Waking up by the light of the sun rather than the buzz on the nightstand is a blissful feeling. It's the weekend. It's time to slow down a bit.
I think about the great day ahead of you. It’s going to be a nice little Saturday. Run to Home Depot. Maybe hit up Bed, Bath & Beyond if we have time. Oh, and don’t forget to make a light breakfast so we still have room for a “Depot Dog.”
I go about my Saturday morning, “easy like Sunday morning.” Then all of a sudden it hits me like a ton of bricks. For the life of me, I can’t stand up straight.
I threw out my back bending over to tie my shoes.
I didn’t get hit by a car.
I didn’t fall on the hardcourt taking a posterizing dunk.
I was literally tying. My. Shoes. For crying out loud.
I try to figure out how to maneuver myself off of the floor as every movement is like Zeus slinging lightning bolts down my right leg.
So much for that Depot Dog...
More importantly than tubular meat product, how on Earth am I going to move? There are chores to do, bills to pay, children to feed. I can’t be incapacitated. Not to mention, this pain feels like I’m being jabbed in the back with a pickaxe.
Thoughts run through my head: Is this just another flare-up? Did I really “slip” a disc this time? Do I need to go to the hospital? Can I go to work on Monday? How long will I have to deal with this?
This all-too-common story is about me. Yes, a chiropractor who has dealt with severe back pain — go figure!
I’ll spare the theatrics to let you know I’m fine right now, sitting with my low back support.
However, it hasn’t been all rainbows and puppies (omit with sunshine and unicorns, if preferred).
Fortunately, for me, I know how to weather the back pain storm. Unfortunately, for many people, they get swallowed at sea.
My personal experience has paved the way I assess and treat patients in the clinic. I empathize with my patients when they describe what they’re enduring. I can literally say, “I’ve been there.”
However, for some, I cannot say I’ve been...there.
The Health Care-ousel of Low Back Pain Treatment
The process of addressing low back pain in our medical system is often a health care-ousel.
First, you pay a visit to your primary care physician (PCP), if you have one. Wait thirty minutes when the doc finally enters the room. You’re asked a few questions about your health history and how the problem occurred.
They want an x-ray even though there was no trauma, e.g., slip and fall, hit by a car. X-ray is unremarkable — no immediate damage like a fracture. But they’ve got to tell you something, so you’re told you’ve got some arthritis and degeneration. Great, thanks. Useful to know.
Next, the doc labels you with a diagnosis like “lumbago” or “sciatica.” You get a stab of steroids in the buttcheek to get the inflammation to chill. You’re briefed the problem will likely resolve on its own in six weeks. Ice and rest in the meantime. Use prescription muscle relaxers as needed for pain.
The doc advises she’ll write you a script for physical therapy (PT) if the problems persist after six weeks.
After less than 10 minutes with the physician, you get your prescriptions and are told to ice and rest. The front desk hands you an educational handout of some back exercises and sciatica stretches that’s destined to find the blue bin.
You’re on your merry way.
You take your medication as prescribed. It helps dull the pain, but doesn’t alleviate it, nor does it last. You have to continue to take more but in the back of your mind you’re thinking, “I don’t want to become a pill-popper.”
Six weeks barely drudge by. You call for the PT script.
The PT clinic your PCP recommended is going well. You think you’re getting better because you’re feeling better. However, you’re still struggling with daily physical tasks like bending, squatting, and getting out of the car.
PT persists but nothing is changing — you’ve hit a plateau and your script is expiring.
Expired? “But I’m not fixed yet.” Yeah, sorry. It doesn’t work that way.
You call the Doctor’s office where you get a referral for the orthopedic evaluation.
It’s the same song but different dance with the ortho: a few minutes of question and answering, and a brief examination. But now it’s MRI time.
Let’s get a glimpse of what's actually going on in there. Finally, some answers.
MRI comes back. There are a few disc bulges and mild degeneration, but otherwise unremarkable.
“Oh, no. Disc bulge? Degeneration? Am I going to make it?”
Luckily, the surgeon is not a hack trying to make quota for the month, so surgery isn’t recommended at this juncture.
“But wait, wouldn’t surgery fix my disc bulges? If my bulging discs are fixed, then I’m fixed. If I’m fixed, not broken, I wouldn’t have this pain, right?”
Anatomy & Why it Doesn’t Matter So Much
The smell of formaldehyde is etched into my olfactory senses.
In the first year of chiropractic school, we spent the majority of our time staring into cadaveric dissection and typeface on paper.
Do you know how smells can bring back memories? The smell of formaldehyde — the chemical used to preserve the bodies — brings me back to the cadaver lab. That lab is where I learned how the sense of smell stimulates memories.
And now I’m writing about how I have memories of a smell that brings back memories of learning about the smell to memory recollection connection.
To much surprise, we had to completely dissect human cadavers in chiropractic school. Cut, pull, peel, discard, the whole she-bam — into every cavity and crevice.
No, we didn’t just dissect the spine and muscles as you would figure. We went through the entire head, neck, brain, chest, abdomen, pelvis, and all of the organs (inside and out).
