If you are suffering or have suffered from back pain, read this article because it might be the most important thing you see today.
Back pain is common. Worse, those who develop chronic back pain tend to see a high rate of recurrence. Worse still, the science surrounding back pain is often hazy and confused - and there’s a lack of good data out there on the internet. I suffered for years with back pain because I had no clue what to do or where to go.
Luckily, I did a lot of the research for you, and I’ll link to sources at the bottom of the article so you can do more research if you’re interested. I’ve also picked up a few tools and tricks through personal experience in over five years as a personal trainer, often working with clients who suffered from back pain themselves.
First of all, you have to understand whether your back pain is acute or chronic.
According to the NIH: “Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.” Anything else is acute back pain, so it may have a specific source or trigger.
Managing Acute Back Pain
If you have acute back pain, there’s a large possibility that it’s not related to any underlying issue. Instead, it’s likely related to something you’re doing. For example, certain postures, movements, footwear, or seating positions may aggravate your lower back, but the pain goes away when you stop using them.
Even if you have chronic back pain, it may simply be because of poor habits or external stressors like the ones mentioned above; this was my problem!
In 2013 I had really bad back pain - I searched high and low for a cure, but it turned out it a huge part of it was the desk chair I was using at the time! When I started using a new chair and made a few more minor changes, a lot of the pain vanished.
Search for potential aggravators in your own life, and try changing them one at a time. If changing one potential aggravator leads to a loss of pain, you’ve found the problem. More about potential aggravators will be listed below.
This can be hard - after all, they’re habits, so it’ll seem silly to waste mental time and effort on changing them. But habit formation gets easier over time. Focus on small changes that can be maintained instead of larger ones that you’re likely to burn out on before returning to your normal habits. The longer you can maintain those small changes, the easier it gets.
Certain possibilities may predispose you to being more sensitive to back pain than others - “bad” posture (that’s a whole other discussion), scoliosis, past injury, mental disturbances, and stress can all lead to back pain, or worsen existing back pain.
So treating these issues may often greatly reduce or completely eliminate back pain, but it’s not the whole story. You can do all the meditation in the world to help reduce stress and this may greatly reduce back pain, but if there’s an external physical stressor causing your acute back pain, the only thing that can completely eliminate it is the removal of that stressor.
Injury can cause back pain - in the short term, think of it like an acute stressor and focus on rehabbing that injury to reduce back pain. If this pain lasts long enough that it becomes chronic, it’s likely that the injury has already healed, but a different approach is needed.
It’s also important not to think of back pain in simple terms - back pain is “caused” by a variety of factors working together, so there are NO simple solutions. Luckily, in acute cases, pain can be easily dealt with so long as stressors are identified and managed. If you’re one of those, congratulations!
Managing Chronic Back Pain
One of the biggest myths is that chronic back pain is caused by a “bad” back. Similar explanations can include degenerative discs, muscular imbalances, and other mechanical issues. This isn’t very accurate, since chronic back pain often happens in the absence of such obvious causes.
MRI scans are very bad at identifying sources of chronic back pain, and it’s likely that while chronic back pain certainly isn’t just “in your head”, the causes of it aren’t really very evident to any existing testing method. Bed rest often worsens back pain over time, even though you’d think that that’s the opposite of how it should work. While the causes of chronic back pain can sometimes be physical in nature, it’s likely that they’re more complicated.
Cases like this are outside of the scope of this short guide. I recommend seeking professional help, but the problem is that even many professionals aren’t very knowledgeable when it comes to back pain. One excellent source is Paul Ingraham’s comprehensive low back pain guide.
What Can You Do?
If you’re looking to solve your back pain problems, here’s a list of solutions. The causes of back pain are multifactorial, so don’t expect any one step to solve your back pain. Instead, try everything and see what works.
Change your desk, couch, or other frequently used sitting method. Try new chairs, try sitting in different positions on the couch. If any of this helps, stop using the sitting positions that irritate.
Stretch. It doesn’t have to be anything complicated. Stretching may help acutely relieve small amounts of back pain. See Movement In General below for more.
Massage. Massage will help. However, while it may help with acute pain, it’s not going to do much long term. Massages can often be expensive, and this makes it less attractive compared to other acute relief methods.
Chiropractic. Chiropractic is generally in the same boat as massage: physical manipulations help with acute pain but are unlikely to help with long term pain. Chiropractors talk a big game, but the evidence behind chiropractic as a practice is pretty weak.
Foam Rolling. A foam roller allows you to perform self-myofascial release, which is a fancy way of saying that you can massage yourself. Foam rolling will help with acute pain, and is much cheaper and more convenient than massage or chiropractic.
Movement in general. Bed rest worsens back pain, so resume normal activities as soon as you can. If you’re sitting at a chair for a long period of time every day, breaking that sitting period up with small phases of movement (stretching, foam rolling) goes a long way towards keeping back pain at bay.
Avoid irritating movement patterns. If a specific movement or lift in the gym causes you acute pain, avoid that movement or lift or modify it until it no longer causes pain. If it’s a specific lift, try different variations and loading schemes (less weight and higher reps, or higher weight and fewer reps, band/chain resistance instead of plate resistance) and see if that helps. But you should never totally cease a movement if it’s causing pain - in the long term, even low amounts of movement can help recovery. Focus on modification and experimentation before complete avoidance.
Meditation. If stress or mental disturbances are a significant component, mindfulness techniques and breathing exercises will help.
Core strengthening. Sometimes, core exercises can help with back pain. Instead of focusing on contraction/crunching style exercises, stability focused exercises like planks, birddogs, and pallof presses will help. I’ve personally found these core exercises to be extremely useful for women dealing with low back pain as a result of pregnancy.
Low Back Strengthening. Exercises like the deadlift may initially be aggravating to the low back if performed with poor movement patterns and unnecessary load. But in the long term, if done with proper form and proper loading (read: don’t overdo it!), they will strengthen the lower back and this leads to a reduction in back pain.
Shoes. Footwear alters walking mechanics, leading to back pain. If a certain pair of shoes causes problems, get some new ones!
Sleep. During sleep your joints are immobile. This long period of immobility leads to stiffness upon waking, and if the position you sleep in is one that causes pain, this pain can potentially last into the day. Make a conscious effort to alter your sleeping positions and see if this helps.
Weight Loss. Excess weight around the abdomen may place additional stress on the low back muscles, leading to pain. However, this issue can also be treated by strengthening the low back and core, so extreme weight loss isn’t always necessary.
Pain Meds. While it’s probably not a great idea to use them chronically, pain drugs will reduce pain in the short term.
Heat Packs. Won’t to do much long term, but will alleviate short term pain. Cold packs, on the other hand, are a bad idea.
Surgery. If your pain is chronic and has an underlying root cause, surgery may help. At the same time, some surgery options perform poorly in studies and actually worsen pain or lead to further degeneration over time. Consult a doctor.
If there’s anything you should take away from this article, it’s that back pain is complicated, and there’s no clear solution for it. The second big takeaway should be that back pain isn’t all in your head, but neither is it a purely physical phenomenon.
Back pain is complicated! Take a complex approach. Fix your own back pain.
If anyone you know suffers from back pain, you should share this article with them. It could save them years of wasted effort.
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For further reading about back pain, check out these links: