, like a deadlift in the gym, or moving furniture in the home and like to blame that last movement as the reason for the injury. This is very rarely the underlying cause. For how do you explain the person who blows the discs in their lower back out from lifting a pencil off the floor, or tying their shoelaces? Most back pain episodes are the result of everyday activities, postures, sports movements, anything involving repetition and small to moderate forces. The little habits we think nothing of that create muscle imbalance, postural deviations, weakness, and ultimately compensatory movement are the root cause of pain. In this article, I will explain in great detail what some of these daily habits we think nothing of are, and how they contribute to ruin our movement and spinal health.
The Safest Position for the Spine is in Neutral
Before we discuss anything about posture, changing habits, and corrective exercises it is important to understand what the safest position for the spine actually is. Some people believe that the spine needs to be kept flexible with Yoga and stretching, whereas others believe it needs stiffness with core exercises like planks and Pilates. Many people attempt to correct problems like anterior pelvic tilt with flattening of the spine in the belief it is protecting their back from damage. Unfortunately, many of these beliefs often lead to creating more problems than they solve, for they forget the golden rule of spinal health which is to keep the spine in the safest place of all. That position is neutral.
This is the healthiest position for the spine to function and where it is in its least stressed position from compressive forces and allows for fluid, efficient movement. In Dr Stuart McGill’s book “Low Back Disorders” they tested several positions of the spine to determine if this was true and his conclusion was neutral was the safest position. The worst position was extreme flexion.
This neutral position is what you should be aiming to achieve with most daily movements to build a strong and healthy spine. This is even more important when we exercise or complete an activity that forces load onto our spine as the compressive forces on the discs and joints is amplified. Your posture and movement strategies determine the load and stress on your joints. The closer you are to a neutral posture, the less stress on your joints and the healthier your body will be.
In addition to compression is shearing forces, which is more accurately described as instability. This is when joints move excessively and begin to create friction and rub against cartilage and other soft tissue causing pain and inflammation. This leads to joint stiffness in an attempt to protect the joint from further damage. Once again finding a way to hold the joints in neutral is the solution for this. This was confirmed by researchers Cholewicki and Panjabi found that limitations in spinal stability led to muscular compensations, fatigue, and pain. They also found that spinal instabilities resulted in degenerative changes due to muscle-activation strategies that are easily disrupted due to the compensation. Reference: Cholewicki J, Panjabi MM. A stabilizing function of trunk flexor-extensor muscles around a neutral spine posture.
This is contrary to many popular beliefs that the spine needs to be more flexible and will benefit from Yoga, Pilates, and stretching. The thoracic spine will benefit greatly from mobilizing and stretching for mobility is its main purpose, however, the lumbar spine will suffer greatly if you apply this type of thinking for its main purpose is the exact opposite. To provide stability. It is also important to understand that it is stability and “good stiffness” that you are looking for with the lumbar spine and not strength.
A classic example of a popular exercise used in Pilates for spinal health is the “roll-up”. Here is Dr Stuart McGill’s thoughts on this exercise.
“This movement is essentially a sit-up that involves segmentally rolling through each joint of the spine. Our science has justified avoiding sit-ups as part of routine for a healthy spine and the roll-up takes a bad exercise and makes it worse. The exaggerated fashion puts and emphasis on moving through the spine, putting unnecessary load and strain on the discs. The real goal should be to minimize spinal movement and instead use our hips as primary centres for motion. This philosophy will allow the back pain to settle.”
Watch the videos below to see more on this.
While it is great to work on your mobility and flexibility we must aim to improve the joints that require this. In the case of spinal health the two common areas that are deficient in mobility are the thoracic region and the hips. With a more targeted approach and individualising your exercise efforts you can easily select Yoga or Pilates exercises that will benefit your body as opposed to creating more damage.
The goal of any exercise program is to become strong and efficient at moving in this neutral position. If you think about any functional exercise you will find that the best place to be is in neutral. From running, to squats, to push-ups and pull-ups, every exercise you can think of will move most efficiently if you can maintain a neutral posture. What exactly is the neutral posture or what is often referred to as ideal posture.
