
The $100B per year back pain industry is mostly a hoax - kawera
https://qz.com/1010259/the-100-billion-per-year-back-pain-industry-is-mostly-a-hoax/
======
femto
I can personally vouch for the effectiveness of a morning routine of 15
minutes of exercise at home, targeting the pelvic muscles. The only equipment
required is a floor mat, if the floor is hard. I started gently and naturally
progressed to a higher level, taking the attitude that there is no hurry,
because I'm going to be doing this for the rest of my life, so there is plenty
of time to progress. My initial routine was just lying on my back trying to
tighten my pelvic muscles without hurting. Three years later I'm up to
front/back/left/right planks interleaved with stretching.

I don't mean to be smug, as back pain really is an individual thing. There's
an element of searching for what works, and I was lucky in that I was pointed
directly towards an effective treatment.

This result was science based, in that I was treated by a general practitioner
who specialised in back pain and insisted on an evidence based approach. (This
doctor also wrote the manual for NSW's worker's compensation scheme and
lectures at a major university on the topic.)

Edit: My doctor's rule was "pain free exercise". Go as far as you can, but
stop if hurts. A test of whether you've really overdone it is whether the new
pain goes away overnight. He also reckoned that it would be difficult to do a
further injury whilst doing exercises, as the pain would make me self
limiting.

Further edit: My initial physio, and a cortisone injection, at the time of
injury, weren't aimed at a long term fix, but at providing enough temporary
pain relief to begin exercising.

~~~
CogitoCogito
> I don't mean to be smug, as back pain really is an individual thing. There's
> an element of searching for what works, and I was lucky in that I was
> pointed directly towards an effective treatment.

I think this is extremely important for everyone to remember. People tend to
(correctly) scoff at anecdotal experience, but often that's all you can work
with. When studying health problems, most studies will tend to find the "best"
thing overall for a varied group of people, but basically forces the solution
to be the lowest common denominator. You see this all the time with different
diet studies, were people "prove" that some diets are better than others. Of
course the true answer is that there is no solution that's best for everyone.

Really you need to experiment and just learn a lot about your body. For
example, I've been able to rid myself of my back problems by running. If I
stop running for a few weeks all my really painful back problems start to come
back. Since I mentioned the diet example earlier, I should point out that for
myself the most effective way to lose weight is basically just starvation. I
exercise a lot and track calories and only consume between 1500 and 2000 a day
(I probably need at least 2500 a day and maybe closer to 3000). It's always
been much easier for me to just be constantly hungry for a couple months than
to play different diet games and figure out which foods are most filling.

You need to learn to listen to your body.

> My doctor's rule was "pain free exercise". Go as far as you can, but stop if
> hurts.

1000 times this! If I'm running in form, I'll probably run 6 days a week, but
I've learned to just quit if I feel acute pain or if my muscles are very tight
and I can't get them to loosen. You gotta know when to fight your battles. An
injury today means no exercise for a while and that's way worse than whatever
gains you'll get by continuing.

~~~
randlet
"I should point out that for myself the most effective way to lose weight is
basically just starvation. I exercise a lot and track calories and only
consume between 1500 and 2000 a day (I probably need at least 2500 a day and
maybe closer to 3000)"

Maybe I'm misunderstanding your point but this is the _only_ effective way to
lose weight. If your body needs 2500 calories a day and you eat 2000 you'll
lose ~1lb a week.

~~~
CogitoCogito
Sorry my point was more that I'm okay going at a 1000 calorie daily deficit
and that I just accept the inevitable hunger. This differs from many
approaches which seem to chase the holy grail of finding food that's very
filling, but also very low in calories and usually not going for that extreme
a calorie deficit.

Put another way, mine is the stubborn bull-headed weightloss plan. Basically I
just try to climb the mountain the fastest and most painful way and then be
done with it.

~~~
randlet
Got it, that makes sense. I tend to the filling but low calorie approach
(vegetables!) myself with around a 750kCal deficit.

------
blister
Anecdote of one: I was diagnosed with Stage 4 Hodgkins Lymphoma two years ago.
My _only_ symptom at the time was pretty severe back pain, which is unusual
for lymphoma.

After treatment and remission a year later, I still had the severe back pain.
The cancer pain management doctor I was seeing was perfectly happy to keep
prescribing godlike levels of opiods. (50+ mg of oxycodone on top of 30+ mg of
slow-release morphine pills).

After a few months, I lamented that I was tired of taking pills and dealing
with all the side effects. He offered to send me to Physical Therapy, but
explained that most of his patients preferred to stay on the pills and that PT
rarely worked.

After 3 weeks of twice-weekly 30 minute PT sessions, my back felt amazing. No
more pain and I was able to quickly wean off the drugs.

At some point, my cancer had caused back pain, which I'd continued to worsen
by avoiding exercise and sitting at weird angles to alleviate the pressure.

As a humorous aside, I had to pay for several weeks of PT out of pocket
because my insurance did not consider it important. They would prefer to shell
out $500+ dollars every month to see a pain management doctor and continue
taking pills.

~~~
gumby
> I had to pay for several weeks of PT out of pocket because my insurance did
> not consider it important. They would prefer to shell out $500+ dollars
> every month to see a pain management doctor and continue taking pills.

Of course you could easily have sold those pills to pay for the PT :-)

~~~
flyGuyOnTheSly
That's nothing to smile or joke about... selling prescription pain killers is
wrong. You're perpetuating the problem.

------
slr555
The thing is, when you've seen one back problem, you've see one back problem.

The spine is a maddeningly complex assembly of bone, nerves, cartilage,
articular surfaces, vasculature, packed tightly, subjected to immense forces,
and articulable is many directions. It is a miracle of evolutionary
engineering and a miserable failure. We needed to crawl longer before we stood
up and walked as a species.

I have been through 2 spinal fusion surgeries. First, L4-L5, L5-S1. Then
L2-L3, L3-L4. One surgery was nine hours the other was eight. Recovery was
approximately 1 year for each surgery to complete return to maximum function.
It was the hardest thing I've ever done. And news of the need for a second
surgery almost crushed me.

But...

I am virtually pain free for 3 years now. My activities are virtually
unlimited. No boxing. No golf. Oh boo hoo. I can hike, scuba dive and travel.

