Back pain is a problem which is badly treated - <AUTHOR> https://www.economist.com/briefing/2020/01/18/back-pain-is-a-massive-problem-which-is-badly-treated <comment><USER3> 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](https://en.wikipedia.org/wiki/Spondylolisthesis) [2]: [https://www.barbellmedicine.com/blog/pain-in-training- what-d...](https://www.barbellmedicine.com/blog/pain-in-training-what-do/)

<comment><USER4> 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.

<comment><USER5> 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...

<comment><USER6> > 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.

<comment> saiya-jin 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.

<comment><USER3> This.

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

</comment></comment></comment></comment></comment></comment><comment><USER7> 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](https://www.youtube.com/watch?v=_F-0rtFbOgI) @ 1:15 is the pose that I use.

<comment><USER8> 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/](https://pso-rite.com/)

<comment><USER7> 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.

<comment><USER9> Kettlebells help the back in other ways as well...

</comment></comment></comment></comment><comment><USER10> 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...](https://twitter.com/mihirchronicles/status/1217449317201596416?s=20).

<comment><USER11> Exersizing and stretching your back is so important. * Edit - properly and with what works for you :)

<comment><USER12> 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.

<comment><USER13> > 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?

<comment><USER14> 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.

<comment><USER15> 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.

</comment></comment></comment></comment></comment></comment><comment><USER16> 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/](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).

</comment><comment><USER17> 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.

<comment><USER18> 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).

<comment><USER19> 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?

<comment><USER18> Digging through the exhaustive NIH entries on this topic is left as an exercise to the reader

<comment><USER19> 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?

</comment></comment></comment></comment></comment><comment><USER20> 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.

<comment><USER21> 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.

</comment></comment><comment><USER22> This, combined with the expense of doing physical therapy is what led me to make MoveWell ([https://movewellapp.com](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.

<comment><USER23> Aww man, no Android version? :(

<comment><USER22> Our web version should work for now!

</comment></comment></comment><comment><USER24> 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

</comment><comment><USER25> 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...](https://www.amazon.com/Crooked-Outwitting-Industry-Getting- Recovery/dp/0062641794/)

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

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

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

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

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

<comment><USER26> 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.

</comment></comment><comment><USER27> [https://outline.com/zZhZLU](https://outline.com/zZhZLU)

</comment><comment><USER28> 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.

</comment><comment><USER29> 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.

</comment><comment><USER30> [https://www.youtube.com/watch?v=l9poXGU11ms](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.

<comment><USER31> 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!

<comment><USER30> 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.

</comment></comment></comment><comment><USER32> 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.

</comment><comment><USER33> 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.

<comment><USER34> 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

<comment><USER35> 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.

<comment><USER36> 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-...](https://www.dickssportinggoods.com/p/teeter-nxt-s-inversion- table-with-back-pain-relief-dvd-16teeuttrnxtsnvrsmec/16teeuttrnxtsnvrsmec)

<comment><USER35> 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.

</comment></comment></comment></comment></comment><comment><USER37> 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 - <USER2> 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.

</comment><comment><USER38> 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

<comment><USER39> "Most back pain, especially lower back pain, is a result of weak glute muscles"

Citation please.

</comment></comment><comment><USER40> 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.

</comment><comment><USER41> 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.

<comment><USER42> 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?

<comment><USER43> 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)

</comment></comment></comment><comment><USER44> 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.

<comment><USER45> 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.

<comment><USER46> 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.

<comment><USER45> "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.

</comment></comment></comment></comment><comment><USER47> 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.

</comment><comment><USER48> 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.

</comment><comment> pi-err 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.

</comment><comment><USER49> 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.

</comment><comment><USER50> 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.

<comment><USER51> 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.

</comment></comment><comment><USER52> 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.

</comment><comment><USER53> 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.

</comment><comment><USER54> 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/](https://scoobysworkshop.com/preventing-lower-back-pain/)

</comment><comment><USER55> 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.

</comment><comment><USER56> 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.

</comment><comment><USER57> 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.)

</comment><comment><USER58> 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.

<comment><USER59> Can you elaborate on this? What was the morning pain like? What exactly are the exercises you do?

<comment><USER58> 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.

</comment></comment></comment><comment><USER60> 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.

<comment><USER61> Running made things much much worse for my back.

Be cautious about this advice.

<comment><USER60> 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.

</comment></comment></comment><comment><USER62> 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?

<comment><USER53> >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.

</comment></comment><comment><USER63> 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.

</comment><comment><USER64> 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.

<comment><USER65> 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.