In ideal posture, a line extending down the side of the body should run through the ear lobe, transect the shoulder, hip and knee joints and fall just in front of the ankle bone.
You can read more about posture in these articles.
Now that we know that neutral is the safest place to be and that poor posture causes all sorts of problems. What are the things that we need to be aware of that lead us to developing poor postures in the first place?
Hurtful Habits
The most important thing you can ever do for improving spinal health is becoming aware of the many subconscious movements you make during the day that lead to potential problems. The best way to change a habit that is causing pain is to replace it with a healthy one. Unfortunately, most people do not even know they are moving in unnatural ways to begin with, yet alone be able to change them! What you will find is some things will be quite easy to identify and change, whereas others will take much more time and effort.
Technology has provided many great things for modern living that makes our lives easier, but one could argue it has almost gone too far and made life so easy and made us lazy. Years ago a lot of time and money was spent with ergonomic workstations to eliminate postural problems created from sitting behind computers. Unfortunately, many people rarely work behind workstations these days as the flexibility of lap-tops, tablets, IPAD’s, and mobile phones have changed the way we work. Mobile phones in particular are a real concern with the amount of time people spend looking down at the phone is considerable. Recent estimates showed that at least 77% of the world's population has their own mobile phone and many studies have been conducted to study the correlation between using mobile phones for texting and both, neck and shoulder pain. See journal results for more information on this.
You do not need to be a scientist to see that repeatedly sitting or standing for long periods in the positions shown below is going to create problems in the future.
The sooner you can recognize these habits are destructive, the better. The good news is that sometimes changing one habit can automatically change a few others. For faster results I like to focus on the one that is of most importance first for this is the one that will regularly change a few others at the same time. For example, the sleeping position is a big one to change for we know we are going to do this for 8 hours every day. Adopting a new and improved sleeping position will not only prevent further damage but will also allow the body to heal itself more quickly.
If you are in pain this is even more important and urgent to get right. For success with any rehabilitation program requires removing the cause. If you fail to do this, you will just end up where you started. As much as removing pain is important, there is no point to leaving the cause of the pain unchecked.
Leading back pain researcher Stuart McGill refers to this as "picking the scab". This is a great analogy to use to explain why so many people never respond well to their treatment, even when the treatment or exercise program is exactly the right thing to do. Any good work achieved from the treatment is instantly erased the minute they get home or go to work they move exactly the same way that created the injury in the first place.
Even rest can become a problem for the back pain sufferer and funnily enough it could even be a big part of the problem! Rest is a good thing for most injuries as it allows the body the opportunity to heal itself. However you can have too much of a good thing when it comes to back pain. Lying in bed for too long can make matters much worse and many people will often feel worse first thing in the morning.
The reason this happens is the discs in the back re-hydrate overnight by filling up with a concentrated protein that is a water-like substance. This is how our discs receive their nutrition to remain in good health. When this happens they swell to a larger size which is fine for someone with good spinal mechanics and position. But it is bad news for someone whose spine is not in optimal alignment as these larger discs now pose problems and makes movement very stiff and awkward until the discs reduce back to their normal size.
Add a poor sleeping position that places the spine in a twisted and unstable position and you have the perfect recipe for more pain. This is something that is often missed in the treatment stage and where so much time and effort saved by identifying poor movements we think nothing of. It is critical that you identify the poor movement strategies and postures you move in as early as possible for you to achieve any long term success with your back pain treatment.
You can read more about this in the articles below.
- Bulging disc exercises and long term treatment strategies
- Back pain treatment is all about learning to move correctly
Okay, so we are aware of the need to identify and change bad habits. What are these various habits we need to be aware of?
1: Slouching While Sitting
Many of us are aware of the dangers to the spine from lifting things poorly, but what is not common knowledge is the damage to our spine and discs from sitting. The spine is a strong, durable and yet flexible structure designed not only to transmit force but also allow a whole heap of movements in all planes of motion.
However, when the amount of these forces exceed the spine’s capability to withstand being squashed by various postures we repetitively adopt, or the dysfunctional way that we move, you will find pain is not far away. Bulging disc injuries are extremely common and affect people of all ages.
Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This places your spinal joints and nerves under pain-causing pressure.
