So your back pain won’t go away…

Posted by abraham.williams@gmail.com on in Back Pain

If you are reading this article, I’m sorry. Back pain is awful. I know because I have had it put the brakes on my life for years. It’s gone now, but what a winding road it was. Before you go down this path and start trying remedies, it’s good to have a map so you know what you are getting into. It’s also good to cast a broad mental net so that you don’t get rat-holed into a particular way of thinking about back pain. You may very well need surgery or you may just need to rest or it may be something entirely different. You have to be open. It’s hard when you are in pain, but do it anyway. It will shorten your pain journey.

Get educated (I say this a lot)

Overall, you should know that back pain is indiscriminate and affects 8 out of 10 people in the US. So, it happens a lot to a lot of us. There are many studies on back pain indicating paths that are probably different from what you are thinking. Check out these critical studies listed in step 1 here.

Get an overview of doctor behavior as a whole and what the guidelines are for low back pain

Right now, doctors are doing more opiate prescriptions than physical therapy prescriptions even though for most people exercise of the spinal musculature is likely the most useful solution. Over at Harvard Heath Publications, this is called out directly. Interesting isn’t it? There are specific guidelines but patients know about drugs, MRI’s, injections and surgery types. They ask for these advanced protocols and pressure the doctors who want to help them.

Here are the current evidence-based medical guidelines

  • call for treatment with non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen and naproxen) or acetaminophen (Tylenol and generic).

  • call for referral to physical therapy when appropriate.

  • advise against early referral for imaging (such as MRI and CT scans) except in rare cases where “red flags” suggest something other than routine back pain.

  • advise against prescribing narcotics.

  • advise against early referral to other physicians for injections or surgery.

Notice, surgery and injections are not on the list.

Read a personal story and journey to see how others resolved back pain

My back pain journey was a lot longer (with many more trials and a surgery) but also very similar to that of Jane Friedman. Her journey, detailed here, included a primary care doctor, waiting to heal, ergonomic changes, posture work, and fitness training. In the end, it was finding a real specialist using the Egoscue method and structural integration reset…also known as Rolfing.

Get an assessment by an expert

After you see your primary care doctor and rule out anything terrible, get connected with Egoscue and see if muscle imbalances are the cause due to irritating movement patterns. If you pull apart a cut every day, then healing can’t happen. It’s generally the same with the spinal musculature. As an example, if you are always hunched over with a backwards tilt of the pelvis for hours at a time, how can your back muscles get trained to be erect? That’s what the erector spinae muscles do. They erect the body. That hunch and tilt has to be revealed and corrected.

Get familiar with corrective movements

SpineUniverse is a great resource and has a lot of information on the site. It’s huge and can be overwhelming when you want to quickly get an answer that’s relevant to you. However, they do organize information very well and are able to cover many conditions. The key reference there is the list of exercises and stretches that are likely beneficial for back pain. Most often, people are charging for this information. They list it for free. Once your doctor has checked you out, integrate these movements into your daily routine.

Follow me on twitter and join my email list

Connect with me and I’ll keep you up to date on the latest studies and interventions that are working for people. I’ve got an email newsletter I do weekly to help people form healthy back habits. Send me an email anytime, and I’ll see what resource might be best for you to check out.

Resolving Back Pain for Desk Workers

Posted by abraham.williams@gmail.com on in Back Pain, Health

For years, I worked at a desk for long hours and wondered why my body progressed from stiff to stuck accompanied by progressive back pain. If you work at a desk job and are suffering from stiffness and back pain, read this now. Please understand that the position you are in the most wins over time. This doesn’t mean you have to quit your desk job. You can keep doing it and just fix a few things.

When you sit for long periods, lots of bad things happen in your body

Contracted Muscles Continually Fire

The sitting position involves a contraction of the hip flexor muscles and the hamstrings. When these muscles are contracted, like any muscle, they fire. When they fire for a long time even at low level it causes an inflammatory response that leads to cross-linking. This means that as the muscles get inflamed, they attempt to heal the inflammation which leads to scaring in the muscle. That scaring causes the cross-linking which is referred to as a shortening of the muscle. This is why the hip flexor and hamstring muscles get short and tight from sitting.

