Back pain is a problem which is badly treated | Hacker News Reader

Back pain is a problem which is badly treated

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467 pointspseudolus280 comments

As someone who has Spondylolisthesis [1], what has worked best is weight lifting. In particular, full body movements using the barbell: deadlifts (also SLDL), squats, and overhead presses (just be extra careful here).

My pain has varied. The worst being when I needed steroid injections in the nerves that run from my spine down my legs. Now, I consider my pain negligible.

I'm no longer a fan of static stretching. I have found it to mostly be a waste of time and to exacerbate any problems. In the context of lifting, I stretch by warming up with the barbell and incrementally add weight until I reach my working weight. In the context of BJJ, I warmup with movements like shrimping, gator crawls, rolling over my shoulders, etc.

Additionally, getting over the mindset that if you have pain that you shouldn't move. The opposite is true. How you feel when you wake up does not dictate how you will feel the rest of the day. Doing some RDLs with no weight, engaging and warming up your muscles is the best cure to my back pain.

I recommend checking out doctors, Austin Baraki and Jordan Feigenbaum, at Barbell Medicine [2]. They are big proponents of the concept of lifting for recovery and not letting fear keep you from recovering.

[1]: https://en.wikipedia.org/wiki/Spondylolisthesis [2]: https://www.barbellmedicine.com/blog/pain-in-training-what-d...

> Additionally, getting over the mindset that if you have pain that you shouldn't move. The opposite is true.

Amen

Exactly!! I always do the stuff that most people would think is the WORST thing to do when your back hurts - like hyperextensions, deadlifts, etc.

I "took it easy" for like 4 months and my back pain only got worse during that time :/ lesson learned

Been there and I see it time and time again with other people, usually when they have back problems. It's sad to see. I'm empathetic and understand why people feel that way, but "putting your feet up" for an extended period of time is almost always the worst thing for you. If/when I get some minor tweak, I make sure to get back to moving as quickly as possible.

This comment scares me.

My wife did a deadlift when she shouldn't have. Next thing we know she spent a week unable to move and came close to not being able to walk again. Ever.

Turns out that the possibility of your vertebrae popping out and pinching the spinal cord is NOT to be taken lightly. It hasn't happened to you, but if a bunch of people with back problems take your advice then you WILL cripple someone.

Yes. Exercise is the best thing for a back. But know what is wrong, what works, what helps, and what doesn't. Don't just be a cowboy and pray.

You're absolutely right and I should've stated the caveat that you have to know your body. There's a difference between some discomfort and something really being wrong. I have enough experience to know when it's the former and when it's really time to pack it up and go home. If I can't execute with perfect form, I stop. And I'm always reducing the load a lot when I'm rehabing something minor. Never be a cowboy.

You really just have to know yourself. It's easy to just to convince yourself to refrain with the excuse that you're injured or whatever when really it's just laziness - only you can know the reality if you're honest with yourself. Also, just because you can't deadlift doesn't mean you can't do SOMETHING else. It's rare that you cannot move at all and some movement is better than nothing.

And now we are in agreement.

We agree that exercise is the best thing for a back. With good posture getting an honorable mention. We agree that a lot of things that a lot of people think are bad can actually be helpful to most.

What I can add to it is that when you have a back problem, it is critical to understand what the problem is, what makes it worse, and what makes it better. The right expert is extremely helpful in this. How to find that expert I can't help you with, but I am very glad to have found Scott Neubauer at http://www.coastalhealthandfitness.com/ and happily recommend him.

I know from the people I have sent to him that the testimonials at http://www.coastalhealthandfitness.com/category/testimonials are much more typical than I would have believed possible. The typical experience seems to be that the patient walks in, describes symptoms, he asks the patient to move and observes, has them lie down, does a little body work, and then he gives 3 exercises that target the underlying issue. The patient goes away, adds those exercises to their routine and the problem goes away.

Personal examples that I have seen follow this problem include a knee problem that I had lived with most of my life, my step-son's back that was injured months earlier in football, or my mother-in-law's dowager's hump that had been there for 10 years. One visit, and a week later the problem was gone. A year ago it was still gone.

He likes to think aloud so there is a constant stream of what he is thinking as you go through this. (I also find him very funny, so the chatter is enjoyable.) Furthermore he is aware of his limits, if your problem may require something that he can't handle (eg x-rays), he is quick to tell you to go elsewhere first.

Wise words! One other thing to this is to always deload properly after a break. Just let the first session back be easy as, way easier than you might feel like. Letting go of the ego of pushing out numbers is key to learning to listen to the body.

You'll probably still feel it the next day nonetheless, when you can go again with a slight increment.

Keep this up and before you know it you're back to where you were.

Also this whole thread is great. Weightlifting is the best medicine bar none for this middle aged mostly desk bound programmer. It has immense mental health benefits as well.

Climbing outdoors on rock is definitely better and more beautiful/recharging. But for most this can't be done easily before/during/after work, so we do what we can

Or mountain bike riding.. but yes, absolutely.

> Weightlifting is the best medicine bar none for this middle aged mostly desk bound programmer.

Couldn't agree more. Loaded compound movements are just unreasonably effective. A nice added bonus (I find) is the therapeutic aspect of lifting. I think some of it is simply that it's almost a form of meditation in the sense that you block out all other thoughts and are focused on just on the movement and your own body.

Not to get too melodramatic about it, but squatting in particular teaches you mental toughness and is a great metaphor for life: you shoulder a burden and when you get down (the descent) you dig deep to come back up again.

I like that metaphor. Squatting is the integral part of my routine, either for heavy with 5x5 stronglifts or for reps/volume as a warm up when doing a shorter/lighter arm filler day session. For me the hardest exercise is still probably the deadlift, fortunately doesn't come up every day. ;)

I have a garage setup, so trying to work out 5-6 days a week by mixing it up. The rack, flat bench, Olympic barbell + ez bar, plates, rubber mats is truly everything I need - and all for less than a highest end phone. It will last my lifetime, and extend it as well. (I ride to work for cardio.)

And yes, the lifting feels like such a relief compared to dealing with family or work. It's amazing how much it can clear the mind.

I'm so jealous of your garage setup, it sounds awesome. Squats have been my "problem lift" since I started, but I still absolutely love them and am FINALLY making good progress again after changing some things. I have decent morphology for deadlifting so I'm a much better deadlifter than I am squatter (my max for DL is ~30% more than my best squat:(). Bench is absolutely abysmal haha.

Man, it sure is hard to make decisions in this world, isn't it?

I've helped several friends and family fix their chronic back pain through deadlifts and similar. Chiropractors didn't help. They didn't believe in or couldn't afford specialists. I'm not even a trainer, just a software developer.

From what I've seen, chronic back pain is way more down to back weakness, and easily and safely fixable by training the back with any of many standard exercise. Your body was meant to do these things!

So, then, how many success stories overweigh a horror story? When should people choose to take matters into their own hands when the world's supply of expertise is limited or giving mixed messages...

...or only unsuccessful. I mean, who doesn't know people that got back surgery and they still have back pain? Want to bet that many of those people should have strengthened their backs instead?

Of course, some people, like my brother-in-law, refuse to exercise, so surgery is the only option.

But I bet a lot of those who got surgery never got a compelling pitch making it clear that exercise usually works. The incentives for those handing out surgeries are too perverse.

Not that you mentioned it, but what scares me is all the surgeries. My coworker's programmer husband got back surgery, picked up an infection in the spinal cord, and now he's permanently paralyzed on disability.

10000%

Anecdata, and unrelated to the back: With 100% correlation, anytime I start getting RSI symptoms, I can reference my training log and it turns out I haven't been diligent with the holy combination of face pulls and raw deadlifts. Data points of approx N=8, patient count only N=1.

No ergonomic chair, keyboard, mouse, etc required; just strength. And not a single orthopedist will discuss face pulls as a solution to RSI.

Now THAT comment I agree with.

True story. Back in the Clinton days, there was a committee created to evaluate medical treatments and make official recommendations on which were cost effective and which were not.

Their first recommendation was that back surgery was not called for until the possibility of all other treatments had been ruled out. The data for this back in the 1990s was very strong and based on the facts, it should have been non-controversial. The data showed a fairly low success rate, and even for the short-term successes, a 10 year prognosis that was worse for equivalent patients than any alternative treatment. (Including "do nothing".)

The data notwithstanding, back surgeons as a group are very well off and tend to donate to politicians. Furthermore hospital administrators make more money off of back surgery than the others. En masse they began calling their local congress critter to say that something had to be done about this committee report. The result was that Congress got together and the committee report quickly got buried, and the committee's remit was changed so that it no longer could issue such recommendations.

As long as you can approach back problems with exercise, do so.

For my wife's problem? What worked was Valium to solve the back spasms, the disk slipped back in and luckily the nerves had not been killed while it was out, and then a slow exercise regime to stabilize her back. However until her spine was well and truly better and she had better stabilization, NOTHING to cause compression of the spine. (Which deadlifts do.)

Thats a scary story, glad your wife was ok eventually. I don’t know much about anatomy and heavy deadlifts always make me a little nervous. Isn’t stabilization the issue though? I always thought the whole core was supposed to be supporting the spine so how could a vertebra pop out unless something went really went wrong?

Deadlifts don't need to be heavy. In fact, if it is muscle weakness in the posterior chain that is causing back pain, more reps at lighter weight is a better way to develop them.

Any references on that Clinton-era report?

https://www.motherjones.com/kevin-drum/2018/07/republicans-f...

Thanks.

I've dealt with chronic back pain for years, and physical therapy has changed my life. But I had to have a certain period of time with pain free movement before I could progress.

I also had lots of signs and symptoms that things were wrong before it got really, really bad (I herniated a disc). Knowing how to understand when your body is not in alignment / moving right, and how to correct it, is what the GPs advice is really about. A lot of chronic back pain is due to muscular imbalances; too weak, too tight, too loose, not firing right. Exercises and body work can be done to help correct these things, to ease pain and return functionality.

I think the advice applies more to chronic pain, not acute pain. Yes, know your body.

My wife had chronic pain before she did the deadlift.

It was only after that mistake that she had acute pain.

"Movement is medicine" is the mantra I tell myself and others.

Absolutely! Been powerlifting consistently now for about 4 years and the best thing for my back has been making it (and my entire posterior chain) stronger. If and when I do get some minor tweak, I focus on slow, really deep squats and hyperextensions which gets the blood flowing and usually resolves any issues pretty quick.

This is ridiculously anecdotal, but I asked a yoga teacher how to make it more comfortable to sit with legs straight in front, and I was expecting some kind of static stretch.

She said to do leg swings back and forth, which I remember I did years ago in Taekwando. I find doing those leg swings really nice for loosing up the hips and all that and as an antidote to office sitting. I also like that I don't need to stretch per-se.

Ymmv, I am not a physical therapist etc. etc.

Was listening to a podcast that was talking about fitness - the name escapes my memory at the moment - but I remember the guy said something interesting in passing: that a 100% bodyweight fitness regimen is fantastic and would be all you need ... except it doesn't develop lower back strength. For that he said, you need weights.

He didn't elaborate anymore than that but anecdotally I related to that statement, all I do is at-home bodyweight fitness (can't afford a gym membership atm) and yet I still from time to time strain or carry lower back pain from random activities.

Feel free to add any of the dozens of lower back exercise you'll find if you google "bodyweight exercises lower back" to your regimen rather than take some guy's word for it.

Even the pushup uses lower back muscles, like any plank.

Without progressive overload the maximum strength of the muscle is very limited. Doing a bunch of pushups or planks will improve your ability to do that exercise, but you can't do pushups for a year and expect to squat 300 pounds-- the muscle growth just isn't there.

I think Joseph Pilates would disagree there!

The classes I've taken all focus around strengthening the core muscles in the lower back area.

I think it was Pavel Tsatsouline on Joe Rogan #1399

THAT WAS IT! I hardly listen to Joe Rogan so couldn't recall this one.

Thanks.

You certainly don't need weight to develop lower back strength.

I'm currently seeing a physiotherapist once a week for lower back pains, which were directly related to lack of lower back strength and flexibility. Most of the exercises I'm given to do at home (which are doable at home AND have low probability of injuring myself because of bad form) don't require any weight.

Exercises are mostly core strength ones, meaning plank and related ones.

I see a lot of advice about deadlifting and other exercises weights, and I'm wondering just how many people injure themselves. Sure, with proper form those are going to be good, but it's also easy to injure yourself because of bad form if you don't have a trainer.

Could you list these exercises you're talking about? Just the names, no need to describe them.

Check out McGill's "Big 3" on core stability (https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-...). He wrote the bible on lower back pain and strengthening, changed my life dramatically after having chronic sciatica for 5+ years. McGill's program follows on from McKenzies older stretching program (which is fantastic in addition to McGill exercises). https://www.spine-health.com/wellness/exercise/what-mckenzie...

Research McGill and McKenzie and you'll almost certainly be able to fix your lower back pain.

Indeed. My wife broke her back in college before we met. Since then she'd had chronic back pain and she figured that's just what she'd have to live with. What fixed it for her was hip thrusters, which are targeted toward the glutes, but also work the lower back to some extent.

To that last, I've wondered how much glute weakness is the factor in back pain. I don't know why it necessarily would be, but a long time ago I saw a study where high school kids with chronic back pain were 100% cured by quadruped hip extensions. Of course, those also work the back to some extent, but it's another exercise that's prescribed for the glutes.

quadruped hip extensions have helped me a lot, too

I've tried hip thrusters in the past when I knew less about how weak my glutes were. I'll give them another try. ty for sharing

I have spent a year working on combating my back pain and I can tell you that the musculoskeletal system is exactly that - a system. The joints and muscles all work in concerted effort to move and this idea of isolated muscular contraction is a bit like pure functions in Haskell: ultimately pretty useless without IO.

The core and spine is crazy complex. For starters I've learned a whole bunch of new muscles: glute medius/max, QL, serratus, interior/exterior obliques, multifidus, upper/lower/transverse abs, inner thighs, quads, hamstrings, hip extensors/flexors, lats, spinal extensors/flexors, rhomboids, upper/lower traps, pecs minor/major, levator scapulae...

