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In a groundbreaking departure from conventional medical wisdom and past practice, the American College of Physicians released new guidelines for the treatment of chronic back pain, including a recommendation of proper exercise before turning to medication, as reported by the online news site Vox.

As part of these new guidelines the American College of Physicians also strongly discourages opioids - such as morphine, oxycodone, and fentanyl - in treating chonic back pain, as these drugs are only modestly effective for back pain and carry serious risks, including overdose and addiction.  

Finally, the medical profession is removing their decades-old blinders and catching up.

Catching up to the diagnostic and treatment realities of chronic back pain.  And focusing ever more precisely on understanding cause, before relying on the "magic pill" solution in which too many doctors, and patients, place their misguided faith in hopes of achieving relief.

As back pain expert Dr. Sean Wheeler has been advocating for years.

For example, Dr. Wheeler advocates that opioid use is no more effective than using aspirin in the treatment of low back pain.

More importantly, notwithstanding that many in the medical profession and healthcare media claim that doctors don’t know what causes back pain, the answer to the causation question has indeed been found. Says sports medicine and pain expert Sean Wheeler, M.D.: 

The answer to the causation question has been found, with the needed shift in thinking about cause of chronic back pain maddeningly small and intuitive. Recognition of this change is what spins the entire discussion of low back pain on its ear. We should all be challenging the status quo of accepted back pain treatment practice.

The answer?

The answer resides within the Bracing Muscles of the body, as discussed on the pages of this site and in Dr. Wheeler's book, UPRISE, where he systematically identifies and challenges the manner and methodology of how the medical profession has misunderstood and treated back pain over the past 40 years. 

And how to prevent the onset of chronic low back pain.

As Dr. Sean Wheeler advocates:

The solution to the broken system of treating back pain is not better, more expensive treatments.  Lack of treatments isn't our problem.  The solution is to engage in a revolution in how we think about chronic back pain and pain management.  We need a revolution in the way both patients and healthcare providers, as well as medical researchers, approach chronic back pain.  Patients and doctors need to come together to make chronic back pain diagnosis, cause-identification, and effective treatment a reality.

And the answers are literally staring us in the face.  We need simply to act." 


Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on chronic back pain and its cause. His recently released book, UPRISE, is changing the way the world thinks of back pain causation and its treatment. With a new vocabulary in aid of understanding the cause of back pain, and new medical approach focused on increasing the endurance of your bracing muscles, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 

The BRACING Series: No. 3

By Sean M Wheeler, M.D.


I'm here today to disavow you of this mistaken assumption.

Let me start with a story.













Proper bracing muscle stability allows action muscle strengthening without injury.

Weightlifting by itself doesn't provide stability, only strength.


Stability Exercise #3: Deep Bracing Muscles of the Spine

This exercise is for the bracing muscles of the spine.





Good luck.

Published in The BRACING Series

The BRACING Series: No. 2

By Sean M Wheeler, M.D.


We gain spinal stability throughout childhood and early adulthood.




And now our back hurts. 






Stability Exercise #2: The Hip Hiker

The bracing muscle exercise viewed above is called hip hiker.



I will introduce another exercise next week.  

Published in The BRACING Series

The BRACING Series, No. 1

By Dr. Sean M. Wheeler, M.D.

I have seen some strong patients in my twenty years of practicing medicine: bodybuilders, professional athletes, Pilates instructors, laborers and others who depend on strength for their work.  

"Weak" is not a term we would associate with them, but the longstanding back pain they suffer is the result of a weakness in a particular set of obscure muscles.  The weak muscles in these very strong patients are the bracing muscles, which are unique muscles that require a particular approach to strengthen. 

I introduce the concept of bracing muscles in my book, UPRISE--Back Pain Liberation by Tuning Your Body Guitar, which will have a major impact on the future care of back pain.  In my book I promise to develop a set of exercises targeting these muscles that can improve the stability of everyone, not just people with chronic back pain. 

Over the coming months, that promise will be fulfilled here as we release a series of videos to demonstrate these exercises. 

In a few weeks local gyms will fill with new members on a New Year's resolution bender, trying to get in shape for that spring vacation they've already purchased.  Many will focus on "core" training, which has become an industry in itself.  And yet an extraordinary number of people who are working on their core still experience back pain. 

