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Back Now Forward
A Field-Tested Guide to Conquering Back Pain
John Tintle
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st
Edition
Back Now Forward
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Copyright
Copyright 2012 by John Tintle
All rights reserved, including the right to reproduce this guidebook or portions
thereof in any form whatsoever. For additional information, please send email to
info@backnowforward.com.
Cover images via istockphoto.com.
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Disclaimer
Back Now Forward is based on working knowledge and personal experience. It is for
informational purposes and distributed As Is without warranty. I am not being
compensated to promote any product or method depicted and disclaim responsibility
for any adverse effects that might result from the application of the suggestions
contained herein. All known trademarks are noted; all other product names and
services identified are used in editorial fashion and with no intention of trademark
infringement. Consult a doctor and use proper discretion before attempting any
technique described in this guidebook.
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Table of Contents
Foreword .................................................................................................................................................. 4
Opening Act .............................................................................................................................................. 6
Diagnosis and Direction ....................................................................................................................... 7
Trials and Errors .................................................................................................................................. 11
Recommendations ............................................................................................................................... 19
Park Routine ..................................................................................................................................... 20
At Home.............................................................................................................................................. 23
At the Gym ......................................................................................................................................... 29
On the Job .......................................................................................................................................... 32
On the Road....................................................................................................................................... 34
Farther Afield ................................................................................................................................... 36
Nutrition ............................................................................................................................................ 38
Rest ...................................................................................................................................................... 40
The Numbers ......................................................................................................................................... 42
Things to Avoid ..................................................................................................................................... 44
Moving Forward ................................................................................................................................... 48
Acknowledgments ............................................................................................................................... 50
About the Author.................................................................................................................................. 51
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Foreword
Back Now Forward is for those who appreciate the importance of a healthy hindside.
If youre currently experiencing, recovering from, or diligently sidestepping back pain,
this means you. If youve ever tweaked your spine, felt an unwelcome shock, or been
on the shelf and unavailable for action, this also means you. If youre striving to
recapture past glory or stake claim to renegade feats, you get the picture.
My goal is to extend useful advice for speedy recovery from back pain and lasting back
health. It is not so supplant centuries of detailed research or the advice of the medical
community. In summary, it is to help you move forward with strength and
confidence.
Personal experience is at the center of the back restoration and maintenance methods
noted in these pages. If I didnt feel it or do it, its not here. What follows is therefore a
work-in-progress, similar to the wellness of every human back on Planet Earth.
Context is a key difference between this and other works in the back pain genre. If
youre short on time, with a houseful of kids, pets, or projects begging for your
attention; if your average training session is the duration of a sitcom before the first
commercial break; and if youre game for a fresh, pragmatic and imminently doable
approach to managing back pain, we should have a bit in common. If not, perhaps we
nonetheless share a kindred pursuit.
I realize its easy to take back health for granted. From our diaper years straight
through our twenties, physical resilience is at our disposal. We assume most injuries
not involving a trip to the ER or OR will vanish fast. And luckily, most do.
But over time, dynamics change. Skimpy nuisances dont promptly go away and were
called upon to trade physical resilience for mental toughness. Self-perceptions are
brought into tune with new realities. To those of you currently on the side of no pain,
no gain, I know the feeling and highly recommend you enjoy it while it lasts. The rest
of us are smarter.
Back pain, being fickle and often not visibly obvious to the rest of the world, is
especially challenging. There you are, able to leap tall buildings on any given Monday,
and the following Tuesday, unable to get out of bed. Not ideal.
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Unfortunately, theres no quick fix. Back pain may go into a form of remission, but
once a serious incident occurs, its yours to live with. You dont need to embrace it,
though you do need to accept it. You also need to accept that regaining a healthy back
is unglamorous business. No one will say, great lower back, or, awesome core
strength that I cant see. Theres no implant for it. No magazine Top 10 list will
cover it. It simply must be managed. And when it is, youll feel better than ever.
My advice and ideas are intended to be straightforward. I dont linger on the
intricacies of the vertebral body or the minutiae of the nucleus pulposis. My
recommended techniques are neither patented nor exotic. I have no agenda other
than the health of your back, starting with the key themes Ive found make the biggest
positive difference.
The enclosed is a compilation of what Ive learned while treating my own back injury.
It is material I wish I had at the start.
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Opening Act
Things shift.
My odyssey began innocently enough: rising from a conference room chair. What
followed was a bout of lower back, hip, and leg pain that introduced physical
challenge to every daily activity. It affected work, travel, dining, sleeping, writing,
exercise, hobbies, chasing (and getting chased by) kids and neighborhood dogs -
everything I did.
In my case, no traumatic event provoked the current of electricity that ran day and
night from my lower back, through my right hip, and down to my right knee. Nothing
glamorous or daring; no cliff diving, stunt driving, mountain climbing, or this-must-
be-caught-on-video shenanigan. No perceived stress beyond my normal, everyday
level. Id simply taken aboard the final straw.
For several weeks, I convinced myself this injury was nothing more than a nuisance,
that time and a little more exercise would solve the problem. Nothing drastic. I
expected the pain to simply disappear. Then it became worse. Eventually, suffering
and exasperated, I realized something must be done, that this time was different and
the stakes were higher.
