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Comment by ransom1538 | Hacker News Reader

Hey man after 3 years I just finally beat back pain - it is possible. In my case it was physical therapy until i understood the routine to strengthen the core and stretching. I also changed how I work: no sitting, ever. Laying or standing. I lost weight (i am 6'1 got down to 165). I took stretching serious, you should be able to touch your toes. You need to drink milk. For depression find a position to work while you lay down, so you can get lost in work (most don't get backpain while laying down). The data on back surgeries is not good, plain physical therapy does better. If you need something for depression I would look into edibles with lots of cbd - do your best to stay away from opioids.

ALSO: Research the anti-inflammatory nabumetone. I don't know why doctors don't bring it up. (not additive, no high)

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+1 to this. I suffered from back pain for a long time. Long distance running made it worse. Running made my core weaker and my back pain became worse. Physical therapy did not help. MRI scan revealed a 5 degree scoliosis and a slightly bulging disc (L5/S1). What has helped since then is massaging my glutes thoroughly with a lacrosse ball regularly. Foam rolling my back, glutes, ITB and quads. Strength training for the back, core and upper body in general. Before starting strength training, focus on relieving tightness for a couple of weeks.

> What has helped since then is massaging my glutes thoroughly with a lacrosse ball regularly. Foam rolling my back, glutes, ITB and quads. Strength training for the back, core and upper body in general.

For the record, this is what a good physical therapist would have prescribed.

Those Glutius Medii (sp?) are tough cookies!!! Core and stability work are often more important than just strength. Also the hip flexors are really key too. My adductors and I have a love/hate relationship. :)

This. Hip flexors are key especially if you sit a lot. Also doing the cobra stretch multiple times a day has helped a lot.

Running and walking are the ultimate efficent exercises homo sapiens. In a perfect world all humans, within the standard deviation, are taught first and foremost how to care for there personal physical health from the time they can walk till they die. Walking and running would be the most efficient exercise for all humans. IMHO

The issues that come from running are related to where you start from lacking knowledge and lacking physical health. Knowledge guides interpretation of pain(what different types of pain mean, when to stop when to push through). Understanding pain is a communication skill that very few people will teach you, but in my opinion is more valuable then literacy. Knowledge also enables positive feedback loops concerning form and efficiency of movement.

Physical health is the structal integrity of the core and stabilizer muscles. Each of these items are on a sliding scale, and somewhere in that scale is a tipping point where if you pass under it you are hurting yourself instead of healing yourself. I hypothesize that 80% of our population falls on the injury side, but that this could be solved with education and PT.

I'm glad you didn't give up, or had the nerve to push past anyone saying "that's just the way you are, you can't fix that" because I feel that statement couldn't be further from the truth.

I've run some half marathons and concluded that long distance running is the worst exercise. It's very repetitive, takes tons of time, messes up your feet, messes up your back, makes your body economical so you'll forever have a harder time losing weight, and on top of that it makes you lose muscle, professional long distance runners look like thin-armed freaks.

Do some strength training and some playful sport instead, like basketball or BJJ. It's fun, you'll look good, you'll move well, and you'll get confident with people, all in 2-4 hours per week.

I'm sorry, but no amount of "ultimate efficient exercise" rhetoric makes running by itself a sufficient workout regime.

You also need to do some kind of strength training. A push, a pull, a spinal compression and a spinal tension. Eg pushups, rows, squats, pullups.

Otherwise your core will be weak and you will be missing key stabilizing muscles that prevent injury when you are in an unusual position, like picking up a suitcase or changing a tire. Which is exactly what causes back pain.

This is exactly the issue with what people think about running/walking and how people execute their motion. You can make any exercise a core strength exercise. I run and walk from my çore, I perform all motion from my core. This is a feeling and skill you learn from taijiquan and it is applicable to any type of exercise.

Slight caveat here: for those with sacroiliitis or SI joint issues, "sitting down is bad for you" is NOT necessarily the answer. In many cases standing is worse for you than sitting. Don't prescribe to generalities, of course, is the lesson.

Thank you for pointing this out. I have chronic SI joint problems, and people always think I should be standing. Would not help.

Correct, these structure areas are some of the most complex within our bodies. There are hundreds of tiny stabilizer muscles in our backs that can be injured. Each disc can have an almost infinite number of ways it can bulge, hemorage or slip. This entire structure is protecting the spinal column and can interfere or damage all kinds of different parts of the body through the nerve connections.

I hypothesize that a majority of depression suffering is sourced by subtle spinal/nerve injuries, which the brain could interpret as death. Once a strong enough signal develops in the brain that's saying, "you're in pain, all the time, you probably should isolate yourself and kill yourself" it's not hard to see how that could lead to depression and suicidal thoughts.

If you're enthusiastic about milk and believe that strength is the way out of pain, I have the best recommendation for you: Starting Strength.

I'm enthusiastic about milk, but why is it so good for us?

If you read Starting Strength, you'd know. To summarize, it has everything baby calves need to grow strong, which is also similar to what humans need to grow strong. Lots of protein, along with some sugar and lots of vitamins and minerals.

