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To Fix Back Pain, You Might Have To Change The Way You Sit (npr.org)
102 points by muzani on Aug 14, 2018 | hide | past | favorite | 71 comments



If anyone here suspects their mattress is causing them back pain, I have a mattress buying technique that worked well for me.

Buy a firm or very firm innerspring mattress. This does not have to be expensive, I got mine at IKEA for $300. Sleep on it a couple nights to find out if it is too firm for your tastes. Adding a 2 inch thick memory foam mattress topper can cost about $60 and will take your firmness to about medium. 3 inches would get you a very soft feel and would cost $100.

Now you have a mattress that won't hardly ever wear out- you can replace the topper as it wears- and was a good value and is easily adjustable in firmness depending on your preference. I also added a waterproof mattress protector sheet, this is probably overkill.


I think your advice would work well.

I've been buying whole beds from one manufacturer (brooklynbedding.com & dreamfoambedding.com) to find that "sweet" spot for me. I'm on my second bed and things are getting better but this is wasteful and expensive. Of note, our bodies change over time, so what is comfortable during the summer (lots of exercise) might be different during the winter months - also changes that occur as we age. I think preventing weak muscles from developing around the spine might be beneficial.


Also, foam toppers are insanely comfortable on nearly every mattress. I'm addicted to mine.


I used to have problems with back pain, neck pain, various aches and pains and “knots” and so on.

Now I don’t. At all.

The difference is that I started lifting very heavy weights at least twice a week for about an hour each time. Like a standard strength training or bodybuilding approach. I’m not actually particularly jacked up, that’s a pretty laid back pace.

My issues with back pain are now just completely gone. If I have to take more than about 10 days off they slowly creep back. But a day of deadlifts and shoulders and so on fixes that.

It’s not science, I have a sample size of one. But it sure seems to make a positive difference.


I can second that anecdote. I took up weightlifting (Strong Lifts 5x5) about two years ago. I used to have pretty regular back pain, but weightlifting 3x a week and it went away. I've also noticed that my standing posture improved on it's own as well.

As anyone whose done squats near their max can tell you, it's far from effortless, but over time a few co-workers have joined me and they've had similar benefits.

For anyone looking to get started, I'd actually recommend Starting Strength (by Mark RippleToe)over Strong Lifts, but really any of the common programs (Ice Cream Fitness, GreySkull, etc) are good.


For anyone looking to get started, I'd strongly recommend getting a trainer over a book. Chances are, especially if you've never done any sort of training, you have no idea how to properly do the basic movements like squats and presses and deadlifts. Especially deadlifts if you're doing this because you have back pain.


I would recommend a book (and YouTube) over picking a random trainer from the set of all possible trainers. I know some that are way better than a book, but I've also seen plenty that don't know how to squat or deadlift, much less teach someone else. If you're at a powerlifting or Olympic lifting gym specifically, absolutely use one of the trainers from there. Crossfit too. But if you're at a typical chain gym, I would not trust most trainers.


I'm a big fan of lifting heavy things. But I also have to admit that much of my lower back pain has been caused by injuries from lifting heavy things. All sports are going to eventually cause some form of injury, and lower back injuries are common among people who lift heavy things.

For the foreseeable future, I've decided to avoid low-bar squats because they use my lower back too much. I've switched to high-bar, which allows me to keep my hip and spine stacked in much the way talked about in the article. I've also made a point to lower the lifting intensity when I increase the intensity of my other activities (grappling). Pushing hard with heavy weights and then making hard demands in other activities can cause problems as well.


> I started lifting very heavy weights

I've been thinking about doing this and was wondering how people get started. Did you hire a trainer? I'm very worried about injury and, as I understand it, a big part of staying injury free comes down to good form. I think I would benefit a great deal from having a trainer to get started. Did you?


Well the first thing to note is that "very heavy" is a very relative term. What scared me at first is now way below what I would even warm up with after a few years. So make sure to start out very light and take your time working up to things.