You can see how the slouched sitting position places 275kg of pressure into the discs! This is much more stress than bending over. Make sure you read the article - How much compression on the spine is caused by sitting to see the full breakdown of various positions.
The slouching posture encourages tight abdominal muscles that lead to stiff thoracic region and a weakened lumbar spine. As the abdominal musculature become progressively shorter and tight, the following postural aberrations may be seen:
- Short and tight upper abdominal musculature.
- Depressed sternum.
- Forward head posture which increases the chance of neck pain and a shoulder injury not to mention the poor breathing resulting from this position.
- Increased thoracic kyphosis, (a hump on the upper back).
It is easy to fall into the trap of slouching and as it becomes a habit we do not even realize what we are doing. The biggest mistake I see is where people fall into a POSTERIOR TILT of the pelvis where the butt rolls underneath and they round out their spine. This leads to what is known as “BUTT GRIPPING” and can become a very serious chronic condition that can be very hard to get rid of.
The very first thing you need to do is move your butt back into the corner of the chair and ANTERIORLY TILT your pelvis so you can maintain an optimal position of the spine and hip. Some people may find this very tiring as the muscles required to do this may be very weak. Using a lumbar roll to sit in the curve of your spine may be very useful here as well as taking breaks by standing up or even kneeling on the floor every 10 minutes to give your muscles a rest.
Watch the video below of how to do this. The second video to the right provides you with a basic office workout to use.
Another great way to combat this is to minimize how much you sit and use a stand-up desk! There has been several studies have been completed as to the effectiveness on these desks with back pain. One study participants have reported up to a 32% improvement in lower back pain after several weeks of using standing desks. Another study published by the CDC found that use of a sit-stand desk reduced upper back and neck pain by 54% after just 4 weeks. Additionally, removal of the sit-stand desks reversed some of those improvements within a 2-week period.
If you do need to sit down for work make sure you have a good workstation set-up. You will find a comprehensive workstation set up featured in this article - Move more and sit less
Before moving on from slouching we also need to recognize the danger of slouching during walking. Once again this is an activity we think nothing of in terms of creating damage and the habit of how we walk could be contributing to problems in our body.
I covered this last year in a detailed article about the value of walking for back pain. In that article I explained how Dr Stuart McGill made note of how poorly Americans tend to walk.
Firstly, he notes that Americans tend to have a poor postural head down approach to walking, as opposed to the Russians who had a chest out and stand tall approach. The Americans tend to lead with their head placing them in a constant falling forward position that has potential to place significant load on the lower back. Over time, a bad habit of this poor “spinal stacking” can lead to serious issues and contribute to the kyphosis posture and over time the dowagers hump.
The Russians on the other hand tend to have a taller more stacked approach to their gait cycle. This helps with proper “spinal stacking” and enable them to use the core more effectively stabilise the pelvis and spine.
I could also include loss of balance, poor vision, and the fear of falling as a reason for people walking with a slouched posture. This is more common with older adults who have lost significant muscle strength and their fear of falling forces them to look at the ground when they walk. However, we must be careful to ignore that some of these problems begin when people are in their 40’s and evolve over time. If we recognise these problems early enough you can use exercise to prevent the rapid decay of their movement and posture.
You can read more about this in the article – Prevent falls with older adults using reflex stability exercise
I think we have well and truly covered slouching let’s look at the next problem.
2: Sleeping Position
Getting a good night’s sleep is vital to the health of the body but especially the neck and jaw. We need quality sleep to repair all the damaged tissue and is also the time the body completes the digestive process. Without a good night sleep we have little chance of improving overall health.
The best position to sleep is actually on your back.
Sleeping on your back allows your spine and muscles to lengthen and prevent these problems. You will need to use a small pillow or even a specific pillow to support the neck as a large pillow will force you into forward head posture again. While this is definitely the best position to sleep in it can be very difficult for some people to adopt and snoring can be a real problem. In this case your best bet is to adopt slide sleeping but you need to be aware of a few dangers here too.