We saw everything. Muscles, organs, vessels, nerves, and all the variations between cadavers. Even a skull removed with a surgical saw like a tophat. Only to cut the cords and deliver the brain. In awe, we cradled it like a first-born. Pretty cool stuff.
We even saw the equivalent of a phallic Reebok Pump harboring within the cadaver’s scrotal sac. Not to mention, the pump must have been “perma-pumped” if you catch my drift. “Looks like we’ve got Big Jim and the Twins Triplets here.” With a lab full of post-college grads, the conversation isn’t exactly at a doctorate level.
Anatomy courses in the lab and classroom were very difficult but rewarding. It’s why I can randomly rip out names of muscles like, “levator labii superioris alaeque nasi.”
Such an intricate name for a muscle lifting a nostril. The “sniffer” is way more efficient.
The thing is why should I give a rats ass? It would be useful to me if I were a face surgeon or frequented anatomy trivia night. I don’t. But if they exist, let me know.
Furthermore, I’ve forgotten a lot of the material because I simply don’t use or need it in my practice of helping people with neuromusculoskeletal pain.
What anatomy class failed to teach was human movement.
Our brain controls everything. Our brain controls our movement. There’s no such thing as “muscle memory.” It’s a layman’s term for doing a physical task enough to learn it. That’s your brain.
You see, we as humans labeled all of our parts. However, our brain doesn’t care.
The brain thinks in terms of movement (function) not muscles (structure).
When it comes to back pain, the way we are taught anatomy translates into how we diagnose. It’s sad, educated clinicians still think in terms of structure, not function.
Psoas this, piriformis that. The disc slipped again. You’ve got degeneration and arthritis.
Wait, what? I’m degenerating!? Talk about a terrible thing to tell someone.
Blaming your pain on a structure is a convenient narrative that appeases our human nature for answers and certainty. But it does not mean it’s correct.
Anatomy class did not teach me how to treat people. People in pain. And to this day, I believe it’s unnecessary to rote memorize anatomical structures to effectively treat most people with back pain.
Surgery? Different story. You have to know your landmarks and what you’re cutting. However, a small percentage of people actually need surgery. More opt-in for elective back surgery than needed, hoping it will “fix” or “cure” them.
Even if the surgery “works” it’s questionable whether or not the repair process had anything to do with feeling better.
What about the individuals with back pain who don’t need surgery?
How We’ve Been Treating Back Pain & Why it’s Not Working
What is Pain?
Pain is an alarm signal. Pain is your brain’s request for change. Pain is an individual experience. It’s disrespectful and harmful to undermine someone’s pain experience.
If pain was based solely on damage to body structure, i.e., injury, phantom limb pain would not exist.
Pain science is not simple or convenient, but it’s necessary for a society where back pain is the leading cause of disability. The way we have been addressing low back pain is arguably the cause of the opioid epidemic.
Long story short, throwing drugs at a problem is easy. But if that’s all we’re doing we’re missing the point. It’s treating symptoms, not the cause. There’s an underlying reason for the pain.
It’s no different than the alcoholic who self-medicates to suppress their emotions. The underlying trauma goes unaddressed. The short-term buzz is a layover from the flight to depression.
MRI Shows Us What’s Going on Inside, Right?
Most cases of back pain don't have a structural abnormality as a pain generator. In fact, people 40 years of age who get an MRI for their back pain have “abnormal” findings regardless of their pain.
Positive findings like degeneration and arthritis are merely age changes. We get gray hair and wrinkles on the outside. We get “gray hair and wrinkles” on the inside as well.
The problem is words like “degeneration” are scary. They provoke an emotional response where you perceive the problem worse than it is. It’s dangerous.
Taking your portrait, I can see what you look like on the outside, but I can’t discern what you’re feeling from the inside.
An MRI can see what you look like, but cannot tell how you’re feeling.
MRI machines are medical devices that make false alarms.
Yet we’re in an imaging-happy culture where we believe we get all the answers when we can take a look inside — a costly assumption as it doesn’t improve clinical outcomes.
Not to mention, early imaging has cost our healthcare system a helluva lot.
Is Surgery the Fix?
A recent article identified, “Even though only 1.2% of patients received surgery, they accounted for 29.3% of total 12-month costs.”
Surgery is expensive, and it’s not guaranteed to work like you pray it will.
Take the case from above where the surgeon did not recommend back surgery. What if it was the opposite. What if the surgeon recommended getting in there to fix the nasty bulges putting pressure on your nerves, logically convincing you it’s the cause of your pain?
Here’s the scary part: it happens all the time.
In fact, I’ve seen a handful of post-surgical lumbar fusion cases where the surgery was deemed “successful.” Successful as in the surgery was done right, it healed, it’s stable, and they're not dead or paralyzed. I mean, that’s good, right?
But what about the pain? The reason why they got the surgery in the first place — the pain — is still there.
I’m not sure if that’s exactly “successful” in the mind of the person who went through surgery and physical rehabilitation, which is no cakewalk.