If your back story had a more sensational beginning, I envy you.
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Diagnosis and Direction
The quest to secure a moving target.
Every patient wants their first diagnosis to be precise: a clear summary of a condition
seen millions of times and a proven action plan for moving head. As Ive experienced,
back injuries are seldom basic. Neither are the opinions that accompany them.
Following the less-than-dazzling onset of my back injury, early symptoms often varied
from tolerable to horrific. Getting out of my car could take five minutes. Then five
minutes later Id have minimal pain. Sitting at my desk could be decidedly
unexceptional one moment, and excruciating the next. Motion and exercise brought
relief, then blinding shocks. Patterns were tough to find.
Post-injury, my first professional visit was to a chiropractor. This seemed a logical,
wholly conventional step. And based on previous far less significant - back issues, I
was confident an adjustment or two would set me straight. (My one and only pun,
promise.) But prior experience wasnt as valuable as Id hoped. After one month of
twice-weekly sessions and minimal improvement, I transitioned to a second
chiropractor and was prescribed an x-ray. Results indicated satisfactory alignment,
though at the same time compression at the lower end of my spine. Diagnosis: a
bulged disc.
A bulged disc! I could comprehend a bulged disc. Id heard of it, met plenty of people
whod experienced it, and was confident Id be back to full-power in a few short
weeks. The disc just needed to glide back into place. Only the weeks were not short,
nor few in number. The pain persisted and the shocks became more acute. All the
while, additional opinions rolled in: Psoas! Gluteus Minimus! Periformis! Tension!
Fatigue! Sacroiliac!
Despite the number of appraisals (or perhaps on account of them), I felt little closer to
identifying the unequivocal source of my pain. What I did recognize is that back
injuries are as common as the breadth of potential root causes is vast. It was time for
additional analysis.
My intuition was to seek a specialist, coupled with the quickest fix I could find. I
rummaged through online searches for back pain expert, cure back pain fast, back
pain remedies, spine doctors, and assorted combinations of my affliction (or region
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of pain) + desired state, antidote, and/or expert. Best of lists were consulted, as
were friends and family. In the name of speed and perceived know-how, I ambled
into a physiastrists office.
My flexibility was examined (OK), my story told (with all the lan I could rally), and
my senses tested (numbness in my right foot; suboptimal). In all, the doctor had seen
worse. Diagnosis corroborated: a bulged disc. Prescription: rest and Advil. Take it
easy and return in a few weeks.
The situation deteriorated again. I continued visiting my second chiropractor, with
limited relief. Rest wasnt working. Simple, traditional stretches werent working;
ditto rest and Advil. Walking wasnt working. After two weeks and at risk of my
sanity, there was no point repeating the same maneuvers and expecting different
results. It was time for an MRI (Magnetic Resonance Imaging).
For the unacquainted, the beauty of MRI is that musculoskeletal issues can be
illuminated in high contrast, helping remove speculation and clarify judgments. The
downside is being stuffed like a bratwurst into a circular microwave for about thirty
minutes. Nonetheless, its a fair trade.
In retrospect, I wish I had opted for an MRI weeks before. I knew the pain was
unfamiliar and significant; I just didnt want to accept it. I expected my body to
respond as it always had: fast, or at least with a familiar sense of progression. But
expectations werent correlating with reality and pride kept me from acknowledging
the lost linkage. Next time, (I hope) Ill know better.
Images from the radiologist expanded upon my initial diagnosis. I was dealing with a
herniated, not a bulged, disc. In terms an average breakfastgoer can understand, the
space between each vertebrae is occupied by a cushion call it a jelly donut. When
the donut protrudes outside the spinal column, you have a bulged disc. When the
inner jelly protrudes outside its designated space within the center of the donut, you
have a herniated disc. Levels of associated pain depend upon whether or not the
donut (or worse, the jelly) touches a nerve. When and where it does, pain ensues.
Where it doesnt, we carry on.
Post-MRI, I returned to my physiatrist for an official readout and reco. Disc material
was pressing on my S1 nerve at L5; i.e. I had an L5/S1. Not an uncommon injury,
especially among the desk-bound, sleep-deprived, and those with less flex than they
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once had. The diagnosis was worse than originally believed, though not as dire as that
of many other patients.
Viewing images of my back from the inside-out made accepting my scenario much
easier. It also steeled my commitment to take more deliberate action than I otherwise
might have. The jelly - and the donut - needed to return from whence they came and I
needed to create space for this to happen. I also needed to think through next steps.
Armed with additional details, I again ventured online and quickly gathered dozens
of opinions, war stories, and recommendations ranging from the practical to the
absurd. In the span of a few days, I searched, attempted to verify, and searched some
more, hoping to zero-in on a consolidated, widely accepted approach to managing an
L5/S1 injury.
As the pain of sitting and surfing intensified, the road to progress became clear: take
action and work smart. I realized this road would not be paved in lights. Nor would it
be just one click away (then anotherand another).
