A Thinking Person’s Guide To Low Back Pain
"We are fearfully and wonderfully complex" - Lorimer Moseley
A little over 10 years ago I embarked on a quest. If you had asked me at the time, I certainly wouldn’t have referred to it as a quest. In retrospect however, it’s the most accurate word I can conjure to describe this long and winding road of self discovery into the world of manual and movement therapies. I had severe, persistent and intermittently debilitating low back pain and in all honesty, I was in search of easy answers. This search for easy answers then predictably spiraled into asking harder questions that required work I wasn’t entirely prepared to do. Isn’t that always strangely the case?
You see, In the beginning I had confidence someone else could “fix” me. As if somehow the answers were outside of myself. Maybe I could pay an acupuncturist to put a needle in a uniquely energetic point on my body or possibly a chiropractor to adjust just the right segment of my spine. My pain would ease and I would go about my day freed of this affliction that I was certain occupied a specific physical location in my body. I was wrong. The answers were my responsibility to find.
The path to physical autonomy is not a passive one. No one can rub out, manipulate, crack or somehow energetically absolve us of our long standing pain. We must seek to understand it, form a relationship with it and ultimately ask it the right questions.
So what are the steps to getting out of back pain?! Glad you asked. The answer I’m about to present is both wonderfully liberating and irritatingly introspective. Why? Because you are in fact a unique snowflake and this question, like most difficult questions that seeks real answers, can only be answered by you. If it were as simple as a few mobility drills, everyone would be out of back pain. So put on your thinking caps, embrace your beginner’s mind and let’s get started.
Step #1: Stop Doing Shit That Hurts You
Remove the negative! This is easily the most overlooked step simply because it’s the hardest. Our physiology is predicated on having just the right amounts of stress. The rub is that many of the best things in life reduce our capacity to adapt to stress. One of my personal low back pain triggers is to stay up late and drink whisky with my bandmates after a gig. Let me tell you, short on sleep and working off a solid whisky hangover is no way for a 41 year old man to treat his body. My low back lights up every time. Does that mean I quit the band? Absolutely not. It just means I need to consider all the factors in my life and make sure they add up to just the right amount of stress at the right times. If you start to combine stressors (think smoking, bad relationships, poor sleep, babies, shit nutrition, crossfit), then you might wind up on the wrong side of this equation.
Key takeaway from Step #1: Consider your life, look for compounding stressors and make sure you are ahead of the curve. More of the “good’ inputs and fewer of the “bad” inputs will balance the equation in your favor. This is the “Calm shit down” part.
Step #2: Understand The Output
The moment I realized that pain did not have a specific location in my body was the moment I stopped worrying and started living. Our brains, locked away in a bony cranium, are completely dependent on information arriving from the sensory receptors of the body. Skin, joints, eyes, ears, muscle, fascia...are all sending a constant barrage of information to the brain. The brain then asks a very important question, “How dangerous is this really?” It instantly compares the massive amount of incoming data with the colossal amount of stored data and makes a reasonable (or not so reasonable) determination as to whether you need to change whatever it is you are doing. You see, pain is a body wide event. A complex interaction of multiple systems that takes into account not just the current moment but the entire history of you.
Why does this matter when my back hurts? Great question! If your back has been hurting for longer than 6 months, then chances are that the healing processes have largely done their job. Assuming you are not continuously engaging in activity that re-injures the area, what’s left is a complex set of protective processes in the brain that remember specific positions and environmental considerations that may have contributed to the original pain experience.
So here is a bit of a thought experiment...If the tissue has had sufficient time to “heal” and you are not continuously re-injuring it, then what is left to produce pain? As you consider this, remember that your brain’s #1 priority is to keep you safe.
My hope is that this line of logic sheds light on the fact that pain is multifactorial with tissue damage being just one of many factors. There will be times when you have to consciously remove the threat surrounding certain movements or positions. When I started adding movements back into the mix and started making the connections to what truly stimulated my pain experience, I started moving with more freedom and with less pain.
Key Takeaway from Step #2: Pain is a response to threat (perceived or actual) and is a request for change. Tissue damage is a component of the pain experience but is not a requirement for pain. This means that our individual pain experiences are largely subjective and contextual. More movement and more confidence in your body’s ability to move, is often the path forward.
Step #3: Fix The Input
Your brain makes decisions based on the best available information at any given moment in time. Accurate and up to date information is an absolute requirement to making good decisions! So where does the brain get the information from? Literally everywhere in the body. The visual and vestibular systems along with joint, skin and muscle afferents are a few of the primary sources of input to the nervous system. There is no way to discuss all of these within the context of a single blog so I will limit this discussion to information being supplied by the joint capsule. Please do not overlook the other inputs though! If you aren’t having success with one pathway, then by all means explore them all.