The bizarre part is these “successful” post-surgical cases can still get better with conservative care. In fact, it’s possible to achieve drastic improvement of near full-recovery. When this happens, the sad part is to think about how that person went through unnecessary surgery.
I’ve seen it on more than a few occasions. One case always sticks out in my mind: Tim.
Tim had a rotator cuff surgery that wasn’t a shoulder problem.
Tim went with the flow. He rode the health care-ousel like any good citizen. He had a rotator cuff tear identified on MRI. It didn’t get better with PT so he elected to have the surgery. Six months go by — surgery, recovery, and more PT.
Nothing changed. No different. Nada.
Come to find out he never had a shoulder problem in the first place. The problem was stemming from his neck, not the rotator cuff tear. And he got surgery on his shoulder.
MRIs make false alarms.
We got him to 90% of his normal range-of-motion and function compared to his other shoulder using conservative movement therapies, i.e., exercise and hands-on work. We addressed the source of the problem, not where the symptoms hung out.
How does shoulder pain come from the neck? This is where anatomy is useful, but it’s basic.
Nerves from your neck send signals from your brain to your joints and muscles. When a nerve(s) is irritated the signal becomes impaired and the muscles don’t get a clear message. The brain sees this as a problem, so it creates a pain response to tell you something is wrong, but not exactly what is wrong.
Think of kinking a running garden hose. The problem you see is the water is not coming out the end, but the source of the problem is the kink.
The surgery in Tim’s case was like cutting off then attaching a new opening to the garden hose. No wonder it didn’t work. The problem was the kink, upstream.
What Do I Do About My Back Pain?
I have back pain. I have “age changes.” But you’re telling me it’s likely not my structure causing my pain, it’s doubtful I need surgery, and my pain could be coming from somewhere else than where it hurts. Got it.
So, how in the world do I know what is causing my pain? Great question.
Common Back Pain Dx (Diagnosis)
To know what’s causing your pain, it’s important to get a diagnosis.
Or maybe not.
A diagnosis is merely an opinion. An opinion is like a butt, everybody’s got one.
Further, a diagnosis is a label. Labeling someone with “lumbago,” “sciatica,” or a “disc herniation” does not tell you how to correct the problem.
“What” the problem is important. More importantly, is “how” it behaves — it’s characteristics.
Offer the diagnosis of a disc herniation to 100 clinicians and you’ll get 100 different opinions. There’s no standard treatment protocol. Dealing with pain there’s no A + B = C. And there can’t be.
The truth is the vast majority of acute and chronic back pain problems are movement-based (or lack thereof) mechanical back pain.
We tend to think the worst. Don’t worry, back pain because of a tumor, infection, or serious disease is few and far between. However, it doesn’t hurt to get an evaluation by a trusted physician or clinician. No pun intended.
If your pain’s behavior fluctuates in any manner, e.g., pain increases/decreases, moves to a different location of your body, occurs when you perform certain movements, I can almost guarantee you’re dealing with mechanical pain.
Mechanical pain is the feeling you get when you reach the point of pulling your finger too far backward. The stretch and tension you feel begin to hurt. The hurt is your brain telling you, “Hey, stop pulling your finger back before you damage it, idiot.”
You let go of the finger and, yes, it may be a bit achy, but there’s nothing wrong with your finger. The pain is not an indicator of damage, rather a warning to prevent damage from occurring in the first place.
Yes, back pain is more complex than a pulled finger, but it demonstrates mechanical pain beautifully. Most back pain is the result of habitual postures, positions, and movements people assume on a daily basis.
Their behavior accumulates stress and tension on their back, much like the finger, but they don’t know it. They only know it hurts. And they don’t know how to let the finger go.
On the other side of the token is chemical pain.
No, not like toxic chemicals. More like body chemistry — the microscopic workings of your insides.
Inflammation is chemical pain. When you roll your ankle and it balloons-up into a “cankle,” inflammation is at work.
Inflammation is a normal chemical process where your body’s immune system sends soldiers to clean up the damage and debris in a process called, phagocytosis.
Essentially, it’s healing.
In the case of a sprained ankle, you need healing. In the case of a pulled finger, you don’t.
Then why does our culture approach mechanical pain with a chemical fix?
Treatments and Remedie
s for Back Pain
“We often preoccupy ourselves with the symptoms, whereas if we went to the root cause of the problems, we would be able to overcome the problems once and for all.” -Wangara Maathai
Hop on Facebook to make a post. Say you have back pain and are looking for suggestions.
Proceed with caution.
Scratch that. Don’t do it. I can already see the answer in the crystal ball: opinion after opinion after opinion.
Rest, Advil, Tylenol, ice, heat, TENS unit, massage, stretching, walking, chiropractic, physical therapy, acupuncture, reflexology, Reiki, essential oils. The list goes on.
Just because something “worked for me” doesn’t mean it will work for you. The answers you get from social media are a popularity contest versus scientific data. Anecdote versus data. Anecdotes are general and non-specific. Scientific data is specific and targeted to answer a question.
