Making Exercise Healthy Medicine
How To Fix Lower Back Pain
Without Drugs or Surgery
© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
Headmaster, AFEM - Academy of Functional Exercise Medicine AFEM
Dr. Bookspan's methods for back and disc pain Health & FItness THIRD ed, and
chronic lower back pain from lumbar overarching, The Ab Revolution No More Crunches No More Back Pain,
are used by military and top spine centers around the world. Pioneer of Functional Fitness and Exercise,
named "The St. Jude of the Joints" by Harvard School of Medicine clinicians
Copyright & Reprint Instructions
Hello, You're on the web site of Dr. Bookspan. This is a no-ad, no-hype site dedicated to getting you back to your life - healthy, mobile, happy. There are hundreds of free articles here for you. This page explains fixing several causes of lower back pain. I make this available to you at no charge to you for a better world.
Lower back pain can be easy to fix. Welcome to Dr. Bookspan's Health Care Reform School. This article will show you how to spot and stop several common causes of back pain. Then you no longer will get that kind of back pain and your back can heal. This is different from taking medicines or doing a few exercises to mask the pain that results.
Not All Exercise is Good Medicine. Here is How To Change to Daily Healthful Movement as Healthy Medicine.
No health insurance needed. Much cost, time, and worry currently spent in medical treatments are unhealthful and often unnecessary. It's not health care if it's not healthy. I researched and checked methods for years in the lab - evidence-based, primary source research, and put the results here on my web site for the benefit of the world. Get better and the world will be better.
Answers In A Nutshell
- This is not "alternative medicine." This is evidence-based sports medicine techniques, applied to real life - where you actually need it. I consider it simple, common sense, standard of care.
- Back pain is not a disease or "condition" or something that once you have, you have it for life. It is usually an injury like a sprained ankle, that with a little common sense and information, can stop, can heal, and you can be better than before.
- You do not need to have surgery or shots or extended medical treatments or bed rest to relieve back pain.
- You do not need to give up impact activities like running or martial arts, give up weights or heavy occupational work, or activities you love to do. Not all exercise is healthy, just like not all foods - some are junk. This article shows you how to change your movement habits to healthy ones, You will get the built in exercise you need for health while you prevent the causes of most back pain. This is different from doing sets and reps of exercises, then going back to injurious daily habits.
- Back muscle pain, discs that degenerate bulge or herniate, facet injury, narrowing, and most joint injury are not the cause of the problem - they are the RESULT of what you are doing to hurt your back - things you can fix yourself. Even when inflammation or immune response are identified, they are results, not causes. This article will show you how to understand and fix causes instead of using drugs and surgery for the results.
- You may have several causes of pain. If you fix only some of them, you will fix only some of your pain. The answer is not to continue on, missing the rest, saying "it just takes time." Don't allow the other damaging causes to continue. Check for other causes you may have missed and fix them all. Then you will stop all pain, and instead of alternating feeling better from fixing one thing and hurting from other causes, wondering why you have intermittent results, you fix all and heal all and get back to your life stronger and better than before.
- You do not need special chairs, beds, devices, or gimmicks to "put you" into any specific posture or position.
- Many common medicines and prescription drugs can cause back and body pain. Several popular exercises often worsen pain or cause it in the first place, including certain hamstring stretches and ab exercises. Many commercial chair posture-changing devices and foot orthotics produce more pain and are not needed in the first place. Un-needed treatments and surgeries are done - causing more pain and reduction in physical ability. Easy changes can stop the need for harmful medicines.
- Not all back pain is from the results that show on an x-ray or other test or scan. You are not doomed by scan results.
- This article summarizes all the above. Make sure you understand the concepts (many highlighted in green). This is not posture (a static rigid concept to most), but functional body mechanics, good ergonomics, healthy movement mechanics, functional movement.
- If you have lower back pain from long standing, walking, and running, and you feel better to sit or lean over, especially if you hurt more to lie flat face up or down, start with my separate article to fix standing pain, then come back here for the rest. If you have back pain from several causes including facet, you can start here, then go to the fix standing pain article.
Back Pain Why?
Editorials, studies, and news reports state that back pain is mysterious and difficult to remedy, but back pain is not difficult to fix or prevent.
Eight of ten people in the United States have back pain at some point- trying hundreds of thousands of daily treatments physical therapy, surgery, exercise, massage, pain management, chiropractic, acupuncture. Pain may reduce at the time because most movement makes you feel better, but pain comes back because you have not stopped the cause. The answer is simple. People do an astonishing number of things every day to strain, weaken, and pressure their backs. They bend wrong hundreds of times every day. They do exercise with the same poor body mechanics. They stand, bend, sit, and lift wrong every day, hold muscles tightly while they move around, then do bad exercises that add to the strain. They may do "back exercises," but not be aware that strong muscles will not automatically give you good posture, make you bend and lift properly, or make up for all the things you do the rest of the day to hurt your back. People wonder why they still get pain even though they "do their exercises." Many wind up in back surgery, or long term or recurring pain, not understanding why their physical therapy or exercise program, or pills, or yoga "didn't work." They call it "stress." Instead, it is simple to retrain unhealthful movement and habits. Then you stop the cause of the injury and the pain will stop.
Instead of doing a bunch of artificial rehab exercises, and using stiff, uncomfortable posture drills, then going back to damaging daily life movement, I have developed functional health and exercise movement mechanics for living and moving in healthy ways. Here is how:
1. Bad Discs (herniation, degeneration, bulging, slipping discs), Sciatica, and Lower Back Strain
If you have disc pain or sciatica, use the full FIX DISC Pain and Sciatica page. The following are a few things to start:
You know you shouldn't bend wrong, But you do all day, every day picking up socks, petting the dog, for laundry, trash, making the bed, looking in the refrigerator, and all the dozens of times you bend over things. Then you go to the gym and lift weights bent over, stretch by touching your toes, do yoga with repeated forward bends, then lift and carry bags like that. No wonder your back hurts.
