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Lenchig Spine & Pain Institute, 1930 NE 47th Street. Suite 300, Fort Lauderdale, FL (2026)

07/27/2021

Many times, throughout our day here at Lenchig Spine and Pain Institute we will inevitably hear a question that goes along these lines, “I already had the shots, why does my back still hurt?” or “The pain in my lower back is gone, but I’m still having pain in my legs.” In other words, they had an injection with some degree of improvement, but they still have pain elsewhere or “different” pain in the same place. Let’s look into why this might be happening and how it could affect you.

Our spine is composed of about *24 individual bones called VERTEBRAE, and about 10 more vertebrae that are fused together in the sacrum and coccyx. They are stacked on top of each other. It gives us both rigidity and flexibility while also protecting our spinal cord. We divide it into 5 sections: Cervical with 7 vertebras, Thoracic with 12 vertebras, Lumbar with 5 vertebras and Sacrum and Coccyx region usually with 5 fused vertebras each. Muscles, tendons, and ligaments hold it together and help us maintain an erect posture.

Problems with the spine can arise from misalignment of the vertebrae (kyphosis, scoliosis, or spondylolisthesis) or structural problems of the actual vertebrae (Stenosis, Osteophytes, Compression Fractures) As well as problems with the muscles and ligaments and other soft tissues of the spine (Herniated Disc, Degenerative disc disease, calcification, etc.). These problems result in either limited flexibility or instability due to too much flexibility. To make things even more complicated, these can present in conjunction, and the presence of one does not necessarily rule out another. In other words, you can have a patient that has all these problems going on with their spine at the same time.

The vertebral column houses and protects the spinal cord within it and the spinal nerves that branch out form it. Many of the problems that cause back pain due to changes in the spatial relationship between the nerves and vertebrae,

As was previously mentioned many of the problems that result in pain are due to a change in the spatial relationship between the nerves of your spinal cord and the bone and ligaments of the vertebra. This refers to the space between them. For the most part it is a reduction of this space that ends up causing problems. This reduction can come about in several ways.

For example, in spondylolisthesis one vertebra is displaced forward from its regular position resulting in a stretching and compression of the space occupied by the spinal cord.

Other conditions such as Spinal Stenosis (Stenosis Definition: the abnormal narrowing of a passage in the body) also reduce the space for the nerves but not necessarily because of mechanical displacement like we saw with spondylolisthesis but by bone growth around the FORAMEN (which are the circular or oval spaces formed by bones through which nerves or blood vessels pass through). Abnormal bone growth like that caused by OSTEOARTHRITIS can reduce the space available in the spinal canal affecting the spinal cord or it can attack the pedicles and reduce the size of the foramen formed between vertebras, compressing the nerve roots and causing distinct left vs right side pain.

Back pain can also originate from problems of the vertebral body, the most common being compression fractures. You can picture the vertebral body as shaped like a tuna can or hockey puck. A compression fracture changes this shape into a wedge and compromises the spines structural integrity.

The disc between the vertebra can also cause pain in several ways such as degenerative changes that are common with aging like desiccation and annular tears, that result in lost height of the disc and reduced space for the nerve like that shown in the previous examples for spondylolisthesis and stenosis. Most of us have heard about Disc Herniation, this happens when a disc is compressed and its contents project outwards from the center and into the spinal canal or foramen and compress the nerves.

Another spot on the Vertebra that can cause pain are the facet joints. This is what keeps the spine aligned when bending forwards or backwards (tying your shoe) and limits your side-to-side flexion (picking up a bucket) as well as torsion (reaching for something in the back seat of your car). The smooth flat articular surfaces of the facets help it slide on top of the one below it while its shape make it act like a sort of guide rail or canal. When conditions such as Osteoarthritis affect the joint, they can change the shape of a smooth surface into a rough one or it can form Osteophytes which are irregular bony growths that can fuse the vertebrae together or otherwise impede movement.

These are just some of the most common sources of back pain along with some very generalized explanations of the mechanics and pathology of each part. As you can see, each part of each individual vertebra on its own can cause or present problems that result in pain. Now multiply that by the number of vertebras in your spine and you can begin to see why there is an entire subspecialty in medicine that deals with back pain.

