Seven Do’s: How to Eradicate Back Pain Before it Gets the Better of You (A Recipe for Getting on the Road to Recovery)

1. If suddenly stricken, ask yourself a few questions about what is usually described as the “inciting injury.”

Did it happen when you were engaged in a standard daily activity, like brushing your teeth, emptying the dishwasher or carrying a couple of bags of groceries? If the answer to that question is yes, it is safe to presume that you have not been seriously harmed, and — no matter how appealing it seems — you should not retreat to your couch or bed and wait to feel better. The spine is not a fragile body part, no matter what many stakeholders in the back pain industry would have us believe. For more on this topic, you’ll want to read what Harvard psychologist Ronald Siegel has to say in Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery’s chapter 9, “Head Case.”

Everything you read here is explained in much greater detail in this book. Obviously.

Important: If the answer to #1 is “no” — because the “inciting injury” involved an ass-over-tea-kettle spill off your bike, or a tumble down the stairs or you were involved in a car crash — it’s time to visit your primary care doctor or head to the emergency department of your local hospital. If you are running a fever that arrived with the back pain, signaling a possible infection, or have numbness along the inside of your thighs, or have lost control of your bladder or bowels, indicating possible cauda equina syndrome, ditto. If you’re a cancer survivor, don’t even think of waiting out back pain symptoms or visiting a chiropractor — call your oncologist.

2. In the case of acute pain — the term means pain of recent onset — get up and take a long walk.

Keep moving, because that’s the best way to stop acute pain from becoming chronic. Recognize that your peripheral nervous system, having scraped its metaphorical knee, is whining and sending your central nervous system unmerited messages of impending doom. In protective response, your back muscles spasm. Help your brain offer constructive instruction to your panic-stricken peripheral nervous system by giving your back muscles useful directives. As tough as it may be, try to avoid “catastrophizing” and “fear avoidant behavior.” For more about these very human inclinations, again, read Crooked’s chapter 9, “Head Case.” Do Stuart McGill’s Big Three, or get yourself to a MDT practitioner, also referred to as “MacKenzie Method,” because they are crazy good at nipping acute back pain in the bud.

3. Before you decide to put your faith in a traditional chiropractor — and by “traditional,” I mean one who wants to take x-rays and then sign you up to adjust your “subluxations” for weeks or months, read Crooked’s chapter 2, “Tale of Two Tables.”

You’ll learn some surprising things about the absence of scientific evidence of the benefit of adjustments beyond one or two chiropractic sessions; and the risk of long-term vertebral instability from overstretching during adjustments; and the World Health Organzation’s list of contraindications to chiropractic treatment, which includes almost every diagnosis that could be ascribed to a person with back pain. But: If you can find a chiropractor who has left behind the traditional approach, focusing instead on exercise and rehab, like members of this group, the International Society of Clinical Rehabilitation Specialists, you might have found a gem. Still, if X-rays or adjustments are part of the treatment, say thank you and shuffle out of there.

4. Instead of heeding the salvo that “pain is a warning sign,” make this minor, but crucial alteration: “Pain is a warning sign that you’ve neglected the muscles and ligaments that support your spine.”

Sure, you’ve been working your “core,” but the notion of the “core” is generally misunderstoo0d. Contrary to popular belief, the spinal column doesn’t stand up by itself. For stability’s sake, your back muscles and ligaments(upper and lower) need their own workout. No matter what your exercise instructor said, strengthening the core has nothing to do with developing “six-pack” vanity muscles. Read Crooked’s chapter 10, “The Back Whisperers” to understand why those crunches you’ve been doing are making your back much worse, and to learn what you should be doing instead. The core muscles surround the entire torso, from the top of the thighs to the breast bone, like a girdle. Strong glutes, thighs and pelvic muscles are also essential to core stability. Got a nice deep valley down your back, with muscles rising on either side of your spine? Got glutes that resemble half melons more than pancakes? No? People with flat buttocks and an absent “spinal valley” are often afflicted with back pain.

5. If #4 seems unbelievably daunting, or if you — like me — are a motor moron, incapable of doing an exercise properly without supervision, do yourself a favor and seek the help of a back whisperer.

In Crooked’s chapter 10, “The Back Whisperers,” you’ll find explicit information on how to locate one. Such super-motivators exist across multiple disciplines, and they know how to keep you safe and make you strong. They do not say things like “stop if it hurts,” because they know that, inevitably, building strength and flexibility is going to hurt — but, under expert supervision, hurt does not mean harm. Do not settle for doing one-size-fits-all exercises in a physical therapy clinic where you are supervised by an assistant PT, and your treatment is mostly about heat packs, cold packs, and muscle stimulation. No evidence for that, either.

6. If you’re not getting better, and you’re feeling depressed, anxious and isolated, (and under the circumstances, who wouldn’t be) consider a chronic pain rehab program, one with both intensive exercise and cognitive behavior therapy components.

These programs run for about 100 hours, over three weeks. They aren’t cheap, but before you dismiss the idea, remember that the opportunity costs of living with back pain, for months or years, are unacceptably high. Learn more about chronic pain rehab programs and the neurological and emotional underpinnings of back pain (and how to address them) in Crooked’s chapter 9, “Head Case.”

6. Do consider getting to work on your posture. This is rarely a matter of reminding yourself to stand up straight, or to stop listing to starboard in your desk chair.

Most back pain-afflicted people have engrained postural habits, which manifest in an off-kilter gait, or an ungainly sitting position or stance. Often, these are patterns passed on from parents, resulting in back pain that “runs in the family.” Get expert help here — from a specialist in the Feldenkrais Method or the Alexander Technique, or from a specialist in Structural Integration. Tai Chi and certain types of yoga can also work wonders. More about this in Crooked’s chapter 12, “The Posture Mavens.”