Twenty-second timeout: within the context of diagnosis, let alone potential recovery
techniques, the quick takeaway is to avoid digital over-investment. Sure, theres
quality content out there and innovative formats for sharing it. There are qualified
practitioners with decades of experience offering their expertise to the world. And
there are useful, accessible approaches to acquiring beneficial knowledge and
support. However, no digital resource will take the place of analog sensitivity, of
personally discerning and articulating what is happening inside your back. And
gaining that sensitivity requires action: sometimes rigorous, yet more often modest,
subtle. Net: stay attuned to your body and thoughtful about how you use the web.
OK, Ill hop off this soapbox for now (and hope I dont re-injure myself in the process).
Aside from the traditional medical sources already cited, there is a wide variety of
non-certified back specialists ready and willing to diagnose and advise. Any such
mavens (yogis, trainers, therapists, shamans, freelancers, etc.) might deliver precisely
what you need. An equal number might not offer the correct diagnosis or approach
for you. This is where personal attention to detail and cross-checking is so valuable,
especially when accompanied by an open mind, respect for the facts, and high-
definition views of your back from the inside-out (again, dont fritter away time
debating whether or not to get an x-ray and/or MRI; the earlier you can obtain and
share pictures, the better).
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The combined opinions of a physiatrist and a chiropractor provided an actionable
diagnosis for me. What works for you might be different, just as the recovery
techniques highlighted later might be individually tailored to your situation.
I also consulted an assortment of books on back pain, though have reviewed just a
few. The reasons are two-fold: 1) for diagnosis, I had access to informed professionals
and therefore little need to play Trapper John, M.D. on myself; and 2) for recovery, I
placed a premium on first-party research and elected to assemble a mosaic of
perspectives on what does and doesnt produce results. Hopefully by virtue of this
effort youll find the enclosed all youll need to get - and keep- your back in the game.
If not, I recommend selections illustrating foundational exercises and holistic healing,
as opposed to alleged quick-fixes, deeply detailed medical references, and/or
psychological cures. Either way, always keep jotting what works for you. Itll
probably be the best material you read.
As you may have accurately presumed, I also conferred with an array of friends.
Enough people have suffered back issues that you can surely obtain ten opinions
within the course of a single day. Ask around. Call, ping, poke, txt, tweet,
writewhatever you need to do. Take notes on every idea and pay special attention
to to-do and not-to-do recos, from doctors and chiropractors to physical therapists
and medications. Each data point will prove in some way valuable, if not also
strangely revealing.
In summary, acquiring a clear diagnosis is a journey, as is mapping the best possible
direction forward. If you arrive at your intended destination fast, terrific. If not, keep
driving. Just dont circle the block too many times. Theres a finite number of
plausible diagnoses that might apply to your situation, and a much larger set of
activities you can embark upon to start making whatever you have better. In my case,
I braked at L5/S1.
After five days of post-MRI-readout mulling, I got to work on next steps, the highlights
of which Ill share with you now.
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Trials and Errors
Learning by doing and sticking with what works.
My quest for full recovery and innovative back health techniques is over one year in
the making. Theres a fair argument this process shouldve moved faster. Given Im
thirty-eight years old and in good physical condition, I accept that. At the same time,
my lifestyle perhaps similar to yours is crammed with commitments: kids, an
intense workload, travel, a highly variable commute, and associated daily mayhem.
This is not an excuse, but an explanation. As much for the time Ive invested as the
practices Ive sampled.
Some of the recovery categories highlighted here may be familiar and my compilation
is by no means exhaustive. In the Recommendations section, Ill expand on what Ive
found works best and share insights on how to achieve daily deliverance when and
where you need it.
First, three alternatives you wont see included: injections, prescription steroids, and
surgery. This isnt to dismiss the clinical importance of each (or all) to individual
recovery. However, in non-debilitating, non-permanent conditions by this Im
referring to conditions allowing a person to at least shuffle from bed to the coffee
maker to the bathroom and not including ruptured discs I have yet to encounter
substantive evidence proving any of these approaches worthwhile. Professional
recommendations may vary. For me, the risks and side-effects of these alternatives
have appeared to far outweigh the returns.
And now my guinea-pig list, in alphabetical order.
An acupressure mat is a personal bed of nails, which may or may not be on your
wish list. Mine is constructed of sharp, white, plastic tacks (i.e. nails) arranged in 2-
inch circles positioned strategically upon a thin foam mat. The mat is approximately
20 inches wide by 36 inches long, for full back coverage/pain infliction. The purpose
of the board is to stimulate the muscles and nerves of the back, and to draw nutrient-
rich blood to where its needed most. This gift from my wife was purchased with the
best intentions (I think), but unfortunately was not associated with notable results.
Perhaps itll work better for you.
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Usability note: not to be attempted shirtless. Or at minimum, add some form of
protection to the upper portion of your back, which will bear the bulk of your weight
and therefore the deepest (healing?) impact of the nails (a.k.a. tacks). Ive used a t-
shirt scrunched to my underarms.
Acupuncture: dont knock it till youve tried it. From that point, at least retain an
open mind. Until my third session, when a needle was placed into the top of my head,
acupuncture was a perfectly valid excuse for a nap. Afterward, I decided Id rather
doze in my car. Net: Im generally down with it, though I didnt experience the
physical benefits or minor epiphanies claimed by many. Perhaps I wasnt sufficiently
zen at the time of my appointments, or maybe I shouldve given the approach more
time. Either way, like the disclaimer on the next miracle diet: individual results may
vary.