That sounds like I've just rattled off some anatomy but literally all of those network together to mobilise your spine and any one of those being out of whack can cause cascading and coupling issues of other nodes in the network.

Glute weakness for sure is one of them so could any of the other ones...

This is very well articulated, but very disappointing to see so-called expert in their field orthopedic doctors advise their patients with the exact opposite.

> The joints and muscles all work in concerted effort to move and this idea of isolated muscular contraction is a bit like pure functions in Haskell: ultimately pretty useless without IO.

Great illustration. I'm all about functional strength.

There is a big difference between being able to pick up and throw 50 pound sacks of potatoes and the isolated exercises most of us do on machines.

Total body strength seems far more useful.

Don't do machines, they are really not that good for most uses. The fringe usability I can think of - competition bodybuilders, training around injury of professional athletes. That's probably it. Anything else ain't worth it.

People often do max 1 specific muscle with them, ie biceps or chest to impress and fight low self-esteem, but that's generally not a good way either.

As mentioned, muscles work in complex groups, and having 1 part way stronger than the rest will lead to injuries in real world usage. And injuries mean you will lose it all, and possibly worse.

This.

P.S. Love your username. You'll be pleased that the name of my garage gym is the Gravity Chamber.

Very well said.

I've had trouble knowing where to start, sometimes spending days working on the wrong part of the system, playing wack-a-mole because I hadn't figured out the right root of my pain.

Going to PT helped a whole lot, reading Robin McKenzie and Jim Johnson is great, but I also really like Jeff Cavaliere's technical explanations on his ATHLEAN-X YouTube channel [1]. He's a physical therapy and strength coach that gets crazy on his body with a magic marker and shows you how a chain of issues drives common problems. That deepened my understanding a lot, layering on top of all the other resources.

[1] https://www.youtube.com/channel/UCe0TLA0EsQbE-MjuHXevj2A

I can add one data point to the glute component. I used to see a chiropractor. They are mostly useless for this kind of thing°, but did recommend glute foam rolling, which somehow helps a lot with my lower back pain. I would encourage people to try it even if they're sure the pain is in their lower back. Something about rolling those muscles really well helps me a lot.

° IMO. I'm sure it helps others and is not a point I make very strongly.

Me reading the first line mentioning weight lifting. My thoughts: "I wonder if Baraki and Feigenbaum will be mentioned?" Didn't fail to deliver. I've found that when I get back pain a set of deadlifts for a day or two fixes things right up

> I'm no longer a fan of static stretching

A physiotherapist once told me in direct words that (in his opinion) flexibility without strength is useless. He'd treated some people that were into Yoga and similar activities, and their flexibility caused injuries doing normal activities, I assume because things were just moving around too much without proper internal support.

I've personally found muscle exhaustion to be the best cure for my back pain. I don't know why, but I figure a) exhaustion and soreness signals being stronger than the pain, and/or b) pain being caused by muscle tension/grabbing and exhaustion removes strength from this.

Tom Kurz talks about this (the relationship between stretching and strength) in "Stretching Scientifically". Generally you weaken the muscle when you stretch it so its important to combine stretching with strength training. Static stretching is pretty mild though.

also re: Yoga ... there's lots of Yoga practices that combine strength with flexibility... Yoga tends to pop up as something that has been proven to be beneficial for back pain while pretty much everything else is as good as placebo (including surgical intervention).

People that sit all day tend to have shorter hamstrings (because the muscle is contracted all day) so I think stretching is important. An imbalance in leg muscles can tilt your pelvis and propagate up to your back...

> also re: Yoga ... there's lots of Yoga practices that combine strength with flexibility... Yoga tends to pop up as something that has been proven to be beneficial for back pain while pretty much everything else is as good as placebo (including surgical intervention).

Pilates is strength-focused yoga. It saved me from needing back surgery. Please if anyone out there is suffering from chronic back pain please look into Pilates.

Yes there are all types of yoga from pseudo-religious through to extremely practical. I've done some holds in some classes that would've been amazing for strength (they left me sweating).

As the other poster said though I prefer pilates, and in particular pilates reformer (with the bed) seems very good for back pain since in a lot of exercises you can support your back to varying degrees depending what you need at the time. The springs means it's not technically just body weight but it seems about right for me, at this time.

I'm definitely a short hamstring sufferer who could stretch more and need to work that in.

This point you made about imbalance in leg muscles has just illuminated a possible source of my back pain that should have been obvious to me but I just attributed it to age. My left leg is weaker than my right due to knee surgery I had a decade ago. My muscles never fully recovered and now I have back/leg pain on my right side. I will have to look into correcting this and see how my pain progresses over time.

The way that all of those things are connected and propagate is not just some pseudo new age nonsense, they're very literally connected in mechanical chains. My shortened hamstrings caused my lower back to roll in at the bottom of my squats. Lengthening my hamstrings fixed my squat and my back.

I highly recommend you visit a well-reviewed physiotherapist. I have struggled with back pain for about 10 years, from a high-school football injury. Turns out, beyond the "injury", I have a really skewed pelvis, which is causing issues around my body including my back pain!

The complexity of human movement is fascinating the more you learn about it.

I suppose it depends on the Yoga flavour. I had severe back pains after turning 30 (had to lie on the floor because I could not sit anymore in the office). I started Yoga a few years later. Doing it for 4 years now. I have a strong core and zero back problems anymore.

There is a tremendous diversity in yoga styles, and teacher capabilities. Always check the credentials of your teacher and do research on the style of yoga you do.

I believe that strenght training is something everyone should do, like brushing teeth. Back pain is only one of many things that it solves.

I've had a similar experience although I've never been diagnosed with anything. When I went to a back specialist, he said he wasn't worried about my localized back pain because I had no sciatica. But, he did say to not "squat or deadlift anymore".

I listened to him for 4 years and I had a constant, low grade ache.

At some point in my 30s I got tired of the ache and decided I would just try to do squats and deads and if I hurt myself, so be it.

Within a week of re-introducing them, my back pain faded away. Every now and then I get a painful tweak, but recovery is often on the order of a week.

If I ever get Sciatica symptoms I will re-evaluate, but so far so good.

I've had the same experience. About a year ago my wife and I joined a gym (again), and this time we stuck with it. One of the primary reasons we joined was to find some good back exercises to prevent us putting out our backs constantly (having 4 kids does this to you...).

I've made deadlifts my top priority, do them at least once per week without fail, and often do squats when time and energy permits. Instead of putting my back out and being crippled for a day at a time once every few months, I now live with a "positive" no pain, no gain ache in my whole body after frequent workouts, and I'm so much stronger than I was in general.

Highly recommend this approach -- just as OP said, be careful with the powerlifts and get a trainer to show you how to do them properly before you start. Injuries here can suck as much as putting your back out (or more).

What about stress on joints with such recovery method? My dad has had problems with his knee for a long time, he's done lot's of stuff to improve his situation. Whenever he tries lift, he feels great, but the stress affects him after some time. I know the solution you mentioned is what works best for you, but genuinely wondering if the stress acts negatively too.

The philosophy of this approach is stress and adaptation. The adaptation is what yields the improvements in muscle, tendons, and ligaments. The adaptation does not occur without sufficient stress.

I had the same results as poster above. It’s pretty cool.

Basically what @netfl0 replied: stress, adapt, recover, rinse, and repeat.

Right now I follow a variation of the Texas Method, which is an intermediate program:

  Squat 5RM: 355 lbs
  Bench 5RM: 275 lbs
  Deadlift 5RM: 425 lbs
  Press 5RM: 165 lbs

Monday is volume day:

  1. 5x5 squats at 90% of 5RM (~325)
  2. 5x5 bench at 90% of 5RM (~235)
  3. 3x10+ SLDL at 225 lbs

Wednesday is recovery day:

  1. 2x5 squats at 65% of 5RM (~265)
  2. 3x5 press at 90% of 5RM (~135)
  3. 3x10+ pullups

Friday is intensity day:

  1. 5RM squats
  2. 5RM bench
  3. 5RM deadlift

I recommend Starting Strength program if a beginner [2].

Full disclosure, I overdue it a bit by:

  * doing BJJ on Tuesday, Thursday, and Saturday
  * biking to work about 5 miles each way
  * daily 16 - 24 hour intermittent fasting and lifting at the tail end of my fast even for 5RM PRs

Note that I added these on gradually and it is definitely difficult to maintain, but I always opt for the challenge and have been able to add 5-10 lbs to my 5RM weekly when I get quality sleep, stick to my routine, and don't drink (I'm more into edibles anyway). Still, I think these extras just goes to show how much stress/recover/adapt a body can take.

Highly recommend Mark Rippetoe's books Starting Strength [3] and Practical Programming [4]. He really knows what he's talking about. I also recommend Alan Thrall for easier access to improving your form on Youtube [5].

[1]: https://www.t-nation.com/training/texas-method

[2]: https://startingstrength.com/get-started/programs

[3]: https://aasgaardco.com/store/books-posters-dvd/books/startin...

[4]: https://aasgaardco.com/store/books-posters-dvd/books/practic...

[5]: https://www.youtube.com/user/athrall7

edit: formatting

> Additionally, getting over the mindset that if you have pain that you shouldn't move. The opposite is true.

This cannot be stated often enough, not moving is going to make things worse not better over time. However, it is hard to do the right thing here. I am not without sympathy

Really happy to see this as this top comment!

The best thing to remember about back pain is that most of the time the pain is not due to a problem in your back, but a problem elsewhere on your body. This is commonly referred to in the medical field as referred pain.

So if your feet are fucked up, the rest of your body is going to be fucked up. If your calves are tight, they will cause issues up the chain and it will/can eventually lead to pain in the back. If your thigh muscles are too tight, same thing happens.

For those of us who sit often, we tend to get what is called an anterior pelvic tilt -- or in plain english a pelvis that is rotated or tilted slightly forward. This ends up causing your lower back to pick up the slack and curve more than it is supposed to, and on and on up the chain.

The single best thing I have found for releasing a tight psoas (to remove the tension and allow your pelvis to orient itself correctly) is to use a ~20lb slam ball and basically lie directly on top of it with it lodged right in the trinagle area that is below your belly button and to the side of your groin. Shove it in there, take a deep breath, lean into it and you will really feel it loosen the tension on your posas. This is makes a profound difference in my hip flexibility and usually does a killer job eliminating lower back pain.

For a good video demo of the psoas release I do often: https://www.youtube.com/watch?v=_F-0rtFbOgI @ 1:15 is the pose that I use.

This. Back when I was overweight I had a fair amount of back pain. Once I started lifting (and foam rolling) I discovered one day that spending 10 minutes foam-rolling my glutes caused 100% relief in my back for a day or two.

A few years of squats and my back pain is now non-existent. Not because my back is "stronger", but rather it seems because of the increased flexibility from the waist down.

Squats and deadlifting is what got rid of my back pain, which had been mild to moderate for years. Highly recommended, as long as you are VERY mindful of your form.

To people maybe not confident with their form: you can do free weight squats (deadlifts too, I suppose, with empty hands). Just get the form right, then add a small amount of weight. Then, in small increments, add more weight.

Very frequently one part of your body compensates for a failure in another part of your body. As a result the bit that hurts can be surprisingly far from and the part where the underlying problem exists.

That said, the principle is simpler to apply in theory than practice. There really are people who understand the human body well enough to debug it. Their results demonstrate that they aren't making it up, but I have no idea how they actually do it.

Thank you for sharing. I'm having a little bit of difficult time imagining your recommendation in the last paragraph above. Is there a video online that kind of shows what you've written above? Thanks in advance!

Yeah, my explanation is not great.

Here is a video using a much smaller ball: https://www.youtube.com/watch?v=OQuQ_aKlDjI

Here is another one: https://www.youtube.com/watch?v=_F-0rtFbOgI @ 1:15 is about the position that I use. Lying down, one leg out to the side and one leg straight back.

I use a slam ball but a soccer ball or volleyball that is adequately inflated would probably work too. If you are tough and flexible you can use a softball or something much firmer but it will hurt a lot more if you are not ready for it.

I regularly roll out my ass and upper back with a lacrosse ball or softball, but haven't tried it on my psoas yet.

What a coincidence. I was searching YouTube for exercise for back pain. I actually have pain in my left side of body. Some pain is in back and some in leg. And this dude's (jujitsu master) exercise was the only thing to help with my pain

I know it seems ridiculous to spend $50-100 on a piece of injection molded plastic, but this thing[0] has been the best I've found for getting deep enough into my abdomen to loosen my psoas.

[0] https://pso-rite.com/

That is really interesting. I know some people use a kettlebell (the handle) which resembles the tool you are sharing without the nice flared base.

Kettlebells help the back in other ways as well...

Thanks for recommending this! Just ordered one to try it out. I've found that foam rollers, even the knurled ones, don't quite dig in deep enough.

I bought one of these and was never fully satisfied with it. Do you put the prongs directly in line with your belly button? Just above or below it?

I simulate that with a lacrosse ball and a kettle-bell. I lay on my back, and put the ball about 2 inches to the outside of my belly button and then place the kettle-bell atop the ball. From there, I move it slowly down passed my hip/groin. Don't go too heavy on the kettle-bell. I don't go over 35# usually.

> The single best thing I have found for releasing a tight psoas (to remove the tension and allow your pelvis to orient itself correctly)

Funny you mention psoas. PRI[0] + Stott Pilates[1] has been life changing for me because its basically all about getting your psoas muscles strong and limber. Anyone with back pain, I highly recommend.

[0] - https://www.posturalrestoration.com/

[1] - https://en.wikipedia.org/wiki/Stott_Pilates

> This is commonly referred to in the medical field as referred pain.

To be a bit pedantic I don't think this is correct--"referred pain" specifically refers to a quirk of the nervous system where acute pain is perceived in a spot that is NOT actually undergoing the harmful stimulus, as when a heart attack causes pain in the arm (rather than around the heart/chest) or acid reflux in the esophagus manifesting as pain/pressure in the chest (rather than the throat).

What you're describing seems more like your back is actually traumatized and therefore in pain, but there's some underlying chronic issue outside the back which has, over a longer period of time, led to said trauma.