Treating back pain is not always a straightforward process that gets you from point A to point B, as you have seen in the previous texts there are many causes of pain that can also present in combination. We hope this helps clear up some questions you might have and as always, we are available to help you with any questions you might have. You can contact the office at 954-493-5048 or email me at crodriguez@lenchig.co

05/11/2021

Pain and Mood
Can pain affect mood and can mood affect pain?
The answer is unequivocally YES, the hard part is figuring out why and how.
How many times have you been having a perfectly fine day, let say you are walking along and then BAM! You stubbed your toe, got stung by a random bee, or missed a step and twisted your ankle.
How rapidly did your mood change at that moment?
How is it that your mental state can affect your perception of pain?
as in this case where a patient underwent a lumpectomy procedure using only hypnosis as a sedative!
Or this case in Iran where a C-Section was performed with hypnosis as the means of Anesthesia. Or this case in Iran where a C-Section was performed with hypnosis as the means of Anesthesia.
Some of our very own patients who also happen to be musicians can tell you that they usually forget all about their pain while they are playing.
Or people who are not just physically tough but mentally tough and can seemingly ignore their pain and carry on until they reach a desired goal such as the case of ultra-endurance athletes like, David Goggins who routinely runs 100-mile ultra-marathons.
When studying how pain is perceived we must consider many aspects that when combined make everyone’s experience uniquely different. Subjective and Objective parameters such a:
• Age
• S*x
• Ethnicity
• Occupation
• Activity level
• Mental Health
• Time of day
• Educational level
• Stress Level
All these factors on their own can affect how someone perceives pain, so you can see how complicated things can get when trying to study pain.
Chronic Pain and mental health are almost inseparable, in fact clinicians and researchers have seen benefits of treating them simultaneously as an integrated issue with the use of Serotonin and Norepinephrine reuptake inhibitors (SNRI’s) like Cymbalta and Effexor.
Although not definitively concluded, because of collective aspects of behavior in cultures where for example, public displays of grief are more common and accepted might seem to be less at ease with acute and chronic pain than someone from a culture where social tendencies seemingly tend more towards stoicism.
As you can see Pain, its experience, Interpretation and Treatment is dynamic, complex, and pretty much an artform. Whether it is taking a few deep breaths to calm down or slipping into a Zen like trance during a surgical procedure your mind is a powerful tool in your fight against chronic pain.

Can one’s culture/heritage affect the way we experience pain? The question has been approached in an academic manner as you can see in this link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157457/

Although not definitively concluded, because of collective aspects of behavior in cultures where for example, public displays of grief are more common and accepted might seem to be less at ease with acute and chronic pain than someone from a culture where social tendencies seemingly tend more towards stoicism.

As you can see Pain, its experience, Interpretation and Treatment is dynamic, complex, and pretty much an artform. Whether it is taking a few deep breaths to calm down or slipping into a Zen like trance during a surgical procedure your mind is a powerful tool in your fight against chronic pain.
So maybe there is something to this saying: "Keep calm and Carry on"
Check out or website for more info.

04/19/2021

Keto Diet for Pain Relief?

The beneficial properties of a ketogenic diet have been known for several decades. First described during the 1920’s when the anticonvulsant effects of a ketogenic diet were used to treat pediatric epilepsy.

Throughout the decades we have become more knowledgeable of how our diets influence chronic pain and have identified Inflammation as one of the principal causes of chronic pain. In this article we will briefly explore how a ketogenic diet can help you reduce chronic inflammation.

The “Keto” diet has only recently picked up in popularity, but as more and more people successfully tried it to lose weight, they almost inadvertently began to take notice and benefit of its pain-relieving effects.

Let’s go over what exactly is the KETO diet and how it leads to reduced pain.

Basically, you want to access your bodies fat stores to meet your energetic needs, “Keto dieting consists of reducing total carbohydrate intake to around 50 grams or less per day.”

What ends up happening is that as your body burns through its glucose reserves, it must switch to an alternate metabolic pathway to power your body. This alternate method is through the burning or utilization of Ketones rather than the glucose.

The process by which our body breaks down fat into Ketones is called Beta Oxidation. This is typically seen during hibernation in some animals or also during periods of extended fasting or starvation or in this case when on a carb restricted diet.

Once a person begins a carbohydrate restricted diet. It can take between 3 to 7 days to go into KETOSIS, this is due to all the Glycogen stored in our muscles.

This results in significant weight loss in a relatively short time.