Ankle weights: perhaps theyre little more than a post-aerobics-era gimmick, but
they seem to work. The weights help maintain tension in my leg muscles, akin to a
rubber band pulled taut. Ill generally wear my ten-pounders for under thirty minutes
at a time, after which my legs feel lighter and more flexible from hip to ankle, which in
turn helps my back. Plus, ankle weights rank high on multitask-ability. You can wear
them on a walk to Starbucks, while working in the yard, cooking, vacuuming,
roughhousing, whatever non-sporting activity you do for fun. Under pants, theyre
discreet. Without pants, theyre, well.your call. If not a breakthrough, theyre at
least cheap and easy.
At-Home Calisthenics are for you and your crazy self to let loose and get fit. If your
schedule is half as frenzied as mine, its not likely you have time for full-on,
professional-grade back rehab and/or strengthening. The kind often referred to as
extremely fast and effective among Olympic athletes. Your day isdifferent. And
youll need to make the most of what you have. If its sixty square feet in your dining
room, basement, yard, driveway, or anywhere else, it will suffice because it must. Had
I waited on perfect conditions, free time, and a pristine facility, I would never have
turned my back around. Will walk you through a few ideas, as well as moves to avoid.
Chiropractic Care requires selectivity and confidence. Im lucky in having found a
good chiropractor whos focused on express recoveries. Following our first visit, mine
said hed rather not see me again. It was a time-honored marketing pitch. But still,
the feeling was mutual and we amicably dialed it down after six twice-weekly
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adjustments. In the interest of ongoing spinal health, Im continuing to see him,
though less frequently. Were civil. If you dont have a chiropractor, be finicky like
Morris the Cat.
The twin non-benefits of repetitive hip stress and compression of the lower vertebrae
have led me to render crunches worthless. Sure, there are varying techniques and
the reverse crunch may be tolerably useful. But in all, you can definitely and
perhaps more easily get ripped like an action figure without crunches than with
them. They are a classic example of abundant movement, limited accomplishment.
The Gym: get there and dont be a superhero. Post-injury, most of your exercises
should be low-impact, low-weight, high-rep, and brief. Target a modest ramp to
recovery and acknowledge that without progressing through the basics and investing
in some reprogramming, youll never return to full-strength. Net: the gym is another
outlet for recovery and not to be relied upon for the entirety of your routine. Will
draft a few ideas for you.
Heat is generally to be avoided. The biggest reason is that heat will not diminish
swelling, the first order of business for reducing sharp lower back pain. This heat
non-reco includes heat balms, heat wraps, heat gels, and all else heat-related. Over
time (and once youre convinced any initial swelling has subsided), a good heating
pad might prove a worthwhile addition to your rehab supply. Utilized appropriately,
a heating pad can help improve flexibility by alleviating muscle tension. The model I
use emits moist heat and features a self-timer and precise temperature setting. I hold
mine in place while at my desk by wedging the heating pad between my lower back
and a weight belt. At risk of scalding, the belt should be just tight enough to hold the
heating pad in place. Alternatively, position the pad across your lower back while
lying on the floor. From there, prop yourself on your elbows and read, watch twenty
minutes of a movie, surf the web, whatever. Just dont spend too much time with the
heating pad against your back. You want to promote relaxation and pliability, not
broil. Seriously: exercise caution.
Hydrate like youre gearing up for an ultramarathon in the Gobi Desert. As discs are
largely water, a consistently high H2O level will help preserve much-needed space
between your vertebrae, and in turn keep you upright and quick. Ive transitioned
from drinking coffee, sports drinks, and fruit juice on a near-exclusive basis to one
gallon of purified water per day. The new model is paying recognizable dividends. I
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feel not only more energized, but also better able to manage a variety of daily
activities. Driving is less painful, exercising is easier, and the back cracks Im able to
trigger are noticeably deeper and more consistent. Self-discipline is key here, as
hydration is an active process. Over the past few months, Ive traveled to and from
work like a house painter, red and white water jug at my side, filled to the brim with
Seattles finest. Its not that water is unavailable where I work; rather that by keeping
a fixed volume of water nearby, Im better able to manage my intake and remain
dedicated to the task.
Ice remains the ultimate weapon against swelling, the telltale indication of a disc
injury. In the days immediately following a flare-up, I recommend icing at least three
times daily for twenty minutes, then following your workouts. To keep ice on your
back while remaining in an upright position, try a sacroiliac belt. Wedge an ice pack
(wrapped in a paper towel to help avoid frostbite) between your back and the belt. If
your injury is at the very lower end of your back, youll want to be wearing shorts and
go commando during this time. To keep your shorts up and not scare friends, family,
and curious neighbors while icing, use a canvas belt long enough to circumnavigate
your waist plus the ice pack and sacroiliac belt inconspicuously wedged between you
and the back of your shorts. Also bear in mind the intended purpose of the sacroiliac
belt: to relieve lower back stress via compression. When in pain, ice. When theres a
chance youre slipping in the direction of pain, ice. When you have nothing else to do
(slim chance of this, I realize), ice. Its good for you.