I always thought the best way to sleep was on your side, but this can also create problems for people by twisting their spine and hips and even force their neck out of alignment as you can see clearly in the picture below. If you do like to sleep on your side make sure you place a pillow between your legs and try to switch sides to avoid repetitive stress. Another notable drawback to sleeping on your side is that it can increase your risk of shoulder pain. Whether you’re on your left or right side, the corresponding shoulder can collapse into the mattress as well as up toward your neck, creating misalignment and pain the next morning. If you currently have a shoulder problem you will know exactly what I mean. A firm mattress and pillow can help alleviate this risk, as well as keeping your head straight in line with your shoulders.
Here is a few tips to help you out.
- Lie down on a medium-firm mattress, using one firm pillow underneath your head.
- Shift over to your left side first. Your ears should be in line with your shoulders, while your chin is neutral. Avoid tucking your chin into your chest or keeping your head down.
- Keep your arms and hands below your face and neck, preferably parallel to the sides.
- Put a firm pillow between your knees (especially if you have low back pain). This helps prevent the collapse of hip and knee joints, thereby creating better alignment in your spine.
- Slightly lift your knees up toward your chest to reduce pressure on your back.
The worst position to sleep in is on your stomach. If you sleep on your stomach now PLEASE STOP! This is a disaster to your body when it is asleep as it is supposed to relax.
During sleep the muscles and ligaments are not instructed not to hold and protect the spine as much as when you are awake, and as a result of this are more vulnerable to excessive strain from poor sleeping positions. Leaving your head and neck in a strained position for hours on end while your body is relaxed is a guaranteed recipe for pain.
I tended to sleep on my stomach a lot and I knew it was not good for me but I had never had any trouble before so I did not worry about it too much. How wrong I was for it was after a night of sleeping like that I ended up with my jaw locked and months of TMJ muscle spasms. This position forces your neck into extreme rotation and places extreme pressure on the jaw and neck easily irritating the joints and muscles. This is an absolute no-no for anyone with jaw or neck pain.
It is impossible for me to advise exactly which position is best for you as we are all so different. If you think your sleeping position is a problem and want to know more about it I suggest to get the book "Sitting on The Job" by Scott Donkin. There is an entire chapter devoted to the sleeping position with many great tips and ideas to help you find what works for your body.
3: Bending Poorly
This is another topic I have covered many times on my website and with You Tube videos for it is something I come across every day. Poor bending actions are associated with bulging discs where we see someone constantly flexing their spine instead of using their hips. Sometimes occupations requiring constant bending contribute to this problem, but it is not the occupation, it is how you bend that is the problem. If it was the occupation then 100% of the people in this job would have a bulging disc. There is no problem with bending if you use your hips and maintain a neutral lumbar curve. Problems arise when you use your spine to do the bending.
In this example the bending movement pattern is the “pain trigger” as Dr Stuart McGill likes to call it. Identifying and changing this pain trigger is the most important part of the corrective program for it allows the body to avoid the very thing causing the pain and begin the process of healing itself. It also allows for you to apply mobilizing and strengthening methods without compensation taking over.
The danger of injury to your lower back or hip with poor form in the bending action is extremely high. To give you an idea of how important learning to move correctly with this movement pattern is, take a look at the rate of back pain in these statistics.
- In 2009 1 in 7 Australians (13.6%) reported having serious back problems—that’s 3 million people!
- Over 2 in 5 people with back problems (44%) have difficulty in tasks and activities associated with mobility, communication or self-care
- 1st according to the Global Burden of Disease estimates, low back pain is ranked 1st in Australasia (including Australia and New Zealand), compared to 6th in the world
Without a doubt the Romanian Deadlift is one of the best exercises you can learn to prevent back pain and is the number one exercise I teach to people of all ages. Whether you are a keen sporting athlete, someone recovering from injury, or even an 80 year old looking to maintain quality of life, this exercise provides amazing benefits and is something we use every day in life.
In the rehab field the RDL is often referred to as a hip-hinge as it requires very little knee movement but a large degree of hip movement. Anyone working with lower limb injuries will know how much influence the hips have with these injuries, and often tightness with the hip flexors and weakness with the hip extensors is a big part of the problem.