In other words, referred pain means trauma in locus A causes pain in locus B, whereas what you're talking about is trauma in locus A causes trauma in locus B causes pain in locus B.

OMG! This is so timely because someone asked on Twitter, what is one thing you wish you could've learned 10 years ago? My answer was taking care of posture. This is so epidemic, IMO. This is the closest I have come to feeling chronic pain that I had no control over.

I tried never ending solutions including Physical Therapy but nothing helped.

But I finally got control over it by doing TWO things: 1. Reading 8 steps to a pain free back by Susan Adams and putting lessons in action right away. 2. Performing THORACIC MOBILITY WORK

I can't speak for you but this CHANGED MY LIFE! I am back at it again with no pain. If you would like to read my experience dealing with the pain check out this thread https://twitter.com/mihirchronicles/status/12174493172015964....

Exersizing and stretching your back is so important. * Edit - properly and with what works for you :)

I have back pain problems right now that go away only when I stop exercising and stretching. I found this out when I broke my ankle and couldn't do anything. Back pain gone!

You were doing something horribly wrong. You'd be best server by figuring out what that was and continuing to exercise and stretch.

Sounds like you need to stretch correctly after exercising. I had the exact same experience, and it wasn’t until I began focusing my stretching on my hamstrings that I saw immediate and significant relief. It’s the holy grail to a back pain free life for me now.

I love how everyone immediately goes to "you were doing it wrong". Gee thanks. It could also be you perform at a very high level and your body is aging, you have an underlying condition that had never had a chance to fully heal, or many other nuanced reasons.

So, in other words... he's doing it wrong. Perhaps "wrong" is "pushing too hard given age or some underlying condition", but the fact is that exercise and stretching should never make you worse off... assuming you're doing it correctly.

In my weight training class, we always avoided the deadlift due to the high risk of injury. Now I'm in middle age and starting to feel back pain, I picked it up, and performing this exercise completely fixes my back pain.

I did once throw out my back while deadlifting. It was completely preventable, but it turns out that the consequences were minimal. I've become a lot less worried about my back since then.

It was the day after a hard 20 mile run, and I stupidly tried to deadlift my 1 rep max in that fatigued state. Something popped and I felt a sharp pain in my lower back. It hurt really badly for about 3 days, and made it difficult to put on socks and pants. And then it healed right up. No pain ever since, and I went right back to deadlifting.

3 days? I'm glad you got better but this is not a serious or chronic back injury under any definition.

It was probably a back strain/sprain. Before going through that, I expected that a deadlifting injury would be debilitating and would take months to heal from. The reality was... different. That's my point.

Someone I know hurt their back during a deadlift. They were out of commission for months until they had surgery to shave a disk.

So.. don't assume that your results are predictive of the results for everyone (typical mind fallacy/typical body fallacy?)

As an aside, there is almost zero reason to PR on any exercise unless it's for a competition. The risk of injury at a PR load is simply too high for recreation. Your 3RM is a good indicator where PR lies, and carries far less risk of injury.

I'm saying this as someone who loves the dead lift and picking up heavy things.

Good advice here. 3RM in my opinion is even pushing it and not something you want to do often. 5RM is probably more ideal to do on a semi-regular basis.

Form is critical too, so with every single lift that you do, make sure you're using the correct form first, otherwise you're potentially wasting your time and putting yourself at risk of injury.

Agreed. Even a 3RM is something that I would no more than 2x/year. As I've gotten older I don't even do that. My workout weight goes up over time which means I'm getting stronger. But I'm not a complete young idiot anymore, and know avoiding injury is job one.

> we always avoided the deadlift due to the high risk of injury

But doing a deadlift properly is the most natural type of movement.

Like lifting your child off the ground. Or putting a sandbag in the back of the truck. I've done thousands and thousands deadlifts with no injury.

Can you provide a reference for your assertion?

I don't think it would make sense for the GP to provide a reference, for what is, after all, an anecdote about a class he took.

As to whether the deadlift in fact has a high risk of injury, it would seem he agrees with you (and myself, for what that's worth): not really.

It's a common misconception about dead lifts. So common, that some 'experts' even say to avoid the dead lift. The problem, as you point out, is that lifting things from the ground is a common every day occurrence. Learning how to lift things properly and add some strength around that movement in fact lowers risk of injury.

Chances are you were lifting the toddler or sandbag with ho hum form. You aren't going to hurt yourself lifting 50 pounds like that. You try ho hum form with 400lbs on a barbell and your body is not going to be very happy with you.

Does ho hum mean bad? Couldn't really find it, just that it means routine/dull. But if good form, then I find it unlikely that you hurt yourself with 400lbs if you progressed to that.

Deadlifts are so safe that... there are hundreds of deadlift safety tutorials on Youtube, where poor form and a bad instructor can cause irreversible damage very abruptly.

Notice how this doesn't apply to jumping jacks or the plank.

That you always have to couch the benefits of deadlifts in the "when done properly" disclaimer should be a hint as to what they're talking about. Hell, even lifting with one's legs instead of one's back comes so unnaturally to some that my refrigerator's box came with "lift with legs" instructions stamped onto it complete with a series of pictograms.

I highly recommend watching this video by Jeff Cavaliere: https://www.youtube.com/watch?v=hCDzSR6bW10 as a checklist of things to think about before attempting a deadlift.

The key thing that he calls out in this and other videos is that most people do not have sufficient hamstring flexibility to safely deadlift off the ground (lack of flexibility will force your back out of a neutral position "rounding of the lower back"). There is certainly no shame in starting your deadlift from an elevated position by stacking plates underneath the barbell or pulling off rack pins while you work long-term on improving flexibility.

I highly recommend watching any of his videos before attempting any exercise, even ones that you think you know how to do well, e.g., bench press :)

Ok, I normally am very skeptical of youtube lifting, but actually these videos are pretty good...

Jeff is a strength and conditioning trainer (formerly with the Mets before becoming what looks like a full-time YouTuber). Ignore the click-bait titles and the fact that he doesn't wear a shirt - that's all part of the YouTube game. His content is consistently excellent.

Trust in AthleanX. If there's one guy you want to listen to regarding fitness on YT, it's him.

My experience exactly, although I can't narrow it down to the deadlift. I had occasional but regular low back pain starting in my early-to-mid twenties. There wasn't a consistent relationship with my level of activity or inactivity, the type of exercise I did, or with my weight, all of which fluctuated quite a lot over the years. Back pain was just something I got regularly, like colds or headaches. I've had virtually no back pain (other than muscle soreness and a couple of sports injuries) since I started lifting heavy weights, which is not the usual progression for somebody from their twenties to their forties.

It's incredibly counterintuitive. Everyone's assumption, if they don't lift weights themselves, is that my case is some kind of weird exception or coincidence, and I can't really blame them. I have no idea how to explain that there's a good chance that they are misusing their back, and that they would be more comfortable sitting, standing, walking around, and lying down if they strengthened the muscles in their back. First of all, why in the world would we need to learn how to use our own bodies as adults; don't we figure this out as toddlers? And second of all, if we spend hours every day sitting down, hours every night lying down, and maybe hours every day walking around and jogging, why in the world would our backs not be strong enough to do those things safely and comfortably? Isn't doing something for hours at a time exactly the right signal to prepare your body for doing that thing?

But it seems to be a very common experience for people who try lifting weights: they find that they are much more comfortable sitting at their desk at work and lying down in their bed at home if they lift heavy things on their feet at the gym. I wish I knew how to convince people to try it.

I had a similar experience.

I am over 2m00 high.

If this sounds "cool/lucky" for most people. It is in reality a nightmare if you are office worker. Everything is in your environment generally lower, shorter or inappropriate for you... This trigger improper posture and inevitable backpain.... Chronic backpain in my case.

After passing through everything, including painkiller, osteopathy, chiropractic, surgery (back bone injection) without any better results I tried (pure amator) weight lifting and this was a miracle for me.

My situation get much better, in just a matter of few months.

My 2 cents on that is weight lifting force you to fix your posture and imbalance when you practice it. Muscles have Memory, and this, even if it is counterintuitive, help a lot.

This. It's incredible.

I've had back pain for about 2 years, up until recently. I did weekly physiotherapy for an extended amount of time until my doctor recommended neurodynamic exercises. It's basically focusing on stretching your nerves. I did that daily for 6 weeks and my pain was mostly gone. When I feel it's coming back, I do the exercise maybe once a week and I'm good. On top of that I can now focus on improving core strength. It's a huge motivator knowing how bad it feels, but that you have it under control (which was a huuuge relief).

Edit: my back pain was caused by bad posture, which was caused by pain from an untreated slightly ruptured intervertebral disc.

How do you do neurodynamic stretching?

Your PT didn't bring any of that up?

My PT didn't mention much about posture like the book did. The book covers a lot of detail on how to sit, sleep, stretch, lift, breath and other basic human activities. Sleep was a huge win because I would wake up with pain most of the time but the moment I learned how to sleep properly and put those lessons in action, I woke up without any pain. I was sore the first day (a good sign, IMO). It is sad that I am old enough but my body has forgotten to perform these basic activities.

My PT did not mention anything about thoracic mobility exercises either. Book also covered chin tucks and shoulder rolls but it didn't stop there. These are some of the common exercises you find on internet and are recommended by mostly all of PTs. But when you are done with your sessions, there is no one to tell you at home about not exaggerating your neck while doing chin tucks. But the book did with amazing visuals.

PT (4.5 yelp reviews) did lot of trial and error solutions focusing on strengthening and mobility exercises. Great, if something worked, otherwise continue trying different solutions.

I also had to meet $1500 deductible for my insurance to cover these PT sessions but I could only afford 2 sessions a week. This point was not an obstacle but I wanted results from PT after 3-4 sessions to justify the cost which didn't happen to be the case for me.

8 steps to a pain fee back helped me quite a bit as well. But is the author not Esther Gokhale?

No discussion of back pain is complete without mention of Stuart McGill (see, for example, his book "Back Mechanic" - https://www.amazon.com/gp/product/B01FKSGJYC/ ).

He's a professor emeritus @ UWaterloo, and spent years studying the biomechanics of the back. As a consequence, he's developed exercise techniques (e.g., the "Big 3" - curl up / side plank / bird dog), and a host of diagnostic and treatment techniques for rehabilitating back injury, especially in athletes.

I personally had a dynamic disk bulge that would leave me in bed, unable to move for a couple days at a time, and it was successfully and completely treated by his methods, leaving me completely pain free and in better shape than ever four years later (and I'm an extremely active person, spending ~10 hrs / week on various athletics).

My dad was a great athlete growing up, and a common way that athletes deal with pain is to rest for a while and then gradually return to exercise.

As he got older, he followed the same routine, except like many aging Americans, he basically stopped exercising. Whenever he had pain, he would rest the affected area, but there was never a return to exercise.

Every muscle/skeletal problem he had seemed to become chronic as the muscles got weaker and weaker. I could tell he was nervous to exercise because he didn't want to injure himself and he wasn't in very good shape, but it was obvious that rest was doing him no good whatsoever, but to his last day, he thought that if he just rested, he would start feeling better.

What's surprising to me is how often rest is recommended as treatment for people whose entire existence is characterized by a lack of intense physical movement.

This is a scary comment for me. I'm partially commenting to remember it.

I do exercise, but I avoid exercise while uncomfortable from back pain. Clearly, if I keep not exercising, I'll eventually only get worse...

So there are a lot of comments here about it, but going to give one of my own -

I've had back pain for the past year. Still trying to figure out the right treatment. But what ALWAYS helps, is a Lagree fitness class (and by extension I'd say pilates would too). Some of hte moves help more than others, but I can go with my back hurting, and I quickly get to where I don't even notice it in the class (because everything is engaging muscles and taking pressure off my back), and by the end of the class I feel great. Two days later it will be back, but, that's also when I take the next class. Still trying to figure out what to do on off days to keep it from returning, and so hopefully able to heal, but, yes. Find something that will keep your back protected, but still work it (and the rest of you).

It's tricky right, because if you are an active athlete, then you may make an injury worse. In martial arts this was a common issue where someone would have a minor injury, aim to "work through it" and make it much more severe.

At the same time, simply sitting around binging Netflix is probably the wrong call in many situations.

What my reading of the current research indicates (and, this stuff tends to evolve regularly) is that a short period of rest (two or three days) followed by light activity for a short phase tends to be the best course of action. To the extent that RICE (Rest, Ice, Compress, Elevate) has become MICE (Move, Ice, Compress, Elevate).

This is the standard recommendation for many injuries. Are there any controlled studies which demonstrate that injuries treated with ice resolve more quickly than without using ice?

Digging through the exhaustive NIH entries on this topic is left as an exercise to the reader

Let's stipulate that this reader is an idiot who didn't think to do that before asking. Is there a single reference you can provide from the exhaustive entries?

The modern view of it seems to be that none of it is needed and can even be counterproductive. Compression can sometimes be useful to reduce swelling. Swelling can be unpractical, but is not bad in itself. Rest, ice and elevation will in general make recovery slower.

Whenever I go too long without exercise, I get back pain. It's like clockwork. Then I start exercising and it goes away until I lapse.

Certainly that's not going to be the solution for all cases of back pain, but I do wonder how many are taking painkillers and such when some regular exercise or other physical changes (posture, weight) could do the trick.

Depends on the location and severity. I've found that using a foam roller before and after a workout, or even daily, has pretty much removed any back soreness I used to get.

Agreed. I bet 10 minutes of simple exercises daily would solve back problems for a lot of people.

Injuries are a different case. I'm in the same set as you, and my father as well. As long as he and I do ~20 pushups per day and maintain a bit of focus on improving/maintaining our posture during various activities - backpain is negligible. But neither of us have ever needed to take pain medication for back pain.

A lot of the people I've known over the years who took opiate painkillers for back pain have had injuries to their spine. Some people I know with spinal injuries tried opiate painkillers, found that they were effective for the pain, but the side effects prevented them from being focused at work, so they chose to live with the pain in exchange for mental acuity. I also know others who have tried very high doses of opiates and it did not significantly reduce the pain from their back injuries.