But science is not sexy. Rubbing on a hot-cold ointment loaded with marketing claims while jabbing yourself in the back with an “As-Seen-On-TV” device is apparently sexy.
But wait, there’s more.
Regardless, most back pain episodes resolve on their own within six weeks. However, whether it’s remedies or time, neither are addressing the cause.
With newly acquired (acute) back pain episodes, the typical goto is over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Tylenol (acetaminophen), and Aleve (naproxen). Wow, is that enough clarification for one sentence?
NSAIDs can be helpful at the onset of back pain when there may be inflammation involved. Although, if you have back pain from sitting too long, the effect will be mild at best.
If I had a nickel for every time someone said, “it takes the edge off,” visiting the Coinstar would be in my weekly routine. The “edge off” response is classic of someone who has a mechanical back pain problem where the first line of defense is reaching for the medicine cabinet.
There’s nothing wrong with popping a few Advil. But what happens when it’s the only thing you know helps you, even if it’s just a bit?
Enter the opioid crisis.
Relying on seemingly harmless NSAIDs is not the problem. Though there are issues with long-term NSAID usage, the problem is the pill-popping mentality.
Reactive vs. Proactive
The proverb “if it ain’t broke don’t fix it” is meant to advise not to mess with something if it’s working. However, it’s foolish to ignore the signs of a process breaking down.
Take one of my patient’s, John, for example.
Fresh cut grass, birds chirping — it’s a beautiful spring day. John decides to tend to landscaping duty. Well, now his back hurts. Pop a few Tylenol, rub on some hot/cold ointment, pour a glass of wine, and catch up on some streaming.
He gets a massage or uses his massage gun because his back is tight. The massage is amazing — really got into those muscles feeling like steel cables running down both sides of his spine. John is relaxed. John made a great decision.
A few days later, he is as good as new.
Ugh, it’s Monday morning. The back is stiff. He takes his time to get out of bed. John’s routine gets him to the office where he schleps away at TPS reports for hours. Finally, he gets out of his seat where it takes a minute to straighten up.
After lunch, he reaches into the desk drawer where the bottle of Advil sounds more like another trip to the drug store than a pain-mitigating maraca.
The NSAIDs just aren’t doing it.
He makes an appointment to see his primary care physician (PCP) about this back pain.
The PCP advises to rest, ice, avoid heavy lifting, and take the prescribed muscle relaxers for pain, as needed. It should subside in six weeks. If not, here’s a script for PT and recommendations in the area.
He takes his PCPs advice seriously. The muscle relaxers help but not much more than the Advil. After a few days of ice and extra rest, he’s feeling better. Not great, but better.
It was a tough work week. Cranking out TPS reports for Lumberg and stressed out of his gourd. It’s 3 PM. He can’t wait to get home to crack a brewski and watch the ballgame.
John gets up to use the John (no pun intended), where his back is stiff. Not again.
The gal in the cube next to him suggests John sees her chiropractor as it helped her back. And she didn’t have to rely on medications anymore. John knew long-term drug use wasn’t a good choice, so he took her advice.
John’s back was so stiff the car ride felt like a voyage on the Oregon Trail pulled by an ensemble of oxen on cocaine and steroids, destined to die of dysentery.
Get me on that table already!
Laying face down, first is a nice hot pack and sticky pads with wires making his muscles twitch. His eyelids shut like steel traps, soaking it all in. Next a little snap, crackle, pop. And finally poking at muscles. It hurts so good.
The treatment was just what the doctor ordered.
John’s diagnosed with chiropractic subluxations and a disc bulge. He’s out of “alignment.” To correct the problem, he’s advised to schedule treatments three times per week for the first four weeks. Then two times for the next month. Finally, ween down to one or two times per week for the last month.
Okay, wait. What is that? 24 visits? That’s a lot of time and money.
Refusing the (excessive) treatment plan because he’s feeling much better, John decides he’ll come back if he believes he needs another adjustment.
He’s on his merry way. The garage door opens. Park the car. Hop on out.
Boom. The back locks up again.
Damn, that chiro was right.
John succumbs to the treatment plan. A few weeks of chiropractic and massage treatments ensue. He’s feeling much better. Though the chiro told him “it’s not good for you,” he’s still reaching for the Advil at work, but only on occasion.
Then it happens again. But this time from pulling weeds. Back to square one.
John goes back to the chiro where the adjustments aren’t working like they used to. He ditches the chiro to continue his hopeful journey to the no-more-back-pain promised land.
John thinks, “Maybe it’s my core. My core is weak — that’s it. Maybe I need PT. Ah, yes. I’ve got that script my PCP wrote for me.”
John goes to PT two times per week for a few months.
Like the chiro, they give him the whole shebang of the hot pack, electrical stimulation (the sticky pads), and rubbing muscles. But this place fancies him with a host of other treatments like stretchy athletic tape, scraping the skin with a tool to break up scar tissue, and needle sticks into sore muscles. Not to mention, John performs an ensemble of therapist-assisted stretches and exercises to strengthen his body.
John’s allotted visits are about to expire. He feels better but only about 50% better.