I might add, if the lactose gives you grief, invest in some kefir grains and ferment it out. You get some extra b vitamins and folate in the exchange. Plus it's hella tasty.

I'll just add that, in my experience, milk and coffee do not mix well. YMMV.

He recommends drinking a gallon of milk a day, aka GOMAD.

go crzy

To wit: GOMAD + barbells got me from 205 lbs to 305 lbs body weight.

+1 to Starting Strength

> I also changed how I work: no sitting, ever. Laying or standing

If you don't mind, could please tell me how do you lie down and work ?

Since I started suffering from back pain , I was thinking if something like this was possible. I was also afraid it would fuck up my eyes, have you had any problems of that sort ?

"If you don't mind, could please tell me how do you lie down and work ?"

I have three "workstations" at my office - two of them take place at my adjustable height desk. I can stand or sit.

I also have a full sized couch that I can lie flat on. I prop my laptop up on a pillow just like you might at home.

I move between these three positions as it suits me and can avoid completely any kind of fatigue or unhealthy postures.

Laying down was a large part of fixing my RSI. On a bed, on my back, head propped on a pillow, knees at a 45 degree angle, bottom of laptop laying on hip bones. This was my primary working position for a few years, and I didn't see any negatives.

Take a look at zero g workstations.

Sometimes you're just physically fucked. In my case it took a microdiscectomy to end the agony.

What do you so for core conditioning and strength?

Also I'm looking for ways to put together a workstation in the horizontal position

I'd seriously consider Yoga.

But to get started, deep breathing I feel has had an affect on my overall core strength.

At times, you'll feel like a moron. Deep, deep breathes. I'd suggest starting off for session of like 5 or 10 minutes. It doesn't matter how you do it. Just breathe deep as a practice. But if you need something to get started: something that's standard is X second in, X second hold, X second release. You probably won't be able to do 8 seconds. So start with 4 seconds, and move up.

Then there's deadlifts, squats, bench. Core functional movements. You should feel your core expanded, and activated. You should be recruiting these muscles when doing these movements.

But yoga. for real dog.

Yoga is not recommended for people with lower back pain. When I started having back pain, somebody suggested to me yoga. Everything went great for three months, the pain was still there but lesser , and I felt good and fit. Then one day, while doing surya namaskar, I felt a pain ripping through my spine and fell down, unable to move. I consulted an M.D , and he immediately asked me if I had been doing surya namaskar.

Tldr; yoga is great , but not for all.

"Then one day, while doing surya namaskar, I felt a pain ripping through my spine and fell down, unable to move. I consulted an M.D , and he immediately asked me if I had been doing surya namaskar."

This is important. Yoga is very powerful and I think everyone should incorporate yoga movements into their fitness regime.

However, typical yoga classes and even established yoga movement series (like the Ashtonga primary series) are heavily weighted towards forward folding/bending which is the last thing you want to do with a weak/injured back.

This doesn't mean you shouldn't do yoga - it means that you should understand the physiology of a bulging/blow disc and build up your strength (perhaps with other yoga exercises/poses) to the point that you are strong enough to do that forward folding ... and even then maintain caution and moderation.

With a fully rehabbed/asymptomatic L4/L5 I am doing heavy freeweight squats and deadlifts and even inverting during BJJ - but I would still be cautious and even modify portions of a typical yoga class ...

I fully agree with you. I had never felt as good as I had while I was doing yoga.

The problem is , most yoga practitioners (atleast the ones I consulted in india) consider it like some sort of magical cure for everything. I was asked to do surya namaskar , despite them knowing I had back pain . I went to one of the most reputed centres here, and all I got from them were pseudo science mumbo jumbo.

I have got much more valuable info from this HN thread. Thank you for sharing for you experience. Your story has given me hope , I feel motivated to learn more about backpain and find a solution tailored for me.

I also feel this sort of information (personal stories of knowledgeable people) should be more easily accessible for people.A non profit , trust worthy website like Wikipedia, or even a github wiki.

I really like this HN thread. It is a wonderful series of coming outs! I want to reply on all comments here and ask and ask and ask. But this post is most relevant, because I started doing surya namaskar on my non-training days, and in general when I only an hour or so to move my body a bit.

Do you remember the exact conditions when you fell down (movement, which part of the day, what did you do before, etc). Have you been practicing yoga alone or with a teacher, group?

Did you went in and try figuring out what caused your pain? Are you on track with it now? If yes, what has changed? Will you go back to your Yoga practice or you feel that it is dangerous for you?

Thanks!

One year back, I started having back pain. I could not sit for more than 45 minutes. I had tripped over the steps some months back and I was thinking it must be because of that.I went to a Dr and took an x-ray. The diagnosis was that it had nothing to do with the fall , an everything to do with my long working hours. The doctor also advised strengthening my core . He referred me to a physiotherapist , and after 1 month of regular therapy I could now sit for around 3 hours before light pain would start.

