How To Fix Lower Back Pain
Without Drugs or Surgery


© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine AFEM

 

Dr. Bookspan's methods for back and disc pain Health & FItness THIRD ed, and
to solve chronic lower back pain from overarching, The Ab Revolution™ No More Crunches No More Back Pain,
are used by military and top spine centers around the world.

Harvard Medical School clinicians have named her, "The St. Jude of the Joints."

 

Lower back pain is easy to fix. Welcome to Health Care Reform School. This article will show you how to quickly stop common sources of back pain. Then you no longer will get the pain and your back can heal. Not All Exercise is Good Medicine. Here is How To Change to Daily Healthful Movement as Healthy Medicine.

No health insurance needed. Much cost, time, and worry currently spent in medical treatments are unnecessary, and often unhealthful It's not health care if it's not healthy. I have developed information through years of research in the lab, and put it here on my web site for the benefit of the world. Get better and the world will be better.

 

A Short History of My Work To Develop These Methods (skip this to go straight to fix pain)
I am a trained research scientist. I started lab research studies in the 1970s to find why standard back pain and other pain exercises and treatments didn't work. I saw that rehab info was not being applied to how people move and live. I applied it. People got better. When I was working on studies of the human body during immersion for combat swimmers, the experimental subjects, the lab physicians, and others in the lab kept saying they had all these aches and pains. Exercises their own physical therapists and docs gave them did not work or made them worse. I fixed them up. Their doctors started calling me (calling the lab actually, as I don't have a phone) asking how I fixed them so well. They (and their physicians) started taking classes with me. In the 1980s, class participants asked me to write everything down for them. I was surprised. I thought they should have taken notes. I typed information sheets for them. More doctors came to me after taking my classes, saying they knew their standard Patient Handouts were ineffective exercises. They asked me to make handouts for their patients. I was surprised. Again. I thought they could do that themselves. I typed Patient Handout sheets for them. I kept collecting data like a good scientist, doing studies to test and retest methods, and develop better ones. When the internet came out, I sent handouts electronically, instead of photocopies. In the 1990s I typed everything in several training manuals that became books. One is Health & Fitness In Plain English - How To Be Happy, Healthy and Fit for the Rest of your Life. After two different publishers, the new THIRD edition of How To Be Happy, Healthy and Fit... eliminates wrong things previous publishers added over my objections. Another book is Fix Your Own Pain, with patient stories in every chapter showing why patients get better, or don't, and why. Several more books of my life's work tell how to make life pain free, stronger, and more fun. Each book is different.  I have seen fitness and rehab myths and fads come and go, but these methods remain effective over time. More about me in Research. See the books on the BOOKS page, and at the bottom of this article. Now, go fix your pain.

 

To make this an easy summary for you, much is shortened. The books tell more.
Use this to get better now, and get the books to fill in the rest.

Back Pain – Why?
Editorials, studies, and news reports state that back pain is mysterious and difficult to remedy, but back pain is not difficult to fix or prevent.

Eight of ten people in the United States have back pain at some point- trying hundreds of thousands of daily treatments – physical therapy, surgery, exercise, massage, pain management, chiropractic, acupuncture... Why do they so often fail? The answer is simple. People do an astonishing number of things every day to strain, weaken, and pressure their backs. They stand, bend, sit, and lift wrong every day, hold muscles tightly while they move around, then do bad exercises that add to the strain. They may do "back exercises," but not be aware that strong muscles will not automatically give you good posture, make you bend and lift properly, or make up for all the things you do the rest of the day to hurt your back. People wonder why they still get pain even though they "do their exercises." Many wind up in back surgery, or long term or recurring pain, not understanding why their physical therapy or exercise program, or pills, or yoga "didn't work." They call it "stress." Instead, it is simple to retrain unhealthful movement and habits. Then you stop the cause of the injury and the pain will stop. Here is how:

1. Bad Discs (herniation, degeneration, bulging, slipping discs), Sciatica, and Lower Back Strain
You know you shouldn't lift wrong, But you do – all day, every day – picking up socks, petting the dog, for laundry, trash, making the bed, looking in the refrigerator, and all the dozens of times you bend over things. Then you go to the gym and lift weights bent over, stretch by touching your toes, do yoga by bending over at the waist, then lift and carry bags like that. No wonder your back hurts.