Your mileage may vary, but the real question is why? The quality of both
surgeons and diagnosticians varies widely across institutions and geography. I
am fortunate that I live in a city with the best orthopedic hospital in the US
and my surgeon is world renowned in the area of spinal surgery.

It took me ten plus years to get the right diagnosis and find the right
clinicians but when I did they repaired my spine to provide me maximum
function and pain relief but it is not a new spine. It is never like new. But
it'll do what I need it to do.

For anyone in pain. I hope and pray you are relieved of it. Search for the
professionals who really know what the fuck their doing and GET WELL!!! Be a
zealous and merciless advocate for your own healthcare.

~~~
deelowe
I'd love some help. How did you find someone who could actually give you some
sort of prognosis/diagnoses? Mine just say either "more PT" or "here's some
pills." Neither work. My disc is budged and it seems like moving the wrong way
will trigger 2-3 days of intense pain and immobility. No one seems to offer
any suggestions on how to fix it. Is it fixable? I don't know...

P.S. the back pain industry is a sham, but there are a few of us out there
that legitimately need help, but can't get it due to the opioid epidemic and
snake oil salesmen.

~~~
specialist
My number one advice is to not accept "No". Someone out there has an answer
for you. Keep asking, educating yourself, searching.

Dr. Srinivasan in Seattle did my spinal fusion. She's the best.
[http://seattleneuro.com/about_dr-
srinivasan/](http://seattleneuro.com/about_dr-srinivasan/)

If you are trying to find a neurosurgeon near you... Ask Srinivasan for a
referral. Or find other doctors that learned, practiced, taught where she did
(birds of a feather).

~~~
heisenbit
I'm all for being relentless when searching for answers. And then for
relentless researching and checking them.

It is important however also to hear the "No", as the article explains: Most
doctors would say "No" when it comes to their own backs. There are certainly a
lot of spine doctors out pushing procedures but anyone who is on the desperate
search for a solution likely also heard from another doctor the word "No" and
did not properly listen. Understanding the "No"s is important to weight the
alternatives and risks.

~~~
specialist
Word.

I've been sick (chronic life threatening illness) my entire adult life. I've
done some very stupid things, knowingly and unknowingly. And a handful of my
doctors, care providers have harmed me. But what else you gonna do?

I've also had severe back pain that got worse over the years. Finding
solutions that worked for me required lots of trial and error.

Now comes my second most important piece of advice:

Everyone must have their own patient advocate. To fight for you, to keep track
of what's happening. And to keep you honest. Self assessments are notoriously
unreliable.

------
dirkg
In my experience in the US you are much more likely to be 'sold' on unneeded
medication and services vs getting an accurate meaningful diagnosis and course
of treatment, when it comes to a whole host of problems but esp w.r.t physical
injuries, rehab etc.

90% of the doctors you see will have no clue about treatments you can find in
a 5min search on youtube. I don't mean hack treatments or miracle cures but
basic physiotherapy, prevention etc.

Overprescription and unnecessary procedures are the norm. Patients are milked
for money rather than being treated. The fear of litigation and desire to make
a profit are the primary factors, not patient health.

I've suffered multiple sports related injuries. Consulted a number of doctors,
out of pocket and covered by insurance. The physiotherapy they recommend is
almost always the most basic and didn't do much. Doctors refuse to discuss
other options or refer you outside their 'network'.

The whole system positively reeks.

~~~
gehwartzen
Not to mention that pain itself serves the very important function of telling
you that something is wrong or to stop doing something becomes it is causing
harm. Prescribing pain meds is a quick way to silence the alarm but allows
whatever behavior or condition that coused it to continue.

~~~
Cthulhu_
The challenge there is that there's no easy fix; medication is an easy / quick
relief, but anything else takes focused effort for a number of days if not
weeks/months/years without direct result. Same reason why the chiropractor as
mentioned in the article is popular - instant results.

------
thesunny
I haven't posted in a while but had to jump in on this.

I had very bad back pain before my first daughter was born. I wanted to be
able to carry my daughter when she was born so I decided to try everything,
whether I believed it would work or not.

I had massages, shots injected directly in the back, manipulation, and
basically lots of different doctors and specialists. Nothing worked.

Since I said I'd try everything, I made an appointment for accupuncture as a
kind of last resort. I had zero faith that this would work but carrying on
with the theme that I'd try everything, I tried it.

The session was extremely painful. Note that subsequent sessions afterwards
have not been. I think this was a function of my muscles being locked in spasm
during that first session or something. Anways, immediately after the session,
there was a marked improvement. It was the only thing that worked. It only
took a few more times before it was back to normal.

If you haven't tried it, even if you don't believe, please give it a try.

I think one clarification to make is that acupuncture directly into the
problem points to release a spasm muscle is more mainstream. Acupuncture where
you poke your foot to fix your liver is perhaps more controversial.

I'm sure I'm trivializing or getting some of this wrong but just wanted to
share my experience with solving my back pain. I hope it will help others.

~~~
thenomad
One thing I've definitely learned about musculoskeletal problems is that you
shouldn't discount apparently unscientific treatments if they seem to work.
There's a lot we don't know about how that particular system functions, and
things like acupuncture seem to fit into that. That's not to say the
_explanations they give for why things work_ are accurate, but the treatment
itself seems to work sometimes.

I'm not advocating homeopathy here, but acupuncture, shiatzu, anything
involving the phrase "trigger point" \- worth a look. Apart from anything
else, they're comparatively inexpensive and non-invasive so the cost of
testing them is low.

Trigger point therapy gets a particular shoutout here for being one of those
things that resolves 10+ year problems in about 15 excruciatingly painful
minutes, sometimes. See
[http://www.goodreads.com/book/show/137795.The_Trigger_Point_...](http://www.goodreads.com/book/show/137795.The_Trigger_Point_Therapy_Workbook)

~~~
pbhjpbhj
My friend had acupuncture on the NHS for severe back pain (prolapsed disc,
ensuing sciatica) which left her with no relief and some pretty severe
bruising. So whilst non-invasive clearly there is potential for problems. Only
painful for a couple of days though and relatively superficial; so probably
worth trying.

------
andreyf
On the flip side, I had lower back pain of varying intensity for about two
years before it got really bad really suddenly and I went to someone
recommended by someone knowledgeable in the subject who fixed it in about 30
minutes of some serious stretching and twisting and turning [1].