People with a limited bending movement pattern that also appear to lack the ability to touch their toes will commonly bend forward from the thoracic spine instead of the hips. They sacrifice any stability of the lumbar spine and flex right over in order to perform the bending movement. Usually the segment they flex over is L4-L5 which funnily enough is the most common area for herniated discs! This part of the spine should be stable and rigid throughout the action of bending with all of the moving components being the hip muscles. This is often where people like to blame tight hamstrings for the inability to bend over, but in this is a protective mechanism. In this case the hamstrings are acting like a parking brake to prevent further flexion of the spine. This explains why the hamstring flexibility never improves no matter how much stretching they do.
To see more about this check out the article – Back pain myths busted as I wrote an entire chapter about this.
How to Do the Romanian Deadlift
The knee will be flexed about 20 degrees at the bottom of the movement and the tibia must remain vertical during the lift. The objective of this movement is to sit back as far as possible with the hips and maintain a neutral lumbar curve and perfect stability with your body. The most important part here is to maintain the natural curve of the lumbar spine by keeping an anterior tilt of the pelvis. Again critical for anyone who has back pain.
Instructions:
- Position the kettlebell on the floor between your legs so that you cannot see your shins in a mirror from the side.
- Standing with feet a comfortable width apart. Reach down keeping the natural arch in your low back, and neck tucked and grab the kettlebell maintaining good posture.
- Inhale and engage your core before you begin to stand to the top position, exhaling when at the top and gently rolling your shoulder down and scapula apart.
- At the top repeat the inhaling process before lowering to the ground.
Additional articles to read with more information about bending movement and deadlifts are shown below.
- Why Romanian Deadlifts are the key to treating back and hip injury
- How to find the right Deadlift variation for your body
- Deadlift tips to prevent back pain
- How to improve hip mobility
The FREE REPORT shown below is an excellent resource to help you with this if you are unsure of how to implement the deadlift into your training.
4: Crossing Your Legs
I won’t spend too long on this subject as we covered the damage of sitting already, however this type of sitting is something that is a habit many people undertake that does require looking into. It is not so much the crossing of the leg that is the problem, it is more the fact that we regularly use the same leg to do this. Subconsciously we develop a habit of crossing the same leg over the other, which over time leads to a muscular imbalance, or asymmetry. It is this asymmetry that is the real concern as this very often leads to problems like lateral pelvic tilt and scoliosis.
You may eventually experience hip, low back, or sacroiliac joint pain as the glutes and hips become dysfunctional. Asymmetries between the left and right are predictive of future injuries because they cause us to compensate for weakness, tightness, or limited range when we’re active. In this example, crossing our leg knee over knee causes the inner thigh muscles (adductors) to contract while the outer hip muscles (abductors) are lengthened. The hip joint is also in a flexed position while it crosses the body’s midline, placing increased stress on the joint. The simple solution is to not cross the legs but if you have to, alternate between left and right.
In a detailed study by NCBI about the effects of sitting cross legged on the lower back. The study compared the differences in trunk flexion angle in two different sitting postures in subjects with and without nonspecific chronic LBP. The results indicated that there was a significant difference between the two groups in the change in trunk flexion angle according to posture. In cross-legged sitting, the trunk flexion angle of the LBP group was significantly reduced compared to the control group, which means that the posture of the LBP group during cross-legged sitting was more slumped.
Researchers concluded that cross-legged sitting leads to a bent and asymmetrical posture and its effect was found to be more pronounced in patients with lower back pain.
This brings me to the next problem which is also linked to asymmetry and that is footwear.
5: Poor Footwear & Weak Feet
You might be thinking what does footwear have to do with spinal problems? More than you realize. With over 100 various muscles, the feet and ankles encompass 15-20% of all the muscles in the body!
Our feet and ankles are meant to withstand incredibly high forces and should provide more in terms of shock absorption than perhaps any other body part. Unfortunately, we begin to gradually lose this ability once we start wearing shoes. Over time, the feet, ankles, and toes become inhibited. And as we expose our feet to some trendy shoes with all types of padding and support, this only make matters worse and exacerbates the lazy and weak feet muscles.
Besides minimizing the ability to withstand intense ground reactive forces, the body gradually begins sending fewer and fewer signals to the feet, leading to distortions in pro-prioception and loss of innervation all the way up the kinetic chain. This is where injuries are born!
