Appropriate Exercise May Be Essential for Treatment of Back Pain
January 31, 2014
Story at-a-glance
Back pain accounts for an estimated 10 percent of all primary
care doctors visits each year, costing Americans as much as $86
billion annually
Back pain is increasingly being treated with addictive drugs and
diagnostic exams that expose patients to potentially unnecessary
and dangerous levels of radiation
Back pain is frequently the gateway that leads people down a
path of drug addiction and lifelong disability
Poor posture and/or improper movement is responsible for the
vast majority of back pain. Proper alignment of the bones and
joints in your body during movement is critical for remaining
pain free
Foundation Training and postural training such as that taught by
Esther Gokhale are highly useful, both for the prevention and
treatment of back pain (as well as other bodily pains)
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
Tumors
Trauma
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
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.