They throw the kitchen sink worth of treatments at him. Like throwing crap at the wall, they’re hoping something sticks. John’s not sure what’s helpful and what’s not. He doesn’t understand his problem. All he knows is he has a diagnosis-labeled problem and the treatments he’s receiving are supposed to fix it.
John asks, “Is there something I can be doing on my own to help me heal, and not have to go through all of this again?”
“Keep doing the exercises,” John’s advised.
The laundry list of exercises helps but the time commitment is overwhelming. John sticks with it for a few weeks, but he falls off the wagon. Life gets in the way. And honestly, the back pain is not that bad right now.
Now he’s really done it. John is elated to grab the chip-in birdie ball out of the cup, only to get annihilated by the lightning storm in his right leg.
John goes back to his stockpile of his non-specific PT exercises in an attempt to fix the problem himself.
No Bueno. John’s in such bad shape he can barely get into position to execute most exercises.
John goes back to his PCP asking, “Doc, I’m in bad shape. I did what you said. I did chiro, but the adjustments stopped working. I did PT where I feel my core is stronger, but I only got marginally better. Now it’s down my leg. What do I do next?”
The PCP jams a needle in John’s butt (cheek).
“This is a steroid shot of Toradol — it’s an anti-inflammatory,” she informs. “It will flush out the inflammation irritating the nerves of your back, much like the inflammation of a swollen ankle irritates the nerves of your ankle.”
Because of the pain down the leg which John did not have prior, she referred him to an orthopedic surgeon for an evaluation.
John meets with the orthopedic surgeon. He tells him the whole story from when his back pain started to where he is now.
“The Toradol shot didn’t work, so here I am.”
The ortho performs a brief physical evaluation where there’s identified weakness of his painful leg and range-of-motion loss of his back.
“We need to get you an MRI,” says the ortho.
The MRI comes back with mild degeneration and arthritis, but there’s a sizable disc protrusion (bulge) of L5-S1 that’s pressing on the nerve.
The orthopedic surgeon recommends surgery to fix the bulge, thus taking the pressure off the nerve, which is causing the pain.
John thinks to himself, “That makes sense. That’s reasonable. Nothing else has worked and I exhausted my conservative treatment options. Now that we know what’s really going on inside, let’s get it fixed.”
John gets the surgery — it’s successful. He’s been advised recovery will take some time and he must perform post-surgical rehab to ensure proper healing and return to full function.
Eight weeks later, following the surgeon’s recommendations, John tells the surgeon he’s feeling much better. There’s no pain down the leg, occasionally in his butt cheek; however, the pain in his back is like a Steve Urkel — it just keeps coming back.
The ortho reassures John he has healed and the disc bulge pressing on his nerve is fixed. He suggested John implement a stretching program or try Yoga.
John walks out of the office frustrated as hell.
“I tried chiro. I tried PT. I got an injection. For christ’s sake, I got surgery.”
“And I still have this problem.”
“WHAT. THE. *Expletive*.”
What Do You Do About Back Pain?
“It is human nature to think wisely and act foolishly. “
― Anatole Franc
John’s story is tragic and unfortunately not a one-off situation. As a matter of fact, his story is a paraphrased testimony of a patient I had treated after the events had transpired.
The reactive pill-popping mentality leads down a slippery slope. Drugs are not inherently bad. The long-term side effects of drug usage are bad. When drugs are misused you fall into a bad place.
Luckily, for John, he didn’t become a statistic in the opioid epidemic like my friend Tom.
However, John got stuck looking for answers riding the Health Care-ousel. And it happens far too often. No wonder back pain is the leading cause of disability in America.
In 2016, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion.
You would think with all the information available at our fingertips you could Google search for an answer for back pain. There’s plenty of answers to go around — take a look. Better yet, ask Alexa, “Alexa, how do I fix my back pain?” You’ll get an answer.
This is why I didn’t lay out every diagnosis of back pain — it’s already out there.
The problem is there are hoards of information available to sift through. Remember the Facebook post example? It’s an anecdotal popularity contest. We are drawn to the latest fads, which prey on our vulnerability to take the easy way out.
Why do you think weight loss pills still sell, although time and time again they’re proven no better than placebo? Science is not sexy. The image of hacking weight loss is sexy.
If someone believes they need an MRI to “see what’s going on inside,” you’re not changing their mind by telling them science says otherwise. Naively, I’ve tried it many times with patients who literally pay me (and insurance companies that don’t) for my expertise. It doesn’t work.
We’re biased — it’s human nature.
As Ozan Varol says in his book Think Like a Rocket Scientist, “We are conditioned to believe that there is one right answer to each question, and the path to that answer is clear.”
There isn’t a definitive answer to every question. There’s more than one right way. But whatever the right way, it must follow principles.
Drugs aren’t bad.
Chiropractic isn’t bad.
Physical therapy isn’t bad.
Surgery isn’t bad.
ABC unconventional therapy in an attempt to “fix” XYZ isn’t bad.
The problem with all of these approaches through the conventional lense is they don’t ever address the cause of the problem.