Two months with not a hint of pain and I'm pretty sure this is yet another
example of the medical industry being incentivized into ignoring existing
solutions. MD I went to prescribed 4 meds (pain killer, muscle relaxant,
topical gel, something else), did and xray before telling me I have arthritis
at 30, and referring me to a list of acupuncturists. If there's a lot of
profit to be made in treating back pain, why would anyone ever fix it in a
for-profit system?

1\. [https://www.yelp.com/biz/tri-valley-bodyworks-
dublin](https://www.yelp.com/biz/tri-valley-bodyworks-dublin)

~~~
tptacek
This argument has always seemed pretty silly to me. Why, if this is how the
market for medical services worked, would medical services cure _any_ problem,
when they could find ways to milk those problems for recurring revenue? Why
aren't malaria or stomach ulcers "chronic manageable illnesses", rather than
curable ones?

~~~
HarryHirsch
Consider Hepatitis C. Chronic infection puts the patient at risk for cirrhosis
and eventual liver failure, and the treatment for that is a liver transplant.

A couple of years ago Telepravir (Schering/Merck) and Boceprevir (Vertex/J&J)
came to market. The price for a course of treatment has nothing to do with the
cost of development and everything with the cost of a liver transplant, it's
slightly less than that.

~~~
tptacek
What argument of mine are you attempting to rebut?

~~~
HarryHirsch
You didn't make it, but you hear far too often that drugs for management of
chronic conditions are more profitable than cures for acute conditions, and
that's what determines what goes into the development pipeline.

The truth is more complex than that. The reason that you don't see investment
in antibiotics is that the low-hanging fruit is picked and you cannot use the
new compounds unless as a treatment of last resort, and sales would be far too
low to be profitable. They will be needed, though, in the medium term. The
financing model in pharma is broken and there is no change on the horizon in
that department.

------
sundvor
I'm a programmer, always at the desk. Back problems came on in my mid/late
thirties, as I let my physique go. Once I started squatting in early 40s, back
pain has largely subsided. Only reoccurred when I got too optimistic regarding
my training, after a break.

Have now fixed that by learning to train in moderation / be more consistent -
as I get older, there really is no excuse good enough for not going.

So yes: Learning to squat (deep / a2g) as well as perform deadlifts, done
properly and with respect is the best thing I ever did for my health (now in
my mid 40s). I must emphasize _properly_ - learning technique from good PTs,
youtube videos, books like Starting Strength, is highly recommended.

A side benefit is all the mental health positives the training gives, as well
as making you more competitive in the somewhat / sometimes age biased work
force.

~~~
DrScump
To clarify the term: "a2g" = "ass to grass", or full extension at the bottom
of the movement such that calves and hamstrings meet.

~~~
sundvor
Thanks, that's a great way of describing it.

------
SilasX
>Also consider this: In a poll at a 2009 conference in Bonita Springs,
Florida, 99 out of 100 surgeons who were asked whether they’d elect to have
lumbar fusion surgery if it were recommended to them said “absolutely not.”

Wow. They charge $80k for a surgery they wouldn't even use themselves for the
very condition they recommend it for?

To reverse the famous quote: "you know what they call ineffective procedures
that persist solely on inertia and avarice? Medicine."

~~~
jackweirdy
Similarly I fractured my foot out here in the US and a podiatrist told me it
absolutely needed surgery. I flew home to have an orthopaedic surgeon look at
it in the UK, they gave me one of those plastic ankle boots, and told me to
slowly ease back into walking over the course of a month.

~~~
cmurf
Doctors in the U.S. are paid per procedure. They are not salaried. And they
aren't paid to make you better. They're paid to try (via the procedure). No
refunds.

~~~
lsc
Other models are available; if you are in Silicon Valley and want doctors who
are salaried rather than paid per procedure, you can use Kaiser. Is it better?
I don't know, really; I use them now and think they are okay, but I'm not
really medically qualified.

I imagine there are similar health groups in other parts of the country.

------
transreal
Anyone suffering from back pain who really wants to recover should read Dr.
John Sarno's work. Here's a link to his book: [https://www.amazon.com/Healing-
Back-Pain-Mind-Body-Connectio...](https://www.amazon.com/Healing-Back-Pain-
Mind-Body-Connection/dp/0446557684)

I was skeptical at first, but just reading his book and thinking through what
he presented healed my lower back pain.

~~~
_delirium
Wait, the process of thinking through the book's contents _itself_ healed the
pain?

~~~
sillysaurus3
This Amazon review is too perfect:

 _After months of intense low back pain, I was recommended this book. I read
it and thought it made sense. I know our mind is powerful and stress can cause
dis-ease. I completely jumped into his program spite the intense pain I
endured. After 6 weeks I did not experience any shift in my pain. And, the
pain intensified to the point that sometimes I couldn 't even stand. I decided
to seek medical help. What I found out was that my L5-S1 disc was collapsed
and the (almost) bone on bone rubbing was why I was experiencing so much
pain._

I wonder why it's at 4.5 stars.

~~~
tcbawo
I think that the premise is that it is possible for some people to reduce pain
symptoms by reducing inflammation caused by stress. I can't imagine this
advice would solve everyone's pain issues, but it might help people who would
otherwise become dependent on pain medication or endure unnecessary surgery.

------
mingabunga
Anecdotally, I do a lot of exercise and for a year I'd always wake up with a
sore back (top of hips, either side of spine), or after sitting down. Physio
eventually told me my hip flexors were really tight and that was the cause of
the referred pain. 4 days of long stretches on those a couple of times a day
and I'm good as! Crazy I went for a year with it irritating. If it helps
someone, glad it did. Something like this (first result on google)
[http://www.stack.com/a/4-hip-flexor-stretches-to-relieve-
tig...](http://www.stack.com/a/4-hip-flexor-stretches-to-relieve-tight-hips)

------
fizixer
Advice on back pain based on personal evidence (single data point).

\- Did squats and deadlifts for the first time at age 33. Did them for 1 year.
At age 36, again did them for 3 months. (I'll get back into it again once I'm
done with my current hectic schedule. Planning on doing at least 3-6 months
every year).

\- Here's how I sleep: No mattress. I create layers out of (bottom to top):

    
    
      - Solid floor,
      - Carpet or rug,
      - Gym mat,
      - Thick korean type blanket (mink blanket?), folded twice or thrice,
      - a comforter folded twice,
      - Regular bed sheet
    

This makes a layer soft enough so I can sleep, but still stiff enough that I
can feel the floor.

