Back pain sucks. I spent almost ten years dreading the first couple hours of the day because I couldn’t bend over without feeling like my lower spine and SI joints were 90 years old and infected with the venom of a 5,000 year old snake-dragon hybrid. I have investigated and consulted with so many experts, read so many books, attended so many ‘movement courses,’ and tried so many protocols. Over time, I have come to the conclusion that the market’s simplistic solutions are never going to solve this complex problem because it has so many contributing variables. If you have ever had back pain or tried to help someone get out of back pain, you know there is a reason that back pain is estimated to be a 23 BILLION dollar industry by 2018. While I am largely out of pain, this article is not a ‘how to’ guide to getting out of pain, but a big picture explanation of the things you need to know if you are in pain and want to take the journey to get out of pain. I think many of these concepts and contributors apply to all sorts of pain, but this will be solely focused on the back.
If you’ve ever unsuccessfully searched for the answer to your back pain, you probably know there are several main approaches to explain back pain. Most of the people in their respective fields are 100% sure that they have THE answer to help you and that confidence helps contribute to you buying their product, but doesn’t necessarily guarantee that their confidence was justified (can you sense the resentment?). In any case, the four major approaches to back pain that I’ll cover are the medical perspective, the mental perspective, the strength and conditioning perspective, and the therapist perspective.
The medical approach
The medical community largely evaluated back pain through structural abnormalities in your back. For example, if your back hurts, you likely need to get an MRI and the pain will be explained as you “have a disc bulge or a disk herniation, which is pushing on a nerve” or something along those lines. They will combat this with injections or surgeries. The problem is that this approach doesn’t always work in the long run and there is often a pretty significant recurrence of pain within a short time following both injections and surgery. Additionally, in a study in the New England Journal of Medicine, the relationship between pain and these abnormalities was shown to be suspect. If you search for expert opinions, you will find a very large number of people who say that the discs are meant to move out of their normal position and return over time, and that there is no need to ‘adjust them’ or surgically fix them to their original position except in very extreme cases. I have never been through a back surgery and I am not a doctor, so I can’t say whether or not any of this is true. But I can tell you as a result of the surgery I have had, that I would personally exhaust all options before I decided to go under the knife to fix the problem. If your doctor says it is your only option, I would suggest that you get a second opinion and really do your own investigation to ensure there isn’t an alternative route.
The Mental Approach
Dr. John Sarno made the concept that back pain is ‘in the mind’ famous in the late 90’s. In his books (Healing Back Pain, The Mindbody Prescription, The Divided Mind, Mind Over Back Pain), he covers in depth his beliefs that back pain is largely influenced by mental processes more than physical, and the pain is more a symptom of emotional repression, anxiety, anger, etc. Now much of medical community scoffs at this idea even though Sarno was, before his retirement, a professor at NYU School of Medicine and graduated from Colombia University College of Physicians and Surgeons, and had an exceptional track record ‘fixing’ people’s backs. The idea is still very controversial in the medical world, but is widely gaining traction and support by neuroscientists and pain researchers. Other back experts, such as spinal surgeon David Hanscom, has corroborated Sarno’s ideas and continues to treat many of his patients with psychotherapy before ever addressing surgical alternatives. I am not qualified to comment on the relationship between mind and body other than to say in my own life, as I addressed some of my psychological stressors, became aware of repressed emotions, overcame insecurities and fears, and generally increased my self awareness, my back pain did have a reduction in intensity and began to subside. Whether or not that would have worked in isolation, I am unsure, but many people report having resolved their physical pain through meditation, psychotherapy, and ‘mental’ approaches to physical pain symptoms.
The Strength and Conditioning Perspective
The strength and conditioning community, like most communities, is extremely combative and fractured in their beliefs. Often times, they war against one another trying to establish authority and a sense of righteousness about their ideas. Within the community, there are experts that say many things about back pain. The ideas vary greatly but some include:
Squat more heavier and deeper
Deadlift more and make your back stronger
Learn how to control your diaphragm and breathe correctly
Do more unilateral work
Stretch more (sometimes with bands strapped everywhere)
Foam roll or lacrosse ball roll your muscles
Be tough and improve your pain tolerance cause it’s normal
It’s hard to get a pulse on the community’s beliefs about back pain because there are people who are primarily academic, people who have primarily spent their time actually working with people, people who are just internet experts who regurgitate opinions that they don’t fully understand, and thought leaders in the field who all have equal access to the masses through the unregulated internet. I can say though that I’ve seen people approach their back pain through each of these lenses and resolve it. I’ve also seen people approach their back pain with these mind states and make the situation MUCH worse.
The Therapist Approach
There are a ton of physical therapists, chiropractors, massage therapists, biomechanics experts, etc who all weigh in on the issue. There are lots of different belief systems so I will just cover a few here and you can research for yourself. Different people believe:
The human body is a contralateral machine and that you need to train your core to stabilize the mid line through anti-rotation exercises and your back pain will go away.
Sitting too much has contributed to our back problems and if you get a standing desk and stretch your hip flexors you will heal your back pain.
Gaining segmental control of each individual joint and the coordination of those segments will relieve any potential injuries as a result of movement
The diaphragms unequal construction creates asymmetry in the pelvic girdle and corrective exercises to set the hips will solve back pain.
Getting adjustments on a regular basis will cure your back pain.
The answer to back pain is in neurodevelopmental patterns and if we go back and optimize these early patterns we can “reset” the nervous systems movement and get out of pain.
