back pain


I’m just back from close to a month in the Middle East, visiting Israel and Jordan.  I’ve been asked to speak and present on the topic as I was staying in the home of Jordanian villagers for part of the trip and visiting the holy sites in Israel in the other part.  I’m putting together an essay on the experience and will have it ready soon.  For now, we’ll continue this year’s exploration of freedom and it’s relationship to health. 

“All of my strength comes from my core.” –Bruce Lee
Back pain is a serious issue.  Millions of dollars are spent every year on pain medicines, doctor appointments, and surgeries related to it.  85% of all Americans experience back pain at one point or another and most of it thankfully, is muscle-related, and does not indicate long-term structural damage.    Depression and back pain are the two leading causes of missed work in the US, and the two are related.  Back pain can lead to depression and depression (and the immobility it often causes) can lead to back pain.  One of the quickest ways to lose your freedom is to become trapped in a cycle of pain and immobility.  The reason this essay focuses on back pain is because it is the most common type of serious pain. 

Most back pain issues come from these things:

  • Poor postural and lifting mechanics
  • Sitting too much
  • Tight, stiff, and / or weak musculature around the spine and pelvis
  • Obesity and particular abdominal obesity

Movement could be viewed as a chain reaction, which if repeated, say in the case of a golf swing, judo throw, or tango move, can become an almost unconscious “computer program” similar to how walking is routine:

Thought > Nerve Signal > Recruitment of Nerves & Muscles > Motor Pattern > Movement
All voluntary human movement starts in the spine.  Reflexively, we move to avoid danger, unconsciously we fidget, or voluntarily we walk across the room vacuuming, picking up after kids, shooting a basketball or so on.   Regardless of whether movement is voluntary or reflexive, it all starts with the spine and the brain connected to it.  Structurally, the spine can be compared to the shocks on a car.  The spine allows a skeleton to form around itself and support human life like the shocks on a car soften and structure movement and allow it to proceed.  When we want to move, our brains send a signal through the spinal cord which initiates movement through nerves and muscles connected to the spinal column.  These are the key components to initiating and supporting human movement:

  • The brain
  • The skeletal spine
  • The spinal chord
  • The pelvis
  • The nerves and muscles connected to the spinal skeleton and chord

You could think of human movement as a series of chain reactions, one followed by another, but all initiating in the middle of the body. cThe highly influential and talented Physical Therapist DPT Grey Cook has coined the term “Move Well. Move Often” as his motto.  Notice the lack of a period at the end of “Move Well. Move Often”, and notice also that Move Well comes before Move Often.  This is crucial.  According to Dr. Cook, we need to move well before we move often.   A baby doesn’t magically hop up one day and start doing planks or lunges or skipping.  A human develops by learning to turn over, crawl, walk, run, and then other movement skills, all sequentially.  How many times have we ourselves or someone else we know gone at things “gung-ho” and done a thousand push-ups, squats, or a sit-ups, yet end up injured only a few weeks into a new fitness program.  So what’s the problem?  As Dr. Grey Cook says, we need to move well first and foremost, and then move often. 

Patterns emerge in our lives over times.  Some of us are tall so we tend to be tight in the hamstrings, some of us are big in the belly and so we are pressuring and overstressing the spine and the discs between the vertebrae, we sit too much and our hip flexors get tight and throw off our pelvic alignment, and so on.  All of us develop into certain repetitive life patterns which affect the integrity of our movements.  This is where pain often comes from.  We’re moving with tight muscles, joint stiffness, muscular imbalances, poor posture, weak abdominal and back support, and to top it all off we’re often  not moving at all because it hurts to move.  So what should we do? 

We should focus on both good movement patterns and posture and getting frequent daily activity and exercise, but we should never sacrifice technique and form to push through an activity and just get it done.  Poor movement patterns lead to injury.   

Just as the Hippocratic oath states, as practitioners of fitness or healthcare we should “first, do no harm.”  Unfortunately, I see healthcare practitioners, doctors, trainers, and therapists harming people all the time in various ways.  For example, these are interactions I rarely hear but should:

Why am I in PT? In reality, because you are obese and the extra weight you’re carrying is wearing our your joints. 
Why do I have back pain?  Because you sit all day. 
Why am I depressed?  There’s nothing wrong with you, but you need to remove certain types of stress from your life like debt, alcohol, self-destructive behavior, and media. 
Why does my shoulder hurt?  Because you’ve over-strengthened your chest at the expense of other muscles.  
Why do I get sick so often? Because you eat a lousy diet and you take too many antibiotics and you don’t sleep enough. 