In addition, I take two large towels, each twisted into a thick rope, then
rolled into something resembling a cinnamon roll. One supports my back, one my
tummy/abs area. When I lie upright, they're on my left and right. When I lie
on the side, one is next to my back and one in the front next to my abs. Every
time I twist or turn while sleeping, I've developed a habit of pulling both in
to keep them packed tight next to my body.

I'm 39 now. Have been sitting in front of a computer all day for the last 20
years. Never experienced back pain.

Disclaimer: try this at your own risk.

~~~
hpcjoe
One important point about this. I've been lifting for 41 years now. Mostly on,
with some off (end of grad school until my daughter was born, and some other
intervals).

Be careful with on/off/on type modes. Squats and deadlifts will stretch large
muscle groups. You can tear these more easily as you get older.

I know. I am recovering from hernia surgery 8 weeks ago. I was doing my normal
leg press and squat portion of my routine. I didn't feel anything tear. Though
I was pushing about 600lbs on the leg press. 2 days later I am in the ER with
severe pain.

Granted, I am not a spring chicken, but I've found that after I crossed 35, my
injuries took longer to heal. And if I took time off from my routines, I had
to start building back up.

I started that building back up (only 9 weeks off so far, but still, I don't
want it to be longer) yesterday and today.

Just saying, be careful. I think of myself as a kid. My body thinks other
things.

------
princeb
I injured my lower back on squats.

it just takes one moment of being tired, losing concentration, forgetting the
form, failing to maintain stiffness and strength in the core, forcing a rep
out of a bad position, not getting enough rest and nutrition on a high
intensity program, and that's it.

I never had an issue before but now I do. massages, physio, painkillers don't
work. I can still walk and work and do everyday stuff, but I will not be
participating in powerlifting meets for a long time.

------
charris0
Had back pain (lower back and neck) for years, mostly I think due to being
tall and poor desk posture.

I used to spend a lot of money at the chiropractor/osteopath, and while they
do give relief I don't see them as a long term solution. That said, I think
they can be valuable for acute episodes.

What cured my back pain is Yoga. Not overnight, not over a week, but months of
adding strength and flexibility to body as a whole. I'm now pain free.

This may not work for all symptoms, but I think it's important to realise (in
most cases it seems) you cannot expect the medical professional to heal you,
only to help you temporarily. You must heal you.

~~~
mathw
I think there are a lot of people with back problems (definitely not all of
them though) particularly desk workers (and not all of them either) who have a
lot of their issues down more to a lack of core strength than anything else.
Yoga, from what I have been told, is pretty awesome for core strength.

It's something I'm working on in physiotherapy, because although I went to see
her because I was having horrendous knee problems (now in full retreat thanks
to some very simple, well-chosen exercises), she looks more holistically than
that and identified some back issues as well. More exercises.

The back ones are harder to do though, and don't seem to be as effective, but
I'll be bringing that up at my next visit.

------
hiisukun
At one time someone close to me was experiencing back pain, we both saw a
lovely episode of the TV series 'Louie'. Here is a quote from that episode:

    
    
      Dr. Bigelow: What can I do for you?
      Louie: Uh, well, I hurt my back today really bad. Uh. 
        Can you help me with my back? I mean...
      Dr. Bigelow: What's wrong with your back?
      Louie: It hurts.
      Dr. Bigelow: My professional diagnosis is your back hurts.
      Louie: Well, what can I do about it?
      Dr. Bigelow: Nothing.
      Louie: Nothing?
      Dr. Bigelow: The problem is you're using it wrong. The back 
        isn't done evolving yet. You see, the spine is a row of 
        vertebrae. It was designed to be horizontal. Then people 
        came along and used it vertical. Wasn't meant for that. 
        So the disks get all floppy, swollen. Pop out left, pop 
        out right. It'll take another. I'd say 20,000 years to 
        get straightened out. Till then, it's going to keep hurting.
      Louie: So that's it?
      Dr. Bigelow: It's an engineering design problem. It's a 
        misallocation. We were given a clothesline and we're using 
        it as a flagpole.

~~~
justboxing
Digging the joke, but is there any scientific truth to this statement?

> It was designed to be horizontal. Then people came along and used it
> vertical. Wasn't meant for that.

~~~
dsr_
It's more accurate to say that the vast majority of tetrapods evolved their
spines to support use parallel to the ground, and that even those which
occasionally walk around bipedally spend lots of time either brachiating (in
trees) or quadrupedally.

There were no designs involved.

Humans are the largest bipedal walkers, but not the only ones. Here's an
interesting survey:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571302/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571302/)

~~~
teekert
I'd say (and I am a biologist) there is truth to it, but we also didn't evolve
sitting all day. There would be much less back problems if would walk and
stand more because our muscles would be trained constantly. Our bodies are
things that wear out when _not_ using them.

------
mml
As a counterpoint to the "deadlifts fix everything" folks, I regularly (4-6
hours weekly) do deadlifts, squats, overhead squats, air squats, goblet
squats, pistols, weighted pistols, muscle ups, snatches, situps, pushups,
handstand holds, handstand pushups, power snatches, toes to bar, toes to
elbow, thrusters, pull-ups, planks, couch stretch, pigeon stretch, vinyasa
yoga, kettlebells etc etc etc. Pretty much total insanity.

I've been a desk jockey for nearly a quarter century, and have had constant
low back pain for nearly as long. My back feels terrible every day,
particularly when deadlifting, or standing up from sitting on the throne for a
bit. Chiros haven't helped (100% quackery imho, I've tried a dozen, and really
want it to work), X-rays show nothing wrong.

The only thing that has helped has been classic "80's ladies" leg movements
(bird dogs, fire hydrants, movements like shown in the linked video), along
with foam rolling out tightness in the hips.

I suspect my hip flexors are extremely strong in one direction, and extremely
weak in the opposing direction (medial glute), pulling my pelvis out of whack,
and thereby hosing up my lower spine.

Anyway, sometimes barbell work doesn't help. YMMV.

------
theseatoms
> The author is often asked for her thoughts on certain forms of exercise,
> such as yoga or pilates, which she also covers on her website. What she
> tells people, repeatedly, is that “movement is essential.”

The exercise economy is the real back pain industry.

~~~
nostromo
Exercise fixed all of my back pain issues.