Whether he likes it or not, the cold hard truth is John is the reason why John hurts.
If I pull back my finger and hold it there until it hurts, no amount of drugs or therapies are going to correct it until I let go of the finger or the drugs kill me.
Nothing in John’s story focused on letting go of the proverbial finger.
What did John continue to do through his charade of treatments and therapies?
Lots of sitting, and little activity.
And when he was active, like landscaping, this size of his glass wasn’t big enough to contain everything he was putting in. Back pain was the result of overflow.
Nothing was specific to him and his unique situation. He didn’t understand why he had the pain. He didn’t understand the variables causing him to have pain. He didn’t understand how to reduce his risk of another back pain episode, nor what to do if it happens again.
Nobody taught him.
He was completely dependent, non-self-reliant.
Don’t slip into this invisible trap. Do this instead.
Here’s What Actually Works
Move more and move often.
Short and sweet. Plain and simple. No rules, just move.
Imagine what it would be like if you couldn’t move.
Movement is fundamental. We are made to move. The first year of our life is dedicated to grooving movement patterns that will last us a lifetime.
As babies, movement looked something like this:
Reach. Roll. Crawl. Creep. Kneel. Squat.
As adults, it looks more like this:
Sit. Stand. Sit. Bend. Sit. Walk. Sit. Lay down. Sit. Sit. Sit.
Too often we get trapped in the rigmarole of daily life, doing the same things over and over again. It’s not until the pain alarm signal goes off that we begin to do something about it. Reactive versus proactive.
You can change that by developing your own movement practice.
Movement variability and capacity: do a bunch of different things and gradually build up your ability to do more of it. Here are options to start adding more movement into your life:
- Move in ways you’re not used to. Dedicate at least five minutes per day moving and stretching on the ground.
- Get your heart pumping at least once per day.
- Use an activity tracker to set and track movement goals.
- While at your desk job, set the alarm on your phone to go off every 30-60 minutes to remind you to get up and move.
- Drink more water. Hydration is healthy, and it will make you get up to go pee more often.
- Ditch the conveniences. We’ve heard it a million times: take the stairs, park further away, don’t drive when you can walk, carry your bags, etc.
- Commit to at least one recreational activity you love such as mountain biking, running, softball, or martial arts.
- Resistance training. Whether it’s a weight in the gym or a box in your basement, learn how to lift heavy objects.
- Get a gym membership. Further, invest in a coach and group training. It’s possible to have all the gym equipment you need at home and hold yourself accountable to a training program. But how likely is that? Highly unlikely. Goal setting and accountability is paramount. Pay someone who knows what they’re doing to hold you accountable — there are affordable options.
The little things add up. Consistency in your actions is the key. However, just because it seems simple, does not mean it’s easy.
As Marshall Goldsmith says succinctly in his book, Triggers, “Behavioral change does not have to become complicated. Achieving meaningful and lasting change may be simple — simpler than we imagine. But simple is far from easy.”
Start with a low barrier to entry. Pick one or two activities to start implementing, then stick to it. Don’t concern yourself with being perfect — you’re bound to falter.
As you fail, you’ll learn.
By creating habits you’ll build confidence. Once you’ve created a habit, challenge yourself a bit more. Before you know it, movement in your life will become the norm.
Sit, sit, sit becomes move, sit, move. You become better, faster, stronger.
Life happens. Pain and injuries occur. By investing in a life of movement, you’re substantially more likely to avoid the costs of chronic back pain, prescriptions, and surgeries.
What you’ll earn is happiness.
Yes, happiness. Imagine what it would be like if you couldn’t move.
Find a Professional You Trust
I’m rarely the first line of defense.
A person who’s been struggling with a difficult case of low back pain or “sciatica” symptoms sees me when they’ve tried everything else. Sometimes even surgery. They get to me because a close friend told them, “Don’t worry, he’s different.”
To clarify, “he’s different” means I am not the typical chiropractor who cracks everything three days per week for the rest of your life, swinging away with the hammer as if everything is a nail.
Once you get cracked, you always come back. Right?
Wrong. It shouldn’t be that way.
Unfortunately, I’m just a chiropractor in the Health Care-ousel.
We are the minority amongst the chiro farms and PT mills, but we’re out there. Chiros, PTs, ATCs, coaches, therapists, and even physicians, all who dig deep, always asking, “Why?”
Regardless of the professional title, what’s paramount is you choose someone who:
Performs a thorough mechanical assessment. The vast majority of back pain complaints are mechanically-based, i.e., the “bent finger” analogy. A proper mechanical examination and assessment is the best filter: it will tell the clinician if the problem is non-mechanical, requiring a referral to another specialist.
Spends adequate time. Five minutes with the chiropractor for a quick rack ‘n crack is inadequate. An exam with the PT then handed off to a tech for all of your rehab is garbage.
Personalized attention. A good clinician will always change gears depending on the results of the continuous assessment. As your progress changes, so should the strategies applied. The same treatment and exercises over and over again are cookie-cutter, not individualized.