This is because you have to get the spine stabilized before you can "get in shape."  

Six-pack abs boost your ego but not your stability.  Stability is the role of bracing muscles. 

Trying to exercise heavily when your spine is not yet stable is like trying to build a second story on a home with a cracked foundation.  It is an invitation to injury.

So which muscles are the bracing muscles? 

Truthfully, they can be hard to find.  They aren't muscles you can flex and impress yourself with in the mirror.  Exercising them doesn't build their size, it builds their endurance and circulation. 

There are six bracing muscles that pull your hip into a stable position in the socket, which collectively I call the gluteus stabilizers.  They work in conjunction with the psoas muscle and the pelvic floor muscles to suspend the hip in "mid-air" inside the hip joint, providing stability while allowing movement. 

When these bracing muscles weaken, the psoas spasms, the hip is pulled up into an impinged position and the pelvic floor weakens, leading to pain and dysfunction.  That's the theory, anyway.

Stability Exercise #1:  The Clamshell

The first exercise appearing in the video above is called a clamshell. 

The important points of technique are to keep the body rotation closed, stay leaning forward, and to keep the knee low.  As with any exercise, rushing through it is not helpful. 

Try to do 30-50 reps on each side every day for the next week until I introduce the next exercise. 

Good luck.

Published in The BRACING Series

Life can be busy any time of year, especially around the holidays.

The holidays often demand that we each deliberately make time for wellness and exercise.  Like any of our daily preventive habits for overall health like brushing our teeth, physical wellness works best when practiced regularly.

Maintaining strength and stability is essential for our health and best accomplished by including both endurance and circulation training for our bracing muscles, and dynamic workouts for our action muscles.  

Even if you only have 5 minutes to spare, science shows you can still reap multiple benefits from a quick workout

The New York Times recently published an article titled "Really, Really Short Workouts" by Tara Parker-Pope.

Pope outlines several short, high-intensity interval training [HIIT] workouts. Anyone with any experience, or none, and any amount of time can try different HIIT workouts, making adjustments as needed. These scientifically-proven workouts incorporate a warm-up, with peaks of high-intensity exercise separated by lower-intensity, and a cool-down

Pope enthusiastically insists:

"You can try it with any aerobic activity you like. The principles of H.I.I.T. can be applied to running, biking, stair climbing, swimming, jumping rope, rowing, even hopping or skipping. [Yes, skipping!]"

HIIT is a step-up from traditional advice that one should be able to maintain a conversation while running or working out: instead, one shouldn't be able to complete long-winded sentences. The focus is on increasing intensity to a point where chatting is difficult because the workout is challenging your body closer to its limits.

Pope recommends incorporating a HIIT workout three times a week.

Even the 4-minute workouts show an improvement in health benefits after 6 weeks. Benefits include increased endurance and lower glucose levels (even in diabetics, even in a single session). One study showed that even for those struggling with coronary artery disease, high-intensity interval training was not only safe—but better tolerated than a more moderate workout.

Additionally, HIIT burns more calories both before and after than continuous aerobic training. The intensity increases calorie consumption and your body continues burning calories for 2 hours after the workout.

The benefits of high-intensity interval training extend past mere increased calorie burn: people report more enjoyment from HIIT than moderate-intensity activity. This benefit has a two-fold effect: people stick to workouts that they enjoy. A short, consistent workout is better than sporadic exercise or no exercise at all.

HIIT also improves cardiovascular health by working out your blood vessels. Exercise physiologist and athletic trainer Scott Weiss, C.S.C.S. explains, “HIIT increases the flexibility and elasticity of arteries and veins better than continuous aerobic exercise. Because of the increased pressure demand of HIIT, the vessels actually get a workout as well.”

Arguably, the greatest gain of high-intensity interval training is in the shortened yet still highly effective workouts. Hectic schedules can incorporate HIIT into a lunch break or an early morning quiet time.

Your body craves both variety and stability - without stability, back pain can spoil a holiday; without variety, action muscles aren't challenged.    

All it takes is 5 minutes. Aim for variety, and most important, have fun.