</comment></comment><comment><USER66> "$88bn was spent on medical treatments for back and neck pain in America, not far short of the $115bn spent on cancer"

</comment><comment><USER67> 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.

</comment><comment><USER68> [https://outline.com/zZhZLU](https://outline.com/zZhZLU)

</comment><comment><USER69> 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?

</comment><comment><USER70> 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.

<comment><USER71> 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?

<comment><USER70> 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](https://imgur.com/a/tmvxHRK) or this: [https://imgur.com/a/Ej2EY2n](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 :-)

</comment></comment></comment><comment><USER72> 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.

</comment><comment><USER73> 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.

</comment><comment><USER74> 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...](https://www.menshealth.com/fitness/a29265805/should-you-deadlift/)

</comment><comment><USER75> 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](https://www.healthline.com/health/sacralization)

</comment><comment><USER76> 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

</comment><comment><USER77> 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.

</comment><comment><USER78> 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".

</comment><comment><USER79> 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](https://www.amazon.co.uk/gp/product/B07ZQKWMKR)

</comment><comment><USER80> 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...](https://www.ebay.com/itm/DRAGONN-Ergonomic-Kneeling-Chair-Adjustable- Stool-for-Home-and-Office/254442274905?hash=item3b3df10059:g:IUIAAOSwx6pd5r6v)

<comment><USER81> 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.

</comment></comment><comment><USER82> 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

</comment><comment><USER83> 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/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931150/)

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

</comment><comment><USER84> 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...](https://www.sciencedirect.com/science/article/abs/pii/S2352721815001400)

</comment><comment><USER85> 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.

</comment><comment><USER86> 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.

</comment><comment><USER87> 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.

</comment><comment><USER88> 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.

</comment><comment><USER89> 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.

</comment><comment><USER90> Rock climbing in a gym (bouldering) cured all my back problems from sitting in front of a computer for 16 hours a day.

</comment><comment><USER91> 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

</comment><comment><USER92> 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.

</comment><comment><USER93> 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.

<comment><USER94> 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.

<comment><USER95> 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?

</comment></comment></comment><comment><USER96> 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???

<comment><USER53> > 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.

</comment></comment><comment><USER97> 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.

</comment><comment><USER98> 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)!

</comment><comment><USER99> 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.

</comment><comment><USER100> 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.

</comment><comment><USER96> 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.

</comment><comment><USER101> 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.

<comment><USER102> 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).

</comment></comment><comment><USER84> 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.

</comment><comment><USER103> The child's pose really helped me, yoga is awesome

<comment><USER104> 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..

<comment><USER105> 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.

<comment><USER106> 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.

<comment><USER104> 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.

<comment><USER106> 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.

</comment></comment></comment></comment></comment></comment><comment><USER107> For those recommending deadlifts, are trap/hex bar deadlifts an acceptable substitute? What about rack pulls?

</comment><comment><USER108> Foundation Training provides amazing correction to our modern degenerative movement patters and poor posture.

</comment><comment><USER109> Just adding the many great tips here already. Crossing your legs while seated can

</comment><comment><USER110> 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.

<comment><USER111> 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.

<comment><USER110> 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.

</comment></comment></comment><comment><USER112> 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](https://calendly.com/adamjensen/trial?month=2020-01)) or check us out at www dot attunecarecoordination dot com.

</comment><comment><USER113> 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).

</comment><comment><USER114> So does everyone just have a subscription to the economist or are they working around the paywall somehow?

<comment><USER115> 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.

</comment></comment><comment><USER9> Also, "pain is a problem which is badly treated".

</comment><comment><USER116> You could say that about all mental illnesses.

</comment><comment><USER117> 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]

</comment><comment><USER117> 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.

</comment><comment><USER111> 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...](https://www.youtube.com/watch?v=GcV1Qdt686E&list=LL1B0cQt6-g-pq4RNHVO7Cow) 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.</comment>


Reportly – The Perfect Companion To AdWords - <AUTHOR> http://www.reportly.com

<comment><AUTHOR> It's not meant to replace AdWords but instead provide automated daily emails in an easy-to-digest format that gets the most important points across quickly.</comment>


Bitcoin transactions taxable, says GAO - <AUTHOR> http://thehill.com/blogs/regwatch/finance/306015-bitcoin-transactions-taxable-says-gao <comment><USER2> I think intent matters here.

If I exchange currencies because I intend to buy goods & services with it, then it's no different than stopping by a Thomas Cook/Travelex.

However, if I'm trading in & out of Bitcoin because I'm arbitraging it, then I'm a trader, not a traveler. And should pay tax on the profits.</comment>