Theres a reasonable likelihood my appreciation for inversion is inherited. I recall
my dad had a pair of bat-boots custom cobbled at a local metalworks. They were
cylindrical and designed to wrap around the ankles, with a heavy-duty hook attached
to the front, a hinge on the back, a closure clip also on the front, and carpet padding
around the inside (for comfort). To complete the exhibit of Yankee ingenuity, he
would hang upside-down from a steel bar in our basement. The result: relief for his
aching back. I sought a similar approach when my back pain reached its zenith. And
it made a huge difference arguably the pivotal difference in accelerating my back
health. Today, you can order an inversion table from many sports equipment
warehouses or discount retailers. I purchased mine at Costco and it wouldve been a
bargain at three times the price. Whether or not youre suffering back pain, consider
an inversion table. As a bonus, improved circulation to the brain may help improve
your odds against the Sunday crossword.
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Massage is among the best investments anyone can make. Deep-tissue only and 30
minutes will suffice (though 60 is preferred). Request focus on the whole back,
hamstrings, and hips in particular the periformis. The type of massage I recommend
is not relaxing. Your thoughts should be much more how much time is left (because
this is borderline torture)? than how much time is left (Id like to stay here all day
and might doze off for a few)? You want a massuesse or masseur with strong hands,
knowledge of muscular connections, good listening skills, and an appreciation for
aggressive techniques. Once every three weeks.
On-the-job training is about taking a new twist on old favorites. If youre among the
desk jockeys of the world, a commitment to staying limber throughout the day is
essential. Ive discovered a two-pronged approach works best: 1) stretch at defined
intervals; and 2) correlate office-time stretches with buzzword exposure. The former
is easy; the latter means your number of daily stretches should bear direct
relationship to time spent in meetings. Win-win. Ill share a few ideas on what this
means and how to remain vigilant throughout your daily grind.
Outdoor Rec is for more than Vitamin D. Its for achieving low-tech, sustained
progress using only the motor you were born with. Meaning its as important as any
aspect of a back health repertoire. A large portion of my outdoor routine takes place
at Big Howe Park, just three blocks from our house in Seattle. Ill run you through the
details, as well as biking, hiking, and other off-the-grid suggestions.
Physical Therapy fell short of expectations. Though I visited two of the highest-
recommended studios in the Seattle area, neither illustrated the expertise or
originality I was seeking. Each instead seemed far more interested in walking me
through my own, personally-derived routine. After three sessions and limited
improvement, I scratched PT off my list. My takeaway from the experience is that
with a little insight, discipline, and a repertoire of fitness ideas, you can be your own
physical therapist. Large portions of what well cover later will help you accomplish
better results while saving time and money.
Physical Training may be exactly what you need, but it depends. At the urging of my
first post-injury chiropractor, I consulted a physical trainer. The trainer was helpful,
competent, and high energy. He isolated an important contributing factor to lower
back pain (tight psoas) and illustrated valuable techniques for stretching my
hamstrings and hips. Yet he lacked the breadth of perspective I needed at the time.
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As much as I wanted to return to full-on exercise, I wasnt ready and my needs were
beyond his scope. Net: a qualified trainer can be a terrific advantage, though is likely
a better partner for those lining up their next feat of strength than those seeking
immediate relief. At present, I train to the beat of my own indie rock. Workout ideas
to follow.
Pilates works the core and its often an under-fit core that contributes to back stress.
This doesnt mean a weak overall core, rather relative weakness in vital places.
Pilates is also, minute-for-minute, a phenomenal workout. The style Ive tested is SPX,
advertised as among the more demanding versions. In all, the range of motion
exercises central to Pilates helped improve my back strength and posture. Give it a
try.
Swimming is the ticket to relief for many back pain sufferers. For me, it yielded
mixed results - possibly because of the extent of my injury, compounded by the fact I
float like a stone. In all, I sense swimming can be terrific at helping de-stress the back
and amend minor misalignments. But for disc herniations and more significant
issues, its less likely to fast-track improvements. Another consideration is weaving
pool sessions into an already crammed schedule. Net: Ill re-squeeze into speedo and
goggles soon enough, though I dont anticipate either being a staple of my repertoire
at least near term. If its core to yours, terrific. Someday Ill jump back in.
Phys-ed style toe touches may also be deleted from your files. Theyll compress your
lower vertebrae with little distinct benefit to their intended target: your hammies. If
you have a physical therapist or trainer who wants you to invest time in upright,
bend-at-the-hip toe-touches, politely end the session. Stretch your hamstrings from a
lying down position. Exclusively, every day.
In the course of nursing my back injury, I recall feeling more physically fragile than at
any other time in my life. It was humbling and in many respects still is. One of the
products I purchased to combat this feeling is a weight belt. Mine has Velcro
closures, firm structural support from lower to mid-back, and a snug fit. If youre
envisioning a gut-buster, youd be right on. Ive been known to run (sprints) in mine,
as well as work out at the gym, dine, grill, you name it. An added bonus of the buster
is that it continuously works the core, a primary focus area for improving back health.
I wear mine a couple times per week. To round out the look, try it with ankle weights
(pants optional) and go for the multitasking triple-play.