I do heavy deadlifts. I can't tell you how many people told me that it would
hurt my back. But it turns out having a muscular back to support my spine was
exactly what I needed.

~~~
andreyf
Seems like this advice could hurt a lot of people if they have a different
issue with identical systems.

~~~
whiddershins
I'm not going to say deadlifts are recommended in every case, and I have no
medical qualifications.

I have done a bunch of research and have tons of anecdotes which indicate that
with proper form deadlifts are far safer and more effective for a wide range
of people than is commonly imagined. And the form is rather easy to get right.

------
lr4444lr
_Anyone who has endured back pain knows it is an erratic dictator. It takes
hold of your psyche, demanding your attention and devotion before all
else—before you can plan a hike, return to a work routine, pick up your child
for a hug. So when someone offers to make that dictator disappear, it’s hard
to resist—no matter what the price._

Although there are many people who do manual labor for whom the inability to
move properly threatens livelihood, which is a very serious situation, lower
back pain does not rank with late stage cancer, COPD, crippling mental
illness, or any of the other health impairments that let the sufferer see the
grim reaper unsheathing his scythe or turn every waking second of life into a
mythological torture.

Back pain can be tough, but can be adapted to. You move more slowly,
carefully, and adjust yourself when you plan to rest or sit for a while. This
rush for invasive treatment is embarrassing to see in my fellow Americans when
we've had a reputation for toughness and independence.

\- Speaking as someone who's had acute episodes of lower back pain so bad that
I've involuntarily collapsed, and could not walk freely for days at a time.

~~~
DanBC
You can see how an acute episode is different to chronic pain right? You can
understand that a pain that comes, lasts a few days, and then goes is
different to pain that you live with every single day of your life?

------
minipci1321
Some personal evidence: I obtained relief by installing a traction bar high
enough my feet don't touch the ground, and remaining suspended for some time,
a few times a day every day. It took me a couple of years to develop forearm
muscles strong enough to withstand more than 30 sec, and to learn to fully
relax the back so it stretches freely. Particularly effective when coupled
with a warming up (at the beginning, from simply walking a few miles, couldn't
do much else). Can now even do that when crises arise (even when cannot easily
walk). Works also in the morning on cold muscles, but some small tendinitis In
elbows can follow.

In this part of the world, insurance-covered doctors are very sceptical when
you turn in with the back pain, and physio offer very basic things, no real
relief.

I did take a scanner and other tests, to evaluate the situation.

Disclaimer: this is not a medical advice, I am not a doctor, "back pain" is a
very broad definition.

------
memracom
I've kept back pain at bay with a simple 3-point plan. Sleep on an
uncomfortable bed with a firm surface and a thin futon for padding. Sit on
uncomfortable chairs, mostly the wooden kitchen chair type. Lift free weights,
i.e. barbells or kettle bells. No levers and pulley systems. The weight has to
be free to fall and hurt you. Just never overdo it so that it never does fall
like that.

Works for me, probably because it keeps all the little muscles between the
ribs working smoothly. Humans are not built for comfort but paradoxically,
avoiding modern comforts will have you sleeping like a baby, avoiding back
pain, and give you reserves to climb a mountain when you feel like it.

~~~
buzzybee
I've been on the "sleep on exercise mat with some blankets" train for years,
but a few months back, stepped it up by eliminating pillows. I still gravitate
towards getting something under my head, but it turns out that I only need
another small blanket or cloth. I wake at more consistent hours and no longer
experience numbness in my arms when waking. I believe there are many more
"details" I can improve too. I got into training fast and slow breathing
patterns for different activities, which seems to help both the training and
the recovery. A plainer diet seems to help a lot of things, although it's hard
to reconcile this against the constant imposition of the world to eat pizza
and drink beer.

------
emdowling
It is in our nature to want the quick, easy solution. That's what has allowed
this and other health industries to thrive.

I injured my lower back quite severely 5 years ago while lifting something at
work the wrong way. Entirely my fault. Physio, chiropractors, etc did not fix
it in the long term - a lot of money spent on temporary fixes. Swimming and
gentle weight lifting over the course of 6 months made a huge, lasting
difference. Occasionally, I still feel some tightness in that region but a run
or yoga session fixes it up very quickly.

------
sangd
I had back pain for 3-4 years and I did many form of exercises including
back/neck stretching, yoga, running, walking, jogging, changing work posture,
changing table, trying to not sit long. And nothing had ever worked for long.
Sometimes I had to take advil or tylernol to ease up the pain. I've heard and
researched about the issue and it seemed like a scam to get a really effective
cure everywhere. 6 months ago, I decided to take vitamin D3 + Glucosamin and
the pain seems to get better, or a lot better. Then 3 months ago I decided to
take Moringa powder daily (I usually don't take anything during weekend to let
my body recover), and my back pain issue is now gone. I am not sure how long
this would last but it's the best method I've found so far to cure my own back
pain. I've tested many kinds of vitamins but I find natural vegetable powder
are the best form to absorb and seems to produce positive results, at least
from the products produced by my body.

------
deepGem
I can personally vouch for push-ups as a cure for back pain. When done in
proper form, push-ups are one of the best exercises even for the spine and
back. The risk of injury is fairly less. I usually do 3 sets of 6 to 8 push-
ups every morning. The plank is also a good exercise. I can't hold the plank
position for more than 30 seconds though.

------
alexbecker
My brother had lumbar fusion surgery after he hurt his back on the job. My
parents tried to talk him out of it, but the workman's comp lawyer and the
doctors convinced him anyway. Three years later, he spent almost all the
workman's comp money and his back is worse than before.

------
visarga
For 10 years I had a chronic back pain. It was like burning behind my shoulder
blades. I went to doctors, did exercises and massage. No effect. Then I
happened to take a Calcium supplement. Pain went away in 30 minutes. Now I am
pain-free. Why couldn't the doctors detect my lack of Calcium and recommend a
basic supplement in so many years? I think there is a lot of bullshit in how
they deal with this kind of issues.

Another supplement that had a huge impact on me is Magnesium. It helps me
sleep well, reduces anxiety and chronic fatigue. Also increases libido. It's
as if it shaves a decade off my age.

So maybe it was all because of the water I was drinking - too filtered,
lacking normal minerals that are found in natural water.

~~~
tim333
In fairness to your doctors that would be a hard one to diagnose.