- Years of bent forward sitting and standing, and bad lifting and stretching where you stand or sit and lean forward, are enough to injure your back as badly as a single accident.
- After years of squashing your discs with bad posture and movement, pushing discs outward to the back and putting sheer force on them from bad forward bending and twisting, the discs can eventually break down (degenerate) and push outward (herniate). The resulting herniation can press on nearby nerves, sending sciatic pain down your leg. If you squash and push the discs in your neck with a forward head posture - letting your head drop forward, and/or constantly holding your chin forward and up, the disc(s) in your neck may herniate and press on nerves, sending pain down your arm. Shoulder stands and yoga plows are becoming more commonly known as common sources of herniation and bone spur.
- Chronic forward bending (flexion) sheers and pushes vertebral discs outward, and overstretches the muscles and long ligament down the back, allowing more room for discs to protrude centrally instead of more to the side.
- Tight muscles from years of poor positioning and short resting muscle length can also press on the same nerves mimicking sciatica.
- A degenerating disc is not a disease, but a simple, mechanical injury that can quickly heal, if you just stop grinding it and physically pushing it out of place with terrible habits.
This is a side view of your spine. Left - normal disc between two vertebrae. Right - disc pushed out (herniated) from bad bending habits.
Chronic forward bending from bad sitting and bending over sheers the discs and gradually pushes them outward to the back.
If you sit and bend properly, you will stop pushing your discs out and they can heal.
Sitting with lower back rounded (and bending that way too)
can eventually hurt the soft tissue and push lower back discs out (degenerate and herniate or bulge them)
Instead, using good bending and healthier sitting instead of band bending and sitting is key to stop the major cause of disc and lower spine damage Instead of damaging yourself all day, many times a day, you stop the damage, and the pain stops with it. Then your injuries can heal. Good bending also gives you built in strength and stretch that further helps fix pain and gives better overall health built in to your ordinary day, without exercises needed. Done right good bending will not hurt your knees and can be used to strengthen and prevent knee pain as well. Other things to do also follow below in this article. More specifics about discs are in the Fixing Discs article.
Strengthening or "Doing Exercises" is Not The Key
As you can see, back pain has a large component of bad movement mechanics, not weak muscles. Strength does not make you bend or move in healthy ways. Many people do strengthening exercises and become stronger people who still bend wrong, move wrong, and slouch. "Core" exercises are especially misunderstood and repeated and prescribed without any understanding that stronger abdominal muscles have little to do with the most common causes of back pain. Moreover, most conventional core training exercises are done in bent forward ways that reinforce the same bad mechanics you started with. For the research and interesting story on what abdominal muscles really have to do with back pain, see my article on Abdominal Muscles - what they do may surprise you. Bending, standing, moving, and living your life with healthy movement mechanics is up to you. The rest of this article tells more on how.
Where strengthening helps - Someone may use good body mechanics all day, yet ache with fatigue at the end of the day. That is not a back injury or true back pain that needs treatments, and should not be addressed with medications. Another instance is someone who really is so weak that they can't hold up their own body weight and instead, shifts it onto their joints, which wear with time and grind under the weight (slouching).
A little strengthening allows you to do more before fatigue pain sets in, and to be more able to use good mechanics instead of slouching. Strengthening will not keep you from slouching, and don't fall prey to unhealthful exercise programs claiming to cure back pain. Almost any movement can make you feel better for the moment. Over the long run, it's better not to use injurious movement techniques for your health. Use good mechanics for all you do and healthier ways to exercise explained in this article, other free articles on this site and the books with more.From a reader:
"Dear Dr Jolie, Your approach is great! Bought two of your books and the more I read and understand, the more I wonder why your common sense approach was not discovered before. Why exercise and at the same time make no change in our poor daily habits? That does not work at all. God bless you !" - Marie vB.
Discs Can Heal
Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal - if you let it, no differently than a sprained ankle. Stop damaging your discs with bad bending, standing, and sitting habits and the discs can heal. It takes years to herniate a disc, and only days or weeks to heal it by stopping bad habits. Several things contribute to disc pain. Read the rest of this article, try everything that makes sense to you and doesn't hurt, then go to the free article on Fixing Your Own Discs and Sciatica.
Certain pop fitness and PT exercises say to tighten or brace or draw in abdominal muscles, squeeze together shoulder blades or gluteal or other muscles. It is not a useful or healthy or effective practice. Tighten your neck! Sound comfortable? Tighten your legs and walk around or go running! Sound sensible? When you bend your arm to scratch your nose, you don't tighten your arm muscles to do it. In fact, you shouldn't want to. You merely move your arm bones using your arm muscles. Healthy movement is the same. No squeezing should be needed. Strengthening and movement does not need tightening. Much of the tightening or squeezing (or whatever other word you use for this unfortunate habit) is often a cause of pain and bad movement habits.
When you chronically over-tighten muscles with hunching forward, overarching backward, and bad habits and beliefs about tightening, they can remain too shortened to let you stand properly. Or they stay tightened in knots or spasm. This changes their muscle chemistry. Stop using bad movement mechanics and your causes of pain can stop. More about spasm, below.
2. Functional Movement to Retrain Your Muscles and Stop Causes of Back Pain
Back pain exercises are misunderstood. Are you injuring your their back all day then hope to fix it with a few exercises? This does not work. When you stop bending wrong many times each day, which injures your back many times each day, it will stop hurting and can heal.
If you lie on the floor to do exercises, then stand up and walk away with no use of the positioning or strength you just practiced, it is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work." The key is what you do all day.
Try the following slowly. See how you feel the next day, then increase. Use these moves, not as exercises to do 10 times, but to retrain how to bend and move all day. Stop hurting your back with bad bending and your back will stop hurting. Start strengthening your body and legs with good bending and you will get free exercise all day:
- Good Bending Using the Squat. You know not to bend wrong to pick things up, but you do it. Every day. Hundreds of times a day. Instead, bend your knees. You already know that. But do you do it? Are you avoiding it because your legs are too weak, and it hurts your knees? Done right, it will prevent both back pain and knee pain. The squat is for all the times during the day you need to lower yourself to bend and reach things:
Use a healthy squat (right) for all the many times a day you bend. Keep heels down and knees back.
Good bending (right) does not hurt knees, strengthens in healthful ways, and prevents bad mechanics that are a common source of back pain. See the separate KNEE PAIN article for more.
- Both feet are side by side.
- Your upper body stays upright, not bending over forward.
- Keep both heels down on the floor. Don't lift your heels.
- Both knees stay back over your ankles, not sliding forward, which hurts the knees. Good bending saves your back and strengthens knees and prevents knee pain.
- Do not keep a large inward curve to the lower back. that was a fad in past years. It was never healthy or good biomechanics. It was exaggerated and caused many problems of its own. Do not stick the backside far out in back, or increase the inward curve of the lower spine (lumbar curve). More about neutral spine and why overarching is another major contributor to another kind of back pain is on the article "Back pain with long standing and running - what abs do, you may be surprised" Good bending does allow some lengthening of the lower spine which gives a built-in (functional) needed lower spine stretch far superior to bending over forward to touch toes. More on that follows.
How the squat fixes your back - is it not an exercise that you do 10 times a day. You use it for all the hundreds of times you crouch and bend and reach down in a day. Stop hurting your back with bad bending and your back will stop hurting. Start strengthening your body and legs with good bending and you will get free exercise all day.
- Good Bending Using the Lunge. The lunge retrains bending habits and gives you free leg and back exercise at the same time. Done right, it will prevent both back pain and knee pain. Use the lunge for daily bending:
Another way to bend well (left) for all the many dozens of times you bend every day is the lunge.
Keep front knee over ankle (left) not forward (right).
- Stand up, feet apart. Slide one foot comfortably back, keeping foot straight not turned out.
- Tuck hip under to remove back arch and stretch back hip.
- Bend knees to dip to the floor without touching the floor. At least dip down a few inches.
- Don't let your front knee come forward. Keep your front knee over ankle. This is the most important part of using the lunge to save your back - you shouldn't hurt your knee. Done properly, the lunge strengthens and protects your knees too.
- Don't arch your back. Tip your hip under to prevent arching and straighten your posture. Don't lean back.
The key to how the lunge fixes your back - is it not an exercise that you do 10 times a day. You use it for all the hundreds of times you bend and reach down in a day. Stop hurting your back with bad bending and your back will stop hurting. Start strengthening your body and legs with good bending and you will get free exercise all day.
Unless you are moving in healthy ways for your real life, it is not a lifestyle and it is not healthy. Healthy bending, sitting, reaching, sitting, standing, and moving is easy and life changing. It is free exercise and injury prevention. When should you do it? Each time you want your daily life to be healthy
3. Why Yoga Forward Bends Are Like Lifting Packages Wrong
Most people know that rounding your back a lot is unhealthy. Armed with that, they leap to the idea that the opposite will automatically prevent all problems. It doesn't. Bending forward with a straight back adds to load directly on the lower spine.
Wen standing and sitting, straightening an overly rounded area of the spine does good things. However, when you bend over, either rounded or straights - both cause extra force on the lower spine. Leaning forward with a straight back increases force until reaching maximum at a horizontal position. Rolling up "one vertebra at a time" causes the separate problems of the unequal pressure on discs.
Here it is again, with the simple physical principles to explain more for those who want:
Thank you Extensionyoga.com for the instructive yoga figures in black.
What to do? Upright Torso Healthy Bending:
Use good bending with the half squat, shown above, instead of bad bent-forward bending, which is one of the major contributors to of lower back pain. UPper body is fairly upright and the upper spine does not round or hunch. There is no exaggerated inward curve to the lower spine, which was a fad in fitness gyms for a decade. More about all the back pain that fad caused is in the Hyperlordosis and Abs article. Good bending, as shown above, gives a daily, natural built-in stretch to the Achilles tendons and the lower spine.
There is no need to bend over forward to stretch the hamstrings. There are better, more functional ways to stretch them, shown on my Stretching Smarter page with more in my Stretching Smarter book. Also, I did studies that found no relation between hamstring flexibility and lower back pain - click to see why it is so often mistakenly prescribed for back pain.
I put more about understanding and using yoga moves for health on the syllabus page for my yoga classes. Many moves are traditional, but unhealthful. Click the Yoga Syllabus here or from my Class page. Remember - yoga, not dogma.
4. Lower Back Pain After Long Standing/ Running/ Walking, and Facet and S.I. Pain
If you have lower back pain during or after walking, running, backpacking, and feel you need to lean or bend over forward or lift one leg to stop the pain, this kind of pain is usually from allowing too much inward curve in the lower back. Summary follows below. Read the full article here to understand why and know how to spot and fix this common hidden source of ongoing back pain.
Standing with too much inward curve of your lower back is called swayback and hyperlordosis. "Hyper" means too much and "lordosis" is the lumbar inward curve. Sometimes people say "lordosis" to mean too much curve too. I will use "hyperlordosis" or swayback to distinguish. Hyperlordosis (overarching) is a major cause of "mystery" back pain and injury. It does not often show up on x-rays and scans. Some people overarch by sticking their behind out in back. Another common hyperlordosis position is to lean the upper body backward when standing, reaching overhead, and lifting things. Both drawings below illustrate the bad posture:
Two main kinds of overarching the lower back (hyperlordosis).
Left - tilting the hip forward and leaning the upper body backward. Left and Right - leaning the upper body backward even with level neutral pelvis. Overarching presses upper body weight down onto the lower spine. Pain is usually noticed after standing, walking, or running.To fix this pain, stop standing with your spine in this unhealthy, injury-producing posture. It is a voluntary, deliberate change in how you stand and move. No strengthening exercise will do it for you.
- Hyperlordosis is an increased inward lower back curve (arch). Also calledswayback.