I don't know what's "ideal" but I can tell you what I did. I joined a regular gym, and a crossfit gym near my office at the same time. Was feasible to do since both had great intro specials.

Crossfit gets a bad rep in some parts of the internet but the owner was an experienced olympic weightlifter and knew what he was doing. I went 3 days a week for the first three months religiously, and asked a lot of questions about how to lift with proper form and all that.

In retrospect I probably didn't actually need to do that, but it took away a lot of anxiety. As a guy in his 40's I knew I didn't know what I was doing, and of course all sorts of strange and unfamiliar aches and pains and soreness came along at first and having someone experienced helping me made me feel confident that those were normal.

After the three month trial was up I let the crossfit thing lapse and started Stronglifts 5x5. They have a great app and set of videos that just tell you exactly what to do, it's great for beginners. The linear progression they use should keep you busy for a year or so before you start to feel like you need something new.

After a year or two I got a personal trainer, but it was mostly just for efficiency because I got really busy. I get a lot more into a single hour than I used to. He helps get things set up and so on and pushes me. One thing that I did do was tell him I just wanted to lift weights so I wouldn't waste time on random exercises. You have to manage a personal trainer like anyone else, and if you don't like things they have you do then don't do them, manage your own program too.

Hope that helps.


Form is definitely important to preventing injury, but that doesn't mean you need to hire a trainer. Trainers can be quite expensive, especially when you are first starting out. Trainers in my experience are a better fit when you are already pretty serious and need direction to "get to the next level" or need assistance like rehabilitation therapy.

Most good gyms will have some people on staff that can help you with questions about good form. If you are unsure about good form, ask someone that works at the gym if they can come give you a look over and give some pointers.

Also, there is a reason there are mirrors all over in the gyms; it's so you can watch yourself to make sure you have good form.

One last pointer; start light. Lifting too heavy will lead to bad form and injuries. A classic example is curls; people lifting too heavy on curls will throw their back a bit on the lift and injure their back. So start light, watch your form, and slowly add those weights.


Mirrors are actually not that great at checking form - the act of looking in the mirror changes how you move. Now that just about all of us carry high quality digital HD cameras in our pockets, that's the best way to check form.


This is all great advice, thank you.

> Trainers can be quite expensive

I'm maybe a little embarrassed to admit this, but paying for a trainer will help me commit. If I'm paying for an hour of time on Thursday morning, I'm more likely to show up.


That's nothing to be embarrassed about. It's hard to commit until you're fit. Eventually you get to a point where you look forward to going to the gym if you stay with it long enough.

If you have a good trainer that can help with the commitment issue. If you have a bad trainer it can make it worse. I've had both. I had one trainer that wouldn't listen to me and just always pushed to hard; then during a session I puked from over exertion. I was so angry and embarrassed I didn't go back to the gym for over 3 months.

Anyway the point there is if you are going to get a trainer then vet them before you sign an agreement.

A couple of other options to help with commitment is to join a fitness group or a class like Farrell's (https://extremebodyshaping.com/).

Some of these have support/accountability groups so if you no show someone is going to call and ask where you were and in return you do the same thing


I never did any weight training till I was 31 years old. To start with, I looked up beginer's lifting schedule on Internet. I started with one day of lifting and one day of running.

As you go along, you will develop your own ideas and know what works for you, so you can modify the program to suit your own needs.

What you can do also depend on what equipment you have easy access to. Harder/longer it is to get to the place of workout, harder it is to get into habit of working out.


Good form is key. I never used a trainer, but there are a lot of videos on youtube that outline common pitfalls and there are places like reddit's formcheck where people can critique your lifts if you upload a video.

Starting with low weights and working on form for the first week or two while video'ing yourself and comparing yourself to instructional videos will allow for self critique.

I personally never had a trainer, but have had good success with self critiquing.


You're just articulating the problem for 90% of people comes down to muscles. Whether it's weakness in their entire hip flexor core or general tightness. A lot people over look how much that entire chain impacts the entire lower lumbar. Any good PT will explain this to their client.


It helped a lot when I did aerobics. It might not just be weightlifting, it could be that any heavy exercise will do.


