The Importance Of Alignment

How To Test If Your Hip And Back Pain Is Actually Being Caused By Misalignment (In Four Steps)

Whether you’re suffering from back pain, hip joint pain, knees cracking, chronic shoulder pain, or other pain in your skeleton and joints… The underlying theme of causation is almost always misalignment.

There are many different approaches your doctors and specialists may be taking to try to help you resolve these issues and “make the pain go away”…only to have it come back again and again!

The problem is, if they are not addressing the alignment of your muscles and skeletal structure, then they are missing the boat in a big way!

There are four ways in which misalignments may actually be the hidden culprit behind your persistent, chronic back, shoulder, and joint pains…

But unless you test your movement, you will never know!


And the pain will keep coming back, no matter how many adjustments you get, how many medications you take, and how many “experts” you see. This gets expensive, and the worst part is, you will keep suffering – needlessly.

This article will show you how to tell if your ongoing chronic back and hip joint pains may actually be caused by misalignments (which, fortunately, have a cure which does not require more medication or expensive treatments).

Once you find out if your pain may be caused by misalignment, you can also find out how to fix the misalignment through some simple exercises and just by changing the way you move in everyday life!

Step One: Let’s try these four tests to see if this is your problem.

First you will either need a mirror in front of you or someone to watch and help inform you of your alignment. This will provide you the direct visual and feedback that you need. It’s important that you assess the position you are actually in and not the position you feel like you are in.

Alignment Test #1


First, let’s test your hip flexion and hamstrings range of motion. These muscles are often the cause of a hunched back or what’s called a posterior pelvic tilt. It’s what most people think of as aging posture.

Lie on your back and put your leg up as far as it will go toward your nose (with the knee straight / unbent and not using your hands to pull on your leg) as shown. If your leg does not go up to a 90-degree angle (or more) you do not have the hip motion range of motion you need to avoid spinal pain and injury.

Ideal functional range of motion is 90 degrees and the greater you are away from 90 degrees the greater the deficiency you have. Angles of less than 70 degrees range of motion are extremely likely to cause spine and or pelvic pain and injury. Further, ranges of motion below 60 degrees are extremely common to cause spinal misalignments which remove the arch from your lower back and places excess pressure on the discs between the vertebrae in your spine. This is a very common cause of disc protrusion for many people.


It’s amazing how one simple test can tell us so much to help you eliminate pain.  


Alignment Test #2


Second, let’s test your hip extension range of motion. There are two primary muscles which restrict the range of motion here. 1) The psoas and 2) rectus femoris. These muscles attach in the front of your hip and when they are restricted are highly correlated with low back pain especially while standing for extended periods of time.

To perform the test lie on your back on a table or at the end of your bed with your lower leg hanging completely off of the table / bed (as shown) then bear hug your other leg toward your chest (as shown).

The first alignment check is to assess if your relaxed thigh is elevated off of the table or if it is lying flat on the table. If it elevated off of the table you have a severely tight psoas which is causing you spinal misalignment and likely causing you lower back pain.

The second alignment check of Test #2 is to assess if your relaxed thigh is straightening beyond 110 degrees. (example lady in picture shown is straightening her knee when relaxed to about 130 degrees). If the knee is straightened beyond 110 degrees when relaxed in this position this means the rectus femoris is tight which is causing you spinal and pelvic misalignment when walking or running and likely is causing you hip pain.

Again, it’s amazing what we find out with a simple test like this.

Alignment Test #3


Next, let’s test internal and external rotation in your hips. This has a huge impact on how your pelvis and hips are aligned which effects every other joint in your body. When the hips don’t have adequate internal and external rotation or when they are assymetrical (one side of the body has a big variance versus the other side) it can throw the entire midsection of you body out of whack.

Bring your right knee up above your hip, bent as shown with the leg extended out and knee at a 90 degree angle above your hip. Then, bring your raised foot in so that it moves toward your left thigh. That is your external rotation.

Then, bring your raised foot out in the opposite direction, away from your left leg and body. This is your internal rotation.

 You should have about 40 degrees of external rotation (foot in toward the other leg) and about 30 degrees of internal rotation (foot going away from the other leg) in the angle your shin is making when you do this exercise (as seen in alignment Test #3 image).


It is very common that when someone has lower back pain, that they have a limited range of one of these rotation abilities. This is especially important for golfers as you require adequate rotation and follow with your swing – when it’s not adequate your spine takes excessive stress and motion to make up for the deficiency in your hips.

Alignment Test #4


Lastly, let’s test if you are using your glutes properly.

To perform this test you need a step or platform to step onto which is about 12 inches tall.