  • The pressure of your own body weight on your muscles and discs over years of poor sitting, standing, and bending habits is enough to injure your back as badly as a single accident.
  • All this chronic forward bending (flexion) overstretches the muscles and long ligament down the back, which weakens the back, and pushes vertebral discs outward.
  • After years of squashing your discs with bad posture, and pushing discs to the back with forward rounding, the discs eventually break down (degenerate) and push outward (herniate). The resulting herniation can press on nearby nerves, sending sciatic pain down your leg. If you squash and push the discs in your neck with a forward head posture - letting your head drop forward, the disc in your neck may herniate and press on nerves, sending pain down your arm.
  • Tight muscles from years of poor positioning and short resting muscle length can also press on the same nerves mimicking sciatica.
  • A degenerating disc is not a disease, but a simple, mechanical injury that can quickly heal, if you just stop grinding it and physically pushing it out of place with terrible habits.


This is a side view of your spine. Left - normal disc between two vertebrae. Right - disc pushed out (herniated) from bad bending habits.
Chronic forward bending from bad sitting and bending over gradually pushes discs outward to the back.
If you sit and bend properly, you will stop pushing your discs out and they can heal.

 



Sitting with lower back rounded (and bending that way too)
can eventually hurt the soft tissue and push lower back discs out (degenerate and herniate or bulge them)

 

Discs Can Heal
Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal - if you let it, no differently than a sprained ankle. Stop damaging your discs with bad bending, standing, and sitting habits and the discs can heal. It takes years to herniate a disc, and only days or weeks to heal it by stopping bad habits. Several things contribute to disc pain. Read the rest of this article, try everything that makes sense to you and doesn't hurt, then go to the free article on Fixing Your Own Discs and Sciatica.


Muscles Can Heal
When you over-tighten muscles with hunching and bad habits, they can remain too shortened to let you stand properly. Or they stay tightened in “knots” or spasm. This changes their muscle chemistry. When you slouch, you keep muscles overly stretched, which weakens and strains them. Stop straining your muscles and they can heal.

 

Functional Exercises to Strengthen and Retrain Your Muscles
 Back pain exercises are misunderstood. Are you injuring your their back all day then hope to fix it with a few exercises? This does not work. When you stop bending wrong many times each day, which injures your back many times each day, it will stop hurting and can heal.

If you lie on the floor to do exercises, then stand up and walk away with no use of the positioning or strength you just practiced, it is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work." The key is what you do all day.

Try the following slowly. See how you feel the next day, then increase. Use these moves, not as exercises to do 10 times, but to retrain how to bend and move all day. Stop hurting your back with bad bending and your back will stop hurting. Start strengthening your body and legs with good bending and you will get free exercise all day:

- Squat. You know not to bend wrong to pick things up, but you do it. Every day. Hundreds of times a day. Instead, bend your knees. You already know that. But do you do it? Are you avoiding it because your legs are too weak, and it hurts your knees? Done right, it will prevent both back pain and knee pain. The squat is for all the times during the day you need to lower yourself to bend and reach things:

 

Use the squat for all the many times a day you bend instead of bending wrong

  • Both feet are side by side.
  • Your upper body stays upright, not bending over forward.
  • Keep both heels down on the floor. Don't lift your heels.
  • Both knees stay back over your ankles, not sliding forward, which hurts the knees. Good bending saves your back and strengthens knees and prevents knee pain.

 

- Lunge. The lunge retrains bending habits and gives you free leg and back exercise at the same time. Done right, it will prevent both back pain and knee pain. Use the lunge for daily bending:


Another way to bend properly is the lunge (left) for all the many dozens of times you bend every day.
Keep front knee over ankle (left) not forward (right).

  • Stand up, feet apart. Slide one foot comfortably back, keeping foot straight not turned out.
  • Tuck hip under to remove back arch and stretch back hip.
  • Bend knees to dip to the floor without touching the floor. At least dip down a few inches.
  • Don't let your front knee come forward. Keep your front knee over ankle. This is the most important part of using the lunge to save your back - you shouldn't hurt your knee. Done properly, the lunge strengthens and protects your knees too.
  • Don't arch your back. Tip your hip under to prevent arching and straighten your posture. Don't lean back.

The key to how the lunge fixes your back - is it not an exercise that you do 10 times a day. You use it for all the hundreds of times you bend and reach down in a day. Stop hurting your back with bad bending and your back will stop hurting. Start strengthening your body and legs with good bending and you will get free exercise all day.

 

Unless you are moving in healthy ways for your real life, it is not a lifestyle and it is not healthy. Healthy bending, sitting, reaching, sitting, standing, and moving is easy and life changing. It is free exercise and injury prevention. When should you do it? Each time you want your daily life to be healthy



2. Lower Back Pain After Long Standing/ Running/ Walking -
If you feel you need to lean or bend over forward or lift one leg to stop the pain, this kind of pain is usually from standing with too much inward curve in the lower back. Summary follows below. Read the full article here.