Although weight loss can lead to pain relief based solely on account of relieving load and stress on the musculoskeletal system, what we want to see, is how by switching from glucose as our primary source of energy to ketones, we end up with a systemic reduction of inflammatory processes and consequent reduction of many chronic aches and pains.

One of the byproducts of the complex chemical reaction when Glucose is metabolized are the Reactive Oxygen Species (superoxide O₂- and Hydroxyl *OH) also known as Free Radicals They are ionized forms of oxygen. Anyone who has ever used hydrogen peroxide as a disinfectant or used an Ozone generator has seen free radicals in action.

So as glucose is metabolized it generates free radicals, these are neutralized by anti-oxidants, but given that these reactions are always occurring, the constant exposure to ionized oxygen molecules reacting with our cellular proteins causes Oxidative-Stress.

A normal healthy person’s immune system is always trying to counteract this by repairing damaged tissues or eliminating damaged cells, but this is what results in Inflammation. Chronic inflammation takes its toll in the form of accelerated aging from stress, joint and muscle degeneration like arthritis, other systemic diseases and of course PAIN!

So, the whole idea is that since we are not getting our energy primarily from glucose by eating foods rich in carbohydrates our body switches over to breaking down stored body fat to make Ketones, and since we are burning fat (ketones) instead of sugar (carbs), less free radicals are formed, putting less oxidative stress on tissues, causing less inflammation leading to………… Less Pain!

Is it indeed possible to lessen the effects of chronic inflammation while at the same time relieving the stress excess weight places on your joints just by changing your diet?

So far, the research and supporting science point to “YES!”

The anti-inflammatory effects of a Ketogenic diet have been well documented and there are increasingly more studies being published almost every day supporting this, but as with all health-related matters make sure to do your own ample research and consult your physician before acting.

Good Luck, Stay well!

01/11/2021

Foods for Pain Relief
You are what you eat!
The wisdom contained in this adage that we hear time and again, proves to be more accurate as we progress in our knowledge of physiology and nutrition.
Each year dozens of studies are published examining the benefits or detriments of a particular food. To say the food industry is gigantic is an understatement, the supplement industry alone accounts for a +100-billion-dollar market share of the global economy each year.
Every few months a new “superfood” or diet fad emerges that promises a panacea or effortless weight loss.
Traditional medicine has always relied on foods or herbs to treator cure common ailments. With the advent of modern pharmacology, we came to rely ever more on medications and less on natural sources. Ironically, a lot of the compounds in use today were originally derived from natural sources. While the benefits of modern medications are without question, within the last couple decades we have once again started to acknowledge the merits of natural foods and recognized their importance in our health and wellbeing.
When it comes to PAIN MANAGEMENT it turns out that the food we eat, can have a positive or negative effect on chronic pain.
When researching the subject of nutrition and pain relief a key word keeps popping up; INFLAMATION.
As defined by: https://www.merriam-webster.com/dictionary/inflammation
Inflammation
noun
in•flam•ma•tion | \ ˌin-flə-ˈmā-shən
Definition of inflammation
1 :a local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration, redness, heat, and pain and that serves as a mechanism initiating the elimination of noxious agents and of damaged tissue
2 :the act of inflaming: the state of being inflamed
Examples of inflammation in a Sentence
The drug is used to reduce inflammation. inflammations of the throat and ears
Throughout human history many foods have been known and used for their pain-relieving properties, however the exact mechanisms were previously unknown until relatively recently. There are many naturally occurring compounds that can have a promoting or suppressing effect on the inflammatory process. When diving a little further into the information a common theme emerges.

Natural unprocessed foods seem to work best, while more processed and refined foods seem to cause or worsen inflammatory processes.
One common ingredient in processed foods is SUGAR. Excess consumption of sugar has been linked to many common ailments such as diabetes and obesity.
During the last 100 or so years the industrialization and processing of food became more common and we slowly started to replace common staples for cheaper and more convenient alternatives.