~~~
Cthulhu_
Wouldn't it show up in a blood test? I mean I wouldn't immediately suggest a
blood test for back pain, but still.

~~~
visarga
Apparently not. There is a reason why blood Ca and Mg levels don't correlate
with their levels in the rest of the body.

------
Spooky23
Back pain does attract a lot of quackery. It's hard to understand where people
come from with back pain unless you experience it. It's debilitating and
utterly dominates your life. But the article took many liberties to make it
sound worse.

Spinal fusions in the lower spine are mostly done laproscopically these days,
and usually don't involve abdominal surgery. That's a huge difference -- I had
a 6 week recovery vs over 4 months for an abdominal procedure.

My L4-L5 was fused at age 25 due to a degenerated disc that failed completely.
Fortunately it was very successful for me. Hopefully we make progress with
artificial discs and vertebrae to improve outcomes for others.

------
ScottBurson
Ramin can debunk chiropractic all she wants; adjustments have worked too well
for me too many times over the years for me to abandon them. (The supplements
some chiropractors sell have never done anything for me, though.)

It's clear that some amount of realignment of the spine happens naturally; I
feel a small pop here or there almost daily. The spine is a complex structure
with many forces acting on it. Getting it adjusted as needed doesn't strike me
as any more "woo woo" than getting my car's wheels aligned.

ETA this amusing tidbit: the worst back injury I ever had was from playing
pinball.

------
code_duck
"Humans usually don’t experience the same withdrawal because they take
sustained-release formulations and taper off opioids gradually."

In theoretical wonderland, yes, that's how it happens.

------
uptownfunk
Not to sound hippy, but yoga-asana has really worked for me. I initially just
started with 20 minutes a day and it's worked wonders. Just the starting
sequence of the ashtanga series is enough to reap massive benefits. Obviously,
check with your doctor and your health before starting this. Yes this is
anecdotal experience, and yes it may not work for everyone, but it certainly
helped me, so paying it forward with the hopes it will help someone else.

Would begin with a few rounds of sun salutations, and the fundamental
positions. And of course, get a teacher and/or proceed very slowly and very
carefully, as with many exercises, you can injure yourself if you don't do it
correctly.

You can youtube any of the positions in the pdfs below and get quite detailed
explanations on how to do them properly.

[https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Downloa...](https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Download/CheatSheet/SuryaNamaskar-
EN.pdf)
[https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Downloa...](https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Download/CheatSheet/FundamentalPositions-
EN.pdf)

------
mirimir
Many years ago, after going down hard while skiing, I learned the importance
of exercise. Both for protecting against accidents, and in recovery from them.
Because muscles can take stress off joints, and help prevent exceeding safe
ranges of motion.

That lesson has generalized very well. For other injuries, and for age-related
arthritis. Basically, if I notice pain somewhere, it tells me that I'm not
exercising that area properly.

------
eddd
Whenever I read such a piece, I recollect Noam Chomsky reflection that
capitalism is a system where well informed consumers do rational decisions.
But, our lives are so flooded with the informative garbage that people tend to
do unrational decisions based on feelings and unknowingly. People are just not
ready to digest that much, our educational system failed us miserably.

------
royinferno
Yeah I remember doc telling me spinal fusion being an option. Refused because
of the long term ailments it may give me. I have a herniated disc L5-S1. It's
been 6 years since then. Did physical therapy and exercise. Last 2 years been
lazy but I know having a strong core is key along with cardio and strength
exercise. However I been saving to have a stem cell procedure done where they
extract it from my bone marrow and inject it into the problem disk. I think
cost is $7K and it's not covered by insurance. But it's better than the
surgical alternatives at have now.

------
notadoc
Most people I've known with back pain related to weak or strained muscles were
best helped with physical therapy. Often it means strengthening the abdominal
muscles and loosening the chest/shoulders. Most of modern life is terrible for
posture and is very sedentary, so this is not too surprising.

Pain is wildly complex though, and the causes are not always understood or
easily helped. Some people require pills and other treatments. The amount of
media animosity towards pain medication and related vitriol spewed at doctors
is shocking and totally unwarranted in most cases.

------
j_s
This "back exercise for posture" video was the first one I ever favorited on
Youtube. It's helpful for anyone like me who is doing zero today. Kind of a
"YTWL" reaching your elbows behind your back. (I did them standing facing a
wall, less crushing.)

[https://youtu.be/bCMNMHBY1Dk?t=46s](https://youtu.be/bCMNMHBY1Dk?t=46s)

I wanted to share this as a first-step, almost as easy as nothing type of
thing that could help someone considering a more serious commitment to "real"
exercise.

------
Aron
I'm on a 3 month back pain streak which is unprecedented for me. It's co-
occuring with higher than usual weight range for me, as well as I had started
making a concerted effort to stand straighter and adjust head-forward posture
and I think that might also have triggered something. I can't tell for the
life of me if it's arthritis or some kind of over-tensioned muscle. But in
regard to the article, I have no hope in the medical industry to help. Damn
sad really.

------
iamgopal
I sleep on the hard floor. Never had a back pain. On the time where I need to
sleep on soft places, sofa or mat etc, it gets painful afterwards.

------
gadders
For people who don't yet have back pain, can I recommend deadlifts? Done
properly, strengthening the muscles around you spine protects it.

------
vibrant
There is a simple solution for back pain:

\- stop eating sugar and flour (and limit rice, potatoes, pasta) - this way
you cut excessive weight quickly and become healthier overall

\- do basic back exercises at least twice per week - or even better do
crossfit

\- stretch your legs and calfs often - tension from your legs translates to
your lower back and causes spine issues

With these 3 you're good forever :)

------
teekert
Me 3, exercise is the only thing that helps. 1 Hour a week boxing, average of
40 min a day on the bike (to and from work). As soon as I start taking the bus
instead of the bike, the back plays up. As soon I don't de boxing for > 3
weeks, I have to start avoiding carrying my 4 y/o no my neck. It's really very
reproducible.

------
riot504
Powerlift - Bench, Squat and Deadlift. All work your back in different
aspects. Plus you will gain all around solid strength.

------
Splatter
One word: Deadlift.

The benefits of the deadlift cannot be over-stated. All adults, especially the
elderly, should deadlift on a regular basis. As a compound movement it
strengthens so many muscles, results in excellent strength gains, and
contributes to quality of life improvements.

------
chad_strategic
My recommendations for fixing back pain or a slip disc. 1\. If you are a man,
get a smaller wallet, don't be sitting on a thick wallet. 2\. If you are in a
crappy job that annoys you, then quit or get fired. Some back pain is
psychosomatic. 3\. Lose about 20 pounds. (I was in great weight lifting shape,
but had kinda of looked like a line backer.) 4\. Yoga 5\. Running 6\. Standing
desk

4 and 5 are free. The medical industrial complex can't make money by telling
you to go to yoga or run. They would rather preform surgery or give a patient
drugs. Unfortunately, people take the easy route.

I have been free of back pain for nearly 14 years. Sure some of it comes back
here and there but it goes away with stretches, exercise and proper sitting /
standing awareness.