Speaks “English.” Your clinician should speak with you in terms you understand, not medical jargon. When you understand the behavior of your problem you can take an active role in your recovery. When your clinician and you work as a team, you get better, lasting results.
Limits describing the body as a machine. The body is a holistic being, all systems working together in harmony. To simplify the body like an assemblage of car parts is insulting.
“Weak” this, “tight” that. “Strengthen” this, “stretch” that. “Shifted” here, “tilted” there. These are very convenient narratives, which make logical sense to a layperson. However, pain science has taught us there’s more to the story than strictly bio-mechanics.
Doesn’t draw a line in the sand. We know what we know. We don’t know what we don’t know. But we also don’t know what we know and know what we don’t know.
Take a breather.
Chris Voss, author of Never Split the Difference describes unknowing the unknown as a “Black Swan.” What we’re doing now will change in 10 years. What we’re doing now may completely change 20+ years down the road.
As clinicians, we’re taught to give concrete answers, but that’s just not how it is. A clinician who shows vulnerability by saying, “I don’t know, but here’s what I do know” means they possess a growth mindset with a malleable patient-centered approach to their care. Work with this type of person.
“It’s what you learn after you know it all that counts.” -John Wooden
Keep an Open Mind
“Let what we know guide us, but not blind us, to what we do not know. We must remain flexible and adaptable to any situation. We must always retain a beginner's mind. And we must never overvalue our experience or undervalue the informational and emotional realities served up moment by moment in whatever situation we face.” -Chris Voss
We don’t know what we don’t know.
Just because something worked for someone else doesn’t mean it will work for you. And vice-versa.
Something you and I think is hippy-dippy may be what provokes the change desperately needed by another person.
Not everything is science and evidence-based. In order for a mode of therapy or intervention to become evidence-based in the first place, it has to start off not. It means clinicians need to experiment and test, and not be reprimanded for doing so.
Without experimentation, we cannot discover the next big breakthrough. We remain the status quo.
Rationalization to the point where it makes sense, or a staunch belief in “common sense” is dangerous.
“Common sense is what tells us the Earth is flat.” -Albert Einstein
If you feel like acupuncture will help you, go do it.
If you want to try reflexology, try it.
If you believe alternative medicine is fundamental in your life, live your life.
Nevertheless, keep your mind open to mainstream medicine as well.
Falling into the depths of alternative medicine as your primary mode of healthcare, disregarding conventional medicine like you’re fighting “the man” is expensive. And you could pay the ultimate price: your life.
Tests and diagnostics can be life-saving by identifying the scary stuff. It’s when the tests fail to give us answers and we’re left scratching our heads. This is what happens with mechanical back pain all of the time. This is when “alternative medicine” thrives.
But remember, the common denominator in all of this is you.
Only you can be you.
Only you can decide where you want to go. You’re driving the car. But when the path gets desolate you need the right navigator to help you get to your destination.
But the proverbial GPS doesn’t always know where to lead you. That’s when the driving gets tough.
We get lost.
We don’t know where to go.
And unfortunately, many of us get lost trying to navigate our mapless bodies.
No one can fix your back pain. They can only help you navigate.
Don’t get stuck in the Health Care-ousel.
Be proactive, not reactive.
Move more and move often. Do a variety of different things and build up your tolerance over time.
Seek a navigator as soon as you sense you’re driving in the wrong direction.
Don’t get lost.
It may be a rough ride, but you’ll get there.
And it will be worth it.
The Move to Sit Less
In the current workplace, we're seeing a push toward a modern environment.
What once used to be a sterile space of cubicles, ceiling tile, and fluorescent lighting is evolving into trendy communal workspaces with adaptive workstations, ergonomic office equipment, and even nap stations.
Let's call it "Googled" workplaces if you will.
Regardless, chairs still exist and aren't going anywhere anytime soon. But chairs aren't the problem, it's our behavior.
Sitting for an hour is not an issue — our bodies are more resilient than that. Sitting for hours at a time, eight hours per day, five days per week is an issue. And that's not counting the weekend.
We can change our behavior. But how easy is it to change a habit?
Not to mention, we're biologically hardwired to conserve energy when our life isn't at stake. Back in the day, we had to expend a lot of energy to survive. When we weren't hunting, gathering, climbing, fighting, or building, we conserved energy for the next bout of survival.
Our bodies are responding to our environment in the way it's supposed to. The reason we resist exercise is that there is no trigger to survive. Why spend the energy if it's not for survival?
The problem is our modern environment has changed faster than our genome. We're wired for primitive, but living in contemporary.
We have to change our biologically programmed behaviors. Yup, you read it right.
If we want to "hack" our hardwiring living in the modern world, we need to be smart and strategic.
Move More, Move Often
"Take care of your pennies, and your dollars will take care of themselves." -Scottish Proverb
Do you know how they say the little things add up?
We've all heard it:
Take the stairs.
Park farther away.
Take 10,000 steps per day.
Get your heart pumping.
Stand up and move every hour.
They're all tried and true ways to implement more movement in your life.
But they're simple. Too simple. So we prematurely dismiss them.