[Image Source: Aurora Bootcamp]

Published in Back Pain Relief

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Why is chronic back pain such a global problem with no widespread treatment moving us any closer to solving the condition?  
For the answer, consider these reasons:
  1. We work harder, longer, and play outside less and less.  Look around your office: it's a safe bet that most of your coworkers are sitting, including yourself. As a society, we're only starting to explore how destructive sitting is for our bodies.  
  2. We live in a world where exhaustion rules as a status symbol.  A person will answer the phone only to tell you for five minutes how busy, tired and stressed he or she is.  If we have back pain, we buckle down and keep moving.  
  3. Preventing disease and muscle weakness is a different type of work, the kind of which slips under our general awareness.  We don't get patted on the back for taking time off to work out over lunch or for breaking social norms like sitting at work. 
  4. It's easier to respond to urgent problems as they occur.  It remains far less common to be proactive and deal with important issues before they become problems.  In health care, this can be seen in the lack of focus on prevention.  Instead, current medical communities focus on what it can diagnose or treat.  
  5. Back pain progresses stealthily under a cloud of injuries, spine instability, and poor posture.  Additionally, your body compensates for weak bracing muscles (the ones you need to keep your spine stable and pain-free) like no other part of your body, making recognizing the root of back pain even more difficult.  We have nothing to compare it to, which means we need a new way to recognize causes and solutions.  
If you struggle with back pain and rely on customary medical advice, the odds are stacked against you.  Research results produced most recently essentially say nothing works when it comes to treating chronic back pain.  Our medical community's algorithms for treatment are flawed and failing.
Chronic back pain is a real problem for many of us, but there is a solution, which while simple in concept requires discipline.   
First, let's rewrite our understanding of what causes chronic back pain.
Second, as a patient, one must understand what to expect in treatment, and what works and what doesn't.  To instill your self-care discipline, seek a trained expert to show you how to care for our back to prevent chronic low back pain.
UPRISE: Back Pain Liberation, by Tuning Your Body Guitar, by back pain expert Dr. Sean Wheeler, offers the starting point for a new global conversation of chronic back pain treatment and relief.  
[Image Credit: The Lancet, Source: The Economist]

Dr. Sean Wheeler expert back pain doctorSean M. Wheeler, MD Back pain medical expert Dr. Sean Wheeler advocates the urgent need for change in how those who suffer from chronic back pain are treated and cared for within the healthcare industry, including by medical insurance companies involved in payment approvals for medical treatment.  

According to Dr. Wheeler, decreasing long-term reliance on pain medication as a treatment option is needed, as the repeated use of these medications does not address the systemic cause of chronic low back pain.  

Now comes word of a new study supporting decreased use of opioids for relief from low back pain, in this report from today's New York Times:

"People with chronic low back pain are sometimes prescribed opioids for pain relief, but a review of studies has found opioids generally ineffective.

The analysis, in JAMA Internal Medicine, pooled data from 20 high-quality randomized controlled trials that included 7,295 participants. The studies tested various narcotics...

The drugs relieved pain slightly, but the effects were not clinically significant, and the medicines did little to improve disability...

Measured on a 100-point scale, the magnitude of relief did not reach the 20-point level the researchers defined as clinically effective, little different from NSAIDs [i.e., nonsteroidal anti-inflammatory drugs] like aspirin."

As characterized in the study:

"For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses."

Beyond today's news of opioid ineffectiveness, Dr. Wheeler commented:

"Fund researching on alternative effective pain management for back pain patients is a pressing need, in a field that has not seen a significant medical advance in four decades.

Research into bracing muscle® endurance as the cause — and source of relief — of chronic low back pain is overdue. 

It is time for our healthcare profession, including health insurors, to effectively address what has become the world's most disabling condition, that of chronic back pain." 

Read more about this latest research on opioid effectiveness in JAMA Internal Medicine, and in The New York Times.


Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary in aid of understanding the cause of back pain, and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 


Published in Medical Research


The POSTURE Series, No. 4

By Sean M. Wheeler, M.D.

There is a difference between a teenager slouching and an adult slouching.

It is gratifying, as a nagger [a skill learned from my mother] to constantly bug a teenager about slouching and watch them follow your advice and obtain great posture. Gone is the insecure 16 year old and in their place is the confident 19 year old.

