To Prevent Back Pain, Orthotics Are Out, Exercise Is In | Hacker News Reader

To Prevent Back Pain, Orthotics Are Out, Exercise Is In

well.blogs.nytimes.com

63 pointsadamsi31 comments

I have had intermittent crippling back pain on and off for my entire adult life, ever since moving an extremely heavy old stove out of a basement when I was 18 and feeling a bad twinge when the other person carrying it let go of his end.

I have been free of back pain for close to three years now, ever since I started exercising regularly, particularly running and cycling. I believe this has to do with several factors: 1) I've lost around 30 kg (70 lbs) of excess weight; 2) I regularly do dynamic stretching (before exercise) and static stretching (afterwards); 3) my posture has improved considerably; and 4) I transitioned to a standing desk about 15 months ago and no longer slouch for hours at a time.

I have a similar experience with recovering from back pain. I injured my lower back years ago and herniated two discs. I would have recurring back spasms and subsequently had three epidural steroid injections to relieve pain and was even prescribed orthotics.

The things that prevented back pain the past few years for me were:

- losing weight (regular exercise and diet)

- using a standing desk at work

- year-long physical therapy followed by regular Pilates sessions

- splurging on a supportive mattress (lots of coils)

If I had to choose one of these, I would opt for the standing desk. Takes a couple weeks to get used to, but nowadays I feel weird not using one.

My back was already improving a year before I migrated to a standing desk, but it has proven to be such a hugely positive change that I find myself wondering how I was ever able to sit for that long. For me it took about four weeks to make the adjustment, during which I felt fatigued and sore. After that, I haven't looked back.

Speaking of back pain, I injured my lower back quite badly about a year ago. I was doing bench press and wasn't able to complete the last rep. Instead of calling for help, I (stupidly) attempted to roll the weight down to my knees and then stood up and set it on the ground. I immediately felt a sharp pain, and for the next week I wasn't able to sit down (I had to constantly stand since bending was painful).

Ever since then, I haven't quite recovered. My back feels fine most of the time, but every few days it aches quite a bit. I recently tried to start working out again and the pain flared up immediately. I've spoken to a few serious weight lifters, and they've told me that reverse hyper machines can help rehabilitate mild lumbar disc herniations (which is what I have). I can't tell if this is "bro-science" though or something that actually works; a quick search on Google Scholar reveals nothing. Also, most gyms do not have reverse hyper machines, so I would have to drive out of my way to use one, or purchase one. Does anyone have any experience with these machines?

Try lying on your front and do a sit up in reverse. The weight of your upper body is enough and helps strengthen your lower back. Ironically it was an osteopath who told me of this exercise as I used to have lower back pain. After a few weeks doing it I never needs to go back!

In addition, running and sit ups can also help massively. But don't over do it until you're completely mended.

If it's not getting better on its own, do yourself a favor and see a qualified medical professional for an evaluation of your back problem. Commonly these problems are treated in physical therapy. A skilled PT is an expert at prescribing the kind of exercise that will help you the most.

I know these things from experience, having lower back pain on and off for 30 years. Yeah, I'm "old" now, and other parts get involved, like knees and hips. But I've learned that a bad back can cause changes in posture, gait, etc. That is, the tendency is to compensate for the movement limitations imposed by the back problem which eventually puts pressure on other joints. IOW a back problem can have negative downstream effects, so get the consults you need.

The article confirms the importance of the right exercise preventing and managing back pain. The worst thing is prolonged "rest", continuing normal activity is the key. I'd also advocate my "no bending or twisting" rule, and taking care when attempting to move heavy items. Mainly a matter of self-observation, but that's a whole program in itself.

From what my sport doctor and physio explained, during a hyperextension movement, when you've doubled over and your head is pointing at the ground, you're opening the spine up, fluid moving between discs and cartilage, etc. In a full hyperextension, you're compressing in the opposite flexed direction. If there's misalignment anywhere in your spine, you might be increasing your risk of exacerbating the issue.