I felt ready to start exercising and zeroed in on yoga. I started practicing with a group of people , led by an instructor. It was very intensive (hatha yoga) and most exercises involved stretching your arms and touching your feet.Other exercises like the bow pose, crow pose and head stand was also there. Sometimes, while I was sitting and touching my foot, the instructor would use his body weight to push my spine down from behind so that my stomach touched my knees. This may be the reason , but am not sure. So, after 3 months of this , I felt better and fitter than ever before and joined another yoga studio near to my home. Here, the poses were not as tough as the other place, but was done considerably faster. 1 month after joining there, I am bending down to touch my knees , and lightning strikes.I couldn't walk and was bedridden for a week. The time must have been around 7 pm. I went after work and did some warm ups as usual.

Coming to the reasons, I can think two things : the instructor exerting his force on my spine and the faster pace of the exercising. This is onle conjecture though.

Right now ,after some months of physical therapy and no other exercise, I have no pain while sitting.

I certainly plan to go back to my yoga practice. However , before I do I need to get some expert advice and some tests done.

I hope this answered all your questions!

Edit:just to be clear, the two reasons I stated are in addition to the main point I made, that some yoga poses are not safe for everyone.

Yoga helped me a lot with lower back pain. It strengthens the core, opens up the shoulders, increases hip flexibility, etc. In less than 6 months I have no back pain anymore and I feel that I have a considerably better posture.

The comments about the dangers of doing yoga are valid, but every sport or exercise can be dangerous depending on your condition, even swimming which is usually recommended as a safe sport. General tips are: ask your doctor for movements that you should avoid, tell your yoga teacher about your condition, if it hurts don't do it. More importantly I think, is for you to understand your condition. Read about it, feel your body and how it reacts to each exercise.

For example, even though I should avoid back bends they still help me build strength and improve my posture when done carefully. I am always aware of that during my yoga practice so I either skip the back bends or I do them softly, depending on how I feel.

Indeed, I had constant neck and back pain (probably because I'm sitting all day long). 3-6 months of Yoga 3-4 times a week healed me. It was also very good to fight stress. It may not work for everybody or every issues.

"What do you so for core conditioning and strength?"

I tend to avoid recommending specific exercises - instead I like to recommend that you think of your trunk in three dimensions and apply weight bearing loads to at least every 90 degrees around that circle (which implies at least four exercises).

So that would mean your flexing your back, your abs, and each of your two sides (Abdominal external oblique, I think).

I personally try to hit every 45 degrees (which implies at least 8 exercises).

You need to try a lot of different exercises and find the ones that work for you and for your body type.

And you need to walk.

You can do 50 different trunk/core exercises and you will never hit every single muscle and combination of muscles the way that walking does.

Your body is a walking machine. You were built to walk. Walking will heal you. It will be painful and difficult at first - when I blew out my L4/L5 I needed to lie down for an hour after walking 4-5 miles. That doesn't last. Your body will tighten and strengthen up all the right muscles to hold your back in the most natural and healthful position it can be in - the one that supports walking.

Was there a book or something you read?

For a back pain sufferer, the comment about your body becoming stronger after walking 4-5 miles is a really encouraging one.

And frankly, even if the system doesn't work for everyone, the way you have deconstructed it into 45 degree angles is something I have never come across before, so kudos to you for figuring this out.

I have the same question as the sibling. Where did you read about this stuff?

No books. I have been lifting weights regularly since I was 14 and was a wrestler through school, etc. ... it's just something I've spent enough time and though on to learn something.

One passive way to work the core, sit on a yoga ball instead of a chair. Just start slow, maybe 30-60 minutes at a time.

After a few weeks, if you don't address your postural issues, you'll discover that you can have terrible posture on a yoga ball just as easily.

Absolutely, but it's a great way to strengthen the core and work on posture. It's always going to take work of course.

This puts a lot of pressure on the lower back. Sitting down for long periods without any back support doesn't seem like a great idea to me.

I would argue that half an hour to an hour is no one's idea of long periods.

You said starting so I assumed there would be a progression. Overall it doesn't seem like a good idea to me because it puts the whole weight over the lower back without any back and arm support (like the ones that exist on a good office chair, they're recommended for a reason). Also, there are a ton of good exercises for the core that don't stress the back, like planks for example.

Anyway, I recommend that people ask their doctor for advice or at least Google up a bit about the pros/cons of this and try to find articles from reputable sources. I did that some time ago and wasn't very impressed with the results.

> I also changed how I work: no sitting, ever. Laying or standing

Do you work remotely? I assume laying isn't an option in an office. Even standing, it may be frowned upon in more conservative work places.

Depends I guess. I know places (~100 people) where their chief architect sleeps on the floor with his feet sticking out from under his desk in the middle of the day.

Glad you found what works for you. Cow milk doesn't work for everyone as some are lactose intolerant.

How is nabumetone better than any other NSAID?

That's what I came here to say. It's a selective COX-2 inhibitor so maybe you could argue it's like celecoxib (which is prescribed for some types of pain, mainly acute). The point being that back pain and most chronic pain isn't really inflammatory, save neuropathic pain.

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