By Dr. Mercola
Back pain accounts for an estimated 10 percent of all primary care doctors visits each year, costing Americans as much as $86 billion annually.1 According to recent studies, much of this treatment is unnecessary, and ultimately fails to address the problem.
When it comes to back pain, less treatment can actually be more beneficial in the long run. As noted in the featured article by NPR:2
"There's evidence that many standard treatments for back pain — surgery, spinal injections and painkillers — are often ineffective and can even worsen and prolong the problem... Some research suggests that 1 in 5 patients who have surgery for back pain end up having more surgery."
An estimated 80 percent of Americans will suffer from chronic back pain at some point in life. Some 25-30 percent end up struggling with persistent or chronic back pain,3 leading many to resort to prescription painkillers, expensive steroid shots, or even multiple surgeries.
Recent data4 shows that back pain is increasingly being treated with addictive drugs and diagnostic exams that expose patients to potentially unnecessary and dangerous levels of radiation. These treatments do not cure back pain—they only treat your symptoms.
Back pain is actually one of the primary reasons why so many Americans are getting increasingly addicted to painkillers. These drugs have now surpassed both heroin and cocaine as the leading cause of fatal overdoses in the US!
This is a high price to pay—too high, I'd say—considering the fact that, in most cases, back pain is usually the result of simple biomechanical problems relating to poor posture, inflexibility, or improper movement, which are best prevented and managed by exercises that strengthen your back and abdominal muscles, as well as exercises that maintain proper function of your joints.
Exercise as a Tool to Improve Pain Tolerance
According to some experts, in the absence of a mechanical problem, the pain may be caused by changes in your nervous system, making it send out false pain signals. Surgery will not do anything to correct this.
Remember, back pain is frequently the gateway that leads people down a path of drug addiction and lifelong disability. This doesn't have to happen, but you need to be willing to look at options beside painkillers and surgery as your go-to treatment. As reported by NPR:
"Dr. Richard Deyo... is an authority on evidence-based medicine at Oregon Health Sciences University who has studied treatment of back pain. One reason invasive treatments for back pain have been rising in recent years, Deyo says, is the ready availability of MRI scans.
These detailed, color-coded pictures that can show a cross-section of the spine are a technological tour de force. But they can be dangerously misleading. 'Seeing is believing,' Deyo says. 'And gosh! We can actually see degenerated discs, we can see bulging discs. We can see all kinds of things that are alarming.'
That is, they look alarming. But they're most likely not the cause of the pain. Lots of people who are pain-free actually have terrible-looking MRIs. And among those who have MRI abnormalities and pain, many specialists question whether the abnormality is really the cause of the pain, and whether fixing it can make the pain go away."
Dr. James Rainville, a rehabilitation medicine specialist at the New England Baptist Hospital in Boston, notes that some back pain may be related to the way your sensory system processes pain signals.
Essentially, you may have hypersensitive nerves. While that may be true in some cases, I believe a much stronger case can be made for the theory that the vast majority of back pain is caused by mechanical problems related to poor posture and soft tissue that lacks regular hydration, oxygenation and nourishment.
That said, Dr. Rainville and others believe that you can learn to more or less ignore your pain through exercise. Dr. Rainville has created a "back pain boot camp" where patients get six weeks of regular visits with specially trained therapists that teach them how to rebuild strength and flexibility in their backs. Part of this process is learning not to fear the pain, and not allowing it to stop you from moving and going about your life.
While I'm not familiar with the techniques taught at Dr. Rainville's "boot camp" and can't speak for their effectiveness, I firmly believe that posture-correcting exercises are a critical component when it comes to treating back pain. This makes sense as it is what you are doing most of the time that is likely the source of the problem. I'll share my recommendations to address this shortly, but first, when might surgery actually be warranted?
Herniated Disc—One Back Problem Where Surgery May Improve Outcome
There are of course instances where surgery may be warranted, although this is without a doubt the rare exception. Some studies have indicated that less than five percent of patients are good candidates for surgery. I would put that number at far under one percent. Surgery may be indicated for conditions like:
- Severe spinal stenosis
- Herniated discs
- Scoliosis and other spinal deformities
Surgery should be your absolute last resort. Remember you simply can never undue a surgical intervention and the multitude of repercussions that surgery introduces. Surgery is an injury…extreme injury, even though controlled. If it is not addressing the foundational cause of your problem it could make your current pain seem like a walk in the park that you would long for. For many it is like going from the frying pan into the fire. It is absolutely crucial to exhaust every single possible non-surgical option before you submit to surgery. I would also include steroid shots in the surgical camp as they are nearly as bad, cause enormous side effects and simply do not address the cause of the problem.