Today it is almost a challenge to avoid these types of foods even when you try to clean up your diet. When preparing a meal,it is very likely that one or more of the ingredients we use will be highly processed or contain added sugars and preservatives.
Read this article for more information on how sugar consumption is linked to Chronic Pain:
https://www.integrativepainscienceinstitute.com/undeniable-link-sugar-aches-stiffness/
We would like to share with a list we have curatedof some well-known foods that can help you reduce inflammation and help you stay pain free: Go to our website for some great articles that expand on the benefits of each food.
As you can deduce from reading the articles we linked to, research into the pain-relieving properties of these foods’ ranges from empirical and anecdotal to scientifically tested, peer reviewed and published studies. The results from consumption of these foods ranges from marginal to very effective. Although the science is not settled on any of these claims there is no denying that they are not only good for you, but tasty as well, and that there is a definitive link between a good diet and good health. We hope that this blog post can help you in your daily efforts to counter chronic pain, with the caveat that it is not intended as a substitute for appropriate medical care but rather as a supplement or tool that you can add to and incorporate to your daily routine.

This site and article are for educational purposes only!!
FAIR USE:
Copyright Disclaimer under section 107 of the Copyright Act 1976, allowance is made for “fair use” for purposes such as criticism, comment, news reporting, teaching, scholarship, education and research.
Fair use is a use permitted by copyright statute that might otherwise be infringing.
Non-profit, educational or personal use tips the balance in favor of fair use.
FAIR USE DEFINITION:
(Source: http://en.wikipedia.org/wiki/Fair_use)
Fair use is a doctrine in the United States copyright law that allows limited use of copyrighted material without requiring permission from the rights holders, such as for commentary, criticism, news reporting, research, teaching or scholarship. It provides for the legal, non-licensed citation or incorporation of copyrighted material in another author’s work under a four-factor balancing test. The term “fair use” originated in the United States. A similar principle, fair dealing, exists in some other common law jurisdictions. Civil law jurisdictions have other limitations and exceptions to copyright.
U.S. COPYRIGHT OFFICE- FAIR USE DEFINITION
(Source: http://www.copyright.gov/fls/fl102.html)

12/22/2020

What if your back pain is not coming from your Back?
This is what’s known as referred pain. Referred pain is pain that you feel in one area of your body but originates in another. Most people have heard that pain radiating down the left arm, is one of the warning signs for heart attack. That is perhaps one of the best-known examples of referred pain.

The exact cause of referred pain has not been precisely defined, but according to the latest hypotheses, when we are developing in the womb, many of our organ systems originate from a common point of fetal tissue that later begins to differentiate and through the weeks develop into separate organs. Overlap and some redundancy remain in some of the nervous pathways, which in part can lead to pain being felt somewhere else despite its point of origin.

Where is your Back Pain really coming from?
The spine can be affected by referred pain, let’s look at some of the most common causes of REFERRED BACK PAIN.

Kidney Stones:
Or renal calculi as they are known in medical terminology are formed by mineral deposits building up in the urinary system and they can affect any part of it, from the kidney to the urethra. A patient can come into the ER with acute Thoraco-Lumbar pain, and after an evaluation find out that the pain, they are feeling in their back pain is caused by kidney stones.
Other causes of referredpain of the spine such as the ones described below can signal more serious underlying disease. They can also indirectly cause referred pain by affecting adjacent organs or tissues thus causing these to originate the pain although they are not necessarily the primary source. For example, An enlarged prostate can impede proper urination causing distension of the bladder which then can include low back pain as one of its symptoms, however the real problem lies in the prostate and not the bladder.

Prostate Problems:
The prostate is another organ which may present back pain as a symptom. Several conditions may lead to this including

Advanced Prostate Cancer
Prostatitis
Enlarged Prostate*Back pain is not a direct symptom of an enlarged prostate; rather symptoms tend to relate to difficulty and pain in urination.

Abdominal Aortic Aneurysm:
Back pain that is acute, severe and tearing.

It is a true medical emergency.
Pain can radiate to the anterior chest.
Rest does not relieve it.
Palpation over the back and changes in position do not aggravate the pain. Palpation of the abdomen may increase pain.
Loss of lower extremity pulses may occur as the dissection progresses.

Gall stones:
Patients can experience severe pain in the abdominal or back area when fatty meals are consumed.
Pain is colicky (sharp episodic pain occurring at intervals) with periods of improvement and relief.

Urinary Tract Infections
Pain is often across the back and radiates to the groin.
Patients often report dysuria, urgency and frequency.
If the infection affects the renal system, the pain is often more severe and can radiate to the upper back.
Fever may also be present.

Ectopic Pregnancy
Missed menstrual period
Vaginal bleeding
Abdominal or lower back pain.
Patients may also be diaphoretic or in shock.