- The increased arching presses on the joints of your spine, called facets. This is the cause of facet pain and much general low back pain. The weight of your upper body slouches down onto your lower spine, creating a feeling of ache, pinch, and. or pressure. The ache goes away immediately in many cases when you reduce the large curve - as often occurs when sitting or lifting a leg or lying with knees bent. These are not cures and are often mistaken for things to do, instead of obvious diagnostic markers.
- Another hidden way that overarching (swayback/ hyperlordosis) hurts is when an existing bulging disc becomes squeezed by the spine bones as they angle toward each other in bad positioning.
- Hyperlordosis is not a medical or structural condition. Hyperlordosis is a posture you can control by using torso muscles to move your spine away from the arched position into a straighter healthier position, described below and in the free abdominal muscle article.
- Hyperlordosis of Pregnancy is the same preventable bad posture. It is leaning backward to offset a load in front. Don't lean backward.
- Neutral spine is a voluntary, deliberate change in how you stand and move. No strengthening exercise or posture drills or core training will do it for you.
How To Stop Back Pain From Hyperlordosis (also called Swayback, Lordosis, and Lordotic Arching)
If you get lower back/ hip/ flank pain during and after long standing, running and overhead lifting, a common cause is standing with the lower back overly folded and tilted back so that it pinches and compresses the joints and soft tissue. People who stand with this poor position usually feel they must bend forward or sit to relieve the ache. Stretching, ab exercises, and all kinds of crazy gimmicks became confused as cures, instead of just not standing wrong in the first place.
In short, look at the drawing above. The left (first) drawing shows neutral. The second shows sticking the hip out in back and tilting the pelvis forward. The third shows a level pelvis, but leaning the upper body back. I spent many years identifying these (now obvious) painful position.
To feel how to change to more neutral:
1. Stand with your heels, backside, upper back, and back of your head against a wall.
2. Press lower back toward wall. The large space between your back and the wall becomes a smaller space. Do not flatten against the wall. Belt line is horizontal from front to back. Back pain from overarching should stop right then, if you do this right.
3. When you walk away from the wall, use this new neutral spine position all the time.
- Use your own muscles to reposition your spine, no matter what else you are doing
- Dont lean your upper body back when carrying things in front of you (anterior loads) like a chair, grocery bags, a pet, or baby.
- Dont lean back when lifting or reaching overhead.
- Dont let bags or loads pull your posture away from healthy position. Stand straight no matter what you are carrying.
The free abdominal muscle article summarizes more of this method, and the book The Ab Revolution teaches specifically how to reposition your torso, hip, and lower spine, and how to use the repositioning for all you do (use neutral spine instead of standing overly arched). Crunches and ab exercises do not do that. How you stand and move all day is what determines if you are putting your lower back into a position that folds it so that your lower back hurts.
Aren't You Supposed To Overarch and Stick Out The Behind In Back?
A small inward curve belongs in the lower back. Unfortunately, people hear that, and overdo. Overarching is not the normal curve to the lower back, it is not neutral spine, and it is not the way to protect your back when lifting or exercising. An injurious phenomenon in fitness and "health" magazines is to stand and exercise with the hip and behind tilted out in back, and the lower back overly arched. It is not attractive because it is not healthy. It is sloppy posture, unhealthy for the lower spine, and shows a lack of understanding of how to use core muscles to hold neutral spine. Overly-arched posture is promoted by popular fitness personalities, and popular exercises, where it is mistaken for, even advertised for, fitness and trimness. Trainers often tell clients to stick their behind out when squatting or lunging, however this is too much arch. The hyperextension is damaging to the low spine joints and soft tissue. It also does not use core muscles effectively.
What Do Abs Have To Do With This?
Abs work like any other muscles - they bend the joints they cross. For example. biceps bend your elbow forward (or keep it from straightening). Abs cross your vertebrae. They bend your spine forward or keep it from swaying backward, but only if you voluntarily engage them. You need to deliberately use your abs while standing to hold you from backward arching, particularly when reaching overhead and carrying loads.
Using Abs (or any muscles) Does Not Mean Tightening Them
Using your abs doesn't mean sucking them in or making them "tight. You can't breathe or move properly with tightened muscles. Tightening does not change your posture or reduce the pain-producing arch.
How Do Abs Help Your Back?
Using your abs means voluntarily moving your spine away from overly-arched position, and into neutral spine when standing. It is not a matter of having strong abs. A slightly-built person can stand with neutral spine, and muscular people can have overly-arched spine posture. It is a matter of using abdominal muscles to prevent the overarching that causes pain. The Ab Revolution teaches this concept and shows how to use it during all daily life and exercise movement.
Doesnt Doing Crunches Help That?
It is not strength that makes you stand correctly. It's how you hold your own posture. Many muscular people stand with terrible posture and have back pain.
- Crunches don't work your abs the way you need for real life.
- Crunches don't train you how to use your abs the rest of the day.
- Crunches promote poor posture, even when done properly.
- Crunches make a person, who likely spends much of their day already hunched over a work area, practice that hunched posture which may be mechanically promoting the back and neck pain they think they are working their abs to prevent.
- Most people do their crunches then stand up arched with no knowledge that back support comes from voluntary posture, not automatic strengthening.
What About Pelvic Tilts?
A common ineffective exercise often given for back pain is to lie on the floor or stand, and tilt (tuck) the hip and pelvis 10 times (or any number of "reps"). The claim is that these minor motions strengthen the area, with the further untrue claim that strengthening will stop the pain, but the exercise is actually miniscule and pain is not from weakness. Often, the person finishes "doing" their pelvic tilts, then stands up and returns to the same overly arched posture (slouch) that causes the pain. Pain returns. It is no mystery.
- The purpose of the pelvic tilt "exercise" is to practice how to move your spine and pelvis - out of the overly arched position that causes pain, into healthy neutral spine (tucked just enough to be neutral). Then you must *use* that neutral position (that you just practiced) for all your standing movement.No tightening or strengthening is involved.
- Tilts do not strengthen. The movement is too minor and low resistance.
