In the fall of 2006, I was a young personal trainer and an aspiring competitive powerlifter. Powerlifting requires one to bench press, squat, and deadlift the maximum amount of weight possible, and it is extremely strenuous on the body. During one set of squats, I felt a “click” in my low back on the left side, but no pain. I filed the sensation away as just another weird feeling that the body can produce when moving big weights and finished my workout without issues.
The next morning, I could barely get out of bed. My back had completely seized, and I had to take the day off from training my clients. I spent the day lying on the floor with my feet on a chair. Since that day, I’ve had intermittent low-back pain of varying intensity. I’ve spent many hundreds of hours trying to get rid of that pain. In this article, I hope to share some of the knowledge I have accumulated over the last 14 years.
Statistically speaking, chances are you’ve experienced low-back pain yourself. In fact, around 80% of adults will experience some form of back pain during their lives. Globally, back pain affects 530 million people at any given time and is the number one cause of disability around the world. Back pain costs the American health care system $50 billion annually.
Unfortunately, despite massive research directed into this area, we still don’t have a good idea about what causes back pain. While there are clear physical causes to back pain, such as disc herniations, spinal stenosis, fractures, and pregnancy, a large percentage of back pain can’t be tied to anything specific. We simply don’t know what causes much of what we call low-back pain. The picture becomes even murkier when we consider the fact that many people with the aforementioned issues (and many others) have no pain at all. In fact, the correlation between back pain and physical evidence for that pain (from an X-ray or MRI, for example) is quite weak.
The sort of pain that has no obvious cause has been termed “mechanical back pain” in medicine. While we don’t know what causes mechanical back pain, research has identified several factors that tend to aggravate it. We’ll go over these in a minute, but first…
Most back pain tends to be temporary. The majority of episodes resolve within 4-6 weeks, and only a small percentage of people end up with chronic pain like I did. If you’ve been having some back issues during the COVID crisis, there’s an excellent chance it is temporary, and it will disappear. There’s only cause for concern if, after a couple of months, the pain is not getting better or actually getting worse.
So, what can you do to decrease your chances of getting back pain or make existing pain better? The answers may surprise you, because they are more complicated than the “sit less, exercise your core” advice you often hear.
Massage therapist and science writer Paul Ingraham of PainScience.com noted that he has never treated someone for back pain who wasn’t a conscientious person. Not necessarily type A, but someone who cared about their job, family, the world, etc. It seems that relaxed people (The Dude from The Big Lebowski comes to mind) don’t get back pain.
Research has also confirmed a link between personality and back pain. People who are prone to anxiety and stress tend to get more back pain. The likely mechanism is an increase in muscular tension of the back muscles, which after a while starts to complain.
Of course, advice like “try to relax more if your back hurts” is totally useless. If it was that easy, we would all just do it! However, if you think your stress and anxiety have gone up right before your back pain started (and who’s hasn’t recently), it might not be a bad idea to look at some relaxation techniques such as meditation, yoga, or breathing practice.
Another way more intense personality types aggravate their back pain is what scientists call “catastrophizing”. It is essentially the tendency to make your back pain worse by over-thinking or dwelling on it, and not accepting that there could be nothing seriously wrong with your back. Fixing this requires a steady diet of positivity, along with professional help from a counselor trained in Cognitive Behavioural Therapy or similar behavior modification techniques.
Poor sleep is linked to a host of negative consequences for the human body and mind, and back pain is just one of them. While it may not directly cause back pain, poor sleep increases our perception of pain, causes stress and anxiety, makes us less likely to exercise, and causes us to overeat, which are all factors in back pain. Lack of sleep essentially magnifies all the issues we talked about in the section above. In fact, fixing your sleep issues (like insomnia or insufficient sleep) may be one of the best things you can do for your health, period.
Up to 15-20% of the population gets insomnia in any given year. Another chunk of the population has other sleep deficiencies, like sleep apnea or waking too early. To fix your sleep issues, the first step is usually to get a sleep evaluation at a clinic and go from there based on the results. If you think your sleep needs help, getting a referral from your GP to a sleep clinic is the best place to start.
You probably know that exercise is good for your back. But did you know that movement itself is beneficial? In fact, according to a Finnish study, maintaining your daily routine is much better at helping your back than bed rest. So, don’t let mild-to-moderate back pain stop you from doing your daily activities. Avoid anything that specifically aggravates your back, like swinging a golf club or side-carrying a child but try to move as much as possible. Going for walks is great for helping with back pain.
What about exercise specifically for back pain? The Finnish study mentioned above actually compared a group of people who did back-specific exercises to the “regular daily activities” group and the bed rest group. The daily active group did best by far. This finding is supported by lots of research that shows that exercise while in a back flare-up is not particularly effective to lessen the duration of the pain. The benefit of exercise is more as a future preventative.
Interestingly and contrary to popular belief, sitting doesn’t seem to be a major cause of back pain. However, sitting does aggravate existing back pain. If you are in a back flare-up, try to move every 15 minutes. This will help to prevent overload of the same tissues in your back.
Interestingly enough, all the focus on strengthening the core may be misguided. An analysis of a large number of studies showed that general exercise programs targeting the whole body are just as effective at preventing back pain as specific core exercise routines. This is actually great news: instead of focusing on a few small muscles in the mid-section, we can exercise much more effectively by doing full-body routines that build muscle everywhere and burn way more calories. I still include a few core movements in my routines with my personal training clients, but they are not a large focus.
An interesting recent concept I’ve come across is “inflammaging”, the chronic low-grade inflammation that develops as we age. This inflammation accelerates aging and manifests in symptoms that many people over 40 are familiar with: general achiness (usually worse in the mornings), stiffness, slower metabolism, and gaining weight. If you have chronic back pain, working hard to reduce inflammaging can be highly beneficial.
Being overweight and inflammaging are closely associated, and losing weight is a good first step in reducing total body inflammation. Exercise is actually a great way to fight inflammation and assist in weight loss at the same time. Supplementing with natural anti-inflammatories like turmeric extract (curcumin) and omega-3 fatty acids can be quite helpful. So is eating a diet that’s low in processed foods and sugar and high in veggies and fruit, fish, nuts and seeds, and olive oil.
TOM TOTH, Movement Specialist, and Fitness Expert, Tom Toth is a strength coach, movement specialist, and fitness educator from Toronto, Canada. Since graduating from the University of Waterloo in 2003, he has dedicated his career to making people move better, feel better, and live better. His primary specialties are helping people with injuries and medical conditions, as well as training high-level athletes. His website is tomtothfitness.com