One can’t help but to look upon that young adult and feel a sense of pride in the constant badgering that accomplished such a feat. And yet, the same adult is unable to fix their own posture. Braces, electronic reminders, Lenten resolutions, shock collars, etc. and nothing seems to stick. Sure they sit up taller for a while, but the head is still forward and the middle of the back begins to hurt. It is not lack of willpower, no matter how much one beats themselves up over their posture.

Something has changed.

The fundamental make-up of a teenager slouch verses an adult slouch is completely different. Until the adult is able to understand the difference, they will always have posture problems.


The tissue isn’t the same.  We joke as adults that a child can stab themselves with a fork and watch themselves heal, but adults pull a muscle putting their belt on and two weeks later they still hurt. It is only funny because it is so true. A young person’s tissue just holds them together better.

Imagine a huge tent for a wedding that has a single large pole in the center. The cloth of the tent is new and taunt. The ropes and stakes that support the tent are strong. The whole structure is stable. Then someone runs into the center pole hard enough to make it wobbly. The tent as a whole is not as stable as it was, but because the cloth and the ropes and stakes are in such good condition, enough stability is maintained to make the tent functional. [This is the case of a young adult who begins to lose their bracing muscle strength.]

As the tent ages, the cloth begins to give a lot more. Tears easier and cannot be relied upon as much to provide stability. The ropes stiffen and become more brittle while the stakes bend. In an older tent, a wobbly center pole becomes an issue that must be dealt with if the tent is to stay up. [Please no comments on tent repair or stability, this is a parable on the aging body, not a treatise on tents.]

When injuries or bad positions occur, adolescents spring back into position like a Weeble. ["Webbles wobble but they don't fall down."] Adult tissue is like the part of the couch that one hates to sit on, because they sink in way too far. It is just not the same tissue.


Gluteus muscles are weaker. The muscles in the buttock that hold the leg into the hip in a stable position are bracing muscles. Muscles that have to work all day stabilizing the hip joint. As adult sits at their job, or find increasingly more efficient ways of completing their jobs, they slowly begin to lose the endurance of these bracing muscles. Sure, the gluts are still strong, but how is their endurance? When standing, how long until they lean into one hip? This is a sign of endurance in the stabilizing function of the gluteus. When the gluteus is weak, psoas tightens [see The Posture Series, No 3].


Pelvis is in the wrong position. Adults not only sit more, but have better chairs. Kids sit in terrible chairs and can’t wait to get out of them. Adults take their hard earned money and get the chairs they deserve. Then they lean back into them. They role their pelvis back, allow their tummy to pooch out and sit like this for hours. The days turn into weeks and months and then years and decades. The pooched out tummy becomes a norm that one would never see in teenagers. It becomes a sign of decreased deep bracing muscle strength around the lumbar spine. A teenager with their pelvis in the wrong position is okay because their tummy is drawn in all the time. An adult has to have their pelvis in the correct position because of this lack of endurance in the tummy muscles (not situps).

Adults then try to get their posture back and think all they need do is make a commitment to sitting up straight. Instead, getting their pelvis in the correct position is going to take a serious 180-day commitment to drawing the tummy in correctly, stretching hamstrings and hip flexors, strengthening the gluteus bracing muscles and deep bracing muscles. Add to this, knowing where the pelvis is supposed to be, rather than pretending they have an adolescent slouch.


These steps might even make putting on a belt less dangerous to one's health.


[Weebles is a trademark for several lines of roly-poly toys designed by Hasbro‘s Playskool Division.]

Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. 

Published in The Posture Series

For chronic low back pain, there is no quick fix.

Which is good news.

Good news as the "quick fix" fantasy must be dispelled, to achieve long overdue medical progress in treating chronic back pain. 

For those who suffer from chronic back pain, the desire of a passive "fix me" quick fix, while not uncommon, ignores a component absolutely necessary to recovery:

Active participation by the patient in their healing. 

Projecting the fantasy of a quick fix expectation upon a back pain doctor or physical therapist achieves the opposite of both "quick" and "fix" if the back pain sufferer is not also committed to investing in themselves, by investing the time to improving their body.  

The powerful reality to achieve the "fix" is for the patient to be fully invested in their recovery.