Stretched Muscles are Getting Weaker

Opposite of the hip flexors, the gluteal muscles are being stretched when sitting. Any muscle that is stretched for a long period of time will weaken. As the gluteal muscles weaken and the hamstring muscles get short and tight, the pelvis will change position over time. It can result in what’s called an anterior pelvic tilt or a posterior pelvic tilt, meaning that it’s either rotated forward or backward. Either case can cause the spinal musculature or other hip muscles to attempt to compensate. Since these smaller muscles are not prime movers like the gluteals, this often results in strains.

Reduced Oxygen to Tissue

Additionally leading to weakness is the pressure on tissue that comes from sitting. There is less blood flow to the area. This means that there is less oxygen getting to the muscles. When there is not sufficient oxygen to the tissue, cells die at a faster rate than they would normally. Without sufficient blood flow and oxygen, the tissue weakens and becomes less functional which is part of a cascade of effects that leads to pain above and below the hips.

Slowed Metabolism

Sitting for long periods coupled with no physical exercise slows down the body’s metabolism. There is no demand on the body and so all fat stores are untapped. The body’s supply of glycogen is unused, but likely the brain has been used. The brain will require more food in the form of glucose and a further cascade of detrimental metabolic effects take place. Over time, continual feeding with long periods of sitting can result in obesity along with diabetes since the cellular turnover rate is so low.

Counteracting the effects of sitting

The number one thing you can do to counteract the effects of sitting is to move. General categories of movement that are beneficial are walking and running. However, if you have been sitting for years and have very weakened muscles along with a poor metabolism, then the activities needed are more specific.

Retrain and Strengthen Muscle

The muscles in the hip are the foundation for the spine. Strengthening the gluteal muscles and retraining the hip flexors along with the spinal muscles are the keys. The movements to do are the squat to train the gluteal muscles, leg raises to train the abdomen and hip flexors, and back extensions to train the spinal musculature.

For the chronic sitter who does not exercise, this is a very solid place to start. Here’s a starter program.

The Exercises

  1. Body weight squats with correct form for 3 sets of 10 reps done with very slow up and down (10 seconds down and 10 seconds up) is more than enough and completely safe to do.
  2. Leg raises can be done lying on the floor with your back flat and lifting the leg with a bent knee using the same number of reps, sets and cadence above.
  3. Back extensions can be done while lying face down on the floor and raising the chest off the ground, while keeping the legs on the ground. Do this for 3 sets of 20 reps but with a quicker cadence of 2 seconds up and 2 seconds down.

Turn on Metabolism

One of the great things about training muscle is that it gets energy released from the cells. It also generates lactic acid which requires the body to convert it to pyruvate which gets processed by the mitochrondria which overall means that your muscles get more oxygen, your metabolism goes up and you get more muscle. This all makes it easier to move around.

Break up Sitting Periods

For chronic sitters, an effective tactic is to break up the sitting periods. Every 30 minutes to an hour depending on your flow of work, get up and walk around the block or up and down some stairs just for 5 minutes. This simple tactic is very effective and is extremely easy to do…assuming you can walk.

Standing Desks

Changing to a standing desk is a popular choice today. If you do this you should know that it will take a while for your body to adjust. Your feet may get sore, your back might ache. You should also know a standing desk is better than sitting, but it will also not fix your posture. Remember, the position you are in the longest wins. If you stand at your desk slumped over leaning on your desk for hours, there will be shoulder and neck pains to come. It’s best to combine a standing desk with some periods of sitting and movement. It’s the variety of movement that’s important.

Here are a couple of cool ones to consider. Both portable, interesting and one is extremely affordable.

In summary…

Sit less because your body needs varied movement. Your older self will thank you.

  1. Set up a reminder every 30 minutes to get up and walk around.
  2. Take 15 minute brisk walks daily.
  3. Try a standing desk.
  4. Retrain your muscles with these 3 key exercises: squat, lying leg raise, and back extension.

Want more? Enter your email address below and I’ll give you the Resolving Back Pain for Desk Workers Program and Log. This will help you to…

  1. Get out of pain related to sitting
  2. Strengthen muscle
  3. Boost your metabolism
  4. And more!

Psychological Stress Leads to Physical Pain

Posted by abraham.williams@gmail.com on in Back Pain, Health, Studies

The more I dig into back pain, the more I come into the concept of inflammation. It’s amazing to me the number of people in the US who have chronic back pain but don’t have any sign of injury. For these people (I was one of them), the pain has just appeared over time. It’s about 8 out of 10 adults over the course of a lifetime.