Standing with too much inward curve of your lower back is called hyperlordosis or lordosis. Hyperlordosis (overarching) is a major cause of "mystery" back pain and injury. It does not often show up on x-rays and scans. Some people overarch by sticking their behind out in back. Another common hyperlordosis position is to lean the upper body backward when standing, reaching overhead, and lifting things.


Two main kinds of overarching the lower back (hyperlordosis).
Left - tilting the hip forward and leaning the upper body backward. Left and Right - leaning the upper body backward. Overarching presses upper body weight down onto the lower spine. Pain is usually noticed after long standing, walking, or running.To fix this pain, simply voluntarily stop standing with your spine in this unhealthy, injury-producing posture.

  • Hyperlordosis is an increased inward lower back curve (arch). Also called“swayback.”
  • The increased arching presses on the joints of your spine, called facets. This is the cause of facet pain and much general low back pain.
  • Hyperlordosis is not a medical or structural condition. Hyperlordosis is a posture you can control by using torso muscles to move your spine away from the arched position into a straighter healthier position, described below and in the free abdominal muscle article.
  • “Hyperlordosis of Pregnancy” is the same preventable bad posture. It is juts leaning backward to offset the load in front. Don't lean backward.

How To Stop Back Pain From Lordotic Arching
The free abdominal muscle article summarizes, and the book The Ab Revolution teaches exactly how to reposition the spine and use the repositioning for all you do. In short,

1. Stand with your heels, backside, upper back, and back of your head against a wall.
2. Press lower back toward wall. The large space between your back and the wall becomes a smaller space. Do not flatten against the wall. Belt line is horizontal from front to back. Back pain from overarching should stop right then, if you do this right.
3. When you walk away from the wall, use this new neutral spine position all the time.

  • Use your own muscles to reposition your spine, no matter what else you are doing
  • Don’t lean your upper body back when carrying things in front of you (anterior loads) like a chair, grocery bags, a pet, or baby.
  • Don’t lean back when lifting or reaching overhead.
  • Don’t let bags or loads pull your posture away from healthy position. Stand straight no matter what you are carrying.


Aren't You Supposed To Overarch and Stick Out The Behind In Back?
A small inward curve belongs in the lower back. Unfortunately, people hear that, and overdo. Overarching is not the normal curve to the lower back, it is not neutral spine, and it is not the way to protect your back when lifting or exercising. An injurious phenomenon in fitness and "health" magazines is to stand and exercise with the hip and behind tilted out in back, and the lower back overly arched. It is not attractive because it is not healthy. It is sloppy posture, unhealthy for the lower spine, and shows a lack of understanding of how to use core muscles to hold neutral spine. Overly-arched posture is promoted by popular fitness personalities, and popular exercises, where it is mistaken for, even advertised for, fitness and trimness. Trainers often tell clients to stick their behind out when squatting or lunging, however this is too much arch. The hyperextension is damaging to the low spine joints and soft tissue. It also does not use core muscles effectively.

 

What Do Abs Have To Do With This?
Abs work like any other muscles - they bend the joints they cross. For example. biceps bend your elbow forward (or keep it from straightening). Abs cross your vertebrae. They bend your spine forward or keep it from swaying backward, but only if you voluntarily engage them. You need to deliberately use your abs while standing to hold you from backward arching, particularly when reaching overhead and carrying loads.

 

Using Abs (or any muscles) Does Not Mean Tightening Them
Using your abs doesn't mean “sucking them in” or making them "tight.” You can't breathe or move properly with tightened muscles. Tightening does not change your posture or reduce the pain-producing arch.

 

How Do Abs Help Your Back?
Using your abs means voluntarily moving your spine away from overly-arched position, and into neutral spine when standing. It is not a matter of having strong abs. A slightly-built person can stand with neutral spine, and muscular people can have overly-arched spine posture. It is a matter of using abdominal muscles to prevent the overarching that causes pain. The Ab Revolution™ teaches this concept and shows how to use it during all daily life and exercise movement.

 

Doesn’t Doing Crunches Help That?
It is not strength that makes you stand correctly. It's how you hold your own posture. Many muscular people stand with terrible posture and have back pain.