Acute Pancreatitis
Can cause thoracolumbar back pain.
Often triggered by binge drinking or gallstone

Duodenal Ulcers
Vague abdominal and back pain.
Pain often worsens with hunger or with high acid levels in the stomach.
Pain often lessens with use of antacids.

Visceral Cancer
Vague low back pain can be the first sign of visceral cancer.
Pain is often not relieved by rest and may be most intense at night.
Pain progresses regardless of modification of activities and use of medication.
While there are plenty of causes for back pain most are of musculoskeletal origin. Referred back pain presents unique challenges to patients and physicians requiring a sharp focus and an awareness of issues outside their area of expertise.

Sources:

https://en.wikipedia.org/wiki/Referred_pain

https://www.physio-pedia.com/Spinal_Masqueraders

https://www.verywellhealth.com/causes-of-referred-back-pain-29672

This site is for educational purposes only!!
FAIR USE:
Copyright Disclaimer under section 107 of the Copyright Act 1976, allowance is made for “fair use” for purposes such as criticism, comment, news reporting, teaching, scholarship, education and research.
Fair use is a use permitted by copyright statute that might otherwise be infringing.
Non-profit, educational or personal use tips the balance in favor of fair use.
FAIR USE DEFINITION:
(Source: http://en.wikipedia.org/wiki/Fair_use)
Fair use is a doctrine in the United States copyright law that allows limited use of copyrighted material without requiring permission from the rights holders, such as for commentary, criticism, news reporting, research, teaching or scholarship. It provides for the legal, non-licensed citation or incorporation of copyrighted material in another author’s work under a four-factor balancing test. The term “fair use” originated in the United States. A similar principle, fair dealing, exists in some other common law jurisdictions. Civil law jurisdictions have other limitations and exceptions to copyright.
U.S. COPYRIGHT OFFICE- FAIR USE DEFINITION
(Source: http://www.copyright.gov/fls/fl102.html)

10/24/2020

10 Exercises to strengthen your lower back

Lower back pain is one of the top three reasons people visit their doctor, right along upper respiratory infections and abdominal symptoms. Given the prevalence of lower back pain, and the many reasons for its appearance, it is almost certain that at any given point throughout our lives we will experience low back pain to some degree.

One way to help avoid it could consist of exercising the muscles of your lower back and core. Strengthening your lower back can improve posture and will help you avoid injury when performing the activities of daily living.

We have complied a list of back exercises that will help strengthen your back and in time help you control chronic back pain. These exercises can be performed at home and with minimal equipment. The whole routine can be completed in about 15 minutes and these exercises can be performed daily. This collection is also aimed at beginners, those who are less athletically inclined, and people dealing with chronic pain issues of the spine.

Warning: Consult your physician and physical therapist before performing any of these exercises. People with certain low back conditions might not be able to perform these exercises in a safe or comfortable manner. These exercises can provoke pain and soreness particularly if you are not used to them or already have chronic low back pain.

1.Cat stretches

The cat stretch can help lengthen the back, make it stronger, and ease tension in the muscles.

To perform the cat stretch:

Get onto the hands and knees with the knees hip-width apart.
Arch the back, pulling the bellybutton up toward the spine.
Slowly relax the muscles and allow the abdomen to sag toward the floor.
Return to the starting position.
Repeat 3–5 times twice a day.

2.Bridges

The gluteus maximus is the largest and one of the most important muscles in the body and keeping it strong can help support the lower back.

Bridges work a person’s gluteus maximus, which is the largest muscle of the buttocks. People engage this muscle when they move their hips, especially when they bend into a squat.

To perform a bridge:

Lie on the ground and bend the knees, placing the feet flat on the floor hip-width apart.
Press the feet into the floor, keeping the arms by the sides.
Raise the buttocks off the ground until the body forms a straight line from the shoulders to the knees.
Squeeze the buttocks with the shoulders remaining on the floor.
Lower the buttocks to the ground and rest for a few seconds.
Repeat 15 times and then rest for 1 minute.
Do 3 sets of 15 repetitions.
3.Lower back rotational stretches
The lower back rotational stretch can help relieve tension in the lower back and trunk. It also gently works the core muscles to improve stability.