Start the test by stepping up onto a platform that’s about 12 inches high with your left leg followed by bringing your right onto the platform. To step down keep your left foot on the step and step down with your right. Complete 10 reps on each side while watching in the mirror or having someone watch you.  

CAUTION: If you feel unstable or loss of balance performing a step up skip this test (this means you have weak glutes, core, and are a high risk for falling).

  • Notice that the clinic picture shows the patient’s foot, knee, and hip all in one straight line. Is your working leg (the one you’re using to lift you up onto the platform) staying straight from the hip through to the knee and through to the foot during loading?
  • Is your pelvis staying level (as shown in image) while you transfer from the ground onto the platform? Note – This is best assessed from looking at the back side of your body.


If your answer is no to either of these questions this means your glute medius is weak and additionally could have weak hip muscles and poor motor control for this movement. The step up is a movement you are likely to use daily and very similar to the same movement as walking. When there is weakness in this area it allows the center of your body (hip and pelvis) to shift to the side causing a stress in your joints. This is called sheer stress. This stress is the cause of degenerative joint disease and osteoarthritis.

Ok! So, how did you do?


Are you holding and moving your body in the right way, and do you have full joint mobility and alignment?

Most people have been moving incorrectly for decades. It feels natural but it is causing pain and injury!

 If not, the truth is you will not be able to fully “fix” your chronic back or joint pains until these things are addressed.

The tricky part with these seemingly small things that happen every day, is that you may not feel any pain while you are doing them…but they will cause misalignment, which will come back to haunt you in the form of “mystery pain” in your back, hips and joints, and also can cause Degenerative Joint Disease and or Osteoarthritis.

The good news is, there’s a VERY easy and simple way to fix all of these things which may be causing the misalignment that is at the bottom of your back and hip pain without expensive surgeries.



Robbie Stahl is a Harvard Educator, the inventor of the Biomechanical Optimization System and the creator of The Fitness Doctor Method.

For over 20 years Robbie Stahl has been helping people over the age of 50 overcome signs of aging, weaknesses, pain, injury, and various physical deficiencies that make it difficult for clients to become fit.

He has developed a first in the world system to analyze clients from head to toe to determine where their unique deficiencies are. With an elite team of doctors Robbie has established a World Class system for clients to overcome the things which are holding them back from quality of life while providing them an individualized prescription for optimizing their function so that they can live life to the fullest.

By the age of 22 he had already been recognized as the best trainer in Arizona for client results serving over a thousand clients with profoundly improved fitness levels. He is a member of the American College of Sports Medicine, has been a featured educator at Harvard Faculty Club, and is known for being an innovator in anti-aging fitness training.



Like this episode? Please share it! We can keep this blog and all our videos ad-free and sponsor-free ONLY because you share our work! Please share and subscribe below to our YouTube channel too! #TheFitnessDoctor

Best Alternative to Pain Killers

Did you know?

  • Musculoskeletal pain is by far the most common form of physical pain that people experience.
  • One out of two people experience significant musculoskeletal pain.
  • One out of three people experience muscle pain restricting daily activity.
  • 80% of the world’s prescription pain killers are consumed in the U.S.

Obviously, chronic pain is on the rise! As a country, we are very aware that pain killers are addictive and do not resolve the problem.

They are not the answer but when you are in chronic pain you want relief! How can you relieve pain and not become a statistic?

What is musculoskeletal pain?

We use this term to define any pain that this caused by an injury to the bones, joints, muscles, tendons, ligaments, or nerves.

It is often caused by non contact misalignment and wear and tear to your structure. Although it can also be caused by jerking movements, car accidents, falls, fractures, sprains, dislocations, and direct blows to the muscle.

Some common example areas of pain include back, shoulder, hip, neck and knee pain.

Headaches can also be considered musculoskeletal pain.

Medical research shows that 90% of low back pain cannot be pinpointed to a specific cause. This research is based on Allopathic medicine.

Allopathic Medicine is the mainstream system of medical practice that aims to combat disease with drugs or surgery.

Many allopathic medical professionals do not prescribe to natural cures for pain relief.

It is not a big part of their training.

We disagree with the allopathic medical field that there is no cause to a high majority of musculoskeletal pain.

We believe there is a cause and help people find a way to removing these pains on a daily basis at The Fitness Doctor.

There are 6 main causes of musculoskeletal pain:

Impinged Nerves

It is basically a pinched nerve. When nerves are pinched in the low back or neck, it often causes a great deal of pain. This is due to the vertebrae being out of alignment from poor motor control, tight and or weak muscles.

Unfortunately, a simple chiropractic adjustment will not solve the problem. Why?