Same. Solved chronic back pain by performing sun salutations 15 minutes every day.


If all you have is a hammer, everything looks like a nail. Biomechanics are only one part of the complex picture regarding back pain.

This article is full of outdated value-laden and fear-inducing language such as "spine is in an improper position", "should sit better", "stressing their backs", "think of a disk as a jelly... jelly can squirt out", "bend over properly". This sort of language has been demonstrated repeatedly to encourage avoidance behaviours and exacerbate problems.

Of course, a dog has four legs, and some things with four legs are indeed dogs. Biomechanics are a part of the picture, but only part.

Here's a great summary of the problem: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...


article available here as pdf without registration:

https://www.researchgate.net/publication/323920714/download


I read about this a long time ago in a book by Esther gokhale called lose the back pain. I think she called it stack sitting iirc.

There was another thing in the book that has really helped me over the years and it's called the shoulder roll. The way to do it is to roll your shoulders in counter clockwise motion and leave it when they move back. It really does help while sitting.

That book was full of such things like hip hinging, walking properly, etc and pictures incidentally also of Indian men who do hard labor much like the loom guy in the article.

Here is a relevant video from her: https://youtu.be/k1luKAS_Xcg


It would be really much more helpful with a proper illustration, instead of explaining how to sit with words. Or to put it differently: instructions unclear, leg stuck behind neck.


The photo of the man explains it. But agreed that it could be better.


Has anyone had success for trapezius muscle pain and found a good fix? Part of my problem with sitting at a desk is my shoulders/neck always hurt. I think the issue is that I need my wrists fully rested on my desk to avoid wrist pain, which then forces my shoulders to always be outstretched and flexed. I do have my monitor eye level and a solid adjustable chair. Have bought all other ergonomic equipment too and now looking into getting a contoured desk top to help as hopefully the final piece. Would love to hear your experience.


I have two tips.

One is yoga, and in particular the "cobra pose", to flex your back in the opposite direction. You can do it several times a day, also at work.

The other is to increase awareness of your posture. Download a time-lapse video app for your phone, and make a time-lapse movie of yourself sitting at your desk during a day. You can show this movie to a therapist, so they can comment on it.


Your tip on the timelaps will make its rounds here in the office since many people suffer and this is an excellent tip to get real help.

Bikram yoga is my poison of choice BTW. I found that really easy for a starter.


Timelapse video idea is a good one. Going to try that because it's so hard to be cognizant of posture all the time.


Some thoughts from my experience:

1) You mention your shoulders being outstretched and flexed when you work, that's a good place to start. When I work at a desk, I try to maintain a posture that keeps my arms parallel with my body until the elbow where my forearms then extend at a 90 degree angle or so. When I think of someone with their arms outstretched, it's hard for me to not imagine you're also leaning forward at least a bit which also puts stress on your neck. Aside from changing desks, you might want to look into an under-desk keyboard/mouse drawer/shelf to lower and extend those things to you in the correct position. You shouldn't be stretching to work at a computer.

2) Headphones. For me, hours wearing big over ear headphones can leave my neck and shoulders sore even when sitting with perfect posture. Consider using earbuds when you work.

3) Your bed. Most neck and back problems start in the bed, whether it's having a pillow that's not properly supportive or has dust mites, not turning your mattress often enough, sleeping on an old lumpy mattress or just sleeping in the wrong position. These things can all contribute to neck and back pain. Don't rule out the possibility that multiple factors could be contributing to your pain.

4) Light exercise with stretching/yoga. Can help eliminate lactic acid from your muscles contributing to the soreness.

5) Diet. This one's sort of on the low end of potential fixes but having too many foods that increase uric acid levels (alcohol, meat, dairy, fried foods, soda, etc...) could lead to joint stiffness in general or increased difficulty for your system in breaking down other acids that lend themselves to soreness like lactic acid.


Thanks for the detailed response. Agreed it's probably a holistic issue. Tough to live well when you're working on a computer at your startup all the time. Need to chisel out time for exercise at least.