- Even if tilts strengthened, back "support" is not automatic. Strengthening any muscles will not a bad posture which causes pain.
- Stronger muscles do not automatically move any body part anywhere. You have to move yourself into desired posture.
- The use of pelvic tilts is to retrain how to reduce your lower back position. Then use that knowledge to move your pelvis/ lower back into neutral position when standing.
A patient insisted to me that her pelvic tilts "worked" and fixed her pain because they strengthened her core. When I asked her when she felt the pain go away, she said when she was lying on her back doing them. Of course lying down with your knees bent and taking a painful arch out out of your lower spine makes you feel better - for the moment. I asked her if the pain came back eventually, she said, "Of course, when I walk too much." So the pelvic tilts did not really fix anything. Strength was not the issue. Standing and walking in poor overarched lumbar posture was the problem. Once you learn your pelvic tilt, don't do it 10 times, you only need it once - to move to neutral position. Then use neutral - while standing, while walking, while running. (No tightening - any more than you tighten your arm to scratch your nose or tighten your legs to go running.) In other words, pelvic tilts don't work from doing them 10 times as an exercise. Do one pelvic tilt standing up, and use that new neutral position for real life, not as a set of exercises
5. The Point of Back Exercises
Strengthening and stretching are important, but do not change posture or lifting habits, and so, do not cure back pain or posture problems. Often the pain was not from needing more strength or flexibility anyway. Use this new Dr. Jolie Bookspan method of using your brain and voluntary healthy movement habits to stop the source of pain. I have redesigned back exercises to be used to retrain you how you hold your body all the time.Doing back exercise is not like getting a shot of penicillin or going to confession. It does not fix bad habits the rest of the time. For example, lying down for pelvic tilts, then standing up and letting your back flop into any old bad posture, not keeping the proper tilt. Back exercise is supposed to retrain your thinking and habits *all the time* not just something to "do 10 times." Strengthening has no effect on posture if you dont apply the strength the rest of the day to control joint angles for all activities.
Abdominal Muscle Exercises
- Use the introductory exercises, explained in the full ab article to retrain lower spine positioning during how you walk and go about your day. If you only use abdominal exercises as reps and sets of an"exercise," that is missing the point.
- More exercises to retrain abs for daily life and back pain rehab are in the book, The Ab Revolution No More Crunches, No More Back Pain. Also come try our Ab Revolution classes.
How to Stretch Your Hamstrings Without Ruining Your Discs
Tight hamstrings are commonly thought to contribute to back pain. Even though that is not so, the irony is that many hamstring stretches are done in ways that bend forward, putting degenerative forces on the discs. Leaning over at the waist, both standing and sitting, for toe-touches does stretch your back and hamstrings, and may feel good, but is not good for discs. This is true even for yoga stretches where you bend over forward sitting or standing touch toes. Most people know not to bend over like that to pick things up or sit like that at your desk. It doesn't magically become good for you by calling it a stretch.
Here is different and functional way to stretch hamstrings. It is done standing, lifting your leg in the air. It is functional because that is how you need to kick, step up high, and do many real things:
- Stand no more than arms length from a wall. Stand straight. Both feet pointing forward, not out.
- Lift one leg to press the foot and heel toward the wall, directly in front of you. The wall will feel too close if you have tight hamstrings, but that is why you are stretching them. Don't move back.
- Stand upright. Lift and straighten your upper back. Don't round your back, or let your hip curl under you. This is a functional hamstring stretch - you need to stand, lift legs, and balance without being so tight you are pulled into unhealthful rounding.
- If your hip curls under, it may be because the front muscles of your hip are too tight. Use this retraining drill to stretch and straighten, not further round the back.
- Next when you get good at this, do it without the wall. Lift your leg in front of you and stand straight and balance on your own.This hamstring stretch is different and more functional than putting one foot up on a bench.
I did studies that found no relation between hamstring flexibility and lower back pain - click to see why.
Dont Exercise in Ways that Damage Your Back
Many people hurt from excessive forward bending. Then add many exercises with more forward bending - toe touches, knee to chest, most Pilates exercises, and crunches. Often these exercises are incorrectly prescribed for back and neck pain. They contribute to the original problem of over rounding and bad posture. Stop crunches. Use functional exercises instead of concentrating on forward bending programs such as Pilates, and certain movements in yoga. Click this article on bad exercises. Click the class page for yoga classes that teach healthful movement.
6. Back Spasm
I am working on a section on spasm in the back muscles to put here. Until I can do more, here is an overview:
Unhealthy body movements or ongoing bad movement habits, that ordinarily would only strain or pull a muscle or make it ache, sometimes result in spasm - painful muscle contraction that will not let go on its own. Exact muscle chemistry change that allow back spasm in healthy people is not known - by anyone. According to the Association of Ringside Physicians, there are reports that certain dietary supplements such as creatine might increase risk of muscle cramps. Increasingly, people take large doses of various supplements. The chemistry of causes of spasm is not my direct expertise. My work has been experiments with spasm already in progress and direct manual lengthening to relieve spasm:
Direct Release. Back spasm can often be quickly relieved with specific brief stretches that directly lengthen specific muscle(s) in line with how they are shortened in spasm. Unfortunately spasm is often treated with long unnecessary courses of drugs, repeated 'adjustments' or other treatments, and fad food myths. The spasm may return between treatments, from the same bad habit(s) that caused it in the first place. Or a stretch that should be used only on the rare occasions needed to take out a lumbar spasm is mistaken for something to do daily - like forward bending stretches, which when done all the time cause their own kind of back pain (explained above and in the Disc Pain article). Yoga Triangles and twists are more examples. When used for a brief stretch - meaning two to three seconds at most - and not forced too far, can give a nice range of motion, give a brief healthy spongy movement to vertebral discs. If a spasm is down a specific side area, then a brief 2-4 second Triangle (simple side bend, no yoga classes needed) or specific direct gentle twist if specifically lengthening a spasm shortened in line with the twist, could release it - used as a one or two-time application. Random lists of yoga stretches may or may not lengthen the area needed. When triangle and twist poses are regularly done and maintained static for the long periods of time held in many classes, they put sheer force on the discs (a large component to herniation) and restrict circulation. Regular long side bends, forward bending, twists, and triangles are not needed or healthy. Standing with too much inward curve in the lower back, for example, keeps lumbar muscles in a shortened length, not their needed resting or functioning length. They may become too tight and stiff to be comfortable. A forward bend often feels good when it lengthens a shortened area, such as a lumbar spine chronically shortened from standing in a bad posture of swayback (hyperlordosis). Forward bends become erroneously accepted as a cure, when not standing with swayback (the too large inward curve) would be the actual cure, and the forward bends a poor and unhealthy antidote. For an acute spasm, a lengthening bend can release it, if done right. If you continually go back to bad habits that make pain return, and claim you have to do yoga or other stretches every day to fix it, then your yoga or treatments are not fixing the causes. It may even be one of the causes. See the Yoga Page for more. For more on why hamstring flexibility is not related to back pain, or required to relieve it, see the Hamstring page. A lower back stretch that is functional and feels great, and also can lengthen a shortened tightened lower back is ordinary good bending using the squat, explained above in sections 2 and 3. A full squat with both heels down on the floor, done right, can be a good and healthy lower back stretch - student and regular success story contributor Robert Davis, demonstrates full squat with both heels flat on the floor, body failry upright, in the photo above right. He also made us a video demonstrating using a simple half and full squat for picking up things around the house - to view Cardiovascular Cleanup, click the Functional Fitnes as a Lifestyle page.