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When back pain is acute, most yoga time should be traded for either less stressful
activities or continuous Sportscenter from the comfort of your couch. The reason,
corroborated by many, is that many yoga poses can place undue strain on an injured
back. This is especially true of hot yoga (see: Bikram, Vinyasa, and manifold
derivatives), which often includes deceptively intense movements. Ive tried them
and on more than one occasion unwittingly pretzeled myself into worse condition
than I couldve imagined. In all, if you have a yoga habit, I recommend a Lenten-style
break following a back injury. Resume once youre pain free, but not before. Its just
not worth it. And for those fortunate enough not to have (yet) developed a yoga habit,
save your $$ and sweat for additional home equipment and/or a snuggie. At least
until youre back to full-power. Namaste.
Aston Patterning is intentionally outside the alphabetical order of this section, a bit
like positioning the breakout star last in the credits and with the preface And
Introducing. And Introducing: Aston Patterning the under-known, whole-body
approach to health and healing. Whereas many medical professionals attempt to
connect the dots via their standard questionnaire, Aston specialists do it in real life.
They identify the imbalances, tendencies, and points of wear and tear that make each
of us unique. This allows them to focus on the forest as opposed to the trees, and to
treat based upon contributing factors.
The premise of Aston Patterning is that you bring a lifetime of experiences to
everything you do. You move in deep-seated ways, favor past wounds, and rely upon
years of physical intuition. You seldom commune with your kinesthetic sense and
simply do what you do, the way you always have.
At risk of over-simplification, a good Aston practitioner will scan you from top to toe
and ascertain the root answer to why youre in the situation youre in. For example,
one key contributor to my back problems is my right knee, in which I tore my ACL,
MCL, and meniscus. This is compounded by a right hip thats substantially less
flexible than my left. One result has been imperfect balance, as currently manifest in
my L5/S1 disc issue. At least thats a theory. And skeptical as I was prior to my first
Aston session, Im buying it now.
Given a focused consideration set, an Aston practitioner will help release tension
areas and re-program movement patterns. If youre an Aston newbie, fair warning
(1): the majority of treatment I experienced was astonishingly subtle. So subtle as to
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reclassify all techniques previously considered subtle in the same order as a no-holds-
barred Turkish massage. So subtle you may fall asleep on the table. And fair warning
(2): Aston Patterning is not likely on your insurance plans co-pay or (better yet) no-
pay lists. It will be simply pay-as-you-go. Only this investment might really change
your life. I walked out of each of my Aston Patterning sessions in considerably better
condition than the sorry state in which I arrived. Worth every penny.
In summary, for as widespread as back injuries and back pain are, theres
surprisingly little consistency among recovery techniques. We tend to throw many
noodles against the wall, hoping to find one that sticks. In the course of your own
trials, pay attention to the range of pain and relief you experience before, during, and
after every activity. It may vary from day to day, but trends should emerge. Once
they do and you can act on them, your recovery will gain speed.
On the errors side, much of what I experienced was nonetheless worth the effort. The
biggest reason is that the errors (*explorations*) eliminated possibilities. Hopefully
the above will help steer you in an efficient direction without similar time and
expense. If not and you need to throw those noodles for yourself, aim mid-wall so you
dont have to bend too far to retrieve them.
As mentioned above, Ill expand on categories involving the most day-to-day
immersion, including: outdoor sports and rec, at-home calisthenics, officeastics, and
the gym. This list will be supplemented by ideas on travel, nutrition, rest, and
additional things to avoid. Onward.
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Recommendations
Hard-hitting ideas for getting and staying on-track.
There are two additional certainties in life: 3) everyone has an opinion; and 4) youre
probably not very good at following directions. A few might resonate, but before long,
youll more likely be freestyling to your own routine than following anyone elses
script. The ensuing content therefore centers on a well-known protagonist: you.
Chances are, youre pinched for time, cash, and bandwidth. As regards your back, you
have directional conviction, if not a tactical plan for reaching point B. Good news: by
paying attention to a limited set of key moves, employing an adaptable methodology,
and remaining committed, you too can put yourself in stronger position than ever
before.
The following recommendations are segmented by location and category, from your
local park to your home dojo, the gym, the office, and points between. In addition to
the to-do suggestions, Ill also point out moves and concepts to avoid. Fair warning:
nothing here is going into a glossy magazine. Hopefully thats OK with you.
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Park Routine
Lets begin in the open spaces, where you can stretch your legs and savor the fresh air.
Note: if youre in intense pain, portions of the following will not apply. All others
modify to suit your status.
1. When did you last run sprints? By sprints I mean honest-to-goodness sprints,
Rocky-style. Just you, striding across the green grass, at whatever you consider a
barely sustainable pace. Perhaps youre casting your mind to an earlier era: are
we talking five years, ten, more? Chances are, its been too long. Sprinters: you
know the benefits are fantastic. The wind against your face, a rapid sweat,
shortness of breath from something other than climbing two flights of stairs, the
list goes on.
With sprints (and Im referring to relative speed here), your fitness will rapidly
improve and your back will be given an opportunity to relax. In addition, youll
be spared the pounding of longer jogging sessions, all while reinvigorating your
fast-twitch muscles. Pure goodness.