~~~
shakermakr
Running is terrible for the lower back. Every time you stride you send shock
waves up your legs that decompress in the lower spine.

I switched to elliptical training. As you don't lift your feet, impact free.

Swimming is also fantastic for the back of course.

Evidence: had a microdiscetomy 4 years ago, lots of rehab, and now pain free.
Every doctor said don't run!

~~~
nradov
Humans evolved to run. Running is good for your lower back, provided you run
with proper form and aren't already injured.

~~~
pbhjpbhj
What's proper form? Front foot or heel strike?

------
loverofcode
i would like to share my experience. I have rheumatoid arthritis and have had
it since age 13. I have been taking hydrocodone since i was 14, started taking
oxycontin and hydrocodone for breakthrough 10 years ago at 25. I have been
able to function as a normal person. I went through a few years of going off
of them when i would gain mass amounts of weight and unable to do anything. I
have only had my dosage adjusted twice, i am able to walk 6 miles a day plus
go up and down 3 flights of stairs x16 times a day. Opiates have saved my
life.

------
gre
Deadlifts helped me for lower back pain from sitting in office chairs.

------
tdsamardzhiev
Here's how I ended my back pain issues - 3x15 squats, 3x15 deadlifts, 3x15
pull-ups, 3x15 bench presses. Two times a week. A month down the road my back
pain was a bad memory.

------
krupan
Foundation Training saved my back. I hate sounding like an infomercial for
them, but seriously people, it works. Simple exercises you can learn from
their book or YouTube videos.

~~~
bernhardwenzel
+1 I always had back problems, but after my now two year old was born it got
much worse, due to lack of sleep, lack of sports and the permanent lifting of
13 kg. I tried a lot of things at home, the only relief were medical massages.

This book "Foundation: Redefine Your Core, Conquer Back Pain, and Move with
Confidence" did almost magic to my problems. The exercises are dead simple and
I'm still amazed how well they help.

Agreed, the infomercial nature is a bit off putting but don't let this
distract you, the exercises are working

------
nas
Here's some free advice. When your back bothers you, try some jogging. If you
can't jog, walk. Taking it "easy" by laying around is not the cure. I'm pretty
sure the vast number of back problems are caused by too much sitting and lying
down.

~~~
tootie
Jogging or long walks is the one thing that causes back pain for me.

~~~
tarr11
Consider your shoes, more supportive shoes may help on long walks. I over
pronate, and when my sneakers are at all worn down, I start to have back pain.

Also, jogging or running would often make things much worse for me.

~~~
tootie
I overpronate badly and do carefully choose my shoes to support that. But, if
I just avoid being on my feet for too long at a stretch I never get back pain.

------
eosophos
One legged good mornings. Jefferson Curls. Ido Portal. Get good bodywork, thai
massage/get a friend to grab handfulls of skin along your bones and pull and
wiggle it. Make room for your tissues.

------
pmarreck
Number 1 reason for your back pain is almost definitely having to do with the
size of your gut in front of it.

------
briantakita
> Ramin reports that they are impossible to point at on an x-ray, because they
> don’t exist; a dislocated joint in your spine would be the result of a
> horrendous injury that sends you to the hospital, she explains, not to a
> massage table.

The Chiropractor I visit utilizes x-rays & a thermographic scanner to identify
the subluxations.

From consistently seeing my x-rays, it's obvious where my subluxations lie.
The thermographic scanner analysis also corresponds with what I feel & what my
x-rays show. The targeted adjustments increase my range of motions, blood
flow, & "good feeling" in the areas of the subluxation; in a progressive way.
The spine (especially the neck) is a complex biomechanical system, so it takes
iterations to enhance. I've also tried yoga (ashtanga) & exercise in the past,
but my back was still messed up.

While it's healthy to be skeptical, it's also healthy to be skeptical of the
skeptics.

During the turn of the 20th century, the robber barons (i.e. Rockefellers)
financed a campaign to promote the nascent allopathic medicine & to discredit
the traditional naturalpathic medicine. They financed universities, including
politically maneuvering in allopathic faculty & ostricizing naturalpathic
faculty. They also utilized the new science of propaganda (later renamed to
public relations) to convince the population of their worldview.

Allopathic medicine tends to be more profitable large companies (monopolies)
for a few reasons:

* it has an innate subscription model (i.e. medication)

* it can utilize patents & professional associations to control markets

* by attending to the symptoms & not the root causes, it can create long-term or even lifetime customers who become dependent

* side effects can be masked & non-obvious via bioaccumulation

* masking side effects creates new symptoms to create demand for new medicine

* having a monopoly in practitioners & capital allows companies/markets to control the funding & dissemination of research results

* since it relates to health care, populations demand government subsidies funded by taxpayers & other government funds (i.e. ObamaCare)

* since it's health care, laws can be passed to "ensure the public good". These laws are often written by the lobbyists to restrict competition. For example, in many states, it's a criminal offense to be a Naturalpathic Doctor.