Relaxing Agents. Several specific agents can let a contracted muscle release, such as a few drinks, a hot bath (not at the same time as the drinks) or a one-day course (two at most) of a relaxing agent. Muscle relaxers are not ever intended for long or extended use for people with regular cramp or spasm. Muscle relaxers can create dependence and withdrawal rebound, causing a cascade of increasing problems. Foam rollers, tennis balls, and assorted overpriced devices are over-sold as cures. Sometimes people manage to randomly press the right place with them which accidentally lengthens, but what is needed is direct lengthening of the specific fibers shortened from spasm. The devices mostly serve to make money for the seller. For general use, they may not do anything physiological or for health. If you like them just to feel good in general, you don't need any invented sham reason to enjoy using them. Just don't pay for hyped products. Make your own.
Surgery Tragedy. Spasm can hurt terribly and limit ability to function. When people who could have benefited quickly from direct stretch or brief limited relaxing agents go for medical scans, sometimes a disc or other injury shows on scans that may not be the entire, or any, source of the pain. Surgery is often unnecessarily performed. The person wakes (on narcotics) thanking the doctor when the pain seems gone (for the moment) because the spasm, the main cause of the pain, was relaxed by the anesthetic. They may have increasing problems from the unnecessary surgery as time passes. Often the anesthetic was what relieved the spasm, not the surgery. A tragic painful and expensive error.
Food cures. No one, no scientist, knows actual cause and chemistry why muscles sometimes tighten so much and do not want to let go. Lack of knowledge brings huge marketing offenses of sham cures of various pills and foods. It seems known that cause is not for lack of bananas or most other foods. Sometimes spasm goes away by itself, leaving whatever unrelated thing the person did or ate that day to become the next crazy claim for cure.
Muscle "Balance". So many false beliefs perpetuate using vague phrases like "muscle imbalance" and that muscles "pulling" on your various parts cause "knots. Muscles pulling on your parts is how you move - normally and daily. Muscles on one side of the part have to pull harder than muscles on the other, or you would not be able to move at all.
For upper back spasm - under, between, and around the scapula (shoulder blades). One common cause is the bad habit of leaning the upper body backwards when standing. The same leaning back is sometimes associated with spasm in the front muscles just below the breast. This is more common when the person who leans the upper body backwards as a bad posture, rounds the upper body forward to compensate, resulting in a habitually shortened area right there that can go into spasm. My article on Neutral Spine shows how to prevent the upper body lean back (I named it Thoracic Lean) and stop this kind of upper body pain. A second cause of upper back spasm is squeezing the shoulder blades together from bad advice on posture. Fixing upper body positioning is often more a matter of "unrounding" the upper spine, not bringing or pinching the shoulders. See the Neck and Upper Body Pain Fix Article on how to restore default healthy position so no squeezing or pressing down is necessary.
In short, back spasm release can be like a simple leg cramp release - a simple brief direct stretch in line with the specific shortened fibers. It can be tricky when different muscles clench at once in different directions. Then you must determine the direct lengthening that briefly gets them at once. Check back - this section on back spasm is in progress.
7. Myths of "Muscle Balance" and "Imbalance"
Much is repeated about "muscle balance" (or imbalance) but what does that mean? The often repeated myth is that one (or some) muscles pull more than others (like a tug of war) creating bad posture, or pulling, or other effect, however one muscle pulling more than another is how you move at all, how you are able to carefully aim a pitch or make it faster or slower, and control any large or fine movement.
Muscle "imbalance" doesn't cause pain or herniated your discs. One (or more) muscles pulling more than others is how you move. You constantly change pulling to move as wanted. Obvious exceptions are Tetanus or Cerebral Palsy. Even with dystonia or palsy, you need to control the muscles all the more. A well person who is uncoordinated isn't an imbalance of how hard muscles pull by default, but how you are able to control the amount of pulling, which grows with practice and is "use or lose" without exercise, like most other things.
You need some muscles pulling more than others just to stand up straight. Otherwise, you would slouch. Having tight muscles here and there isn't "imbalance" and sometimes tightness doesn't cause anything bad, even helps hold you in position without "rattling" too loosely. If you have to strain so much that it is painful to stand up straight (able to relax upright in healthful way, not in overly-stylized excess) then use the stretches and healthy movement skills in my articles and books. How you stand, sit, and move all day is mechanically important to preventing damage and pain. Don't get sucked in by myths of fancy terms like "muscle imbalance" - you can control how you move. You don't need treatments and adjustments and medicines.
