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Comment by frankish | Hacker News Reader

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...

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> 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.

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.

> 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.

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.

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

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.

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.

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.

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

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

> 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!

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