Certain joint receptors have a direct line of communication to the brain. The instant two bones of a joint move force is directed into the channels of soft tissue activating receptors that send information to the brain. This has direct influence on the way you respond to the environment. Muscle activation, timing and the general coordination of your body’s response to environmental constraints is much less pattern based than most people think. It is a moment by moment, seat of our pants operation that is heavily affected by the incoming information to the brain. So how do we make sure the information our brain is using to make decisions is the “right” information? Make sure your joints move the way they are supposed to! Prioritize joint health and make damn sure that your mobility is up for the challenge of your chosen activities. If it is not, you will have compensation somewhere along the chain. Remember that your brain will accomplish the desired task even if it is compensatory and will prioritize short term goals over long term health.
Key takeaway from Step #3: Prioritize joint health to make sure your brain has accurate, up to date information and it will reward you by making better decisions, expose you to fewer injuries and generally open you up to acquire new movement skills safely.
Step #4: Find Stability With Fundamental Movements
Stability from the perspective of the nervous system = Safety. This concept is useful when troubleshooting pain as you can then ask the question: “How did we learn to move and feel stable in the first place?” Or to put it another way: “What does the nervous system require to feel safe?” It turns out there is a bit of an order to it and if any of the fundamental prerequisites to complex movements aren’t in order, then the nervous system will likely produce an output of pain and tightness to restore safety. The big 3 for me are Breathing, Rolling and Crawling patterns. Time spent in these areas has been a game changer for myself and every client I’ve worked with who is dealing with chronic pain. Get the foundation right and you will be able to layer in mobility and strength with great success. Get it wrong and you will simply wind up layering movement on top of dysfunction and the vicious cycle of pain will persist.
Key takeaway from #4: Working on Breathing, Rolling and Crawling patterns can impart a sense of safety to your nervous system. This is how you learned to move in the first place and is the prerequisite to more complex movement. If your nervous system feels safe, it will produce fewer outputs of pain and tightness.
#5 Get Strong
Now we come to the easy part! Assuming the first four steps of this process have been managed to some degree, we can finally get to the fun stuff and drive a little adaptation into the beleaguered tissue. The caveat with this step though, is that the potential for re-injury is high. The pro move when it comes to getting strong is to make sure that you can keep getting strong for years to come by not getting injured. Injuries are lame and your number 1 priority going forward will be to stay off the ridiculously time and energy consuming injury train. How do we do that? Here are some time tested, mother approved tips to keep this thing moving in the right direction.
Start light and progress slow. As in way too light and really fucking slow. Give yourself room to grow and you will be rewarded with years of progress that strengthens tendons, ligaments, joints and muscle. These different tissues heal and adapt at different rates. Respect it.
Prioritize unilateral exercise. This means single leg and single arm work is going to be more beneficial to you for at least the first year or so. Life doesn’t happen on two legs and nobody gives a shit how much you can bench press. The benefit of unilateral work on core stability and eradicating compensatory movement is impossible to deny. This is not to say that you can’t do bilateral movements but building a program around them is risky business.
Don’t stop breathing, rolling crawling and don’t stop working on your joints! You will be working on that stuff forever. Accept it and do the work.
Take rest weeks. The thinking person’s approach to physical health and well being takes a long term point of view. Take a cue from high level athletes whose physical health is non-negotiable and take deload weeks. I recommend 4 week cycles with 3 weeks of training and 1 week of increased non-exercise activity. You could also do 6 week cycles of 5 weeks training to 1 week increased non-exercise activity. What is non-exercise activity? Simply stay active. Go for hikes, take a dance class or garden your ass off. It doesn’t matter what you do but the key point is to switch it up, cycle stress and not get injured. You will come back to training with a fresh mindset and renewed vigor.
Key takeaway from Step #5: You aren’t out of the woods yet! You will have to be smarter than the average person. Patience and consistency are absolutely essential for this thing to work. Keep the plan the plan, stay off the injury train and respect the process.
That’s it!
My 5 step process to getting out of low back pain. My real hope in sharing this information is that you feel empowered to take personal responsibility and control of your physical health. There are no magic formulas and there are no shortcuts. Anyone who tells you differently is selling you the proverbial bill of goods and I suggest you run the other way. Don’t accept pain and weakness as your reality. The adaptive capacity within each of us is profound and is up to the challenge in every way.