There is more on this topic in my books.
8. X-Rays and ScansPain When Your X-Ray is Normal
You may be in great pain from simple damaging mechanics. Your X-rays and scans are normal. You may be told nothing is wrong, or to give up favorite activities. Your pain persists from bad postural habits. This is no mystery. Change the bad habits to change the pain.
When Pain Is Not From What's On Your X-ray
Other times, the scans show some minor problem like arthritis, herniated disc, or degenerating structures. Just like car tires that are mid-life, but perfectly good, some wear may show on exam but this is unrelated to performance or pain. Pain is falsely ascribed to the arthritis. Patients feel doomed, and are often told to give up activities. Pain (even the anomaly itself) may mostly result from poor mechanics. This is no mystery. Change the bad habits to change the pain.
Sometimes, the scans show some major problem, and major surgery is performed to correct it. When the original problem was from the bad positioning, often pain persists or returns because you never corrected the mechanics that caused it. The defect itself may return from uncorrected mechanics. Surgery can be avoided. Fix the source of the problem and the results of the problem can heal, usually without surgery.
Pain from orthotics and back pain cushions. An extremely common scenario is someone who goes to the doctor with a little pain from the usual poor lifting and movement mechanics. They are prescribed foot orthotics, which a rigid molds mistakenly believed to "hold" the foot in proper position. However, consider this - they are molded sitting or lying down, not when the person is standing where they need it and when foot position changes. OR the orthotic is "custom shaped to the person's foot" which was in the wrong position to begin with. Often the orthotics are rigid and hard, which would cause pain in any case. The person get new pain in the leg, hip, which can increase to numbness, then they are told to further reduce activity and pay for PT or give up and live with pain.
9. Not All Pain is Orthopedic
Pain From Your Medicines: Common prescription and non-prescription medicines cause much back pain. The pain is not a rare effect as previously thought.
Are you on medicines for lowering cholesterol? Sleeping medicines? For stomach acid? Drugs for depression and anxiety? Irritable bowel drugs, stomach acid drugs (a large contributor to osteoporosis and thinning bones, too) drugs to concentrate, to help wake up, to calm you, for allergies. Increasingly, drugs are found to make more pain as side effect, even drugs you are taking for pain. Trying to stop them causes rebound and withdrawal pain - good for drug companies to keep you on them, but bad for you and your health.
Stretches and exercises do not fix this kind of pain. In a worsening cycle, side effects are "treated" with yet more drugs with effects that lessen and degrade your health. That is not "side effects" and that is not health care. Many of these drugs are not needed. Some, like stomach acid drugs, cause the problem in the first place. Others have even more serious consequences.
A top health priority is to stop the need for these drugs so that you can lessen, then stop the need to take them. If you are in pain, so don't exercise, then get cholesterol and other health problems from not moving, can't sleep, then take cholesterol and sleeping medicines that cause dependence and more pain, use the healthy principles in my free summary articles and all my books so that you can move again, and be healthfully tired at the end of the day and sleep well at night. Not exercise is good medicine. Healthy exercise as healthy medicine will stop the pain and need for medicines that cause more problems.
Pain From Food? There are foods that promote inflammation - dairy, meat, refined sugar, white flour. Even though most back pain is not inflammatory in nature, for those who load on inflammatory foods, and are sensitive to them, unhealthy changes can hurt. Instead, eat anti-inflammatory foods - leafy green vegetables, flaxseed, cherries, grape skins, blueberries, spices like ginger and turmeric.
Unhealthful fad diets are increasingly recognized for joint and muscle pain effects, specifically Atkins and other low carbohydrate diets that restrict fruit rather than junk sugar. People will stick to these diets no matter how unhealthy; they'd rather lose weight through a fad diet than through healthier ways (low carbohydrate diets reduce water in your muscles - water weight loss - making muscles susceptible to pain, weakness, cramping, and other health troubles).
When you reach for anti-inflammatory medicines and pills (even foods) remember that most back pain from bad habits is not inflammatory in nature, and may be why all those pills aren't working. Change the bad habits that are the cause. Reduce inflammatory foods for all the conditions with inflammatory components like heart disease.
More on all these topics is in the books.
10. Why Back Surgery Is Not Needed
My Fitness Fixer (tm) column ran on Healthline.com for 4 years. I wrote over 800 articles on making medicine and exercise healthier. Several articles documented studies showing back surgery does not do better than not having it, plus the pain and bills for the surgery. Much is actually known about why back surgery is usually not needed. Until I can collect and put all those articles here on this page, below are some links. When the column ended in 2010, the company removed most of my photos, and all the movies I made to help understand the articles. I will be putting the full articles here, so check back. Until then, let me know if these links still work:
Studies Say Back Surgery Not Needed
Prevent Back Surgery
Fix Disc Pain Without Surgery
Here is a Blogspot archive I recently found that allows use of my "label" tags to group articles of same topic. In this case, surgery. It also retains most of the original photos, movies, and comments. Let me know how it is working for you: http://healthlinefitnessfixer.blogspot.com/search/label/surgery
Remember that doctors have a history of prescribing things that may seem to "work" at first, but are not healthy.
They are not usually scientists; they often can only repeat what they were told by people who sell pills and surgeries.
What To Do Every Day To Prevent Back Pain
- First thing in the morning, don't sit on the bed. Instead of sitting and rounding your back first thing, turn over and lie face down. Prop gently on elbows, but not so high that it strains. Don't do this if it hurts. It should not hurt to simply lie straight. It should feel good and help you straighten out first thing. Get out of bed without sitting.
- Count how many times you bend each day. Imagine the injury to your back by bending wrong that many times each day.
- Lift using the squat and lunge, not by bending over.
- Notice the huge amount of forward bending exercises, crunches, toe touching and most PIlates . Most people do not need more forward bending any more than they need a Tetanus shot every day. Use when needed instead of daily overdoing.
- Notice bent forward and hunching positioning and exercises in fitness magazines. Then notice your own habits.