Most sprint days (approximately twice per week, weather-permitting), I run
fourteen 75-100 yard reps. I generally intermix sprints with additional Twenties-
era exercises, to keep my legs fresh and permit sufficient recovery. Give this
simplest of routines another chance. Youll feel ten years younger. Fair warning:
start the first few reps slow and gather speed. Some ex-wunderkinds I know have
ever gone out too fast, pulled a hamstring, and limped home. Not ideal, trust me.
2. Karaoke is another hip-opener and back-tension-release-valve, to which I also
devote 50 yards at a twist. If youve never karaoked, start by positioning yourself
sideways to the direction you intend to move. Lets assume this is to your right.
Bring your left foot forward and across your body, landing to the right of your
right foot. Return your right foot to its original position, then quickly transition
your left foot behind yourself, until it again lands to the right of your right foot.
Your right foot should hop quickly to its original position, and repeat, front and
back, until youve covered your 50 yards. Its a quick move, hop-hop-hop,
involving an important bit of trunk twisting and hip action. As exceptionally
important as the hips are to back health, I highly recommend this exercise. Plus,
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its terrific for improving your footwork. Benefits for your back; benefits for the
dance floor.
3. Because variety is the spice of any workout, I also run in reverse. Why not? Its
like time travel without the hassle of wormholes. At the same time, youll need to
be alert to sprinklers, drainage ditches, Fidos fertilizer, and sundry other minor
barriers to a surprise-free routine. Scout your track first, maintain a straight
course, and you should be fine. Running in reverse is another example of a
motion you probably dont practice every day, which is all the more reason to
integrate it into your plan at least twice weekly. I generally commit one reverse
rep for every five forward, of equal distance and as controllably fleet-footed as
possible.
4. Another classic is the shuffle; a.k.a. the defensive stance. The inspiration for this
exercise is the basketball drills of my youth, when I was on the dribble each year
from November to March. As the name implies, its a sideways shuffle designed to
improve lateral movement while opening the hips. Ill generally do four reps in
each direction, covering approximately 50 yards per rep. The motion is simple:
while engaging your core, lower your posterior to a squat (or near-squat)
position, keeping your upper legs parallel to the ground. Move to your right at a
brisk pace, touching your feet for a fraction of a second, then either turn around
and reverse your lead leg (if youre on a 100-yard field) or shuffle back to your
starting point, facing the same direction. For full hoops re-enactment or
preseason training, keep your palms up and visualize the glory of defensive
shutdowns.
5. Occasionally I do jumping jacks, to round out the Presidential Physical Fitness-
style routine. Shall we? How about once per week, two sets of 100, plus four 50-
yard sideways versions? Your call. I think it would be good. No need to wear
your shorts outside your sweats or count aloud here. Just do it.
6. Back pain relief can be a quest for traction. You want it wherever you can get it.
Sometimes, primarily Saturdays and Sundays for me, this means taking advantage
of playgrounds normally reserved for rambunctious four-year olds. I steer clear
of the climbing walls, rope ladders, and slides, and proceed straight to the
monkey bars. A good two-minute hang can work wonders for lower back pain.
If your local bars are munchkin-level and youre unable to fully extend, dont let
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that be an excuse. Stretch your legs in front of you, bring your heels to the ground
and, while hanging, press your sacroiliac earthward by engaging your core, in
either long (15 second) or short (5 second) reps. The little kids may find you odd,
the big kids my find themselves jealous. You, however, will find sweet relief.
In summary, the idea is to make these moves your own. Theyre all possible in under
twenty minutes and will help improve your back health while affording
cardiovascular + agility benefits. If you feel self-conscious, let it pass. This is your
back were talking about.
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At Home
My family and I live in a 1928 craftsman thats full of quirks otherwise promoted as
charm. My man space is in the basement, all 100 square feet of it. Minus a couch, a
dresser doubling as a television stand, and a side table full of books, Im left with
approximately 60 square feet of exercise area. Its more than sufficient.
The organizing principle of at-home fitness is that any time can be workout time. Ten
minutes between waking up and hopping into the shower: workout time. Eight
minutes following dinner cleanup and before sending the kids to bed: workout time.
Procrastination time: workout time. Fifteen minutes you might otherwise spend on
email: thats right, workout time. Blend it into your daily routine and it will be
impossible to imagine life without it.
You do not need to complete a full exercise repertoire daily, let alone in a single
session. Its far more critical you do something every day and preferably more than
once. If thats three stretches in the morning, followed by another three at night,
followed by weights and kettlebells the next day, or any a-la-carte combination that
works for you, so be it. Youre in charge.
The following is a consolidated set of ideas from among thousands of alternatives,
presented in the order I most commonly carry them out. Theyre all mix-and-match-
able and many can be researched online. Find the combos and variations that work
for you, with one exception: dont do anything that doesnt help you feel better.
1. I generally begin with the cat-back, sway back. Place your hands and knees on
the floor, at ninety degrees, your back level like a tabletop. Arch your back
upward as high as possible, pulling your tailbone underneath your hips. Then in
the opposite direction, arch your back into a convex shape, belly low toward the
ground, and press your tailbone outward. Repeat 10 times, with a five-second
pause at both the high and low positions.
2. Once reasonably warmed up, its time for some big rubber ball action. Lay
chest-down atop an inflated exercise ball (preferably 65-75cm circumference).