Massage, ART, acupuncture, scraping, or other soft tissue methods are the key to resolving back pain
As you can see, there are so many methods and approaches to back pain that it’s hard to know where to start. Each one of these approaches, like the strength and conditioning approaches, has a success and failure rate. I’m assuming the success rate is not high enough to warrant it being ‘correct’ otherwise people wouldn’t be desperate enough to spend tens of billions of dollars if the answer was that straight forward.
So, now it should be clear how complicated the issue is and how easily it can be to get confused and frustrated if you have back pain. When we have so many choices, so many options, so many ‘expert’ opinions, etc it creates more stress and anxiety jumping from problem to problem only to find that you were disappointed with a less than perfect outcome. Instead of trying to isolate the problem to a single one of the above, I believe that integrating ALL of the concepts into an approach out of back pain is the most favorable, and was the key for me to get out of pain and feel comfortable lifting heavy again without fear of my back seizing up for weeks at a time.
Step 1: Address your mind and psychology. First of all, stop thinking you are broken. Stop thinking that something is “wrong” that you are going to fix and go back to the way it used to be. Accept that back pain is part of your present reality and that the nature of the world is dynamic. We age, our training/behavior choices have consequences, the body does not comply to our wishes, and you are not the only person dealing with back pain so stop feeling sorry for yourself. Address childhood wounds, address the stress of your job, look into the health and well being of your relationships, analyze your level of self acceptance, and figure out how to lower your levels of mental stress. Whether or not this actually solves back pain or just makes you happier is irrelevant. This should be your number one priority. We have a right to pursue happiness, we should always ensure we are exercising that right.
Step 2: Address your health and lifestyle choices. Consult a doctor if required to ensure nothing serious is going on in your back. Make sure your sleep quality and amount is optimal for you. Ensure you are eating enough of the right foods. Figure out how to truly relax. Whether you do that through meditation, breathing, playing golf, fishing, hiking, writing, reading, art, watching movies, etc matters not. What matters is that you are actually learning to truly relax your body and nervous system. What people tell you is ‘healthy’ may not be healthy for you, so ensure that you are developing some level of self awareness with regards to your body’s feedback mechanisms.
Step 3: Improve your movement quality. Movement is a very complicated topic. It includes the technical precision of the skills you perform on a regular basis, it includes your vestibular system, it includes the tension relationship in your musculature, it involves your nervous system, it involves your ability to move through space in different environments, and more. Movement training needs to be as difficult as the rest of your training and progressive to ensure it’s causing adaptation. Your body needs an increasing stimulus in order to advance. People make the mistake of thinking that their movement training can be easy or that it can be encompassed in a ‘program.’ But, the reality is that it involves developing greater levels of self-awareness. It requires you to learn to be more sensitive to the control and feedback mechanisms of your body. It requires you to learn the intricacies of movement and the optimal pattern for your body to perform physical tasks safely. There is no expert that should say “anybody who performs (insert any exercise/skill) movement must be in these positions.” Bodies are so variable, minds are so variable, and the elite in every single discipline all have some unique level of self-expression and nuance to their movement that differentiates them from their peers. Instead of trying to model after ‘perfect,’ try to find the principle components of a movement that are necessary for all people and then seek to refine your specific way of accomplishing the task.
Step 4: Ensure your training distribution is correct for you. Pain is related to the nervous system. This is continually being investigated in the scientific literature, and over the next decades I’m sure we will make dramatic strides in understanding pain signaling. However, in the mean time it’s safe to say that our levels of stress, constant sympathetic stress, anxious minds, and overly stressful training can alter our nervous systems pretty dramatically. Different types of training will cause different types of physical responses. For example, stretching or a low intensity hike will have a much different response on your nervous system than a 1 rep max snatch or a 1 mile maximal effort run. If you have a coach they should be getting feedback from you on your levels of pain, levels of soreness, mind state, etc to try to find patterns and an appropriate distribution of training qualities that suits you. If you are coaching yourself, you should begin collecting data on the types of exercise sessions that cause the following days to be more painful versus the variables that cause the pain to subside. As you find patterns, you can make changes that suit your life and needs. Remember that different people can tolerate different types of training in different amounts. You might WANT to hit maximal effort conditioning workouts with your friends 15 times a week because your idol does that, but your body might not be suited for that. As we mature we realize that the world doesn’t comply to our desires and instead we are forced to do what we have to do to survive and thrive. If you are stubborn and try to force your body to comply to your demands, it will likely buck back and continue to make your pain more severe.
There is an ancient proverb, “you’re only as old as your spine.” If you’ve ever dealt with back pain you recognize this quote’s wisdom. No matter how old you are, it makes you feel like you need a walker or a wheel chair just to move around comfortably. The cycle becomes vicious in that moving causes pain and then the lack of movement causes greater levels of immobility, which causes more pain. That can leave people, without anything ‘wrong’, feeling crippled and helpless. I remember vividly the desperate feeling thinking that I had to live the rest of my life in such horrendous pain or that I would never be able to lift weights again because they were the ‘cause’ of my issues. But, I feel those faulty beliefs were half the cause of my emotional pain. This angst then began altering my nervous system, which then began altering my perception of pain. I have “Corpus-Animus” on my company seal because I wholeheartedly believe that our thoughts, emotions, feelings, beliefs, etc are an integrated component of our physical bodies. So, if you are someone sitting in front of your computer or phone reading this article with your back in pain, remember there is hope. Even if you are reading this article that was written specifically for back pain without any back pain, I believe the recommendations of how to approach ‘fixing it’ should be applied regardless of whether or not you have any issues. Work hard so that you can move freely and enjoy the body you were given to explore this weird thing we call life…