Typically muscles need a comprehensive approach to increasing their mobility, you need to learn and apply improved motor control and how to align your body, and finally strengthen your structure to develop a functional range of motion with stability sufficient for living a fully active life. To have a permanent solution you need to cover all of the bases.

You must address the muscle groups with strengthening and lengthening or mobility in order to resolve the pain problem!

Excessive Friction in Joints

This is a very typical shoulder injury. Follow this example. You lift your suitcase into the over- head compartment but when you lift your arms over your head, you experience shoulder pain. This is caused by excessive friction in your joints.

The muscles that need to be mobile are tight, pulling on the joint. And the muscles that need to be strong enough to hold the shoulder in the proper position are too weak to support the structure with alignment.

When you combine these problems, it changes the alignment and the function of the joint causing friction. Excessive friction on soft tissues causes inflammation, which causes pain.

It takes a comprehensive exercise prescription and often times manual therapy to resolve this problem. This includes neuromuscular retraining of the support muscles and loosening of the tight muscles.

Excessively Tight Muscles

When you do an activity that your body isn’t used to – you feel tight muscles. It is a restrictive feeling and you cannot move the way you used to move which your body tells you with signs of pain.

After the age of 50, certain things happen. One transition is that specific muscle groups become tighter. It is an adaptive process based on your body positioning.

Your hamstrings become shorter after hours of sitting and your chest muscles get tight with excessive time hunched over a computer. Your back muscles get stretched and feel tight.

 This may lead you to believe that you have a back problem while in reality; you have excessively tight chest muscles! An accurate diagnosis is paramount to relieving pain.

Understanding which muscles are actually causing pain is the only way to pinpoint and mobilize them, stabilize them and improve your quality of life.

Weak Muscles

The muscles are not strong enough to support the structure and hold your body in the right position (and at the right angle) to keep the other issues we mentioned at bay. Weak muscles contribute to excessive friction in joints, impinged nerves and excessively tight muscles.

Weak muscles keep your body from working the way it was designed to work. When your body senses a weakness, the brain tells the body to tighten up and stay close to the core just like when you carry a heavy object it’s natural to hold it close for support. When muscles do this it can feel as if they are really tight when in reality they’re really weak.

After the age of 50, your weak muscles tend to be tight muscles because they are trying to stabilize the body. Muscles know how to do two things – lengthen and shorten. A weak muscle will shorten to try to protect you. You may even feel muscle spasms.

 The weak muscles need to be identified. Very specific exercises should be used to strengthen and lengthen the weak, short muscles. This will stabilize the entire area, making your body stronger and more mobile eliminating pain.

Poor Motor Control

Let’s face it. Some movements are awkward. In fact, many exercises are awkward but they need to be done with great form or you are in danger of injuring yourself.

Here are a few examples: Doing squats with your back arched in the wrong position or letting your knee fall in when you’re doing a lunge, or angling your shoulder blade in the wrong position for shoulder alignment when you are lifting things overhead.

Most people have been moving incorrectly for decades. It feels natural but it is causing pain and injury!

 To correct this, you must re-educate your body on proper movement with neuromuscular retraining; allowing perfect movement without impingement, friction or weakness. You will start to feel young again!

Excessive Use

When your body becomes accustomed to a more sedentary lifestyle if even for a few months, you must gradually build up your endurance to enjoy a pain free, active lifestyle. Otherwise your body will start to rebel and you will feel pain.

You cannot go from the couch to the Grand Canyon. Your body requires proper stretching, strength and mobility plus endurance to hike the Grand Canyon or run a marathon.

Your body will build stamina with proper training. The best way to build endurance is to increase your training by 5 – 10% a week.

 This gives you time to correct tight muscles, improve your motor control and resolve any other problems that you have had. Then you will be able to exercise without experiencing pain.


Here’s the great news! All of these issues can be removed!
Instead of using pain killers or staying stuck in a sedentary lifestyle, you can use the Bio Opt System to resolve any or all six of these pain problems, including old injuries.

Impinged nerves can be released and excessive friction can be removed. You can mobilize tight muscles. You can strengthen weak muscles. You can improve your motor control and you can avoid overuse with proper training.

At The Fitness Doctor, we use biomechanics, kinesiology (the study of the mechanics of body movements), manual therapy and your specific exercise prescription to eliminate musculoskeletal pain.

 Our four phase approach will help you resolve your pain problems and help you reach your fitness goals. In phase one we focus on solving all of your musculoskeletal problems before adding more pain free high functioning ability in phases to follow! We are proud to say that we have saved many clients from needless use of pain killers.