The more I dig into inflammation, the more I come across cortisol. Recently, I came across this study over at www.pnas.org. It’s an unfortunate acronym, but I digress.

It reported that immune cells become resistant to cortisol when that stress hormone is chronic. This means the immune system becomes deaf to the “turn off” signal that cortisol is providing and inflammation gets out of control driving disease and pain. This sounds similar to type 2 diabetes where too much insulin from consistently high blood sugar deafens cells when signaling nutrient storage.

The study points out relationships with specific diseases like cancer, cardiovascular disease, asthma, autoimmune diseases, and type 2 diabetes. Other startling references are a downstream pathway from parents who have chronic stress to children who have cancer. It also points out people with high levels of loneliness have this chronic cortisol issue.

Diatribe begin:

Holy crap. Watch the stress. Start saying no to things. Meditate. Identify any neuroses and eliminate them because they are chronic behaviors. Consider how to change chronic stress into a more positive fight-or-flight response that releases beneficial epinephrine, norepinephrine and adrenaline that tell the cells to let out their energy stores for quick action. Then take a bath. Go watch a movie. Spend time with friends. Do something fun and relaxing. Go to the beach. Surf. Yes, surf.

So much of our go-Go-GO culture is telling us how to keep going and to do even more. We see articles on how to not procrastinate and how to get more done in a day. I think procrastination is real and putting off hard things happens. However, let’s not confuse procrastination with exhaustion.

How long do you need to operate “outside of your comfort zone”? I’d say not for long periods. No chronic stress. Do hard things briefly, then recover. When forced to be in a chronically stressful situation, then expect to do diligent work to reframe it as a positive challenge and seek out the bright spots. Do focused efforts on hard tasks and then take breaks.

This is a critical study. We would do well to consider its implication in our lives.

 

9 Common mistakes for back pain sufferers and how to avoid them

Posted by abraham.williams@gmail.com on in Back Pain, diet, fitness, Health

Welcome to the straight and unconfused path to getting out of back pain and getting back to a healthy and athletic life. If you are reading this, then you have taken the first step to getting out of pain and back to your kids, friends, sports, and fun. Back to your  life.

I used to suffer from terrible back pain and even had surgery that didn’t fix my pain. Through a lot of trial and error, I have found the principles necessary to get out of pain. Now, I’m sharing.

What follows are the key mistakes I have found both with myself and from interviewing other sufferers of back pain. Check these out and make sure you stay well out out the mistake zone!

Mistake #1 – Not getting help

By far, the biggest mistake that back pain sufferers make is to try and go it alone. For some reason, asking for help is just not in the cannon. For some reason, people will think they can solve it on their own. Rather than looking for someone who can help, they will try stretches and then wonder why in the world this horrid pain has been bestowed upon them. The best thing you can do is to go and get checked out by a doctor and not a very confident but incorrect friend.

Mistake #2 – Not getting educated about the back

This is huge. People do not seek out information about how the back works and what treatments are available. When you know nothing about what might be going on in the back, then whatever treatment that is finally pursued is based on “feel”. People don’t know what treatments are most effective. As a result, people effectively guess what might work and then try that for a few wasted months. Enter your name and email on the right to get educated. 

Mistake #3 – Not being proactive

When you have chronic pain, it can be very hard to do something about it. The pain is very limiting and all encompassing. Quickly the victim mentality can set in. This is very understandable because the pain can wreak havoc on your mental state. They key here is to channel that sadness into an aggressive desire for relief. It is completely possible to get that relief and you must drive towards it with positive aggression not accepting what won’t work. Get proactive.

Mistake #4 – Doing the same ineffective thing over and over

This is a tough one. You’ve been seeing your back person and doing the scheduled follow ups but you are not getting any better. If this is happening, then the treatment is not effective and you need to stop and find another option. However, see mistake #1 and #2 above. Not knowing what the issue is will again lead to another guess on what might work. Take stock of where you are and if you are making progress. Cut out what’s not working and get educated. 

Mistake #5 – Accepting weak and injured as an identity

For people who have back pain that is chronic and severe, it’s awful. Terrible. Awful. It can destroy your mental and emotional state because the pain wears you down. If there is no relief from the pain and it goes on for days or even weeks, it’s hell. Part of that is the idea that you can’t do anything about it. This is completely untrue. It’s a mindset that has grown from the pain. You can switch that mindset to one of overcoming the pain and drive energy towards that outcome. Do it now!