The little things add up. Consistency in your actions is the key. However, just because it seems simple, it does not mean it's easy.
"Behavioral change does not have to become complicated. Achieving meaningful and lasting change may be simple — simpler than we imagine. But simple is far from easy." -Marshall Goldsmith
There are plenty of simple options to groove new habits, more than "take the stairs."
Anything movement is good. There's no such thing as a bad movement.
Move more, move often. Variability and capacity. Do a variety of stuff, and increase your ability to do more of it.
It's simple but not necessarily easy. Here are some ideas:
- Take the flipping stairs!
- Skip steps (two at a time) on the stairs.
- Park your car in the further spot away from the building.
- Replace a two-minute drive with a 5-10 minute brisk walk.
- Use an app to monitor and limit leisurely screen time.
- Play with your kids at the park, e.g., monkey bars.
- Do planks or pushups before and after a meal (10 pushups at a time for three meals is 60 pushups. 60 pushups every day is a phenomenal habit).
- Every time you pick up something from the floor, squat instead.
- Carry your luggage like a suitcase as opposed to rolling it through the terminal.
- Twerk in your seat. No, I'm not kidding.
- Use a standing desk or, preferably, a convertible desk — periodic changing of positions is key as prolong sitting nor standing is ideal.
- Take a knee at your desk. Or drop a knee off the edge of your chair where one butt cheek stays on the seat. Use a cushion for your knee, if needed. Change sides periodically. Kneeling is a childhood development milestone at 11-months — completely natural and keeps you back in a neutral position without thinking about it.
- Develop your movement practice by enrolling in one of my free courses.
- Follow these three posture tips:
- Get up and move
- Drink more water
- Set a timer for micro-breaks.
We tell ourselves we'll make healthy changes, but willpower only goes so far. Let’s pretend you had a terrible night's sleep because you binged on streaming the night before. THAT never happens. What happens the next day when you're exhausted and faced with the decision of stairs versus elevator? Going up. Willpower loses.
Author and behavioral psychologist, Benjamin Hardy, goes as far as to say, "Willpower doesn't work."
To make lasting long-term changes, you need to start small. I mean super small. Laughably small.
As Chris Kresser put it, you need to "shrink the change" when attempting to change habits.
Start with a low barrier to entry. Pick one activity to start implementing, then stick to it — only one.
Make sure they are SMART goals. Specific, measurable, achievable, realistic, timely.
I will take the stairs rather than the elevator whenever I arrive and leave the office, every day for one week.
Is it specific? Yes: take the stairs.
Is it measurable? Yes: stairs opposed to the elevator to and from the office.
Is it achievable? Hell yes. Almost too achievable where you brush it off as nonsense — don't do it!
Is it realistic? Yes: taking the stairs opposed to the elevator is making a simple choice.
Is it timely? Yes: one week. What have you got to lose?
Don't concern yourself with being perfect. You will get off track, and that's okay. As you fail, you'll learn. Heighten awareness by identifying the situation, then get back on track and move on.
After one week of achieving your SMART goal, you keep doing it because it's easy. You've been doing it. It becomes a habit.
By creating habits, you'll build confidence. Once you've established a habit, start creating the next one. Daily movement practice in your life will become the norm in no time.
Sit, sit, sit becomes move, sit, move.
You begin to notice you don't feel stiff as a board when you stand up from the chair. You don't walk like you have a stick up your ass. You no longer have that crick in the neck, which prompts, "Hey honey, would you please rub my shoulders?"
Your body doesn't feel like hot garbage.
Wrapping it Up
Look, none of this stuff is sexy — I get it. You could take a primitive approach by going “off the grid.” God forbid if you have to give up checking Insta stories.
What we once had to do to survive has been replaced by modern conveniences. Our environment has changed, but our biology has not.
It's not our fault — we're programmed this way.
But willpower is not enough.
We need to set goals. SMART goals. Then shrink your SMART goals.
Modify your environment. Remove the triggers that cause the behavior(s) you're trying to change. Otherwise, the triggers will win — every time.
Or you could risk living a life with chronic back pain. I’m not kidding. I see it every day.
Is sitting the new smoking? I would clarify chronic sitting, or lack of activity is the new smoking.
The costs go beyond monetary. The effects of long-term sitting and inactivity have severe health implications startlingly similar to smoking.
Too many people are going down that path. But you don’t have to. Habitual activity won’t save your life, but you can bet your bottom dollar it will save your lifestyle.
Like smoking, inactivity is a slow killer. You know deep down inside you should change your behavior, but you don’t bat an eye. Change is hard. It’s easy to sit. It’s easy to conserve energy. It’s easy to be lazy.
What’s hard is living a life with chronic pain and immobility.
Before you know it, it’s too late. In your younger years, you could move but preferred not to. Now you want to move, but you can’t.
Wishing they could play with their kids is a real thing for too many people.
“I’m sorry, honey. But mommy can’t get down on the floor because she won’t be able to get back up.”
Like so many, don’t look back on your life thinking about what could have been.
You have time. The time is now.
Make the first move.
Take the first step.
Because they add up.