Also hadn't considered headphones before. The ones I have are over ear and now that you mention it are pretty heavy. Easy switch.


I use the Microsoft sculpt keyboard. It has a detached number pad, which means you can move your mouse closer in line with your center of body, plus tlergonomically angled keys. I also use a mouse which let's you keep your wrist more naturally perpendicular to the floor.


I use a Kinesis 2 for Mac split keyboard at work. Definitely helped me get my arms more perpendicular to my desk and the the built wrist supports really help too.


What mouse?


A good posture wasn't enough for me (back, shoulders, wrists, good chair, everything...), what really worked, in my case, was weight loss (-17%). Now i'm in the very average, pain is entirely gone (sometimes i couldn't even sleep).


For me, using wrists supports makes all the difference. I switched to an 'Ultimate Hacking Keyboard' today which has wrist supports as an option; before this I've used an Ergodox for years which I used foam wrist supports with. I think the key to wrist supports is using a split keyboard, and setting it up for negative tilting (i.e., sloping away from you).


I'm having the same problem but started standing more on the standing desk, with a ratio of about 30 min standing to 30 min sitting as I read somewhere. I figured out that when I'm standing I become more aware of my shoulder position and fix it a bit. Started also doing so workout for my upper body and I guess that's helping a bit


A basic strength training routine did wonders for me. Squat, deadlift, bench press, lat pulldown. Just a couple sets of each, at moderate weights, about twice a week.

Doing this routine for about a month fixed problems that had persisted through years of massage therapy, posture exercises, ergonomic chairs, etc.


Try an exercise called face pulls. You'll need a cable machine with either a rope handle or a towel and google or, preferably, a trainer. Unless you're unconsciously hunching your shoulders or something weird, you'll find out almost immediately if the exercise helps.


For me, when they get tight I roll them out with a lacrosse ball against a wall. Pin it between your trap and the wall and just roll around for a while. Push hard, and hold spots that feel tight. Try to breathe and relax the muscle into the ball.


Switching to a standing desk greatly decreased how my upper back, neck, and shoulders would be tense. Keeping my back straight and not rolling my shoulders forward turned out to be an important part of that.


Working from a standing desk & performing daily sun salutations completely eliminated my chronic back pain.


It says "There's a perception that we sit way more than any other culture out there", and then they say no, the Hadza sit a lot (" 'The Hadza are in resting postures about as much as we Americans are' "), but if you search for photos of the Hadza sitting, they are always sitting on the floor/ground, or crouching, not sitting in a chair. That's not the same thing at all!

Then there's a photo of the Indian weaver they mention with the caption "No special chair required" (compared with the kneeling chair the author had bought, I guess). But the weaver is sitting on a low, (backless) bench! I've never seen an office/computer worker sitting like that.

So it's all about how you sit, but never that sitting in chairs might be (part of) the problem?


And look at how pianists sit, they stay on a bench similar to the guy in the picture for hours, often with great posture as well. Pretty sure most office chairs are terrible.


There are a lot of pianists with back problems.


Is anyone else similarly frustrated with journalism? This article is 2,300 words - yet it could have transferred the important information in less than 20% of that.

At least the last few paragraphs included the summary: "[it's good when you are] sticking your butt back and creating this little curve at the lower part of your spine"


I thought I was the only one. Almost every article I read is way longer than it is necessary. Some information is repeated and the gist is tucked away someplace at the bottom.


It's written for a general audience, who typically want the human angle. This is how journalists are taught to write.


And if this were in a newspaper, they probably would have. But NPR is like the New Yorker - they are storytellers as much as they are journalists.


I enjoy reading the storytelling if it is for an article based on the events. For example, there were few articles I read about Steele dossier. The articles did lot of flash back into Steele's early life as MI6 agent and his harassment in the hands of FSB etc etc. That was a fascinating read. In an article about science though, I am not looking for a story, I am looking for data and the conclusions/recommendations.