By not telling someone the truth, we’re harming them but often health care practitioners charged to take care of people do just that because they are afraid to tell the truth.  Just the same, when we throw someone into boot camp who isn’t ready, or have someone run who is not capable, or someone lift with bad form or muscle imbalances, we are potentially hurting them.  Before any serious training begins, and as it is ongoing, moving well should be a primary focus.  Over the long haul, when it comes to back pain, we need to take daily care of the spine.  This is the way it’s done.
3 steps to maintaining a healthy back for a lifetime:

  1. Contact a qualified professional therapist or trainer to conduct a standardized and objective movement analysis and then structure a fitness program based around the results to address limitations and deficiencies.
  2. Learn and employ proper breathing, posture, exercises, and exercise techniques to keep your spine, back, and pelvis healthy.
  3. Avoid sitting for long periods.  Walk, lean, or work standing up but whatever you do don’t sit all day.  Sitting is the new smoking. 

These are some other great tips for back pain prevention I’ve learned over the years:

  • Stay hydrated. Drink plenty of water.
  • Exercise in a multi-planar way.  Move in a variety of ways to cross train the muscles and nervous system.  Twist, flex, extend, rotate, and statically hold the spine in a controlled way using a variety of exercises. 
  • Perform exercises like deadlifts with perfect form, instead of avoiding them altogether.  Counterintuitively, strengthening the back with direct and intense weight training, if done right, prevents pain.
  • Use implements like the bed, the wall, various foam rollers and balls, towels, and swimming pools and spas to stretch.  They each add a dimension of versatility and variability to aid in recovery.
  • Soft tissue work is important.  Stretching with trigger point foam rollers, self-massagers, or acupressure has its place. 
  • Always warm up before a sport.
  • Lactic acid is a pain management drug.  What this means is that exercise itself blunts the effects of arthritis and other degenerative joint issues.  Move often!
  • Vitamin supplementation and even more importantly a proper diet are crucial to muscle and nerve function.
  • Sleep is when recovery takes place and the muscles, bones, and nerves heal.  Aim for 7-9 hours per night. 
  • Research the side effects of medicine you’re taking and if possible stop using it, or use a natural alternative or limit intake.  Consult your physician for guidance. 
  • Keep your body weight and especially abdominal fat under control.
  • Most back pain can be managed by doing floor exercises and stretches for the back, abdominals, pelvis, and glutes. 
  • If you’re in pain, visit a physical therapist to get a) guidelines and on what you are capable of doing on your own and b) treatment for your pain.
  • No matter what, do something!

The spine is a living, breathing organ.  It changes over time, for better or for worse, but contrary to popular opinion not always or necessarily for the worse.   The back can get change, heal, and get stronger and healthier with each passing day if things are done right.   We are all going to age and get stiffer but this doesn’t mean pain is necessary.  This is something health care practitioners miss.  My background in physiology easily allows me to notice things that others don’t when it comes to pain- the effects of upbeat music, cardiovascular conditioning, meditation, proper hydration, warming up, mental focus, and the negative effects of prescription medicine for example.

Don’t every get stuck in a deconditioned trap if you can help it.  If you can’t run, walk, if you can’t walk, crawl, but stay active and move often with good posture, balance, and spinal mechanics.  A severe case of back pain can limit your freedom, your ability to walk, to jump, or even to go to the bathroom.    Maintain the integrity of the spine in an intentional way by knowing what you should be doing and continuing to do it over your lifetime, before it’s too late.  

P.S. There are many tests which can be conducted to measure spinal mechanics but a simple test which has revolutionized the field of fitness and physical therapy is the Functional Movement Screen developed by Dr. Grey Cook, as mentioned in the article.   I use this with clients daily and I test myself a few times a year.  Email me for more information.

Read Next: Chaos and What You Can Do About It

Sources: Grey Cook’s Functional Movement Screen:




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