I’ve struggled with back pain for years and spent a lot of time researching for ways to relieve my misery. Name a form of treatment and I’ve done it. In this article I want to give my personal experience with what helped me with my back pain and what did not seem to make a difference, so maybe you have an easier time navigating through the treatment jungle.
What is pain?
When we are in pain, we often panic. Something has to be damaged! Well, we now know that this isn’t necessarily the case (at least with chronic pain). Study after study shows cases of pain without tissue damage and tissue damage without pain. It is suspected that a pain memory exists that prevents us from doing the stupid stuff that got us injured again.
Why am I telling you that? Because most back pain patients don’t have an underlying injury. Which is good news! The only question is “but how do I tell my body that it stops sending pain signals?” Well, let’s take a look what helped me.
What not to do
Most people want to know what they can do to get rid of their pain. In my experience it is more important to stop doing the things that led to the pain. Combat the problem at the roots! As long as you keep exposing yourself to the problematic stimulus, doing more won’t help you.
Training through pain is therefore probably the dumbest advice you can get. “Just suck it up buttercup, it will go away!” Well, I can tell you that it won’t go away. Maybe shortly it will, but it will come back in full force, and most likely even more painful than ever. Just. Don’t. Do. It. As soon as pain shows up, stop the exercise and every exercise that only slightly gives your pain. When exercising we are full of hormones that numb pain, so if you are feeling it already during exercise, even if it is only a little bit, the problem is already there in full force. Take a break, you are only worsening things.
I completely remove any problematic movement when my back pain shows up again. Anything that involves shear forces on my spine has to go and is replaced by exercises that are “safer”. E.g. barbell squats are out and replaced by belt squats. Really look for any type of exercise that is problematic, there might be some that are not so obvious. E.g. I had to remove even barbell curls at the peak of my pain episodes because they were taxing my back. Most of us are no competitive athletes that have to do certain movements because their sport forces them to do so, so there is plenty of room to work around back pain for general population like us.
Speaking of numbing pain, training while under the effects of pain killers is also a bad idea. Similar to the hormones you produce during training, but much more potent, they remove the pain, but the problem still stays, which makes it easy to overdo it!
Stretching never seemed to help me in any way. Maybe it is because I am already quite flexible, but I also think that my back pain stems from too little stability and not too less flexibility. If you are somebody who is very inflexible and you suspect that this is the cause for bad movement which leads to pain, give stretching a try. Otherwise it likely is a huge waste of time.
Constantly worrying about your back pain only causes it to be (quite literally) in your head. Probably more than it needs to be. I know it can be frustrating to deal with constant back pain, so you research as much as possible about it, you think about new ways of setting up your training and what you can do to make it better, but in my experience it is best to not worry about it too much. Try to get back to a normal life as soon as possible.
What to do
Now I’ve told you about all the stuff you should not do, which I still think, is the most important stuff. But there are also some things you can and should do.
Walking is not very sexy, but incredibly underrated. Underrated in general, but also for treating back pain. Walking more was a game changer for me! I don’t know exactly why it helps, but it does. Probably it has to do with the constant shift of weight from one foot to the other, which lets all the small muscles that surround your spine work, increasing blood flow.
You should keep training everything that doesn’t hurt. Especially pull training sessions (upper body pulling and rowing, not pulling from the floor -a.k.a. deadlifting) has proven to be beneficial. My latest back pain flare up literally completely went away after a rest day and a pull session I did at home using bands. Again, I suspect increased blood flow and passive movement to be the beneficial aspects of this.
I’m not convinced what I should think of direct core (abs) training. I’ve always included core training in my workouts, before, during and after I developed back pain, so at least I can say that training your core will not completely protect you from back pain. As much as I think that core training isn’t the magic pill against back pain, I still think that almost everybody should do it. A strong and well developed core is not only aesthetically pleasing (if body fat is low enough to have a chance of spotting it), but plays an important role in stabilisation during exercise and normal movement. I also don’t think that there are any core exercises that are strictly “better”, just find something that you enjoy (that’s the hard part) and allows you to work progressively.
While it is important to stay away from everything that hurts, it also is important not to live in fear of the movements that caused your pain. Gradual exposure is the key word. Slowly introducing the problematic movement in a save way and slowly loading it are of great importance. You have to signal your body that now, that your “injury” is gone, it is okay to perform the movement that led to it. This process isn’t easy and you probably should seek the help of a professional for this (see below).
Manual therapy like foam rollinger, trigger point massage, “normal” massage and heat therapy bring short term (30-60 minutes) relief from pain, but don’t expect lasting improvements from this. That said, these things can still be very useful to “loosen up” a tight back from time to time and to make movement less painful. As mentioned above, movement is very important for improving back pain, so making movement more enjoyable and relaxed is key. Give different methods a try and see what works best for you.
Try to reduce overall stress as much as possible. I know, it’s easier said than done, but it really helps. Back pain is strongly suspected to have a psychological component and many people who experience stress, suffer from back pain. Correlation is not causation and back pain is not probably (solely) caused by stress, but it still has a strong influence of it and it personally helped me a lot to release my back pain.
You probably want to get some professional help to get rid of the pain as soon as possible and to make sure there is no serious injury going on that needs medical intervention.
Finding a good physio can be very helpful. “Good” means that your physio works with you together to get you back lifting as soon as possible and doesn’t tell you things like “well, squatting is bad anyways, so stop it.” I also hate physios that basically tell you that you are a complete wreck and point all the weak points you have and leave you frustrated. Your physio should help you feel better, and not bury your dreams.
I wasn’t too impressed with what doctors could do for me. Normally doctors sadly don’t know much about sports and are pretty overwhelmed by anything that doesn’t go away with their pain killers. However, they can X-ray or MRI you to see if everything is okay. If they find minor things, don’t get discouraged, we all aren’t perfect and these things are small enough to just work around. Doctors can prescribe you pain killers, which can take the pain away and allow for a normal, more or less painless life, which is very useful for improving your back pain. However, don’t do stupid stuff at the gym because you feel great while taking pain killers! They only take away the pain sensation, which doesn’t mean that your back is fine again.
A coach can help you with exercise selection if you are unsure how to set up a good training program that is challenging but doesn’t set up your back. A good coach can also help with proper exercise technique. While the importance of “good form” is heavily discussed in the evidence-based physiotherapy scene, there are certainly things that are “no-goes”. Proper lifting form is highly individual and sometimes small things matter big times, especially when dealing with back pain. Minor “mistakes” can be completely okay for healthy individuals but set you up for a major pain flare up. These things have to be monitored by a coach and can make a huge difference in your comeback.
Will it ever go away?
Every case is different and I don’t want to placebo you into back pain, but as far as my experience goes, if you once had “the real deal” back pain and not just a slight niggle, you are probably going to struggle with it again and again. But don’t let this scare you off! I know numerous people who have made fantastic come backs, coming back stronger than ever before. You just have to pay more attention to planning taxing lifts, getting recovery and keeping your back healthy than other people. It is a weak spot of you and probably will stay a weak spot, but it should not keep you from lifting!
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