Mistake #6 – Stretching incorrectly after sitting

If your low back is hurting, forward bends are likely to make it worse. If there is a kyphosis of the lower spine accompanied by pain from long periods of sitting, then a forward bend is going to multiply the pain by intensity and time. Don’t do it. Get educated about the hips and do movements and stretches that will activate the neuromuscular motor units in the right musculature…in this case the muscles of the anterior hip joint. An iliopsoas stretch may be the right one to employ. 

Mistake #7 – Being inactive

The more you are inactive during pain, the longer the pain will last. The movement pathway in the nervous system is the same as the pain pathway. While you really should take it easy if there is an injury and you need to keep that area immobile to heal, often with chronic back pain there isn’t an injury from a particular incident or the major healing has already taken place.

Once the severe pain period is over, doctor approved light everyday activity needs to happen. Blood flow to the area will help it feel better. Movement will help it feel better. Often the common prescription from doctors is to take acetaminophen and stay active. This is often the least followed advice but the most effective.

Mistake #8 – Believing there is no exercise you can do

When you are immobile, there are other areas of the body that can be exercised. If you can’t lift something, you can probably do leg extensions or a chest press or a pull down in a gym. You can ride a stationary bike or you can swim. There is movement you can do and that movement will help you get out of pain and heal. Find movements that you can do. Email me if you need help at abe@backathletic.com.

Mistake #9 – Overlooking a huge thing you can control – diet

If you can’t get up because of back pain or you can only walk to the bathroom, then one very powerful thing you can work on is your diet. You can skip bread, crackers, cookies, sweets (including fruit), and anything starchy and eat vegetables, nuts and seeds. This is a very simple thing in concept you can do to lose weight while you are inactive. The most effective way to lose weight is with diet changes switching to  lower energy or lower-glycemic foods. It also happens to be something that is very easily done when you are unable to be active. It’s just a decision and then chewing.

That’s it! These are the 9 common mistakes of back pain. Do the opposite! Be the person who doesn’t make these mistakes. Commit to getting help and getting educated. Don’t waste another minute of your life believing you can’t do anything about your back pain and take action. Learn the right movements and stretches that will help you. Get active and stay active to prevent back pain. Remove starchy sugary foods and eat healthy vegetables so you can improve whether you are in pain or not!

Your partner in ending back pain,

Abe

 

 

Study finds Mindfulness Meditation can lead to back pain relief

Posted by abraham.williams@gmail.com on in Back Pain, Studies, Tutorials

A study by the University of Pittsburg found that mindfulness meditation can help reduce severe back pain pain in older people. The study will be published in the March issue of JAMA Internal Medicine.

The study focused on adults aged 65 years and older who experienced severe back pain daily or almost daily. The participants were guided through 3 different kinds of mindfulness meditation for an 8 week program followed by 6 monthly sessions. The mindfulness meditation practices used in the study were modeled on the Mindfulness-Based Stress Reduction Program. Here they are:

  1. Self-examination of the body without judgement
  2. Breath focus while sitting
  3. Walking meditation with awareness of body sensations

At the end of the program and even 6 months later, the test group experienced relief from long-term and most severe pain measures.

What this means for a sufferer of backpain

This is very good news for sufferers of severe back pain. You can try this immediately. It’s very simple. Let’s get right to it with a very light set of instructions for a 15 minute session:

  1. Find a quiet place where you can get comfortable and reduce distractions.
  2. Recline or sit as needed.
  3. Set a timer for 10 to 15 minutes.
  4. Take a few deep breaths and slowly close your eyes.
  5. Slowly notice how your body feels from head to toe.
  6. Observe the sensations in the different areas of your body. Notice and accept them.
  7. You may experience emotions around these sensations due to a long history of pain. Notice and accept them as well.
  8. Notice how the sensations and emotions are not you but are feelings that you experience.
  9. Move through the body a couple of times with this process.
  10. Repeat daily.

If you do this meditation over time, you’ll start to notice differences. The ability to separate yourself from the pain or the emotions is a powerful skill. It takes time to develop, but it will develop. Meditation can be a hard habit to start. If necessary, you can make the practice much easier to do so you can do it regularly. Shorten the time to 5 minutes for example. You can also use the popular meditation apps Calm or Headspace.

If you’d like to go deeper on this meditation program, here is a free resource on the Mindfulness-Based Stress Reduction Program: http://palousemindfulness.com/