This holds true for me as well. If i'm not doing some light regular exercice, I start to experience back pain.

Me too. I think just moving your body around and getting the blood flowing through your muscles tends to loosen things up a bit. Something like yoga can be extremely helpful as well, although I've overdone it and actually hurt my back too, which required two weeks of lots of Advil, ice and heat until it got better.

I'm usually pretty dedicated to my gym time, but recently I've found my interest waning, and this is what surprises me - I've been away for a month-ish, and I find that my back has starting to get twinges. It never got twinges before. It'd be stiff the next morning, but that was due to DOMS, not because I got out of bed funny.

For the past several years I had serious problems with lower back pain, once every few months it would get so bad I couldn't stand/sit/walk without severe pain for at least a week, even painkillers didn't help much. One year ago I started to exercise at gym, twice a week, and it worked wonders - no back pain, except for minor one from time to time if I lift something the wrong way, but overall I feel so, so, so much better (and look too xD).

This, combined with the expense of doing physical therapy is what led me to make MoveWell (https://movewellapp.com).

Most people don't know how good they can actually feel. Sitting down all day isn't natural and taking opioids or expensive surgeries that aren't guaranteed to work (see Steve Kerr's story) aren't great options.

I think most people would be surprised at how good they can feel by just taking 5-10 minutes every day to do mobility work and/or foam rolling as part of their daily work habit. You spend 8 hours a day messing up your posture. You should take 5 minutes to help undo it.

> and taking opioids or expensive surgeries that aren't guaranteed to work (see Steve Kerr's story) aren't great options.

Not only not work but make things worse or irreversibly damage the body.

Android version please!

Aww man, no Android version? :(

Our web version should work for now!

The single best thing I did to fight back pain: Start juggling.

I work 10-14 hours per day at my notebook without any external monitors and at changing locations. So, my typical posture is cramped over a 12 inches display. I started to juggle 4 years ago. Initially 1 hour/day – nowadays whenever I have time or something at hand. Usually 10-15 minutes/day with some extended excises at the weekend. I did not have a single problem since then. Try it :-)

Bonus: Juggling connects both sides of the brain. It makes you happy and intelligent. As well it helps overcome e.g. anxiety, ADHD..

- Start with 1 ball and level up to 3 balls – with regular practice it will take you ca. 1 month

- Look at YouTube, but practice at your own speed - 3 balls is totally fine

- Picking up the balls from the ground is part of it – embrace it

The best overview of the back pain industry is the recent book, "Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery"[0]. The author's interview here[1] is a chilling survey of how the back pain industry extracts money from the population. The article mentions back pain becoming independent of injury, and that idea is from Dr. Sarno[2] in the 1970s, and he was ridiculed for decades about that idea. It is now recognized that a pain circuit can establish itself and run long after all physical injury is healed.

One reason back pain is tricky is that the intravertebral muscles spasm to protect the spinal core, and the spasms don't stop for up to ten days. By that time, the patient may have seen three doctors and had three different therapies. When the spasms subside, they associate the last treatment as the one that "healed" their back, when in fact, 80% of all back pain resolves itself with or without treatment.

There is a growing body of evidence-based research into exercise and back pain. The most studied device is the MedX lumbar extension machine[3][4], invented by Arthur Jones, the genius behind Nautilus exercise machines. Slowly the knowledge to strengthen the specific perispinal muscles is spreading[5].

[0] https://www.amazon.com/Crooked-Outwitting-Industry-Getting-R...

[1] https://www.youtube.com/watch?v=ztdKosnQHaE

[2] https://en.wikipedia.org/wiki/John_E._Sarno

[3] https://www.youtube.com/watch?v=1Z-FyeG7pqY

[4] http://ssudl.solent.ac.uk/2270/

[5] https://highintensitybusiness.com/podcast/dr-ted-dreisinger/

An excellent book. A long term back pain sufferer herself, in the course of more than a decade the author interviews numerous physicians and trainers in the field of back pain therapy about their method or insights, and does a nice job of contrasting their philosophies and tracking trends in back rehab over time.

Ultimately her experiences and intuitions make a strong case for focused strength training to correct our natural overreaction to past injuries, which often overstresses muscles and joints that can't compensate fully, causing pain.

https://outline.com/zZhZLU

The variety of solutions people have mentioned in this topic is a testament to the complex and varying nature of back pain (and the body in general, if you'd like to go there).

I would therefore like to add my personal savior: Hamstring stretches.

Changing your lifestyle (not necessarily drastically) and excercising/stretching in general is the solution in most cases, yes, but for me the single greatest contributor was the hamstring stretch. Lie flat on your back, keep your legs straight and raise one until you feel its back sides burn. Strain it a little; using a towel, rope, bedsheet or spare pair of pants to pull on your heel if necessary. IANAD, but I hear it's pretty hard to injure your spine this way.

Something I've found is that sitting on a couch for anything more than a couple minutes will leave me with lower back pain for the next day or two.

Much to the dismay of all the older people in my life, we got rid of our couch and have taken to just sitting in solid chairs or on the floor.

We also sleep on a futon mattress directly on the floor. Any time we visit relatives, I wake up with back pain.

Any time the topic comes up, I seriously wonder how many people's pain / mobility problems could be solved by just getting rid of all the furniture in their lives that actively works against the body being able to support and align itself.

https://www.youtube.com/watch?v=l9poXGU11ms

I urge anyone dealing with back pain to watch this video, there is a part 2 as well. It isn't short but hey, that's a complex topic for you. Deconditioning yourself from fragility and fear-mongering prevalent around this topic is very important. Even those that mean well do it without realizing it.

I'm a big fan of Barbell Medicine's work but they really need an easy to digest article on the bio-psycho-social model.

Look at how much fear-mongering is in this thread alone!

I agree it's an unfortunate problem. To really grok this issue requires some time investment.

In this thread I've seen people recommending yoga, stretching "tight muscles", the McKenzie method, the McGill book, and stretches. I've only seen a couple of mentions of actual training. Sad state of affairs.

I've herniated ('slipped') a disc twice in my twenties, both times when I was in periods where I let my fitness level fall. The pain was absolutely debilitating - you're really not able to do anything. Even with pain meds...standing, walking around, sitting, sleeping...it's all hard to do. Recovery sucks because you have to move around to recover, but it causes unbelievable pain.

I firmly believe for most people slipped discs happen due to a lack of core muscle strength and spending most of our days in terrible postures (sitting at a desk, for example).

I spend at least 50% of my exercise time focusing on my core now. Things like planks, squats, and yoga. My thought being that a strong core keeps everything (eg your spine, discs, and soft-tissue) in place. I have absolutely no scientific backing on this, but it's worked for me so far.

Running was actually the cause of my herniated disc. Well probably weakened over the years by slouching forward at the computer and not building a strong core. But after recovering from one huge bout of back pain I started running again and a few days later I had sciatica and foot drop. I still have nerve damage.

Doing the McKenzie back exercises every morning for the past five years is the reason I’m able to still function I think.

I can’t say if the pain from sciatica caused by a disc herniation is the worst pain I will ever feel, but it would be hard to imagine worse.

my thoughts exactly. I recently re-injured my back with a muscle spasm caused by DDD and the PT tried cupping. this led to unimaginable nerve pain. I can't imagine worse pain than that

I herniated a disc while playing basketball. The herniation didn't hurt my back, but pinched my sciatic nerve. This led to my left leg literally feeling like it was being cut off my body. I've torn my ACL and had appendicitis. The pain from those was not even in the same universe as the nerve pain.

I have sciatic issues--my leg feels either numb, or on fire when it acts up.

I bought an inversion table. I get in it backwards and hang from the affected leg (the other I leave free) for about a 40 count. It brings me from pain to fine in usually a single session. Mind you, I don't have anything herniated and I think scoliosis is pinching the nerve in my case. I am not a doctor, and try this at your own risk. For me it is life changing.

https://www.dickssportinggoods.com/p/teeter-nxt-s-inversion-...

I received an injection in my back to get the initial pain under control and then let inflammation go down over time. To prevent further issues I stopped playing basketball and spend more time doing yoga, spin, strength training and jiu-jitsu. My doctor and I posited it was the impact from the running/jumping/cutting in basketball that led my initial problem.

Most back pain, especially lower back pain, is a result of weak glute muscles, caused by extended periods of sitting. Fixing weak glutes, will fix a major chunk of problems.

Had plenty of back pain while running. Havent had any back related issues since I started weightlifting.

Weightlifting FTW

"Most back pain, especially lower back pain, is a result of weak glute muscles"

Citation please.

I've spent considerable amount of time in the last 15 years trying to figure out why I have back pain. It was never fully debilitating pain but more the occasional flare-up with usual mid / low level pain in the lumbar area and in the neck. I don't have pain or only negligible pain in the last 2 years. But so many more important things have changed.

There is no short recipe for killing pain. You have to change how you live, and understand that you are responsible for your body. It took some time (years) to ease into the situation and realize that it is an opportunity from which I can learn. So I had learnt. Learning through movement is double fun because the body is complex and is "me", so I can experiment and experience at the same time.

OK, maybe I have a short recipe, here it goes: Be gentle and be curious and build trust towards people who can help. And most importantly help others.

Search for Dr John Sarno (books/videos etc). I remember reading an article by Tony Schwartz about how beneficial it was. Easy to search for.

Sarno comes up on HN with some frequency, and I never understood why. AFAIK there is no good evidence that the "tension myositis syndrome" he describes even exists, or that his treatments are much better than placebo. I one of his books, I think "The Mind/Body Connection", and found it to be very new-agey. It basically amounted to "be kind to yourself and forgive others and your body will feel better". Maybe there is some truth to that, but it's been decades without good evidence?

It's because it works.

I had completely debilitating RSI where I could only use one hand at a time to type for 15m at a time before I had shooting pain all the way up my arm to my shoulder. His solution (which admittedly does sound like new-agey bullshit) took me from that to zero pain in 3 weeks. I have no idea if his syndrome exists or not, but his solution worked for me which is really all that matters.

Granted, I did not do an in-depth look into the evidence backing his arguments but I did find the argument of referred pain to be compelling, if not robustly proven. (e.g. the lack of existence of RSI in the time of typewriters, the increase in incidence of ulcers as soon as they were tied to stress by medical literature, physical back pain manifesting in some but not others with the same physical symptoms showing in MRI, etc)

I don't fully buy his exact theory either, but it doesn't matter -- it cured my wrist pain anyway. The specific mechanism of action is less important than the core premises, which are:

1. My brain is capable of generating the sensation of pain in various parts of my body.

2. My brain has been conditioned to generate pain automatically (and unconsciously) in response to certain stimuli.

3. It is possible to recondition my brain to remove this automatic response.

The surrounding body of theories and recommendations are just methods for accepting these premises and completing the reconditioning process. For most people, accepting the "diagnosis" is the hardest part. The pain feels very real and very much caused by structural problems in the body. Personally, it was only after I had accumulated a sufficient set of evidence ("the nature and exact location of my pain is not consistent," "a nerve conduction study found nothing wrong," etc.) that I was able to begin reconditioning. The turning point came when, after I started to see some reduction in pain, I began experiencing strange symptoms in other parts of the body (e.g. headaches, which are rare for me). This aligned perfectly with what Sarno's book said would happen. After that, I was able to "buy in" 100% and the rest of my pain was gone within a few weeks.

I suggest reading Aaron Iba's blog post on the subject; it's what convinced me to give it a try: https://aaroniba.net/how-i-cured-my-rsi-pain

I think he got the right answer the wrong way.

Sarno comes up because what he suggests works. It did for me back in 2001 when nothing else did.

I've too posted multiple times about Sarno because by just reading his books I got cured of my years of chronic back pain (I think it was more than 11 years of pain doing physiotherapy, yoga, pain meds, ayurveda, etc none of which helped me for long).

It had gotten to the point where I couldn't sit for 1 hour or pick my daughter up.

Pain is all I could think about waking up to before sleeping.

Then I read this comment on HN and my life changed. All I had to do is read Sarno's book and even before I could finish it I was feeling a lot better. It was like a decade of pain leave my body in 2 days. Though it does take time after that to learn how to get totally pain free.

I'm glad to say that someone else too read my comment on HN and posted that he was thinking of ending his life due to immense back pain but he too had a similar experience like me after reading the book and feels almost cured.

It's also not placebo either since I'm pain free for almost 3 years now.

Helped me with back pains and a plethora of random pains. Also helped my partner with hers.

Anytime I raise this book to somebody I'm told I'm full of shit though.

Well this is timely content for me. I am 32, healthy weight range, and going to have athroplasty next week to replace L5/S1 disc. Information I was told is 9/10 have positive outcome with 1/10 still experiencing pain post recovery.

I implore you not to do this, as a healthy 32 year old, until you have attempted to corset, or lock in place, your disc with your own muscle.

You could do this with a lengthy, complicated series of midsection/trunk exercises, or you could hit every associated muscle in the correct balance and proportion by walking.

Your body was built to walk - you are a walking machine.

I had a blown L4/L5 going into basic training and was immediately walking 5-8 miles per day. It was very painful and debilitating for the first week ... and then it was gone. I believe the muscle action pulls the spine back into proper alignment and gives the disc nowhere else to go but where it belongs.[1]

If you look, you will find this to be a very common anecdote.

[1] IANAD and obviously cannot speak to severe trauma, fractures, etc.

I second this. I am similar age with similar back issues. I focus on core work and strength training. I also run 3-4 miles a few times per week. I am very careful to use proper posture vs speed. I have been able to avoid surgery. I still have bouts of pain and flare ups on occasion. I typically fix them by increasing stretching and better my posture.

>I implore you not to do this, as a healthy 32 year old, until you have attempted to corset, or lock in place, your disc with your own muscle.

This is not advice you should be giving.

You are not his doctor. You don't know the extent or type of his injuries. You have no idea if core workouts will help. You have no idea if he/she even can walk.

90% of herniated discs resolve in 3 months. For the 10% that don't sometimes surgical intervention is needed. Don't muddy the water with vague uninformed advice if you don't know this persons exact medical details.

> You are not his doctor.

