If I give you the equation 2+(6*2) - 72, how would you know how to solve it? Or even where to start? There’s an order of operations – PEMDAS – or “Please Excuse My Dear Aunt Sally” that informs us what should be done first. And I don’t know Aunt Sally, but whatever she did left enough of an impression for math folks to remember her name. Anyways, PEMDAS would tell us that the first step in solving the equation is to evaluate the parentheses: (6*2) = 12. Next, we’d solve the exponent: 72 = 49. We’re getting somewhere!

Things have gotten a little muddy, so let’s rewrite the equation to clean it up a bit: 2+12-49. I bet you can do that one! But me, not so much (After two minutes of trying to subtract 49 from 14 in my head, I broke out the iPhone, which enlightened me that the answer is -35). Bravo! Now, how would we know what to do without this order of operations – PEMDAS? You might add 2 to 6, subtract 7 from 2, or who knows what else.

Your body also has an order of operations for its movements. If you’re reaching overhead to put something on the top shelf, you’ll need 1) shoulder flexion, 2)thoracic extension/rotation, and 3) maybe some plantarflexion from your ankles to get on your tippy toes. If you can’t extend from your mid back (#2), more demand will be placed on #1 and #3. Then, your shoulder might start to take too much of the stress, and you’ll get pain! So if your shoulder hurts whenever you reach for the top shelf, it may be because your body didn’t follow its order of operations; it tried to perform multiplication before it handled the parentheses.

I had the pleasure of working with a gentleman named Sean. Sean managed a warehouse and was constantly on the move, lifting boxes, putting away parts, and helping unload shipments. Sean came to see us because he was having chronic back pain, and each time he tried to lift something off the ground, his back would flare. Seeing that he lifts things every day, this really interfered with his work. He was also very confused and frustrated with his body, echoing, “How can it hurt so much if I’m so active”? I felt for him. We Americans struggle with general activity levels, and here was someone meeting the requirements, yet still dealing with chronic pain. Then we got to discuss the idea of first move well, then move often.

After looking through his movement, we found he couldn’t extend his mid-back very well. He also lacked some hip mobility. It’s like each time he tried to lift something, his body’s order of operations started doing addition before even considering exponents. Rather than PEMDAS, his body was using APSDEM (sounds like an obscure software company's stock ticker).

We were able to re-order his order of operations – get his mid-back and hips moving – and he could once again lift boxes without having to fear his back might “go out.” He came in one day and said, “Whatever we’ve been doing, my back is fixed!” Then I reminded him that his body wasn’t broken and didn’t need “fixing” in the first place; we just needed to do things in the proper order. “Please Excuse My Dear Aunt Sally,” I told him. His response, “What did your Aunt Sally do?” She tried to move often, before she moved well.