The trouble with bro science is that those lifters may never have actually had the problem you're experiencing, and if they had, may not have had it in the same way that you have.

Core strengthening exercises are good in general as stronger/thicker muscle better protects the connective tissue providing backup support for your joints. It's a reason some athletes can tear ACLs and such and walk around normally while a normal person might end up debilitated.

Please get a referral from a sports medicine specialist for a physio. Even if you go only once, have someone give you strategies for strengthening and protecting your back the safe way.

It's bro science, ie not science at all.

The truth is simple but boring: https://news.ycombinator.com/item?id=10640658

Not to take from your point but something can be both broscience and true at the same time. It just means it hasn't been formally studied within controlled experiments, which is unfortunately quite common in the S&C world where the science is often playing catch-up confirming or disproving ideas that practitioners have been using for decades.

Check into Voltaren gel for when you have the flair ups, it's an NSAID gel that a lot of my patients have a lot of success with for back pain. I haven't heard much research about reverse hyper machines. Agree with above poster who says PT might help as well. Strengthening and stretching exercises are great, same with water walking/swimming.

I suffered a moderate-to-severe back injury while surfing when I was 19. It wasn't debilitating, but it regularly affected my quality of life and was healing very, very slowly (at the rate it was going, it probably would've taken 6-12 months to fully heal).

I began deadlifting twice a week, and within two weeks my back pain significantly reduced, and within six weeks my back had healed completely. I also felt much less back discomfort or pain from activities that would previous cause discomfort or pain in my lower back (e.g., sleeping on my stomach).

I think everyone (women included) who is physically able to should lift weights regularly. Not only for the primary benefits of getting stronger and looking better, but for all the passive secondary benefits that come with it: improved posture, permanently increased metabolism (6-10 calories per day per pound of muscle), reduced risks of osteoporosis, reduced likelihood of injury, etc.

The important thing is to lift consistently, heavy, and progressively lift heavier. It can be pretty intimidating for someone who hasn't done it before, so I recommend a routine like StrongLifts 5x5 or Phrak's variant of Greyskull LP to start. /r/fitness has lots of good info in its wiki.

Was big into lifting in my twenties, was very healthy.

These days I have a rare spinal condition that limits me to lifting 25lbs Max, so I've had to exercise differently, I run and cycle (cycled for years) and have started Pilate's, the Pilate's made a massive difference to quality of life, its amazing how back pain over a long period causes postural changes your arent aware off as you instinctively restrict your own motion to minimise pain.

> and progressively lift heavier

I assume it varies from person-to-person, but is there some kind of rule-of-thumb for what rate to increase your weights?

There are lots of strength training programs out there for beginners (Starting Strength, Stronglifts, Greyskull). Most studies I've read suggest all that really matters is that you are strict with your form and stick to it. A program's success depends largely on you showing up...

That said, I'm a big fan of the Greyskull program. You increase the weight 2.5 - 5 lbs per session (provided you hit the goals of your previous session).

So that you are lifting with 90 - 100% of your strength. Then you are developing your strength. I try to stay away from the 100% end by always gradually working my way up there. "warm up with weights"

I had a lower back injury at about that age resulting in a ruptured disk. It was debilitating and required surgery. The surgery worked wonders but, unsurprisingly, I've had intermittent back trouble in the decades since then.

I've had two periods of my life where I've been free from back problems for extended periods. The first was when I was doing aikido. There was some minimal warm up stretching, but the main thing was that practice involved a lot of range of motion. Despite seemingly bad things like awkward positions and getting thrown and hitting the ground hard, I had no back problems at all during that time. The second time was when I was lifting free weights. Squats and deadlifts (done correctly) strengthen the support infrastructure for the back (and everything else). During both of those regimens I also lost a fair amount of fat. (I actually gained weight while lifting but my wife remarked that I looked thinner).

I think that many kinds of exercise could have similar effects. Yoga, anyone? Maybe Tai Chi? Man, I need to get back to doing something regularly again!

Annecdote time.

My back has hurt for about 15 years, since the age of 18.