For maximum sacral relief, situate your hips at the top of the ball and drape your
torso over the front. (This is the reason youll want a large ball.) Keep your knees
off the floor and hold for a ten-count. Then peel yourself upright and reposition
sideways on the ball. Return your hips to the top, re-drape your torso, hold for
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another ten-count, and repeat on the opposite side. Once youve covered your
front, right, and left sides, lay back-down atop the ball and relax for another slow
ten-count.
Maybe youve seen the big rubber ball in an infomercial, maybe your chiropractor
or a friend has suggested it, or maybe youve noticed one in your local sporting
goods store. If you dont already own one, dont delay. If you do, consider a
second for the office, either as a substitute seat or to stay proactive on the job. It
will make a huge difference and bring new meaning to being on the ball.
3. The trunk twist is another standby. Two approaches predominate. First: From a
seated position, lift your right foot over your left knee, position your left
elbow/upper arm on your right knee and your right hand on the floor behind,
twist and hold for ten seconds, then repeat on your opposite side. And second:
From a lying down position, hold your arms to the side in the form of a T. Lift
your left leg up and across your right side, keeping the upper and lower portions
of your crossing leg at ninety degrees. Bring your left leg as far to the right as
comfortably possible. You should feel the stretch in your lower back and hips.
Hold for ten seconds, then repeat on the opposite side. Of the two approaches,
the second has produced consistently deeper stretches for me, though I also find
it potentially riskier due to the inherent torque of the move. Give both
approaches a try and feel your flexibility improve fast.
4. Then theres the pelvic tilt. Lay on your back, knees bent, feet flat on the floor.
Raise your lower back to where the area from your shoulders to knees is flat, then
lower and repeat twenty times. Slowly. Lift your toes for a deeper stretch. I
spend the greater part of my floor routine decompressing in the opposite
direction in this example lying on my back and pressing toward the floor.
However, its equally important to pivot in the opposite direction, which the
pelvic tilt is designed to do. Stay diligent about this one; range of motion will
keep you spry.
5. Upon introduction to the psoas stretch, I couldnt spell psoas. (Note for aspiring
spelling bee champions and highly motivated parents.) The move is easy.
Position your right leg, quadriceps-down, on a bench, sofa, mattress, or any other
item capable of holding your weight while allowing freedom of movement with
your left leg. Lean upward and back on your right leg by pressing your left leg
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into the floor, feeling a stretch in the groin area along the front right side of your
pelvis. Hold for ten seconds, then repeat on the opposite leg. If youre wondering
why the psoas stretch is important, Ill use psoas in a sentence: A tight psoas can
squeeze lower back discs and limit hip rotation. These are clear net negatives.
Stretch your posai daily.
6. A central event of the at-home workout is core stress. Lay on your back and flex
your core. Repeat 300 times. Simplest exercise ever. Vary the curve of your
lower back every fifty reps. Start with your lower back pressed firmly against the
floor for the first fifty, then relax your back and allow space between your back
and the floor for the next fifty, then a little more space again for the next set
before returning to the starting point of the triad. During the sets where your
lower back does not begin pressed firmly against the floor, the move is to steadily
drop your back to the floor while fully engaging your core. Dont slam your lower
back to the floor; move with control and precision. There are few limits to the
places you can do this exercise and fewer still to the benefit of it.
7. The plank will also help improve the sturdiness of your lower back. From a face-
down position, elevate your body onto your forearms, lean up onto your toes,
stiffen your back into a perfect plane, visualize what inspires you, and hold your
position for 60-90 seconds. As with many core exercises, there are modifications
galore, most notably leg and arm extensions. Experiment. If they work for you,
by all means refashion and incorporate them. My quota is three times per week.
8. Speaking of modifications, the side plank is an oblique-hitting interpretation of
the above. Elevate your body onto your right forearm (or left, if thats your
preference). Similar to the downward-facing plank, hold your position for 45-60
seconds per side. Add light dumbbells, canned pinto beans, or any other weight
to your free hand and extend your hand downward through the space between
your elevated core and the floor, then upward to the sky for the duration of your
workout. Target a minimum of 30 reps.
9. Because lower back power is directly correlated with hip flexibility, youll want to
cross your legs while on your back. Lay on the floor and cross your legs as
though you were sitting in a chair: right ankle on left knee. Then reach through
the space between your right and left legs, grab the back of your left leg, and pull
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your left leg toward your chest, which will bring your right leg along with it. Hold
for a ten count, then switch. Three sets daily.
10. I often add a dose of teeter-totter. Stand on one leg. Hold your hands in front
and slowly lower your torso to a position of ninety degrees, extending your
opposite leg behind. Pause at ninety degrees, creating a T from your head,
through your shoulders, and back to your toes. During the sequence, your hands
should fall in the direction of the floor. If youre able to touch the floor terrific.
If not, extend as low as possible. Then slowly return to starting position and
switch to your opposite foot. Repeat 5-10 times per side. This is a stability test.
Over time, or if youre already strong on your feet, hold a light weight in your
hands, bearing in mind the objective is control and balance. Save your power for
other exercises.
11. During a prior fitness renaissance, Bosu