On one hand I agree, but it is useful advice to say make sure to talk to different doctors. If someone goes to a surgeon, they are likely to lean towards surgery. I'm going to assume the GP has already seen doctors that specialize in non-surgical treatments like steroid injections directly at the site, but for anyone else reading this information could be useful.

And, the OP is right. The doctors I've talked to have all said surgery needs to be the absolute last resort. Many end up worse off or needing more surgery.

I blew out my L5/S1 and I woke up after surgery with almost no pain at all. It depends entirely on the damage. My disc was totally smashed so all the PT in the world wouldn't put it back together.

I was 25 when I had surgery though, so god only knows what kind of shit I'll be in when I'm 45. Hoping those stem cell treatments take off.

I am glad you had a good outcome. I have not taken this decision lightly. I have tried many non-surgical interventions (chiro, physio, walking) for over two years so the time has come. I think for every 'I had back pain and I fixed it with _insert non-surgical solution here_' there is just as many 'I put off surgery for _x_ years and wish I'd done it sooner'.

Anecdotal but walking significantly helped me as well. I did a lot of PT for my back issues and while they were somewhat helpful the only thing that really made it go away for good was several miles of brisk walking every day.

At least for me it's certainly some muscle thing as once winter comes (and I'm walking less) the back problems come back. One of the best things this winter was getting a job in an large sprawling office, which means I'm walking several miles every day at work (all indoors). Haven't had any issues this winter at all.

"At least for me it's certainly some muscle thing..."

Again, I think a good mental model is that of a corset, or a brace. In this case, the corset you are donning is made of your own muscle.

You could attempt to build that own-muscle corset section by section by doing all of the 40 different trunk and midsection rehab exercises, but even then, in what balance or proportion could you hope to execute them ?

Instead, you can hit all of them, in concert, and in appropriate proportions, by walking.

The difficult part is that bad back pain will not make for easy, pain-free walking - at least at first. I found 4-6 mile walks to produce a fair amount of back pain in the year immediately following my initial disc herniation/tear. It took that forced week or so at the beginning of basic training to pull my spine back together.

I do tai chi chuan, with a teacher that insist on having the right (ie efficient in combat) postures. That's pretty tough to reach (you need a lot of muscle flexibility); that is, years of mild training. Although I'm nowhere near having the right postures, working on that twice a week makes a huge difference on my back pain. I also do standing tree posture chi kung, 20 minutes every working days. Helps a lot

And I started to do all of that not because I love martial arts, but because it relieves my pain significantly. If I had the time, I'd some some swimming too and some running to help my heart too.

I found a cure for my own lower back pain last year.

I had dealt with back pain throughout most of my 30s, and had self-diagnosed it as a bulging disc. Every few months I would lean over while brushing my teeth, or sneeze weirdly, or bend over to tie my shoes, and my lower back muscles would spasm and I'd be laid up on the couch for a week, taking muscle relaxants.

Early last year, I slowly came to realize that I had an unconscious habit of constantly holding my stomach in and tensing my abs. After unlearning this habit, my back pain is almost completely gone, and I haven't pulled a lower back muscle in about a year.

Over 10 years of terrible back pain, tried all kind of things. At some point, I was prescribed painkillers, tried PT, yoga, everything.

Turned out that the “glutes/hip weakness” approach was correct. Changed my life - not a single issue since years of muscle reinforcement in the posterior/hip area with a focus on posture.

Definitely the worst thing you can do is lay there and do nothing about it. you have to keep moving. Perhaps it has to be done in moderation if you have a lot of pain but the movement seems to be for me the best cure.

I think because of my profession sitting in front of the computer it's easy to get into certain habits that really just are not healthy and there's not enough movement. I don't really get into the hype of the standing desk either. Sure, I can stand up and work but also I just need to move a lot more and it makes things a lot better.

I got a herniated disc which went undiagnosed for a long time. I've been prescribed/taken/done alcohol, tricyclic antidepressants, ibuprofen, codeine, anti-inflammatory steroids orally and by injections, McKenzie, light deadlifting, CBD, and THC cannabis, excessive biking, walking, running... the list goes on. Yet, the most significant cure for me was getting a standing desk. It seemed like only once I spent most of my time not straining my back, was I able to gain much from all the else.

Seconded.

As a tall human being I also had to get fairly big monitor stand to add to the standing desk to save my neck from strain. Cervical disks can herniate too, and it sucks!

More power to you fellow back pain enthusiast. I also had a herniated disc (L4/L5) and the only thing that helped me was surgery (lumbar laminectomy). Then lots of walking.

The spine is the central structural pillar of the body not only mechanically, but electrically as well. Messages are passed between body parts using electrical signals through nerve fibers, which run from the brain down through the spine branching out to the rest of the body. When these things get messed with, even a little bit, it creates enormous effects.

The spine is surrounded by a system of muscles, all of which work in concert to support your body as you put it through various positions and movements. Depending on how these things work together, certain areas of your body may experience more stress and strain and break down. Muscles become tight and overworked, soft tissue cushioning degrades, and nerves become pinched, stretched, or otherwise compromised.

The way that this manifests in any individual's body depends a ton on that unique individual. There is a bell curve distribution to the way that people's bodies work, but just like taking general technical advice and applying it to a specific problem without understanding what makes the advice applicable to a specific set of circumstances can have disastrous results, so too can it here. Taking general purpose mobility, posture, and injury prevention advice without understanding the mechanics of my body is actually what led to my back injury.

The mental factor of the condition is certainly the biggest hurdle. What helped me deal with two major herniations at L4-L5 and L5-S1 was becoming educated on not how all back pain works, but on how my specific back pain works. It makes you feel as if you own the injury, not like it owns you.

Once you herniate a disk, it's over.

I can do 20 pullups, I can deadlift 500lbs, but every ~3 years my back flares up doing somethiing like standing up and I can't walk for 3 days.

The simplest thing you can do to avoid/treat muscle related back pain is performing two exercises every morning: “Superman“ back extensions and hamstring stretches. They take less than 5 mins.

Scooby’s workshop is a great resource to learn the exercises and more about lower back pain: https://scoobysworkshop.com/preventing-lower-back-pain/

Injured my back a dozen years ago playing with my toddler - spent a couple of days barely able to move for the pain.

Doctors recommended some mild exercises (on all fours, lifting opposite arms and legs).

But what really changed it for me was deadlifts. I had been very wary of deadlifts (bend over and pick up a weight? crazy!), but I started very light (just the motion, then a light bar), was very careful with form, and progressed very carefully.

Really made a huge difference for me.

My roommate at the time and I had just started at our first jobs fresh out of school.

The first thing he bought after he got paid was an extremely nice office chair, soon followed by a nice desk.

I didn't quite catch on until 5 years later, but I can attest to being blessed with near 0 back pain so far. (Fingers crossed.)

I had back pain for a couple of years, starting in my mid twenties. The worst of it was in the early morning in bed, it often woke me up. I already had an ergonomic office chair, did bodyweight exercises and cycling. Over the years I bought 3 or 4 new mattresses. Doctors had no clue. Couple years later, when another horrible issue popped up, lots of tests and a couple doctors later, turns out I have ankylosing spondylitis and back pain that gets better with movement is an early symptom. Now I get prescribed physical therapy, as long as I do their exercises I don't have back pain. The main exercises are opposite arm and leg raise and the bridge. No luck so far with the chronic SI joint inflammation.

Can you elaborate on this? What was the morning pain like? What exactly are the exercises you do?

Pain in the lower back, iirc mostly in the muscles next to the spine. The wiki page says "stiffness", but I never experienced it like that, it was more like regular pain. I used to have 2 different beds so I could switch in the early morning, this way I could continue sleeping. The pain also occurred when standing for long periods, and later, when sitting for long periods. Improvements with walking and moving around, and as I later learned, with NSAIDs like ibuprofen because it's an autoimmune disease. (Don't take on empty stomach).

The exercises at first focused on identifying and strengthening the Transverse abdominal muscle (TVA). During the later exercises you're then supposed to activate this muscle.

TVA: while lying on your back, feel with your fingers next to the protruding hip bone. Try to imagine you have to put on pants that are a little bit too small. Meanwhile keep breathing with your belly, so you don't tense your abs. Feel if you can sense a muscle tightening. Then first just tighten this muscle a couple days, then start with lifting part of your leg, etc.

Then you can start with bridge and opposite arm and leg raise. These are pretty well documented on google. With bridge, focus on lifting 1 vertebrae at the time in a rolling motion. With the opposite a/l raises, focus on maintaining good position of your hips, keeping them horizontal throughout, and starting off with the correct amount of cat/camel roll. Do only an arm or leg first, then opposite. Make more difficult by moving your arm, someone pushing you, unstable surfaces. Sideways planks and pushups are also good.

Other exercises we did but I never practiced much: sitting in chair with straight back, activate TVA, lift 1 leg a little. Standing up, activate TVA, keep hips horizontal, slide 1 foot forward, sideways, circles etc. We also do a lot of stretching, mainly piriformis, hamstrings and thighs.

AS here too. Been there with the pain-insomnia and SI inflammation. My first line of treatment was with NSAIDs, and it was a huge improvement. Later on I started with Adalimumab, and it was another huge improvement.

Try running. It's one of the rare scientifically proven ways to help heal disk problems. It's helped my SO and myself.

But not a lot. 1 to 3 km every day is fine. Walking 1/2 of it is fine. Just go out for 30 min and try to run as much as you can, but go slowly. Just a bit over walking pace is better than short bursts. You really don't need a lot and isn't any better for extreme runners. It'll get better in a week or two and it will start hurting again if you stop for too long before your fully healed (months probably)

It's all about pulsating vertical compression. And even if it does not help due to that, it surely will for other things.

Good luck! I hope it helps.

got a link to the research that backs this up?

On my phone, will link when I get home, but I found this with a quick search: https://www.ncbi.nlm.nih.gov/pubmed/28422125

I think there was a meta review, but will have to ask my SO, it was her research that lead us to it.

Your joints and spine absorb the shock from running on pavement or concrete.

I am a runner, I had slight lower back pain before running that went away in the early days of running. I mostly assumed it was losing weight, which I am sure helped, but there is no doubt both my focus on posture and actual posture improved. So it is a bit of a positive feedback cycle.

To your point about no to much running, after I began running for periods over 2 hours, I would get some back pain during the run and stiffness after. However, I began doing pushups and planks, sure enough I strengthened my core and I don't get backpain on even 4+ hour runs (not to mention I developed a 6/8 pack which I never had in my life, a nice surprise in the mid-30's).

I used to run when I was still losing a lot of weight. I'd still be running except that it seemed to cause an endless series of injuries and pains that no one could tell me how to fix.

I've been guided to instead cycle. If your back pain is caused by muscle imbalance (e.g., another leg longer than the other) or herniated disc, then running will supposedly make it worse. Yet, activity is important, which might be why running works for you.

Running made things much much worse for my back.

Be cautious about this advice.

The advice is very specifically for mild disk problem. Also for light running. You're not going to run any marathons. It's just a little more than walking. Overdoing anything will hurt you.

I had lower back pain for over 2 years. 7months ago I started running. Once every week for 1hour(~10km). First 3-4 runs I took pain killer, because I was ok during a run, but wasn't sure what will happen next day, then I stopped taking all pills and just went for 1-2hours run once a week. After a month or so the lower back pain was almost gone and I run more than 400km since. Of course, my whole body feels significantly better.

edit: You should consult that you wanna start running/swimming with your doctor!

I also recommend a small back brace to assist with posture while walking a bit..

Dont wear it all the time - but it helps to remind yourself of your posture and put your awareness on your spine.

Wear around the lower back.

I never had back pain until I started running.

Now it won't go away no matter how much physical therapy I get or other exercises I do.

Seems like back pain is one of those things that it’s really hard to get legit non-anecdotal advice on. It’s like weight loss in that it attracts all the usual kinds of pseudomedicine and quackery. Read this book! Do this scientific-sounding exercise! Go to a chiropractor! Do acupuncture! Drink this mystical energy tea! It worked for me!

Is there really any real, reproducible and trustworthy source of info on the topic?

>Is there really any real, reproducible and trustworthy source of info on the topic?

There are a few longitudinal studies on surgical versus conservative treatments for back pain. However due to the long duration of the disease there tends to be a high dropout rate. Also the risks of surgery tend to have a long incubation time (re-hernias at 5 or 10 years on for example).

Even with the most rigorous studies it is a very hard field to pin down exact probabilities for.

in terms of accumulating a statistical sample of anecdotal data, I'm in the control group for "didn't pursue any particular "cure", and I got better; guess I learned to manage it". I tell my story not because it's interesting but because you might think "I'm better, yoga did it" and I'm better and I didn't do yoga.

In the past (starting in my mid-20's) I have had a number of episodes of very severe backpain, several times on the order of "can't stand up" for a week at a time. A handful of times (each independently) have been given Flexeril or cortisone shot or NSAIDs or mild opioids.

Mostly I've learned to recognize the early twinges of pain and I immediately switch to "being more careful about bending over" and how I sleep etc. and I'm able to not get into an acute situation.

I don't do yoga, work out, etc. I manage my weight by dieting and I'm not fat, more in the dad-bod category of "people with a slight amount of extra weight have better health outcomes from surgery, severe illness, etc".

Running on the daily makes my back hurt, and I can't "run through it", it keeps getting worse. I stopped trying to run on the daily. Twisting playing tennis makes my back hurt. I stopped playing tennis. Shoveling heavy snow makes my back hurt. I still shovel snow from time to time, immediately afterward I pop 3 ibuprofen and relax my back, and repeat if I feel stiffness the next day. Popping ibuprofen at the first sign of stiffness to "get ahead of it" seems to work, but who knows, I'm not conducting trials.

That's all I take ibuprofen for, and I average fewer than 1 ibuprofen a week. I might have a few days of bad back every five years now, and usually because I did something stupid like agree to help somebody move.