According to an eight-year follow-up study published in the journal Spine,5 patients with herniated discs in the lower lumbar who undergo surgery experience greater long-term improvement in pain and functioning, compared to nonsurgical interventions like exercise, physical therapy, or pain medication. That said, the study also reveals that nonsurgical treatment can lead to significant improvement in some patients. As reported by Medical News Today:6
"When outcomes were compared for patients who actually underwent surgery versus non-surgical treatment, significant differences emerged. On a 100-point pain scale, pain scores averaged about 11 points lower in the surgery group. Measures of physical functioning and disability showed similar differences. Surgery also led to greater improvement in some additional outcomes, including bothersome sciatica symptoms, patient satisfaction, and self-rated improvement.
While average outcome scores were better with surgery, many patients had significant improvement with nonsurgical treatment. After eight years, about one-third of patients who were clinically indicated for surgery have chosen not to have operative treatment."
Uninterrupted Sitting Can Cause Back Pain
Unfortunately, I am one of the 80 percent of Americans that have suffered with back pain. This is despite having exercised for over four decades. Fortunately, I took the pain as a signal that I was doing something wrong and I committed to finding the problem. I believe I nailed it down to all the sitting I was doing at the computer. This resulted in chronic poor posture, and inflexibility in my thoracic spine, chest, and hips. Thankfully, I found some good mentors to help me address the cause of my pain. Hopefully, you can learn from my experiences.
To learn more about the importance of regularly getting out of your chair, please see my interview with Dr. Joan Vernikos, former director of NASA's Life Sciences Division and author of Sitting Kills, Moving Heals. The research is really clear, if you are sitting regularly without interruptions you will likely die prematurely, but it will also disrupt a number of your vital bodily functions:
- Decreases the activity of lipoprotein lipase (LPL) which will increase your risk of cardiovascular disease
- Can worsen insulin and leptin resistance
- Can weaken your bones
- Can harm your blood vessels
- Doubles your risk of heart failure
It also decreases the motility of your organs as well as the mobility between the organs. Over time they literally become adhered together. I am firmly convinced excessive uninterrupted sitting played a major role in my back pain and now that I have modified my patterns the pain has vanished. It makes perfect sense that what you do all day long is going to have more impact that what you do a few hours a week in the gym. That is why I make it a regular practice to get up at least every 15 minutes and engage in some movement even if only for a minute or less. Simply standing up would likely work but I think you can do better by addressing your posture and including some movement exercises.
I have been working with the 3-dimensional dynamic movements that Lisa Huck teaches during my 15 minute sitting interruption period. This 3-D technique opens up the nooks and crannies of the body, areas that were compressed and starved of resources, and irrigates those areas with life-vitalizing fluids. The movements create a pumping action, pulling in the "good stuff" (hydration, lubrication, oxygenation and other nourishment) and pushing out the "bad stuff" (metabolic wastes and toxins).
When you accomplish this regular essential resourcing and detoxification of the soft tissues you maintain healthy, properly-mobile joints that working together as a system of joints can achieve better alignment as well as efficient movement. Each joint is doing its ideal delegation of work, creating an efficient team, while no one joint is getting over-worn. I have been experimenting with these ideas really enjoy the increased range of motion it has provided in previous less than flexible areas of my body.
Most Body Pain Can Be Traced to Poor Posture and Improper Movement
Many fail to realize that back pain may actually originate from tension and imbalance at a completely different place than where the pain is felt. For example, when you sit for long periods of time, you end up shortening your iliacus, psoas, and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis. When these muscles are chronically short, it can cause severe pain when you stand up as they will effectively pull your lower back (lumbar) forward.
Imbalance among the anterior and posterior chains of muscles leads to many of the physical pains you experience. By rebalancing and strengthening these muscles, you can remedy many pains and discomforts, including low back pain. One of the best things you can do to prevent and manage back pain is to exercise regularly to keep your back and abdominal muscles strong and flexible. Foundation Training—an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain—is an excellent alternative to Band Aid options like painkillers and surgery.
Foundation Training exercises are designed to strengthen your entire core, and teach your body to move naturally, the way it was designed to move. Another option is The Gokhale Method, created by "posture guru" Esther Gokhale. Her techniques teach you how to sit, lay, stand, and walk with proper posture. Yet a third approach is creating and maintaining a balance between stability and mobility as well as your body's ability to move efficiently and resiliently on all planes with Lisa Huck's 3-Dimesional Dynamic Movement Techniques. All of these strategies are far more effective than the typical conventional medical approach for low back pain. Additionally, chiropractic or osteopathic care can also be quite beneficial.
