Ok, we have all been there and done that–worked on strengthening our back muscles and our “core”… heard the studies that 80% of back pain cures itself, and that staying active and losing weight are what you need to do for back pain.
But what if I told you that you can be overweight and not have back pain? Sure, being overweight contributes to back pain. It is also not healthy for you. However, you can improve your back pain without losing 50 pounds. What if I told you that hitting the gym and “strengthening your back and core” is not necessarily going to help your back and actually might predispose you to getting worse?
Yes, being active is good, and exercise is important for your back. But your back is both complicated and simple.
Setting aside the neurologic importance of your back, it is an important stabilizing structure. We stand erect, which forces gravity and body weight to go from the top of our head straight down the body to our feet. Those forces go through the spine, which is essentially a bunch of stacked bones with little shock absorbers in between. What keeps the back from buckling under all this force? Your muscles help to keep things both dynamic (able to move), yet stable. So, this structure, that is also supposed to be as firm as a pillar, is also supposed to be mobile. Muscles are what make it possible for this structure to be both.
If the complex interaction of these muscles is weak or one-sided, then the forces applied to the back are not controlled or mitigated by the muscles. Force will then be allowed to transfer completely to the discs and bones. (Hitting the gym and strengthening only the back extensors, rectus abdominus, or obliques can create even more of an imbalance.)
One-sided means that, instead of the muscles on the right and left or front and back contracting together to create a firm foundation, they play tug of war on your back with resultant twisting and torsion. This causes discomfort, pain, and sometimes damage to the bones or discs. So what does your body do when it is in pain? It tenses up: muscles contract to protect the spine from any further forces. They then stay tense, and you get that “pulled muscle” feeling. If you have a muscle imbalance, then tense guarded muscles only create a constant one-sided tug of war on your spine.
How do you help this? The common ways are heat, ice, muscle relaxers, and pain pills. But does this really fix your back? Or just alleviate the symptoms? The real problem with the back is not your current symptoms–“back pain.” Rather, it is the underlying weaknesses and imbalances that keep allowing unmitigated forces to put too much torque on the structures of the spine.
Much of back pain can be addressed by correcting certain muscle imbalances, releasing tension and breaking cyclic patterns.
I know some are saying there are sometimes real structural problems in the spine–ruptured/bulging discs, degenerative discs, stenosis, arthritis, vertebral bone compression/fractures, or bone spurs (to name a few). If these problems exist, your body is probably great at compensating and mitigating stress, force, and pain–well, at least for a while. Often times, it is simply a lack of strength and muscle balance that is no longer allowing the body to mitigate the forces. Sometimes you are just stuck in a cycle of inflammation and muscle spasm, not allowing the recovery. Surgery has its place on the spine, but as I explained in “Why Do I Suddenly Hurt?” sometimes you just need to get back to a place where your body is capable of tolerating the forces to help support the back even with structural problems.
I love helping patients with back pain by teaching them simple exercises that engage the psoas muscles (anterior muscles important in lumbar stabilization) and helping them move past the improper compensations and cyclic torsion forces that their muscle imbalances are creating. I have helped decrease pain in overweight, aged, and arthritic people with spinal issues.
Just because we have structural problems does not mean we have to be in constant pain.
That is my belief, I would rather help fix the problem than treat the symptoms–give freedom back rather than give up, because the structures appear too far gone to help.