Back pain: Why it happens and what to do about it

Issue #74: Fixing your back pain

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Read Time: 7 minutes

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Housekeeping:

This is the second of 4 issues coming your way over the next month that will go deep on one issue.
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In this week's issue of 66.1:

A deep dive into that pesky back pain so many of us have felt more than once.

Background

According to the most recent CDC data available, 39% of adults in the US experienced back pain in 2019. Over the course of their lives, up to 80% of adults will experience low back pain. Perhaps most concerning is the fact that 85% of these back pain cases have an unknown cause, according to this article.

For the purposes of today's issue, "back pain" refers to that pesky low back pain so many of us are familiar with.

It's a strange thing--the majority of people suffer from back pain at some point in their lives--yet we don't seem to have much idea about how to deal with it.

When I encounter friends, family members, and clients whose backs are troubling them, there's an associated feeling of disempowerment. They sneezed and their back suddenly hurt terribly. They bent down to pick up their toddler and a sharp pain flew in.

I've been there. Multiple times in the past 3 years I've had a sharp pain in my low back show up seemingly out of the blue. What I realized in retrospect, though, was that this pain was easily traceable to a pattern that went something like this:

1. Poor posture for a long time​
   Shoes with a heel lift (which pitch your hips forward and cause extra stress on your low back) and 8+ hour days spent sitting at the computer
2. Exertion​
   A 1-rep squat max, a hard jiu jitsu training session
3. Sharp pain​
   A shooting pain across my low back that has me sidelined immediately

Fortunately for me, the pain always went away with a change to zero-drop shoes, an increase in mobility work, and more time spent walking every day. We'll look deeper at these mitigation strategies later in the issue.

First, though, a look at why your back actually hurts.

Why does my back hurt?

At its most basic level, pain is a message that something isn’t right. With back pain, there are many folks who have structural damage (bulging disks, stenosis, etc.). If that's you (or you suspect it might be), make sure to consult your doctor before taking any of the advice I'm sharing here.

When it comes to back pain, everything is connected. If your hips, shoulders, knees, and neck are out of whack, you’re bound to have a sore back. This misalignment can come from a thousand different stimuli you encounter every day: sitting at your desk, rolling your shoulders and lowering your head to look down at your phone, sitting in the car, the shoes with a heel lift that dump your hips forward.

Many times, the sharp pain in your back comes on exertion, even if that exertion is a sneeze. As you increase your effort, you're placing more stress on your misaligned back and eventually that sharp, debilitating pain is going to come your way.

The key is to listen to your sore (but not screaming in pain) back before things get bad. This pain isn’t a reason to panic. It’s merely a message from your body, telling your brain that what you’re doing isn’t working. It’s a signal to get out of a dangerous posture. But when you’re in that sub-optimal posture for hours every day, your body takes measures to safeguard against further damage.

Muscles around the area in question will tense up to provide stability and safety. This tensing is a short-term approach that keeps you out of the danger zone but in the pain zone. The tensed muscles actually end up holding your back in a sub-optimal position even after the stimulus causing the posture place is removed.

We'll address this challenge later, but first let's look at where back pain is the most severe in countries and regions across the world.

What the data says

The graphic below shows the prevalence of low-back pain in various countries across the world. You’ll notice that low back pain is most common in the United States, Europe, and Australia. Certainly there are a few countries that are exceptions to these trends, but generally, African and Southeast Asian countries have the lowest prevalence of back pain.

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The next graphic from the World Health Organization’s Global Status Report on Physical Activity 2022 shows the prevalence of adults who do not meet WHO’s physical activity guidelines. You’ll notice here that adults in North and South America suffer from inactivity most dramatically. Across the world, lack of activity generally correlates with increased prevalence of back pain. More activity doesn’t necessarily eliminate back pain (if this was the case, we’d expect to see a lower prevalence in Africa and higher prevalence in Asia).

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With this understanding that sedentariness is correlated with higher levels of back pain, it's helpful to explore why people in some places are so sedentary (and thus, suffering from back pain).

A lifestyle challenge

It seems that, as with many aspects of modern life, the high prevalence of back pain in the US is largely a result of so many of the advantages of modern life. We no longer need to grow and harvest our food. We drive our car or take the train rather than walking.

I was introduced to the image below in my Mayo Clinic Health and Wellness Coaching certification program. The point the author, Gordon Hewes, is making, is that humans are abandoning many postures that we've spent significant time in historically. Because we spent more time working with our hands and doing things like hunting and gathering without the luxury of tables and chairs, we were forced into what I would call "high mobility" postures such as below.

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What Hewes' work shows us is if you've experienced back pain, it's likely not because you were simply born with a "bad back" or woke up one day with a new back issue. It's because it's really hard to find a reason to get down into these postures in the modern world. Rather than squatting in some sort of a modified lunge, you sit at a desk. As a result, your hips, knees, shoulders, and neck get tight. This tightness adds stress to your back. Eventually, you feel that sharp, shooting pain in your back because the tight muscles surrounding your back have caused such strain.