Like that of an athlete with their coach, the patient's relationship with their medical team remains important:

Overall, the coach–athlete relationship is…at the heart of achievement and the mastery of personal qualities such as leadership, determination, confidence and self-reliance. – Sophia Jowet for The British Psychological Society

Just as athletes training for the 2016 Olympics and Paralympics work hard to win a place on their teams, the chronic back pain sufferer must also actively invest time in improving their body to relieve chronic back pain.

[My coach] basically said that there is no shortcut to success. If you want to be good enough to be on the team you’ve got to work hard. That mentality has kept me going through my whole career. –Michael McKillop, Irish middle distance runner and Paralympic athlete

If a back pain sufferer, owning your power to return to and maintain good health means you are bringing a halt to the spiraling fear and worry that come from backache and potential disability.

When you no longer wait for the hope of someone to "fix me," you take the all important first step to healing.

As McKillop says, there are no shortcuts to success and the work is time consuming. But the good news is the reality of pain freedom is achievable by most any sufferer committed to improving themselves with knowledgable "coaching" from their medical team over a period of 180 days.  

As back pain expert Dr. Sean Wheeler encourages chronic back pain sufferers in Chapter 2 of his new book, UPRISE:

Don’t let [the reality that only you can do the strengthening] scare you, though – it should be empowering.  Let’s not wait on the medical establishment to catch up. Let’s each and every one of us start the revolution now… More than a new plan for treating back pain…Tune Me is a revolution in how we think about, care for, and maintain our bodies.

While the medical establishment is in need of its own revolution in back pain treatment, for you a “revolution of one” can begin any time, with you taking control of your own back pain treatment with direction and support from knowledgeable medical assistance.

The revolution and your healing begins by embracing pain freedom reality with your active participation.

And banishing the passive quick fix fantasy.

Published in Back Pain Relief

Dr. Sean Wheeler back pain expertBack Pain Expert Dr. Sean WheelerOliver Finlay is an accomplished sports performance professional, a highly educated and chartered physiotherapist with over 16 years in top-tier national and international sport, supporting elite players and coaches in achieving the highest levels of athletic success.

Based in Edinburgh, Finlay has worked with Olympic Medal winners and world champions, in addition to championship and cup winning teams, with a client roster including Team Great Britain, including during the 2012 Olympic Games, Scottish Rugby UnionPittsburgh SteelersNew York Giants, and Tottenham Hotspur Football Club.

Given their mutual interest in sports medicine and human performance, Finlay recently reached out to sports medicine and back pain expert Dr. Sean Wheeler, to discuss Dr. Wheeler's new book UPRISE, soon to be published in the United States.

"We struck up a conversation regarding a book [Dr. Wheeler] has been writing over the last seven years.

Dr. Sean Wheeler is one of those guys you wished you had known for years, had the chance to collaborate with, bounce ideas around with & learn from during subsequent conversations.  

Even in his emails, a passion for the work he has immersed himself in resonates loudly & his vocabulary is a refreshing music to the ears of those that work in the rehabilitation battlefield.

I can’t wait to read his book UPRISE, once you read the interview Sean kindly agreed to do with me, I think you might understand why."

During an exclusive interview in which Dr. Wheeler describes why he wants to change the way the world treats back pain, he shares the thinking behind UPRISE and what he hopes to achieve:

OLIVER FINLAY: How do you hope that the approach to treatment in the [low back pain] field could develop over the next ten years in light of the work you are doing?

DR. SEAN WHEELER: I hope to reframe everything that is being done in spinal research. The entire field has been built upon the flawed idea that discs just break down. We have to change that fundamental belief.

I hope to change musculoskeletal medicine with the idea that, in addition to the back, there are five other areas in your body that have to be stable and weaken quickly: the neck, shoulders, hips, ankles and feet. Subsequently, when you get an injury that lasts for more than five days, you must not only address the injury, but also address the muscles that stabilize that area.

For example, I hope to change the way we view the chairs our kids sit in. The posture we accept in our children. The fundamental strengthening of our children as they grow to prevent future back pain, neck pain, knee and hip arthritis, among other things.

Read the full interview for more insights behind the coming revolution—the revolution in medical care for low back pain.

Published in Dr. Sean Speaks
Page 1 of 3


– Sean M. Wheeler, M.D.

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