  • Crunches don't work your abs the way you need for real life.
  • Crunches don't train you how to use your abs the rest of the day.
  • Crunches promote poor posture, even when done properly.
  • Crunches make a person, who likely spends much of their day already hunched over a work area, practice that hunched posture which may be mechanically promoting the back and neck pain they think they are working their abs to prevent.
  • Most people do their crunches then stand up arched with no knowledge that back support comes from voluntary posture, not automatic strengthening.

What About Pelvic Tilts?
A common ineffective exercise often given for back pain is to lie on the floor and tilt (tuck) the hip. But then the person gets up off the floor and lets their lower spine arch as they walk away, and the pain returns. It is no mystery.

  •  The purpose of the tilt "exercise" is to practice how to use your abdominal muscles to move your spine out of painful arching, into healthy position that you then *use* for all your standing movement.
  • Tilts will not strengthen.
  • Even if tilts strengthened, back "support" is not automatic. Strengthening any muscles will not change an injurious standing posture which causes pain.
  • Stronger muscles do not automatically move any body part anywhere. You have to use them to move you into desired posture.
  • The use of pelvic tilts is to retrain how to reduce your lower back position, then use that knowledge to move your back into proper position when standing.

 

Abdominal Muscle Exercises
- Use the introductory exercises, explained in the full ab article to retrain lower spine positioning during how you walk and go about your day. If only used as "exercise," that is missing the point.
- More exercises to retrain abs for daily life and back pain rehab are in the book, The Ab Revolution™ No More Crunches, No More Back Pain. Also come try our Ab Revolution™ classes.

 

Pain When Your X-Ray is Normal
You may be in great pain from simple damaging mechanics. Your X-rays and scans are normal. You may be told nothing is wrong, or to give up favorite activities. Your pain persists from bad postural habits. This is no mystery. Change the bad habits to change the pain.

When Pain Is Not From What's On Your X-ray
Other times, the scans show some minor problem like arthritis, herniated disc, or degenerating structures. Just like car tires that are mid-life, but perfectly good, some wear may show on exam – but this is unrelated to performance or pain. Pain is falsely ascribed to the arthritis. Patients feel doomed, and are often told to give up activities. Pain (even the anomaly itself) may mostly result from poor mechanics. This is no mystery. Change the bad habits to change the pain.

Sometimes, the scans show some major problem, and major surgery is performed to correct it. When the original problem was from the bad positioning, often pain persists or returns because you never corrected the mechanics that caused it. The defect itself may return from uncorrected mechanics. Surgery can be avoided. Fix the source of the problem and the results of the problem can heal, usually without surgery.

Food Contributors
There are foods that promote inflammation - dairy, meat, refined sugar, white flour.
Instead, eat anti-inflammatory foods - leafy green vegetables, flaxseed, cherries, grape skins, blueberries, spices like ginger and turmeric.


The Point of Exercises
 Strengthening and stretching are important, but do not change posture or lifting habits, and so, do not “cure” back pain or posture problems. Use this new Dr. Jolie Bookspan method of using your brain and voluntary healthy movement habits to stop the source of pain. I have redesigned back exercises to be used to retrain you how you hold your body all the time.

Doing back exercise is not like getting a shot of penicillin or going to confession. It does not “fix” bad habits the rest of the time. For example, lying down for pelvic tilts, then standing up and letting your back flop into any old bad posture, not keeping the proper tilt. Back exercise is supposed to retrain your thinking and habits *all the time* not just something to "do 10 times." Strengthening has no effect on posture if you don’t apply the strength the rest of the day to control joint angles for all activities.

How to Stretch Your Hamstrings Without Ruining Your Discs
Tight hamstrings are commonly thought to contribute to back pain. The irony is that many hamstring stretches are done in ways that bend forward, putting degenerative forces on the discs. Leaning over at the waist, both standing and sitting, for toe-touches does stretch your back and hamstrings, and may feel good, but it is terrible for your back. This is true even for yoga stretches where you bend over forward sitting or standing touch toes. You know never to bend over like that to pick things up or sit like that at your desk. It doesn't magically become good for you by calling it a stretch.

- Lie on your back and hold one leg in the air, keeping shoulders, head, and hip flat on the floor and back straight. Keep your other leg straight and flat against the floor too. If you can't do this it may be because the front muscles of your hip are too tight. Use this retraining drill to stretch and straighten, not further round the back.See the stretching article.

Don’t Exercise in Ways that Damage Your Back
Many people hurt from excessive forward bending. Then add many exercises with more forward bending - toe touches, knee to chest, most PIlate's exercises, and crunches. Often these exercises are incorrectly prescribed for back and neck pain. They contribute to the original problem of over rounding and bad posture. Stop crunches. Use functional exercises instead of concentrating on forward bending programs such as Pilates, and certain movements in yoga. Click this article on bad exercises. Click the class page for yoga classes that teach healthful movement.