Don't worry, though.
We can tackle that challenge together.

Applying it to your life

Talk to your doctor first

Before we spin up a hyperactive back pain mitigation plan, let’s be clear: if you’ve had a painful back for an extended period of time (months-years), it may be worth getting some imaging done and confirming that you don’t have structural damage to your back. If this is you, please talk to your primary care provider before you start doing anything I suggest here.

However, if a) you have confirmed that you don’t have structural damage to your back or b) your back hurts only when you’re seated, slouched or slothy then improves when you’re active and away from chairs and screens, we can tackle this issue without imaging, painkillers, or injections.

Step 1: Remove the stimulus

Addressing your back pain requires a two-part approach. First, you’ve got to stop doing the things that are causing your back pain.

If you're wondering how to do that, especially if you spend your days at a computer or in a different posture that pains your back, I've got some ideas.

The point here isn’t to go crazy. The goal is to disrupt the patterns and postures causing you pain. The more you disrupt them during the day, the less time you’ll have to spend undoing them later.

1. Get your steps​
   ​This study from researchers in the UK showed that an 8-week moderate intensity aerobic intervention reduced back pain by 20%. In simple terms, this level of exercise can simply mean walking on a treadmill for 10-30 minutes every day. Personally, I've found that my aches and pains have decreased dramatically since getting a treadmill for under my standing desk a few weeks ago. I've also been taking an additional 3,000 steps/day thanks to the treadmill.
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2. Don't sit​
   According to the Hospital for Special Surgery, "The most important thing to do to reduce back pain...is to get up and move around frequently."
   If that sounds tough, let me suggest a standing desk.
   It's a great way to give yourself options (including walking if you slide a treadmill underneath) for movement without skipping out on your workday.

Step 2: Tackle the pain head-on

Now that you’ve addressed the sedentariness that likely contributes to your back pain, it’s time to relax the muscles around the painful area so your back can return to an anatomically correct position.

Doing this takes work, and it often comes with some pain. I’m no physical therapist, but I am a relentless self-experimenter. What I’ve found to be beneficial for myself and clients is a combination of stretching and targeted pressure exercises to break the tension in my muscles. 10 minutes per day on these exercises is more than enough to get started.

A few of my favorites include:

1. Couch stretch​
   Enter a lunge position in front of a couch or wall.
   Put your rear knee as close as possible to the couch, with your foot up against it.
   Maintain the lunch position with your front leg as you straighten your torso.
   You're going to feel the pull in your ankle, shin, quads, and hips.
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2. Rolling with a foam roller​
   You may have seen these at your gym.
   They're a funky-looking piece of cylindrical Styrofoam.
   Their job is to help you administer a self-massage.
   Lay on top of the foam roller and smoosh your painful parts.
   If you're just getting started, start with your larger muscle groups (thighs, hamstrings, your entire back).
   More surface area in these groups = less pressure = less pain.
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3. Rolling with a lacrosse ball​
   Ease your way into this one.
   The lacrosse ball is small and harder than the foam roller, meaning it applies more pressure.
   More pressure means more pain, especially if your muscles are tight and you're new to this exercise.
   Start by pressing the lacrosse ball into the muscles around your hips (above your hip capsule and below your iliac crest from front to back).
   Once that pressure is comfortable, do the same thing but place the ball between your hip and the wall to increase pressure.
   Finally, do the same but lay on the ball to maximize pressure.
   Don't overdo it to start--the key here is to build gradually so you're not so sore you don't want to do it again tomorrow.

You'll notice that I didn't say anything about attacking the exact pain point in your back. That's because your back pain is often a result of issues upstream and downstream of the painful area. Take care of your hips, hamstrings, and shoulders, and a lot of back pain will disappear.

Resource Bank

A compilation of the tools I mentioned in this issue.
They're resources I own and use on a regular basis.
Use these to get started as you tackle your back pain.

Educational resources:

​Becoming a Supple Leopard by Kelly Starrett
My go-to resource whenever I have an ache or pain I'm struggling to make sense of.
Like a user's manual, for your body.
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​Deskbound: Standing up to a sitting world by Kelly Starrett
Strategies to mitigate the negative health effects of your sedentary job.
A must-read for anyone who works at a desk.
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​Tools (not toys) to help you get out and stay out of pain:

​Standing Desk​
​Under-desk treadmill​
​Foam Roller​
​Lacrosse Ball​
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That’s all for this Saturday.

See you on Wednesday with our classic newsletter format.

Have fun out there.

Marcus​
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Why 66.1?
​66.1 is the average health span (years lived without a serious disease) in the US, as of the start of this newsletter publication.
​We're here to extend that.

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