- Don't hold rigid "posture." healthy movement is dynamic. Stopping back pain does not involve never moving the spine. healthy motion is crucial for health.
- Stand and carry things without rounding your upper back forward or leaning back (exaggerating lumbar curve to the back or side).
- When sitting, it is not true that you must "keep feet on floor" or keep flat thighs - parallel to the ground. That is often repeated, but it does not change injurious mechanics and is not needed. Focus on the main issue, not the trivia. Use the free Sitting Healthy article.
- Learn to restore upper back muscle length using the free Fix Upper back and Neck Pain article.
- Dont tighten your muscles to move or exercise. Gluteal and ab tightening was a pop fitness fad, not healthy medicine.
- Walk, run, and jump lightly. You don't have to tiptoe. Your body needs motion and impact for health. Just don't jolt your joints into dust.
- Make sure your pain is not from medical conditions (vascular, infection, Lyme disease, other) or from many medicines known to have body pain as side effectsEasy Back Saver reminders for commuting, sitting, exercising and other activities- click items.
Simple and Different! - Don't Change These Concepts and Methods Back To Ingrained Wrong - These Methods Work Only As Written and Intended:Henry Louis Mencken said, "Any man who afflicts the human race with ideas must be prepared to see them misunderstood" Even so, please don't change my work back into what you know. This is different and works differently than the pop fads that have become ingrained in fitness and health. To paraphrase Bertrand Russell, "An untrained man's report of what a knowledgeable man says is never accurate because he unconsciously translates what he hears into something he can understand." My work is primary source, and often not what we learned in school and the gym. Remember, that is good.
How Long Does It Take To Fix Back Pain?You should begin to feel the difference the same day as you try everything as presented above. If you're not feeling better right away, check what you are doing compared to what is presented above. Are you tightening or clenching any muscles? Are you overcompensating? Are you doing bad exercises from other sources? Are you going back to bad movement habits during the day? Check my free article on Bad Exercises, this one on bad stretches, and this one showing better health and understanding what abdominal muscles really do with The Ab Revolution.
It takes years to hurt a disc and practice injurious muscle habits, but only days to start healing once you no longer are injuring yourself. Make sure there is not something else contributing to your pain. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.
(to keep this article a quick and easy summary, much is left out. The books tell more.)
SummaryBack pain is not a mysterious "condition." People spend their day sitting, working, walking, and driving in terrible positioning, hunching over the computer, lifting and bending wrong all day, walking heavily, standing and walking with too much inward curve in the lower spine, slouching all day, then exercise in ways that strain and pressure discs and muscles and deliberately train injurious movement habits like overarching and bad bending. People do yoga and Pilates that forcibly pushes discs outward, and reinforces flexed (bent forward) hip and forward bending. They take anti-inflammatory medications for mechanical pain that is not inflammatory in nature, try remedies that do not address the cause of the problem, do physical therapy in ways that exacerbates the original problem, give up favorite activities, have surgery, then return to previous injurious habits, and everyone is astonished that they "tried everything and nothing seemed to work." It is like eating butter and sugar all day, then waving your hands in the air for 5 minutes and saying "I don't understands why I don't lose weight, I do my exercises."
- Use healthy positioning to stop the cause of disc damage and muscle pain and they can heal. Then no need for pills or surgery or adjustments.
- Does my work mean you never do any flexion? Of course not - that is misunderstanding the concepts. The idea is to notice if you spend most of your day that way then use flexion exercises on top of that. Then it is no mystery why you hurt. Understand, don't memorize blanket and arbitrary rules.
- Dont memorize rules and postures or think that an exercise or kind of exercise will fix back pain, - which is more likely from a number of all your bad movement habits. Understand what healthful movement needs and then move accordingly for all you want to do. Use your muscles to reposition for daily life - to get built in exercise. That is exercise as a lifestyle.
- Please don't combine other people's injurious stretches and exercises then come back to me and say my work isn't fixing that.
- Exercise as a lifestyle does not mean going to a gym a few times a week. It means how you move all day in real life. Get exercise as a lifestyle through all day healthy movement and your back can heal, and you can do more than before. People love to go to a gym to exercise their abs, then go right back to overarching the spine and leaning back to carry packages, because that makes it easier. If they used their abs to maintain neutral spine instead of leaning, they would not have the pain and would get ab exercise for real.
- Exercise is more than good for you - it is crucial for your health and recovery. Not all exercise is healthy, just like not all food and medicine - there is junk food and unhealthy medicine. Use my work to understand the concepts so that you can tell what is healthy movement for yourself. Then apply it to your life - happy, healthy, active.
- If your lower back pain is from too much inward curve to the lower spine, then changing to neutral spine will feel better right away. Often people tuck too hard, or tighten, or push their hip forward instead of changing the tilt, then claim neutral spine is wrong or does not work. Use a side view mirror and learn to feel and tell how you are moving your body. If your pain is not from a too large too large tilt and you use neutral spine, don't complain it isn't fixing your pain just as you wouldn't blame penicillin for not fixing your back pain. Check for the unhealthful movement patterns you habitually use and change those, simply, without straining or forcing. Most of the people coming to me saying that neutral spine is making them hurt or isn't fixing their pain turn out to not be using neutral spine or actually able to produce it. If it hurts, you're doing it wrong. Make an appointment with me instead of debating the same wrong points on Internet forums.
- Please do not e-mail me saying you are "doing the exercises 10 times" and want me to tell you how to fix pain from bad positioning." Here is your answer now: Doing an exercise then going back to unhealthful body usage is missing the point. Stop bad bending and unhealthful positioning and habits. Stop the causes and the pain will stop. This free article summarizes. The books tell more.
- How is your body positioning right now? The whole point of exercise and therapy is missed if you dont learn to consciously use healthful positioning the rest of the day for standing, sitting, bending, and all you do.
PATIENCE PROLONGS A CRISIS. How long do you want to suffer? Stop injurious positioning today. Don't wait.
You Dont Have To Live With Pain
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