I was experiencing hip pain after too much sitting and not moving enough. Went for some consultations and ended up with a surgeon that wanted to operate because I was told I had a labral tear, amongst other things. I read more about this and it turns out that most people when evaluated with imaging have a variety of indicators that doctors use to suggest that surgical intervention is required to fix. The problem is is that most people don't have any pain associated with the indicators. Also, the recovery seemed painful and long and from reading around, the outcome seemed dubious, if not net negative. They really put their thumb on the scale in terms of measuring success. Anyways, long story short, I spent about 2 months with a variety of stretches and deep tissue work on the muscles on my legs and hips and the pain completely vanished. I started lifting weights again (squats and deadlifts with plenty of deep tissue work and stretching) and I haven't had hip pain since.

Ha, I had exactly that same experience, with the same injury, no less. The physiologist told me that sure, the surgeon is always going to recommend surgery - but if you’re going to have to do PT, why not do it first and see if it fixes the problem?

PT is the closest I have come to experiencing a miracle cure from modern medicine. Speaking as someone who frequently breaks themselves.

A lot of surgeons only know how to cut so that’s what they will recommend. There is also a lot of money to be made. Better to try physical therapy, therapeutic yoga or similar first and see how that goes.

"$88bn was spent on medical treatments for back and neck pain in America, not far short of the $115bn spent on cancer"

Any sort of joint pain is an extremely complex phenomena, and back pain in particular is one of the most complex. It's almost never a case of "this mechanical structure was injured resulting in this pain". There are tons of studies out there showing a significant percentage of the population has disc herniation and zero pain while another significant percentage of the population has serious back pain but no structural injury visible on a scan.

I'm dealing with this personally in the contest of a shoulder injury diagnosed as a torn labrum. My research has turned up a number of NIH studies showing that something like 70% of the population over the age of 40 will show a torn labrum on an MRI regardless of whether they have any symptoms and concluding that the tear showing on the scan likely has absolutely nothing to do with the acute cause of the recent pain.

https://outline.com/zZhZLU

I'm surprised that people work on laptops for extended periods. I'm used to working on a proper desk with full size monitors and a good chair. I could never work on a sofa or coffee shop table with a laptop for hours, but seems common - how does your neck and back survive?

Which is caused by the bad cultural ideas in the first place. Ideally, people should almost never sit (on the chairs at least, yogic sitting postures are Ok once mastered). Maintaining the right posture while standing for whole days is hardly possible for most of the people too. People should mostly lay while using computers + walk for at least an hour + have about 20 minutes (see the "The First 20 Minutes" book by Gretchen Reynolds for scientific references) of high-intensity exercising and there will be no back pain. Sitting is what killing us. Whenever I don't have to go to the office I do my coding laying on the floor an feel a way better. Sadly, I've never seen an office where you would not be meant to sit.

How exactly do you code while laying on the floor? Do you prop your back up at a slight angle with a cushion or something? How is your laptop secured on your lap?

I lay on my stomach (that's what I meant, not on my back) with a hard foam roller + 2 cushions under my chest with the laptop on the floor in front of me (not on my lap).

That is not a perfect set-up, however - my neck and shoulders still hurt occasionally this way. The perfect set-up looks like this: https://imgur.com/a/tmvxHRK or this: https://imgur.com/a/Ej2EY2n - this is how spinal surgery and scoliosis patients study in Russia and Ukraine.

Besides healthy back feeling, effects I experience while working this way include increased energy, decreased appetite and better, more enthusiastic mood (kind of like on ADHD meds - feels like it boosts dopamine or something).

As for laying on your back - it sounds funny but the most comfortable set-up I've ever sat in was a stomatology chair (thank's G-d I have healthy teeth and don't have to be afraid of it :-)) - put a big monitor in place of the lamp, invent a comfortable way to place the keyboard and I'm not leaving it voluntarily :-)

Mobilize (stretch, foam roll, hard ball) the posterior chain, i.e. the back of your body, especially the glutes, hamstrings, hips, calves, and the back muscles. This is a CHAIN, the links are connected, feed slack into the painful areas by loosening up the whole chain.

Back pain was what took me to start into lifting, workouts and bodybuilding.

Too much coding trying a startup that never grew enough to go on. I shut down in 2015. It also got me into quite some overweight and then a couple of episodes of acute back pain.

Pumping iron fixed that an a lot more.

For years I had lower back pain. Finally I went to PT, and learned a lying-down lower back twist that would cause some faint cracking noises which brought immense relief.

Now after lots of lifting, and a much more muscular core, the pain and the ability to crack are gone.

My biggest life lesson is that weightlifting is not an optional activity that folks can enjoy if they choose. It's an absolutely vital activity for everyone outside of a very physical career.

But deadlifts are not necessarily for everybody: https://www.menshealth.com/fitness/a29265805/should-you-dead...

I will have an occasional bout of constant back pain triggered by some action (sitting down the wrong way, sleeping the wrong way, bending the wrong way) that will last 1-2 weeks, then it will go away 100% and I'll be back to normal.

I am overweight and do not exercise much other than a little bit I get at work. I have a feeling being so unfit is causing these occasional issues, I'm just glad they are not permanent.

I did have one scary time of back pain where my back would spasm and try to lock my legs up and that lasted a number of weeks, but eventually it too went away. Thankfully so, because it was the most pain I've ever felt in my entire life

I used to suffer from constant lower back pain through almost all my life, not anymore. Regular excercise and most specifically, strengthening my core (this should be prioritized), has left me with almost non existant back pain.

A while ago the pain got so severe that I could barely walk and this lasted for a couple of weeks until I got treatment. I got diagnosed with L5 Sacralization [1]. The treatment consisted of physiotherapy excercises, which focused mostly on using resistance bands.

Hope this helps anyone.

[1] https://www.healthline.com/health/sacralization

I'm sure there are many variations to this problem. What worked for me was like McKenzie (sp?). Roughly, picture doing a pushup, except that every muscle in your body is completely relaxed, aside from your upper arms. You're sort of passively arching/tractioning your spine. Do it slowly and repeatedly. It should feel good. Do as many cycles in a day as you care for.

Beyond that, be careful when you get out of bed each morning for 30m or so. Your discs are full of water, and you're more susceptible to injury during this time.

It's a little terrifying that the article starts with a guy just waking up with a slipped disk one morning, and it seems the most effective takeaway is "learn to live with this pain".

If you are looking for a great and simple program for building posterior (as well as overall) strength. Check out Pavel Tsatsouline "Kettlebell Simple & Sinister" program [1]. All you need is a couple of kettlebells and 5*30 min a week. It's very much a minimal effort, maximum effect program.

[1] https://www.amazon.co.uk/gp/product/B07ZQKWMKR

Any thoughts on a kneeling chair and whether it would be helpful or appropriate in dealing with a herniated L4/L5 disc in my lower back? I work in front of a computer all day.

https://www.ebay.com/itm/DRAGONN-Ergonomic-Kneeling-Chair-Ad...

I have a Varier Balans which I use a few hours a day and it's helped a lot with my back pain. The rocking and variable angle is a big part of it, I don't reckon the fixed ones would work as well.

Iyengar Yoga fixed mine, as well as running 5K 2/3 times a week. I still get sciatica every so often, but I can walk and stand without pain.

My yoga teacher is 80 years old, and she's an inspiration. If you're reading this and have back pain, try Iyengar Yoga. It's guided and careful, and my class is roughly 50-50 split of men & women, and the vibe isn't competitive or nasty. Just 20 people carefully doing stretches together really

A lot of back pain is caused by being overweight or obese, and people just don't want to talk about "the elephant in the room."

Healthy-weight people have far fewer back problems.

See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931150/

According to this paper, exercise has been shown to offer an improvement.

If you have back pain in the morning, make sure you try a new mattress. Research suggests adjustable (e.g Sleep Number) can help you find the best. https://www.sciencedirect.com/science/article/abs/pii/S23527...

Back pain may fluctuate and spike at certain times. A person needs to find what alleviates the pain without adverse side effects. Exercise needs to be filtered for what works for the individual. Good exercises might be swimming and cross-country skiing. Always seek medical assessment and treatment, while also being willing to take responsibility for own health.

Conversely my uncle could not walk because a disc was bulging against his leg nerve (sciatica?). He tried no surgical methods for a year of hell because everyone had read articles like this. Then he had his back operated on and suddenly can work his leg again like a miracle. So in his case he should have had more surgical intervention. It's really tricky.

I had low-grade back pain for years. Then after an incident where I could barely walk for a few days, I decided to go to physical therapy. Within a month or so, the pain was pretty much gone (although I went to PT until they told me I was good).

Basically, as long as I do a couple of exercises (mostly leg strengthening) every day, I basically have no back pain.

I fixed my SI joint back issues with kettle bell exercises and lots of stretching. Now my back feels even better than before the issues began.

I can see the need for intervention using drugs as a pathway to rehabilitation if the pain is crippling, but outside of that, exercise and strength training seems to solve a lot of problems safely and without drugs.

I know someone in China can use pure herbal medicine to treat back pain very easily and thoroughly, myself indeed cured by it, its really amazing experience and I indeed helped some of my friends that have same issues, all cured without any side effects. If someone interested and can trust the foreign medicine, pm me.

Rock climbing in a gym (bouldering) cured all my back problems from sitting in front of a computer for 16 hours a day.

In my case had to do with diet. Eating food I was allergic to being careless caused kidneys stones that the doctors could not detect. MRI, X-ray had it all done after two years saw a natural path gave me kidney stone cocktail, pushed out some kidney stones and been back pain free for 7 years now

Everybody here has personal anecdotes but I think they are mostly worthless. Mostly what we read are instances of "illusion of causality/control biases"

Best thing to do is to consult a specialist who is aware of the latest research and that has identified your condition and follow what they say.

Yea, L5/S1 pain here for years. Finally started seeing a chiropractor.

So far, I've gone from constant pain to occasional pain, so that's an improvement. I've had to make some lifestyle changes too. No more lifting with heavy free weights. No squats or deadlifts. Ah well.

I have personally been involved with a woman who was almost killed by a chiropractor. The guy cracked her neck, did damage to the underlying veins, which caused a blot clot and a brain-stem stroke. She lost the ability to balance, loss of heat/cold detection, slightly droopy side of her face, and more. It nearly ruined her life and though she won a settlement, it was far lower than you'd think it'd be for such a huge loss of functionality.

This of course is just anecdotal evidence, but it's 100% true (I'm not an anonymous dude on the Internet, this is my name, and I stand by my words). Do yourself a favor and stay as far away from chiropractors as you can. They're not doctors and what they do can have serious consequences.

I'm sorry for your friend. That's terrible. However,

> Do yourself a favor and stay as far away from chiropractors as you can. They're not doctors and what they do can have serious consequences.

I've heard of one or two malpractice suits against MDs. Do you blanketly recommend avoiding hospitals as well?

well, did dig up this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016850/

Though, I've had my neck cracked several times now, so a little late to be doing research. There seems to be a suggestion in that paper that perhaps these injuries are a result of a chiropractor aggravating an already weakened/injured artery. I remember hearing a story of someone having a stroke after cracking their own neck :O

Do yourself a favor and see a real doctor about it and try Physical Therapy. I always had my doubts about chiropractors but I tried one for a month and like you went from constant to occasional pain but never any better. I went to PT and they taught me exercises for my core and stretches that have me pain free to this day.

Have you tried mackenzie method stretches? I had L5/S1 disc bulge and pain for over a year. After a few days of Mackenzie I was pain free, and now use the stretches as needed but probably 4 times a week.

I went to a Chiropractor for a few weeks but it never helped my lower back, but did help the upper back a bit.

Advice needed! Two slipped disc, one operated on. NHS discharged, still in pain daily. Working on my feet, stretching, walking etc. Is there anymore I can be doing? I was told by my physio at the time it was very rare for someone to have two slipped discs at the same time???

> I was told by my physio at the time it was very rare for someone to have two slipped discs at the same time???

Its not that rare, infact having one disc herniated can put you at risk for another herniated due to the uneven loading you may be doing to protect yourself from pain from the first injury.

I found gabapentin very very helpful. Reduced neuropathic pain tremendously.

Sorry, I know that sucks. I've got chronic back pain, but I can keep it livable with Stuart McGill's Big-3. Google it.

Other folks have already recommended the Big-3 on this thread.

Guys, if you’re having muscle related pain, focus on your electrolytes! Most muscle spasms are caused by imbalances.

Sodium, potassium, magnesium, zinc, calcium.

Also if you cook at home a lot you might not be getting enough sodium. especially if you’re sweating a lot you need to replace an tom or sodium.

I discovered that most of my back pain went away when I started drinking enough water each day. Not to downplay back injuries, but I suspect many people are walking around slightly-dehydrated each day (and one of the 1st symptoms is headaches and/or back pain)!

Anecdote, but I hear it a lot: I have back pain, I start boxing every week. Backpain gone. Don't box for three weeks and take the bus instead for biking? Hello back pain my old friend.

Keep moving, keep the "core muscles" strong.

I'm not a doctor but I see a lot of this anecdata.

I was complaining about my back pain to older friend and he said that you know many people start getting those after 25 or so and then they stop before they hit 40. That's why everyone also has story of miracle cure.

Very controversial. Pilates finally did it for me.

Any advice on someone who had two slipped discs, they operated on one and left the other. I’m working, exercising ( walking, stretching) but still in pain. I’m about to start the whole hospital procedure again and not sure I can wait another 4 years.

I would recommend inversion for some people. Inversion set me down a path of reversing years of compression, muscle dysfunction, and chronic pain from a tailbone injury 12 years earlier.

Agree, inversion helps me a lot too.

I also find simply hanging from a bar (or anything) gets that helpful decompression for my spine, especially if my feet drag behind me a bit. A lumbar disk will often shift back into place after hanging for a minute and maybe doing a few press ups (i.e. cobra pose with core relaxed).

If you have back pain in the morning, try changing your mattress. Adjustable firmness (e.g. Sleep Number) are particularly helpful as they allow you to test various options.

The child's pose really helped me, yoga is awesome

Child's pose helped me too and also helped some insomnia issues. Deep squatting (without weights) also helped me with my spine. However, yoga is not for everyone or better, yoga can be for every one but with modified poses. Beware.. Many people doing yoga hurt themselves attempting to do certain poses, even professional yogis break their backs sometimes..