I didn't exercise reguraly during that time.

I haven't had any pain for the past 2 years... The change us definitely tied to this: I started working out reguraly (HIIT style in my case).

I see a lot of posts about back exercises, I would just like to add that ab exercises are JUST as important in preventing back pain. Your trunk muscles play a huge role in supporting your spine. A strong core pulls your spine and pelvis into a more optimal angle for weight bearing. A weak core will produce a bad angle in your lumbar region (which can compress the nerves exiting the spinal tract in a number of ways).

http://www.somastruct.com/wp-content/uploads/2012/07/anterio...

Experience: athlete + med student

Personal anecdote: Used to skip ab exercises during lifting. Had lower back pain during football. Decided to stop skipping ab exercises. Lower back pain disappeared.

Like most people here it seems, I can confirm this. Had back pains on and off every since I carried my sun around the city for an hour. It vanished when I started weekly (1 hour) boxing training (it's not about fighting but there are a lot of push-ups, sit-ups, punching bags and other people's gloves, and 10 min of rope jumping.)

Sun = son, 2 hours, so can't edit anymore :|

Any good link for the back exercises? I do aerobics regularly, play football 3 hours a week and hit gym twice a week. I still feel sometimes that I need a more stronger back.

Male, age 39, with one completely "blown" disc in my back and another that is probably bulging.

I am completely asymptomatic, pain free, and perform extremely high stress and high flexibility athletics. Here's how I do it:

- hip raises on the ball[1] 20-30 reps.

- scorpion stretch[2] - 20-30 reps, back and forth.

- roman chair[3] - 40-50 reps, some with a weight across chest

- plain old straight leg deadlifts with dumbbells

- and of course, balance it all out with ab and trunk strengthening

But, BUT ... the real key is walking. Your body is a machine built for walking. You may scoff, but nothing nothing will tighten and straighten up your back, and all of its supporting muscles, and erase the imbalances and create the alignment you need more than walking.

Walking will heal you. The first week or so might make things worse - a LOT worse. Just keep it up. The walking will heal you.

[1] http://reach-yourpeak.com/tag/glute-strength/

[2] http://www.jsonline.com/multimedia/video/?bctid=64438317001

[3] https://en.wikipedia.org/wiki/Roman_chair

How much walking works for you?

> However, the protective effects typically wore off after that, with recurrences rising after 12 months, probably because many of the people who’d been involved in the studies stopped exercising, Dr. Maher said, and their back problems returned.

Ah, speculation. In 5 years, we'll be hearing how exercise causes chronic back pain, and the solution is to exercise for 6 months, then take 6 months off, because some other highly-decorated surgeon thinks it probably makes sense.

If the back pain is caused by weak postural muscles or a muscular imbalance, then it's possible that exercise is correcting those deficiencies. Your muscles adapt to whatever loads they routinely bear. If you spend most of your time with a supported posture then your postural muscles will naturally weaken over time. I used to have neck and back and knee pain until I started lifting regularly.

In my experience, it hurts differently when you're damaging your body versus training your muscles. It is possible to seriously injure yourself a little at a time if you're not cognizant of this, and it's much better to err on the side of caution and progress slower than to ignore your body and risk a serious injury.

If we see a study like you say, it will almost certainly fail to control for the confounding effect of a cautious or incautious approach on injury rates.

> it hurts differently when you're damaging your body versus training your muscles

In my experience it's the difference between soreness and pain.

Yes, but to someone unaccustomed to it, soreness is pain.

A little surprised that Yoga did not get any mention.

http://www.nih.gov/news-events/nih-research-matters/yoga-or-...

Here's a rule of thumb that will serve you well:

If you brace something[1], the thing being braced will become weaker.

It will happen almost immediately. Your body is very, very good at efficiently allocating resources in as miserly a fashion as possible.

[1] In your body, that is.

Same experience as most commenters here. Back pain developed suddenly, reoccurred later on in the year. Began regular light exercise, and now zero pain and no relapse.

this http://www.kieser-training.co.uk/

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