If you’re ready to find out more call 602-434-4248 or Schedule your Biomechanical Health Evaluation below. 🙂

Like this episode? Please share it! We can keep this blog and all our videos ad-free and sponsor-free ONLY because you share our work! Please share and subscribe below to our YouTube channel too! #TheFitnessDoctor

Could the Real Problem be Referred Pain?

In this post, we’re going to talk about referred pain. Hi, I’m Robbie Stahl, Harvard Educator and inventor of the Biomechanical Optimization System. Today, I’m going to teach you about what referred pain is and what you can do about it.

First, referred pain is basically pain that you feel somewhere in your body but the actual cause is somewhere else. For example, the elbow having pain caused by the shoulder or the shoulder having pain caused by the neck or pain in the back of the leg like sciatica caused by the hip.

Let me give you a quick example of this. I had a client who came to me that spent six months having therapy – all types of therapy – massage therapy, physical therapy on his elbow and after six months of treatment, he came to us and what we figured out is actually his shoulder, his shoulder mechanics, his shoulder alignment was causing an impingement of a nerve and triggering down the arm.

Let me share with you my 18 years of wisdom as a kinesiologist, in the research that I’ve done, you won’t find this in books, but here it is. Here’s the wisdom. Generally, referred pain, on the outside of your body, on your extremities, is generally due to a problem somewhere near the midline of the body.

Somewhere closer to the middle. So usually pain in the elbow commonly caused from issues in the shoulder or shoulder pain caused by issues in the neck. Or pain down the leg, again like sciatica is caused because of the hip. So whenever its further away from the midline of the body, and you’re feeling pain, usually the problem area is closer to the midline or what we call in sports medicine, the core.

What can you do about it? Watch the video below to find out!

So what should you do about it if you feel you’ve been suffering from referred pain? Well it depends on where this referred pain is at in your body. For example, if you’re having pain in the elbow, and you think it might be coming from the shoulder, you need to figure out if your shoulder is out of alignment. Is it drawing forward more than it should be? Are the muscles in your back weak? Do you have forward head posture?

Which is putting pressure on the shoulder, which could impinge a nerve, radiating a pain down your arm. If you have pain in your lower back, are your hips aligned? Do you have good mobility and stability in your hips? Are your hips causing a problem and pressure in your spine because they’re forcing your spine to bend in a position or with frequency or load that it is not ideally designed for?

If you’re suffering from sciatica, which is typically caused be the piriformis muscle, which runs laterally across the backside of your pelvis, if this muscle is tight it’s going to impinge on your nerve and send a pain down the back of your leg. So in this case, you need to figure out which muscle is tight and mobilize or loosen that tissue.

If the glute medius is doing its job, you may need to loosen the TFL. You can relieve the pressure by rolling the TFL on a foam roller. You can also roll the entire IB band from hip to knee for relief. This will relieve the stress and tension in the TFL and in the IT band. If you do these simple exercises and stretches, you will get awesome results.

It really depends on where in the body you having this referred pain. We can always solve referred pain problems for our clients and we always do. I invite you to place your comments below and dialog with me, ask me any questions you want. I’m here to help you. It doesn’t mean you have to come in for an evaluation. Feel free to comment below and I’d be more than happy to provide support helping you get rid of referred pain.

Like this episode? Please share it! We can keep this blog and all our videos ad-free and sponsor-free ONLY because you share our work! Please share and subscribe below to our YouTube channel too! #TheFitnessDoctor

The Importance Of Alignment

How To Test If Your Hip And Back Pain Is Actually Being Caused By Misalignment (In Four Steps) Whether you’re suffering from back pain, hip joint pain, knees cracking, chronic shoulder pain, or other pain in your skeleton and joints……

Best Alternative to Pain Killers

Did you know? Musculoskeletal pain is by far the most common form of physical pain that people experience.   One out of two people experience significant musculoskeletal pain.   One out of three people…
5 abnormalities that all women over 50 experience

5 Abnormalities That All Women Over 50 Experience

5 Abnormalities That All Women Over 50 Experience Here’s what to do about it! It doesn’t seem fair. We always knew that women lost weight slower, lost muscle faster and had more hormonal issues than men but now science…

Surprising Link between Personal Trainers & Injuries

Surprising Link between Personal Trainers & Injuries Have you or anyone you know ever been injured while working with a personal trainer? The latest research shows that more and more people are getting injured when working…

6 Biggest Mistakes when Choosing a Personal Trainer

6 Biggest Mistakes when Choosing a Personal Trainer Imagine this – You’re all set to hire a personal trainer…but now what? Where do you start? How do you find the best trainer for you? It’s like hiring an auto…
Could the Real Problem be Referred Pain?