I've had enough trouble with yoga in the past that I only use a few postures on a regular basis. I think people with persistent/severe issues really need one on one coaching from an experienced teacher. Yoga classes are often crafted more around people's fitness demands than rehabilitation. And people often don't have enough experience with pain to judge the good from the bad during solo practice. I've had better luck with taijiquan, but it's a very different approach. It often makes the pain worse, by way of correcting years of misalignment and poor habits. It builds strength and flexibility very gradually, focusing more on the tendons, ligaments, and fascia, than the large muscle groups.

Exactly. Don’t go to a gym yoga class. Avoid anything yoga that has “power” or “core” in its name. There are specialized therapeutic yoga teachers. Iyengar teachers are usually quite good.

I wouldn't go as far as not trying a yoga class, it may genuinely help. However, I wouldn't try to do everything they are doing in class and wouldn't force my body.

Take it easy and gradually and make sure it's the type of class suited for you. There are beginner/intermediate and advanced classes. If something feels right it is most likely doing good and if something feels wrong don't do it anymore. Yoga could be tremendously helpful but if you don't do it right it could do more harm than good.

Especially don't be competitive and look at other people. Some things may just be out of one's reach. It took me a while (and some injuries) to accept that I will never be able to do what a lot of women in their 20s can do. In the end it's not important to do extreme poses.

Most days I can't even begin to get out of bed without child posing first. I'd rate my physical health in the top 1% of this country, but physical activity needs a similar type of movement therapy (or whatever you want to call it) that sitting around all day needs. Gravity never takes time off.

Me too!

For those recommending deadlifts, are trap/hex bar deadlifts an acceptable substitute? What about rack pulls?

Foundation Training provides amazing correction to our modern degenerative movement patters and poor posture.

Just adding the many great tips here already. Crossing your legs while seated can

Pushups. Unless you're completely feeble or injured, do them, even if it's on your knees. Guaranteed to clear up the majority of back pain due to weak muscles.

Also Yoga, I picked this up recently for a low impact workout. That shit will change your life, WAY harder than it looks.

There is a zero percent chance making your chest stronger will fix your back

Pushups work much more than just your chest, particularly your core muscles, critical to everything including your back. Try just a static plank for ten minutes, and tell me what you feel.

While I agree your core is critical to your back, a pushup or plank also strengthens your hip flexor muscles. A couple of those (e.g. psoas) attach to your lumbar spine, so strengthening them makes them shorten and pull harder on the lumbar spine, increasing your pain. For low back pain, it is the wrong exercise.

For my low back pain, I stretch the hip flexors to relieve their pressure on the lumbar spine. I strengthen my abs with side planks to stabilize my core without engaging the hip flexors. Finally, I strengthen my glutes.

Every situation is different, and not all back pain should be treated with a pushup, so you have to understand body mechanics so you're working on stretching or strengthening the right parts for you. Going to a Physical Therapist is very helpful, then progressing to some appropriate strength training.

This is absolutely awful advice.

Yes doing push ups with proper form will strengthen your core, but a lot of upper back pain is caused from tight pecs and lower delts which cause a hunch. Doing push ups would continue to tighten the pecs and contribute to back pain. They'd be counter productive for upper back pain, really.

Most people would probably get more back pain relief by laying face down on the floor for 10 minutes rather than doing 10 minutes of push ups.

Most people suffer from lower back pain, example all of us sitting here days on end at the computer. Obviously for upper back pain, working your upper back is not a great idea. My point here is that most back pain is related to our sedentary lifestyle, and simple pushups alleviate a lot of it.

This article accurately captures the scope of the problem of back pain, but I am not satisfied with its characterization of current views on the topic (as someone who had nonspecific back pain from age 13-25, finally fixed it by internalizing the right information and skills, and is now running a company that reliably assists people to get over nonspecific back pain using talk-based coaching interventions). We do free trials; more on that later.

The sentences in the article that's supposed to sum up the current state of the field is: "A definitive physical cause—such as a fracture, a tumour, pressure on a nerve, infection or arthritis—is found in 5-15% of people with back pain. The rest is all labelled as “non-specific”, and there is increasing evidence that it is not mechanical in origin...Researchers who specialise in pain increasingly believe that, in most cases, chronic pain means that the [pain] system has become damaged in some way that keeps it switched on." So, paraphrasing, researchers believe that most of the time the cause is not mechanical, yet there is something damaged that accounts for the pain. Later on, it goes on to quote a doctor saying that, "the reason they’ve got back pain is that they have financial problems, marital problems, disabled children, they are not sleeping at night." Notice the second doctor doesn't stipulate that anything is "damaged" in the person's pain system at all — he explains the pain as a response to the fact that the person has a lot of things going on in their life, any one of which may not feel completely handled or completely ok at any given time, there may be a whole slew of unresolved concerns.

So, sometimes, someone with persistent back pain has a pain-danger-alarm system that is working absolutely fine. The pain system is not damaged. The pain system a responding to a present understanding of the world that make a person feel not ok / not safe / in danger of some kind, or to past trauma that a person hasn't completely processed, that is still lingering, and making the person feel unsafe. It's a map vs. territory issue, there's not "damage" in as much as there is something about the person's map that implies something about their current experience is dangerous.

Sometimes, when someone's pain/danger "check engine light" is stuck on, persistently creating pain as if to say "hey something is not quite right" — all that person needs to do is get information that physical pain isn't a 1:1 indicator of physical damage, and to not worry about the pain. Sometimes, they need to address current stresses and past trauma that are making them feel not ok, and then the pain goes away. Howard Stern talks about a doctor who saved his life by telling him his tissues were fine. John Stossel got relief from decades of back pain from the same doctor, and profiled him on ABC's 2020. That doctor recently passed away, considered a pseudoscientist to the end of his days, and current research is just starting to catch up. Expect a study in 2020 by Tor Wager, Dr. Howard Schubiner (one of our advisors), and Allan Gordon.

If anyone out there needs a white-glove concierge package that can assist you to figure out what's driving your pain, and what you will be able to do to solve most nonspecific back pain in a year, book a free trial here: (https://calendly.com/adamjensen/trial?month=2020-01) or check us out at www dot attunecarecoordination dot com.

Not sure what's the full story because it's behind a paywall. But I want to address the part that I got to see

> Mr Moore received a prescription for opioids to help him cope with the pain; but the pain persisted, and he found himself becoming loopy.

Opioids/pain killers is not a poor treatment, it's not even treatment. I think of using painkillers like seeing some dog poo in your living room and instead of cleaning it up and making sure the dog gets to poo outside, you just cover it with a napkin and call it a day.

In the culture of "fixing" our body's problems with painkillers, we're making it worse for ourselves in the long term. The mild pain indicates something is not good. Instead of finding the cause and fixing it before it gets worse, we just patch it until it cripples us and forces us to solve it with drastic measures (i.e. surgery).

So does everyone just have a subscription to the economist or are they working around the paywall somehow?

Jesus, I can't believe this is so far down in the comments with no reply, that too on HN of all places!

Article:

PETE MOORE was 43 when he woke up one autumn morning with back pain so excruciating that he struggled to dress himself. His doctor in Romford, an English town, referred him to hospital for an MRI scan; this showed that some of the spongelike discs that separate the spine’s vertebrae were bulging out of the slots into which they customarily fit. Such “slipped” discs can be caused by an injury; but they are also the sort of thing which can just happen with increasing age.

Mr Moore received a prescription for opioids to help him cope with the pain; but the pain persisted, and he found himself becoming loopy. Unable to work or do much else, Mr Moore, who had been a painter, sank into depression. Three years into his ordeal, he says, he was “thinking of ending it all”.

Back pain does not, in and of itself, kill people. But it makes a huge number of lives a misery. In most countries for which there are reliable figures, whether rich or poor, back pain is the top cause of disability, measured by the aggregate number of years lived in poor health. That burden is decreasing (see chart) but only very slowly.

The costs, however, have been rising quite quickly—and are enormous. In 2013, according to one study, $88bn was spent on medical treatments for back and neck pain in America, not far short of the $115bn spent on cancer (more recent figures have not been analysed in a comparable way). A great deal of this money seems, sadly, to do little good.

Doctors used to think that back pain was almost entirely the result of mechanical damage to tissue beyond the capacity of X-rays to detect. The advent of MRI scans showed this was not true. A definitive physical cause—such as a fracture, a tumour, pressure on a nerve, infection or arthritis—is found in 5-15% of people with back pain. The rest is all labelled as “non-specific”, and there is increasing evidence that it is not mechanical in origin.

Back pain, like all pain, is experienced in the brain not the body; nerves coming in tell the brain that something is amiss, and the brain projects an appropriate sensation of pain. Researchers who specialise in pain increasingly believe that, in most cases, chronic pain means that the system has become damaged in some way that keeps it switched on. “It’s like a fire alarm that goes off after the fire has been extinguished,” says Lucie Knight, a psychologist at a pain clinic in St Thomas’ Hospital, in London. Back pain may also be related to other aspects of a person’s life not going well.

Taking this view seriously throws into doubt a great deal of the medical treatment of back pain—much of which, in effect, seeks to silence the maddening sound of the fire alarm by putting out a fire that isn’t there. But it does not offer an obvious medical alternative. Some pain medicines, such as paracetamol, do not work at all for back pain. Opioids, for all their reputed analgesic potency, offer back-pain relief little if any better than options such as ibuprofen. Their continued use often makes pain worse rather than better, and is highly likely to cause addiction.

Drugs that worked better and did less harm would be a boon. But they have proved hard to develop. The mechanisms in the nervous system and brain which generate pain are complex, and can doubtless go wrong in a variety of ways, says Steve McMahon of King’s College London. He thinks that the development of drugs for chronic pain has a poor record because the people they are tried on have a range of different problems.

Evidence of ineffectiveness has not stopped doctors from writing prescriptions for the drugs they have. The prevalence of chronic back pain provided a huge expanse of fertile ground for the deceptive marketing and poor prescription behind America’s opioid epidemic (see Bartleby). In many countries doctors also frequently prescribe painkillers called gabapentinoids, despite strong evidence from trials that, as far as treating back pain goes, they offer no benefits.

There are also a lot of treatments for the back itself. Spines are injected with cement-like mixtures or fitted with various types of medical hardware. Vertebrae are fused together, discs excised or tampered with in various ways. Yet—unsurprisingly, if it is largely the pain mechanism which is the problem—there is a growing body of evidence that the benefits all this offers to most patients are limited or non-existent.

Even just looking at the back causes problems. Only 1-5% of people with back pain have a problem that requires urgent treatment, such as an infection or a tumour; in such cases the pain will tend to be accompanied by other symptoms too, such as weight loss, fever or incontinence. In America and western Europe guidelines say that it is only when such red flags are present that a patient presenting with back pain should promptly be given an x-ray or an MRI scan. Yet general practitioners and hospitals routinely ignore this, sending 40-60% of people with back pain to be scanned—far more than they did 20 years ago. According to Jan Hartvigsen of the University of Southern Denmark there is a broad consensus that about 80% of such scans are useless.

That might be fine if the scans were sometimes helpful and never harmful. But few bodies are completely normal, and learning of your particular “abnormalities” in a medical setting and while suffering is alarming even if a healthy back might look just as odd. Disc “degeneration” is seen in roughly half of young and middle-aged adults with back pain, but also in a third of those with no pain at all. Some 40% of people with back pain have disc protrusion, a form of “slipped” disc; but so do nearly 20% of people who are pain-free.

Both patients and doctors, though, tend to think that if they can see something they should do something. Some sufferers catastrophise the news into the idea that they have a broken, fragile back and start avoiding normal physical activity—not least, says Ms Knight of St Thomas’, because doctors often fail to explain to them that abnormalities are, in fact, quite normal, and that degeneration can basically be wear and tear. The stiffness and weakening of the muscles this inactivity brings often makes things worse. And doctors may take abnormalities as a cue for further medical attention. Many studies have confirmed that patients who receive unwarranted imaging in the first few weeks of back pain are more likely to have surgery and unnecessary follow-up tests than similar patients spared the scans—but that they enjoy no benefits in terms of pain reduction or lessened disability.

In 2011 Cigna, an American insurance company, ran a follow-up study on patients who had undergone procedures in which vertebrae are stitched together with implanted bolts and braces. “Spinal fusion” of this type is a frequently used surgical response to back pain that is associated with the degeneration of spinal discs; in 2015 there were roughly 85,000 such surgeries in America. The company found that two years after treatment 87% of customers were still in pain severe enough for medication or some other treatment; 15% had more surgery. This is going to hurt

It all sounds depressing. It need not be so. There are ways of dealing with back pain that waste much less money and leave patients less distressed and with a greater sense of their own agency.

Mr Moore, the patient with whom this story began, tried to come to terms with his disabling pain by starting a support group for fellow sufferers. A psychologist from St Thomas’, which has the biggest pain clinic in Europe, came to talk to them about “graded exercise” and the importance of pacing themselves when going out and about. “Nobody had told me I could do these things,” says Mr Moore. In 1996, three years after back pain had come to dominate his existence, a two-week residential programme at the pain clinic taught him what it teaches people today: exercise daily; accept flare-ups as temporary setbacks; don’t get fixated on the pain. Learning to keep going this way “saved my life”, Mr Moore says.

The programme, explains Ms Knight, aims not to reduce pain so much as to add to life. People naturally struggle against the pain, which means they are burdened with the pain and the struggle too. “If you can drop the struggle,” says Ms Knight, “then you have your hands free to do more.” Patients are taught how to gradually overcome their fears of exercise and daily activities that can cause some pain. The goals that they start with can be as simple as calling a friend and meeting for a coffee, or attending a wedding. In a typical class of ten people, Ms Knight says, one or two decide that the approach is not what they want, and may drop out. Most of them take away at least some skills which add to their quality of life. One or two, like Mr Moore, find the programme life-changing.

Various countries have tried to encourage people with back pain to stay active, with promising effects. One such campaign, in Australia, is reckoned to have led to a 15% reduction in the number of doctor visits for back pain and a 20% decrease in related medical costs. Such campaigns appear to work best when they provide practical advice on how to stay active and at work despite the pain, and when as well as speaking to the afflicted they enroll employers, clinicians and unions as partners.