Our feet are designed to do 2 critical things.
- ABSORB shock and then.
- Provide the ability to stabilize and PUSH off the ground when we walk, run or jump.
The foot needs to act like a spring being soft flexible foot to cushion the stress of each step we make, and then instantly become stiff enough to provide enough power to move us forwards or upwards. This is also known as being able to lock the foot at one point and then being able to unlock the foot at the very next part of the movement. Problems arise if we lose either one of these two things, and ultimately lose our spring as our body will be forced to compensate.
Over pronation is a very common problem today and is easily seen when a person is standing barefoot. If one arch is lower than the foot of the other side and the foot is slightly splayed outwards you can safely assume they are over-pronating. Sometimes both feet may do this but usually one side is worse than the other.
Take a look at the picture below of what happens to the pelvis and the spine as a result of poor foot stability.
This foot is basically very unstable, has become over stretched along the bottom of the foot that now makes it almost impossible to become a rigid lever to create the "spring" and release energy. When the pelvis is not maintained in a square and level position the body compensates by shifting the hip of the supporting leg out to the side, rotating the lower limb inwards, forcing the opposing side of the shoulder to collapse. The body will be always want to maintain an erect head position with eyes level and will sacrifice anything in order to achieve this.
Foot instability will always result in gluteal weakness, due to the inability of the glutes to fire from the dysfunctional positioning and alignment. The glute medius in particular is vital for maintaining stability in the single leg stance but it will be severely impaired by compensation of other muscles like the adductors. And when this happens is when the gait cycle is disrupted.
What causes weak feet?
Poor footwear is the main reason or should I say wearing shoes too often! Most shoes place us in elevated heels and create short tight calves with rigid ankles and weaken our feet.
Female high heel shoes which are great for fashion, but terrible for the body do some very destructive things.
If the body were rigid a two-inch heel would displace it 22.5 degrees forward, while the four inch heel would displace it 45 degrees forward. Because the head and eyes must always remain level for reasons of posture and balance the body has to make adjustments at other joints to maintain this. The forward leaning creates compensation at all joints above the foot! Postural problems from these shoes are seen below.
Flip flops (thongs as they are known in Australia) are even worse as they completely change our gait cycle and require “toe gripping” to keep them on while you walk. Constantly wearing this footwear is a fast way to develop foot problems that eventually lead their way up the kinetic chain.
Now this does not mean you can never wear high heels or flip flops ever again. It means you need to be aware of how often you wear them and you will also need to spend time trying to strengthen the feet. Years ago we moved around a lot more than we do now and possibly spent a lot of time barefoot developing the stability and strength into our feet. We would never have needed to implement foot stability drills back then. Unfortunately this is another example of how the modern world has made us lazy that now requires us to do exercises or we will pay a big price.
Watch the videos below about foot stability to see how you can do this.
You will find tons of information about this in the article below.
- Exercise solutions for weak feet
- How the big toe influences stability and movement
- How the Sensa mat improves foot stability
Do You Need More Help?
There obviously is a lot more things to consider and if you are someone suffering with back pain, neck pain, or shoulder pain I would encourage you to get it diagnosed by a qualified health therapist. There is some great programs below you can you instantly download that provide you with all of our assessments and corrective exercises to restore your body back to good health. Click the image below of the program you require.
Summary
I hope you have enjoyed reading this article and I have been able to educate you as to how the little things we think little of can sometimes be the big thing we need to change. Maintaining good health with our spine is very important to living a life free of pain and limitation and becoming aware to the potential dangers from repetitive habits in our daily life can make all the difference. If you are in pain right now these little habits could be the one thing holding you back from finding a solution to your pain. If you are an active sports person these repetitive habits could be compromising your sporting performance. Start paying attention to these over the day and see often you adopt a poor position. The first part in changing a bad habit is recognizing when you are doing it.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.
If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
- The Vital Glutes - By John Gibbons
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek
- Twist Conditioning Sports Strength - By Peter Twist
- Twist Conditioning Sports Movement - By Peter Twist
- Functional Training For Sports - By Mike Boyle