Prevent and Treat Back Pain with Foundation Training
I enjoy Foundation Training exercises, which work to gradually pull your body out of the movement patterns that are hurting you. The focus is on strengthening your core, which includes anything that directly connects to your pelvis, whether above or below it. Foundation Training teaches all those muscles to work together through integrated chains of movement, which is how your body is structured to move.
Every muscle that directly connects to your pelvis should be considered part of your core, and this includes your glutes, adductors (inner thigh muscles), deep lower back muscles, hip flexors, hamstrings, and abdominal muscles. Having strong, balanced core muscles is like having a built-in corset that not only holds your gut in, but also stabilizes your spine, vertebrae, discs, and most importantly your pelvis. Teaching your body to naturally support itself at the deepest level is going to be far more effective than strapping on an external back brace, which over time can lead to even weaker musculature. The following video demonstrates one of the foundational exercises of this program.
The basic Foundation Training program takes about 20 minutes, and is ideally done daily. You can purchase the Foundation Training DVD from my online store. FoundationTraining.com also offers several free videos, and their thought provoking first book called: Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidence.
Other Strategies for Preventing Back Pain
Preventing back pain is surely easier than treating it, and there are many alternatives available, in addition to what I've already mentioned above. Here are a dozen more tips that can help you lead a pain-free life:
- Exercise and physical activity will help strengthen the muscles of your spine. Make your exercise time count by including high-intensity sessions. You probably only need this once or twice a week at the most. You'll also want to include exercises that really challenge your body intensely along with those that promote muscle strength, balance, and flexibility.
Yoga, which is particularly useful for promoting flexibility and core muscles, has also been proven to be beneficial if you suffer from back pain. The Yoga Journal8 has an online page demonstrating specific poses that may be helpful.
- If you spend many hours every day sitting down, pay careful attention to consciously sucking in your belly and rotating your pelvis slightly up. At the same time, make sure your head is back with your ears over your shoulders and your shoulder blades pinched. This will help keep your spine in proper alignment. You can hold these muscles tight for several minutes and do this once every hour. My interview with Esther Gokhale goes into far more details.
- Optimize your vitamin D and K2 levels to prevent the softening of the bones that can often lead to lower back pain.
- Ground yourself. Grounding yourself to the earth, also known as Earthing, decreases inflammation in your body, which can help quiet down back pain and other types of pain. Your immune system functions optimally when your body has an adequate supply of electrons, which are easily and naturally obtained by barefoot/bare skin contact with the Earth. Research indicates the Earth's electrons are the ultimate antioxidants, acting as powerful anti-inflammatories. Whenever possible, take a moment to venture outside and plant your bare feet on the wet grass or sand. Walking barefoot is also an excellent way to strengthen your feet and arches.
- Address psychological factors. Few people want to be told that their pain is psychological or emotional in origin, but there's quite a bit of evidence that backs this up. Dr. John Sarno,9 for example, used mind-body techniques to treat patients with severe low back pain and has authored a number of books on this topic. His specialty was those who have already had surgery for low back pain and did not get any relief. This is one tough group of patients, yet he had a greater than 80 percent success rate using techniques like the Emotional Freedom Technique (he's now retired from practice).
- Get regular massage therapy. Massage releases endorphins, which help induce relaxation and relieve pain.
- Keep your weight spread evenly on your feet when standing. Don't slouch when standing or sitting to avoid putting stress on your back muscles.
- Always support your back, and avoid bending over awkwardly. Protect your back while lifting – this activity, along with carrying, puts the most stress on your back.
- Wear comfortable shoes. For the ladies, it would be good to not wear heels most of the time.
- Drink plenty of water to enhance the height of your intervertebral disks. And because your body is composed mostly of water, keeping yourself hydrated will keep you fluid and reduce stiffness.
- Quit smoking as it reduces blood flow to your lower spine and can cause your spinal discs to degenerate.
- Pay attention to how—and how long—you sleep, because studies have linked insufficient sleep with increased back and neck problems. Pay attention to your sleep position. Sleep on your side to reduce curving of your spine, and stretch before getting out of bed. A firm bed is recommended.
Back Pain Is Common, Yet Largely Avoidable
If you're among those seeking medical care for persistent back pain, I'd advise you to consider your options before filling that prescription or going under the knife. Once you understand that back pain is typically the result of poor posture or improper movement, the remedy becomes clear. I believe Foundation Training and postural training such as that taught by Esther Gokhale are among the most beneficial, both for the prevention and treatment of back pain (as well as other bodily pains). Other lifestyle strategies like Earthing, yoga, EFT, and others, can be of benefit as well, but cannot take the place of strategies that teach you how to move properly again.