Activity is not a panacea, and if leading an active life with pain is better than withdrawing from the world, it is still not ideal. But interventions like this seem to offer people more succour than highly medicalised approaches. Unfortunately, medical schools, patient expectations and the policies of insurers and governments all sustain the latter.

All around the world, family doctors are woefully undertrained to treat common, unglamorous conditions such as bad backs. In most medical curricula musculoskeletal conditions, like back pain, are a minor feature. Back pain is “not sexy” for medical students, says Chris Maher of the University of Sydney. Even if they are going to be family doctors they still want to hear about cures for cancer and impressive forms of surgery, rather than humdrum stuff like back pain or preventing falls in older people.

Spinal surgeons, for their part, often take a dim view of evidence that what they do may be ineffective. Surgical training is based on an apprenticeship model. “You learn from a master, a great guru, and you do what they taught you. You don’t learn from a paper in the British Medical Journal,” says Andrew Carr, who heads the department of orthopaedic surgery at Oxford University. Surgeons generally consider an operation successful if the incision is small, things heal nicely and there are no complications, says Maurits van Tulder from Vrije University in Amsterdam. If they ever hear back from patients, that is usually from those for whom the operation worked—which leads surgeons to believe that it works most of the time.

Though research on surgical outcomes is becoming a lot more widespread, it is still hard to convince surgeons that what they have been doing for most of their careers is ineffective, says Dr Carr. It is also hard to convince patients that, when it comes to treatment, less may be more. Told that the best thing they can do about back pain is exercise their body and their patience, they often think they are being fobbed off; a deluge of online marketing for ineffective treatments does not help. Some harangue their doctors for scans or injections, or find a new more biddable one. For a busy doctor, says Rachelle Buchbinder of Monash University in Australia, “it’s easier to prescribe an x-ray than explain why you don’t need one.”

Once pain becomes chronic, persuading sufferers that the cause is not a fixable physical defect becomes much harder. Graeme Wilkes, a British doctor, says that he might spend an hour telling a patient that the things seen on his MRI may not be the reasons for his back pain, and that a spinal injection is unlikely to help. “The reason they’ve got back pain is that they have financial problems, marital problems, disabled children, they are not sleeping at night—not those changes in their MRI scan,” says Dr Wilkes. “And they go home and someone says ‘Oh, that’s absolute rubbish that you can’t get an injection, because my mate at work had it and he was much better afterwards. Don’t listen to them, go back to your GP and get referred’.”

But the biggest reason why so many people with back pain get the wrong treatments is that governments and insurance plans pay for them. In America, Australia and the Netherlands health plans pay for back operations that cost $25,000-100,000 apiece. American plans often support the alternative therapy offered by chiropractors. There is some evidence that this may do some good in back pain, but the research is patchy and any benefits small and short-lived. Yet the same plans typically offer little support for physiotherapy to the same end. If a therapy has been accepted by an insurance company, or a government scheme like America’s Medicare, it is very hard to get it removed, even if evidence for effectiveness persistently fails to turn up. “Once they are in, it is hard to take them out,” says Dan Cherkin from the Kaiser Permanente Washington Health Research Institute. The manufacturers of medical devices are very good at lobbying to get them covered as treatments. They are also “incredibly effective” in marketing their wares to doctors, says Richard Deyo of Oregon Health and Science University.

Back pain is big business for many surgeons, doctors and chiropractors. “If we stop doing low-value care, some entire professions have to change fundamentally what they do,” says Lorimer Moseley of the University of South Australia after enumerating a long list of ineffective treatments. In some systems cupidity encourages such things. In America, where procedures are more lucrative than talking to patients, an unscrupulous doctor might prefer to spend a 15-minute appointment giving a patient an injection rather than some education, just as a harried one might.

Other countries have had some success with an approach called “Choosing Wisely”, in which doctors explain to patients the evidence on the effectiveness of various treatment options and decide together what is best given each patient’s personal goals (which could range from simply wanting to be able to play with their grandchildren to cycling or running). In Britain there has been a determined move towards triage which assigns back-pain patients to more or less intensive treatment depending on the complexity of their problems. In Australia some emergency rooms have started sending some back-pain patients brought in by ambulance straight to physiotherapists, which avoids a significant amount of hospitalisation. Choosing poorly

But when professional associations in America urged doctors to take up the Choosing Wisely model their campaign made almost no difference to back-pain treatment—perhaps because doctors were under no obligation to change, says Dr Deyo. Nor has a change in the advice provided by the American College of Physicians had any great effect as yet. In 2017 the college stopped recommending medication as an initial response to back pain, suggesting instead acupuncture, yoga, tai-chi and psychological therapies aimed at reducing stress, all of which have been shown to reduce pain-related disability. Insurers have taken note, with some now covering some or more of these alternatives. That will make it easier for doctors moved to change their practice to do so.

Another approach might be to nudge doctors incrementally, rather than to change their practices once and for all. Tweaking the interface of the electronic systems doctors use to order MRIs so that it takes them longer to place an order has been shown to reduce the number of unnecessary scans. Adding a pop-up reminder explaining why imaging is frequently unnecessary has also shown effects.

Disability-benefit systems matter a lot, too. In many countries benefit systems give people signed off with back pain few incentives to improve, and their erstwhile employers no incentive to encourage them back rather than find someone else. In the Netherlands, though, this has changed. Medical assessment for disability benefits does not kick in for two years after a patient reports sick, and during this time employers must pay the sick employee 70-100% of their wages. Employers and employees are also required by law to agree a return-to-work plan. After the country switched to this system, in 2006, the total number of sick days for back pain fell by a third. The return-to-work rate after a three-to-four-month sick leave due to back pain is now 62% in the Netherlands. In neighbouring Germany it is only 22%.

Drivers for such change are hard to come by in part because, as Dr Maher says, back pain is largely invisible. People do not die from it and there are no “back-pain survivors” to spearhead lapel-ribbon campaigns for change. Few national medical plans even mention back pain. Sufferers are often viewed as impostors, or told that it is all in their heads. Though other aspects of a patient’s life do impede recovery from back pain, many people cannot easily take control over the context of their life, still less the content of their heads. The lack of a lobby accounts in part for the absence of more impressive projects to move beyond medical devices and drugs.

In 2018 Dr Buchbinder was one of the authors of a series of studies on back pain published in the Lancet which they pitched to the journal in the hope that summarising the debacle in rich countries would warn developing countries not to follow suit. But when the researchers began to compile the data, she says, they discovered that in poor countries the horse had already bolted. In India, Brazil, China, Nepal, Iran and other developing countries doctors are already prescribing drugs, injections and X-rays for simple back pain. In some urban areas of India and Africa opioids can be easily bought from the roadside chemists where many poor people go first for aches and pains.

Mr Moore, for his part, has not taken pain medication since 1997. To keep his pain at a manageable level, he starts his day with stretching at home for half an hour, followed by an hour and a half at the gym. And he leads a full life.■

Correction (January 16th 2020): An earlier version of this article stated incorrectly that Mr Moore’s doctor was in Peterborough and that he was given steroid injections.

I use qutebrowser with no JS enabled globally (I use whitelist) and I was able to access the article and read it without issue. I also use stevenblack's adblocking hosts which may play a part in it.

Also, "pain is a problem which is badly treated".

Neurosurgeon here. Many people have talked about the importance of exercise, which is critical. I won't comment about what specific exercises to do, schemes devised to swindle desperate people out of their money, nor about the centralization of peripheral nerve pain. However, some posters have talked about surgery for back pain, which concerned me enough to post.

In general, indications for surgery at my institution are:

1) Nerve pain 2) Spinal cord compression 3) Cancer 4) Trauma

(1) Nerve pain: Some posters have talked about nerve pain related to their back. As some have posted already, the vast majority of nerve pain resolves spontaneously. Surgeons can do a world of good for people with intractable nerve pain. But most reasonable people (including yourself) should wait for a few months for it to get better on its own. It's worth noting that a subset of people with a pinched nerve don't have pain; in this case, people will develop numbness in a specific part of their limb, or weakness in one or more joint in their limbs. Finally, if at any point with back pain you can no longer pee, have stool incontinence, or lose sensation in your groins, go to the emergency room immediately (do not pass go, do not collect $200).

(2) Spinal cord compression: This is serious. Some surgeons at my institution will twist patients into having an operation (even if they feel fine!) if there is evidence that the spinal cord is at risk. Signs to look out: progressive difficulty with walking and/or manipulating fine objects; dropping objects and falls; and bladder/bowel dysfunction.

(3) Differentiating cancer pain from normal back pain can be tricky. Doctors are taught to look out for several cardinal "B signs", including fever and unexplained weight loss, which helps point people in the right direction. The diagnosis is made easier if someone has a previous history of cancer (most commonly for the HN readers: prostate and breast), or having pain that is unrelenting, dull and present at night. If your pain is constant and present even when you're not moving, that's a concerning feature. However, even if you are diagnosed with metastatic cancer to the spine, most people still don't need an operation -- many people can be treated with radiation therapy alone.

(4) Some people who break their neck or their backs (from falls, motor vehicle collisions, etc.) don't need an operation. Others absolutely do. In general, if you break your back or your neck severely enough to impact either the nerves or the spinal cord, you probably need an operation. If your nerves aren't affected, ask your surgeon why you need it in your particular case (have the bones dislocated? Is there objective evidence that the ligamentous complex has been damaged?) and what non-surgical options are available.

Most (but not all) people with back pain don't need to see a surgeon. If you are referred to a surgeon for back pain, bring all of your scans to the appointment. But before signing up for surgery, be sure to ask the surgeon two important questions: First, what recommendations does the literature say about surgery for isolated back pain and how does it apply to your specific case, and (2) what is the likelihood you'll be back for more surgery after your first operation. An honest surgeon will say that high-quality data for isolated back pain are lacking in the literature.

[P.S. I am the same person as user needlesurgeon]

In general, indications for surgery at my institution are:

1) Nerve pain 2) Spinal cord compression 3) Cancer 4) Trauma

10000000000% I could talk all day about my back pain (so I'll just go on ahead and do that a bit here) and the journey I've been on to fix it. It's awful. I've been dealing with 2-4 bulging discs and all the back pain symptoms you could dream of. The back issues that I have had have gone from the hamstrings all the way up to the ears - and seems to be different every week.

If you do not address your back pain, you will go down hill and it's not a fun place to be. Chronic pain leads to suffering and leads to depression. If you don't address it, the pain is going to break you. It will become the first thing you think about in the morning and before going to sleep. Take care of yourself!

I'm going to buy and read the 8 Steps to a Pain Free Back book - here are some things that have helped me

MASSAGE THERAPY HELPS. MUSCLE RELAXERS HELP. Especially with bulging discs you are likely to experience muscle stiffness (a somewhat natural reaction of the body. Stiff muscles offload weight from the spine... but not a long term solution) The stiffness can be so severe that you will be unable to stretch it or relax it away. Heating pads and ice will not work. I've had erector spinae muscles so stiff that you'd honestly believe that they're bones. You could rub your thumb along them and hear them pop and crack while the tight fibers rub against one another.

I was on muscle relaxers for weeks (3x a day, every 8 hours), and those also helped loosen up the muscles, but never fixed the pain. I stopped taking them because their effectiveness was wearing off as I took them longer.

Massage therapy has been fantastic to help loosen these up so that I can do other exercises and stretches more effectively. I actually got sick from my first 1 hour session - mild rhabdomyolysis) A good massage therapist will give you tips on how to loosen up and stretch things, as well.

I've been able to manage my lower back pain pretty well for a few months now, and recently had a breakthrough with my upper/thoracic pain:

Lower Back:

- Mackenzie method exercises

- Hamstring stretches (hamstrings become over developed and tight from sitting)

- Glute exercises (strong hamstrings cause weak glutes, and cause the glutes and hamstrings to fire out of order. You need to target the glutes specifically to build them up, relieve the hamstrings and reduce pressure on the back muscles)

- I need to find and do more glute/hip exercises. I've recently discovered this as a cause.

- Hanging from a pull-up bar (spinal decompression)

Thoracic:

- Foam roller

- Upper cross syndrome (any stretch to help this will help)

- recent breakthrough: MY THORACIC MIRACLE STRETCH! I recently discovered this and have been doing it a few days. I woke up without thoracic pain for the first time in months https://www.youtube.com/watch?v=GcV1Qdt686E&list=LL1B0cQt6-g... Watch the entire video before doing. There's a lot of proper form to account for.

- I found chiropractor visits to be somewhat helpful for the upper back, but chiro's can be hit-or-miss

I could go on forever about this crap. Back pain is awful. There are likely dozens of exercises I will be doing regularly within the next year that I don't even know about yet.

I'm convinced that most of these are due to the lack of back muscle development. Muscles which would normally stabilize your spine as you move are too weak to do so, so things get screwed up. I had really bad back problems in my mid-30s. They all went away when I started lifting weights. Took me a while to even get to a point where I could lift _anything_ without back pain in fact. Initially lifting 60lbs off the ground would cause pain - an embarrassing fact for a heavy-set 6'2" male. After a year and a half of consistent progress I topped my deadlift out at 525lbs. I decided not to go further, since I don't compete, and I'd need to buy more plates and a different bar for my barbell. I haven't had any back pain ever since.

The worst part of the situation is, nearly 100% of the doctors will tell you not to do back strengthening exercises beyond the bullshit you typically see at your PT office, which really does nothing to make you stronger. I do not advise most people to lift as much weight as I do, but you gotta give that posterior chain a good workout at least once a week, and the best way to do so is by squatting with a barbell and doing deadlifts. The loads can vary, do as much as you're comfortable doing.

Back pain is a tough nut primarily because it varies so much from person to person. Depending on the anatomy of the injury and the post-injury healing the symptoms and severity can change drastically.

Sometimes the best prescription is time. Sometimes you need surgery to save yourself from paralysis. Sometimes surgery puts you in worse pain, sometimes it fixes you for the rest of your life. It's frustrating, and each patient needs to become their own best advocate.

You could say that about all mental illnesses.

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