 

What To Do Every Day To Prevent Back Pain
  • First thing in the morning, don't sit on the bed. Instead of sitting and rounding your back first thing, turn over and lie face down. Prop gently on elbows, but not so high that it strains. Don't do this if it hurts. It should not hurt to simply lie straight. It should feel good and help you straighten out first thing. Get out of bed without sitting.
  • Count how many times you bend each day. Imagine the injury to your back by bending wrong that many times each day.
  • Lift using the squat and lunge, not by bending over.
  • Stop injurious forward bending exercises, including crunches, toe touching and most PIlates exercises.
  • Stand and carry things without rounding your upper back forward, or leaning back (exaggerating lumbar curve to the back or side).
  • Sit in car and desk in healthy ways. Free sitting article.
  • When sitting, it is not true that you must "keep feet on floor" or keep “flat thighs” - parallel to the ground. That is often repeated, but it does not change injurious mechanics and is not needed. Focus on the main issue, not the trivia.
  • Learn the upper back principles and restore upper back muscle resting length using the free Fix Upper back and Neck Pain article.
  • Don’t tighten your muscles to move or exercise.
  • Walk, run, and jump lightly. Don't jolt your joints.
  • Make sure your pain is not from medical conditions (vascular, infection, other) or from many medicines known to have body pain as side effects.
  • Notice injurious positioning and exercises in fitness magazines. Then notice your own habits.

Easy Back Saver reminders for commuting, sitting, exercising and other activities- click items.

 

How Long Does It Take To Fix Back Pain?
You should begin to feel the difference the same day as you try everything as presented above. If you are not feeling better right away, check what you are doing compared to what you have learned in this and the other articles on this web site.

It takes years to hurt a disc and tie muscles into knots, but only days to start healing once you no longer are injuring it. Make sure there is not something else contributing to your pain. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.

Summary
Back and neck pain is not a mysterious "condition." People spend their day sitting, working, walking, and driving in terrible posture, hunching over the computer, lifting and bending wrong all day, walking heavily, and slouching all day, and then exercise in ways that strain and pressure discs and muscles. They do yoga and Pilates that forcibly pushes discs outward, and reinforces flexed (bent forward) hip and forward bending. They take anti-inflammatory medications for mechanical pain that is not inflammatory in nature, try remedies that do not address the cause of the problem, do physical therapy in ways that exacerbates the original problem, give up favorite activities, have surgery, then return to previous injurious habits, and everyone is astonished that they "tried everything and nothing seemed to work." It is like eating butter and sugar all day, then waving your hands in the air for 5 minutes and saying "I don't understands why I don't lose weight, I do my exercises."

  • Use healthy positioning to stop the cause of disc damage and muscle pain and they can heal. Then no need for pills or surgery or adjustments.
  • Don’t memorize complicated rules. Just use muscles easily to reposition for daily life.
  • Please do not e-mail me saying you are "doing the exercises 10 times" and want me to tell you how to fix pain from bad positioning." Here is your answer now: Doing an exercise then going back to unhealthful body usage is missing the point. Stop bad bending and unhealthful positioning and habits. Stop the causes and the pain will stop. This free article summarizes. The books tell more.
  • How is your body positioning right now? The whole point of exercise and therapy is missed if you don’t learn to consciously use healthful positioning the rest of the day for standing, sitting, bending, and all you do.

 

You Don’t Have To Live With Pain

 

What To Do Next:

Now that your back is better and you have hope again, click the DONATE box. think of the hundreds, maybe thousands of dollars you saved unhealthful pills, surgery, expensive products, and unneeded medical treatments :-)   I receive no salary to write this, have no paid desk job, and all my patients got better so no income from "rerun" patients. If you send anything, it is appreciated. Go green and recycle money -

thank you !

More Fun Things to DO:

 

Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats.
- Howard Aiken

 

 

That said, this information, drawings, and photos are © No Derivative Works 3.0 United States License. To cite it you must preface with byline author Dr. Bookspan, this link and this site name.
This article is here to benefit the world.
If fixes your pain, send it to a friend (the article, not the pain).
Pass on goodness. "Make health contagious."

 

HOME || Dr. Bookspan's Office and Fix Pain Articles || See My Research || Academy and Fellow Advancement || Thai Massage || Gifts || The Ab Revolution™ || Classes and Certification || Books