To perform the lower back rotational stretch:

Lie back on the floor with bent knees and feet flat on the ground.
Keeping the shoulders firmly on the floor, gently roll both bent knees over to one side.
Hold the position for 5–10 seconds.
Return to the starting position.
Gently roll the bent knees over to the opposite side, hold, and then return to the starting position.
Repeat 2–3 times on each side twice a day.

4.Knee to Chest Stretches
Doing a knee-to-chest stretch can help elongate the lower back, relieving tension and pain.

To perform the knee-to-chest stretch:

Lie on the back on the floor.
Bend the knees, keeping both feet flat on the floor.
Use both hands to pull one knee in toward the chest.
Hold the knee against the chest for 5 seconds, keeping the abdominals tight and pressing the spine into the floor.
Return to the starting position.
Repeat with the opposite leg.
Repeat with each leg 2–3 times twice a day.

5.Lying lateral leg lifts
Lying lateral leg lifts work the hip abductor muscles. These muscles support the pelvis and can help reduce strain on the back.

Keeping these muscles strong is essential, as they help a person maintain their balance and can affect mobility.

To perform lying lateral leg lifts:

Lie on one side with the legs together.
Keep the lower leg slightly bent.
Draw the bellybutton into the spine to engage the core muscles.
Raise the top leg about 18 inches, keeping it straight and extended.
Hold the position for 2 seconds.
Repeat 10 times.
Turn onto the other side of the body and repeat, lifting the other leg.
Perform 3 sets on each side.

6.Supermans
A person needs strong back extensors to maintain good posture. These muscles run along either side of the spine.

Weak back extensors can reduce spinal and pelvic support, but doing an exercise called a “Superman” can help.

To perform a Superman:

Lie face down on the ground and stretch both arms out in front of the body, keeping the legs stretched out and flat on the ground.
Raise both the hands and feet, aiming to create a gap of about 6 inches between them and the floor.
Try to pull in the bellybutton, lifting it off the floor to engage the core muscles.
Keep the head straight and look at the floor to avoid neck injury.
Stretch the hands and feet outward as far as possible.
Hold the position for 2 seconds.
Return to the starting position.
Repeat 10 times.

7.Seated lower back rotational stretches
The seated lower back rotational stretch helps relieve pain, working the core muscles and strengthening the lower back.

To perform the seated lower back rotational stretch:

Sit on a stool or chair without arms, keeping the feet flat on the floor.
Twist at the core to the right, keeping the hips square and the spine tall.
Position the hands behind the head or place the left hand on the right knee to support the stretch.
Hold the position for 10 seconds.
Repeat the exercise on the left-hand side.
Repeat on each side 3–5 times twice a day.

8.Partial curls
Strong abdominal muscles play a significant role in supporting the spine and can also help keep the hips properly aligned.

Weak abdominals can result in poor core strength and lack of stability, which can cause lower back pain. Curls and partial curls help build a strong core.

To perform partial curls:

Lie back on the floor and bend the knees, keeping the feet flat and hip-width apart.
Cross the hands over the chest.
Breathe in deeply.
On the breath out, engage the abdominal muscles by pulling in the stomach.
Gently raise the head and shoulders 2 inches off the ground while keeping the neck in line with the spine.
Hold for 5 seconds then return to the starting position.
Repeat the exercise 10 times.
Perform 3 sets.

9.Draw-in maneuvers
The draw-in maneuver works the transversus abdominis. This muscle is on the front and side of the abdomen, stabilizing the spine and lower back region.

To perform the draw-in maneuver:

Lie back on the floor with knees bent and feet flat, keeping the arms by the sides.
Breathe in deeply.
While breathing out, pull the bellybutton toward the spine, tightening the abdominal muscles and keeping the hips still.
Hold the position for 5 seconds.
Repeat 5 times.

10.Pelvic tilts
The pelvic tilt exercise can release tight back muscles and keep them flexible.

To perform this lower back flexibility exercise:

Lie back on the floor with knees bent and feet flat, keeping the arms by the sides.
Gently arch the lower back and push the stomach out.
Hold for 5 seconds, then relax.
Flatten the back and pull the bellybutton in toward the floor.
Hold for 5 seconds, then relax.
Increase the number of repetitions daily, building up to 30.
The draw in maneuver and pelvic tilt exercise are similar looking but the abdominal movement is in the opposite direction. In the draw in maneuver you contract your abs towards the floor and in the other you push out with your abdominal muscles.

Lenchig Spine & Pain Institute

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