I actually really enjoyed it. I find articles that are like "This Simple Trick Will Cure Your Back" a bit too simplistic. I want to know why the technique works and what's wrong with the standard way we're doing it. They actually split this into 3 different articles/podcasts saying a similar thing and I read them all.


What you're referring to is known as wordiness.


Ironically enough (given that someone mentioned the general audience, which they imply we aren't), most software guides are overly-verbose as hell.


It feels like I am putting too much pressure on my male parts when I do this. Am I doing it wrong, or could it be the chair that I am using?

Edit: After looking at the picture from the article, it is obvious that the man has his legs spread wide, and this position is much more comfortable. I also lowered my chair to bring my elbows back to desk level.


This sitting style worked fine for me for a decade. It takes the pressure off your lower back. However, I'm now starting to get shooting pains where you least want them since all the weight is on the seat. Sit straight in moderation, I guess. Sit straight in work seating, slouch in overpadded chairs maybe.


No discussion of weight loss, injury, mobilization techniques, foam rolling/self-myofascial release (i.e. self-massage), no discussion of massage or PT. These are all huge for back pain and the author manages to brilliantly avoid these while discussing one-on-one sitting training sessions.

The reality for most people is that nearly all of these things can affect their back pain. Once again, an article attempts to reduce a multivariate model to a univariate model, reducing many variables to one is simpler but not more true, just easier to dispense in a news post.


I don't think the evidence for foam rolling or massage is good for long-term benefits. It feels good and people like it, but I don't think it's associated with long-term relief.


The article is "To fix back pain", for which regular massage therapy and foam-rolling have been shown to be beneficial in some ways. More work for longer-term benefits must be done, however: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637917/


Here is what I do, which barely helps (I focus on managing anterior pelvic tilt):

• Toe-touch stretch to stretch lower back • Kneeling hip flexor stretch • Glute bridges (I don't do these enough) • Crunches (the "right" kind where you don't go all the way up) • Rows and deadlifts to keep shoulders back • Wallsits at work with hips tucked in • Planches at work to help straighten out core

I still get pain once every few months.


I tried a number of solutions to sitting back pain, and the one that's worked the best is a $20 cylindrical pillow that attaches to my crappy office chair with an elastic band. It makes sitting in a slouching position subtly awkward and subtly encourages me to tuck my tail and sit up, as recommended in this article.


I suffer from various back ailments. I’d suggest to people that if your back pain is bad enough, and it’s been around a while. Provided you can afford it, see a good orthopedic surgeon and get an MRI (w/o contrast). This will help diagnose or at least rule out a lot of things - it’s all guess work otherwise


> I've mastered Pilates, increased flexibility and strengthened muscles. At one point, my abs were so strong my husband nicknamed them "the plate."

still not doing the right thing

you need to strengthen the lumbar muscles, eg with a specific weight machine (see Kieser Training, MedX) or other programme that can do that


sitting differently won't help much in the long run unless you fix the underlying weakness


I think taking frequent breaks during long hour sitting session is also equally, if not more important than how we sit. I usually set a "Pomodoro Timer" for 25 minutes and walk around the room for at least a minute during the breaks.


Did not understand the tail tucking thing in the article. Can anyone explain with pictures?


Anyone has pictures or examples?


Has anyone tried massage for lower back pain. Did it help?


Massage helps with loosening and relaxing the muscles, usually those muscles get tight and sore with trying to compensate for posture etc. But I've found it's just a temporary fix. Things like massage or chiropractors help a little, but if you don't fix the underlying issues the pain will keep coming back.

You need to combine with either strength training, movement and stretching, or adjust the way you are sitting to feel longer term relief.


or to start attending swimming pool


Too long, don't read, sit up straight.


That's what the article is telling to be careful with. "Sitting straight" means the butt is curved, back is straight, not thrusting chest forward. Also the weight of the body should be supported by the thigh and not the lower back.


Honestly it’s my feeling that all this stuff about sitting better is missing the point. I am beginning to feel like sitting or standing at a desk all day is just bad for your body. It’s hard for us to swallow and our economy isn’t set up for this, but I think we just work too much.




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