* there's been a recent epidemic (~60 from 2015-2016) of Naturalpathic & well known critics of the allopathic medicine industry/science with mysterious deaths

I'm sure there are many other strategems that I'm missing; but this shows how
allopathic medicine is quite a lucrative business with heavily dependent
customers. It's also politically incorrect to call out the state of affairs as
it's an involved & emotional topic with massively capitalized special
interests who want to keep their golden goose.

~~~
astrostl
Without making any observations for or against chiropractors in general, or
yours in particular, reading, "consistently seeing my x-rays" (of your spine)
prompts me to share

"In this investigation, cervical spine films gave rise to radiation doses that
are similar to those of chest x-rays. However, lumbar spine radiographs
generated effective radiation doses that were approximately an order of
magnitude greater than these other studies. In both the cervical and lumbar
regions, AP views resulted in significantly greater radiation exposure than
corresponding lateral images."

via
[https://www.ncbi.nlm.nih.gov/pubmed/18679095](https://www.ncbi.nlm.nih.gov/pubmed/18679095)
. Remotely regular exposure to high levels of radiation is bad, and not good.

------
gcb0
what is it that cause so much back pain in the USA?

anecdotal evidence, but after a few years there I had weekly visits to
chiropractic just to function. one week out of the country, anywhere else, and
I am good as new again. back to the usa, back to chiropractic. I already tried
to change everything I can think of. even doing more exercise in the us caused
a nerve pitch that was hell.

why? why?

~~~
nradov
obesity and sedentary lifestyles

~~~
gcb0
I am still overweight when I leave the county :)

------
mcbobbington
I think a medical license is a total joke. Now instead of quacks peddling
snake oil, we get extremely expensive quacks with diplomas peddling snake oil.
My wife has back pain and we paid for a $1000 injection the doctor recommended
that did nothing.

~~~
scient
And I think people who make these kinds of ridiculous blanket statements are a
joke.

~~~
mcbobbington
The government doesn't have any business telling anyone they can't smoke weed,
and they don't have any business telling skmeone they can't get medical advice
from someone they trust.

The licensure is a government run monopoly, which always leads to higher
prices and lower quality care.

The fact is good doctors will be good doctors regardless of licensure because
they will put in the effort to learn what's needed to treat the patient. Bad
doctors will be bad doctors, becaude their motive is money, and they won't
care about patients welfare either way. In some ways a license gives a false
sense of security.

------
seanwilson
I thought this community would be more scientific...instead of anecdotes I'd
rather see links to rigorous studies e.g. showing acupuncture or chiropractors
work especially since these two forms of intervention have been subjected to
decades of research already, have no plausible scientific basis and claim to
treat many more things besides back pain. They should be held to the same
standards as other medicine.

~~~
erentz
It's disturbing. I suspect most of this community would be anti-anti-vax (pro-
vax?). And if one were to suggest on this forum that "I vaccinated my child
and they got autism, therefore vaccines cause autism", they would be met with
the appropriate skepticism. But in this thread people are professing "I had
acupuncture and got better, therefore acupuncture works" and somehow that's
considered defensible.

~~~
CodeWriter23
"Anecdotal" is not the correct term. "Testimonial" is. People are relaying the
truth they observed, which is testimony. Anecdote means more along the lines
of hearsay, or repeating something from a third party as if it were
testimonial.

~~~
seanwilson
Anecdotal sounds accurate to me:

[https://en.wikipedia.org/wiki/Anecdotal_evidence](https://en.wikipedia.org/wiki/Anecdotal_evidence)

> Anecdotal evidence is evidence from anecdotes, i.e., evidence collected in a
> casual or informal manner and relying heavily or entirely on personal
> testimony. When compared to other types of evidence, anecdotal evidence is
> generally regarded as limited in value due to a number of potential
> weaknesses, but may be considered within the scope of scientific method as
> some anecdotal evidence can be both empirical and verifiable, e.g. in the
> use of case studies in medicine. Other anecdotal evidence, however, does not
> qualify as scientific evidence, because its nature prevents it from being
> investigated by the scientific method.

> Where only one or a few anecdotes are presented, there is a larger chance
> that they may be unreliable due to cherry-picked or otherwise non-
> representative samples of typical cases.[1][2] Similarly, psychologists have
> found that due to cognitive bias people are more likely to remember notable
> or unusual examples rather than typical examples.[3] Thus, even when
> accurate, anecdotal evidence is not necessarily representative of a typical
> experience. Accurate determination of whether an anecdote is "typical"
> requires statistical evidence.[4] Misuse of anecdotal evidence is an
> informal fallacy and is sometimes referred to as the "person who" fallacy
> ("I know a person who..."; "I know of a case where..." etc.) which places
> undue weight on experiences of close peers which may not be typical. Compare
> with hasty generalization.

~~~
CodeWriter23
Wikipedia != dictionary

------
erentz
[http://sciencebasedmedicine.org/acupuncture-doesnt-
work/](http://sciencebasedmedicine.org/acupuncture-doesnt-work/)

~~~
mamcx
Not work? But except for the parent and a lot of other people.

~~~
grardb
Seriously. I always roll my eyes when somebody claims that acupuncture
"doesn't work," because it's worked for me on multiple occasions. Typically,
it comes from people who have never tried it.

A little over four years ago, I had a ton of shoulder pain. I went to two
doctors, had an MRI scan, and was prescribed physical therapy. After all of
that, I was still in pain, and neither of the doctors could figure out why, so
I decided to try acupuncture for the first time. I went to Chinatown, got
needles put in me, and got some electricity sent to my shoulder. I left the
shop about 30 minutes later, and about 70% of my pain was gone. I woke up with
next morning with only a tiny bit of pain left.

The pain didn't come back, even after months. I eventually found a doctor who
figured out what was wrong, and through a better round of physical therapy, I
was able to eradicate my shoulder pain permanently.

Maybe acupuncture didn't solve my problems completely, and of course it
doesn't work for _everything_ (e.g. weight loss, cancer, etc.), but to simply
say that it "doesn't work" is ludicrous.

~~~
seanwilson
Why after decades then has acupuncture not been shown to work in any rigorous
high quality studies? It's not like it hasn't been studied and proper studies
are significantly more reliable than acendotes.

~~~
DanBC
That's incorrect. There are a couple of recent studies showing acupuncture is
better than treatment as usual for some musculoskeletal problems.

[https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...](https://discover.dc.nihr.ac.uk/portal/article/4000672/acupuncture-
shown-to-have-benefits-for-treatment-of-some-chronic-
pain?utm_content=buffered7fb&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer)

(On mobile, apologies for the weird URL).

For lower back pain I think the advice is, after seeing a doctor, to start
exercising.

~~~
seanwilson
Thanks for the link. I'm not claiming to be an expert so can you explain what
the values here mean? How significant an improvement are these numbers and how
do they compare to just doing nothing?

> It had moderate effect compared with non-acupuncture care for
> musculoskeletal pain (standardised mean difference [SMD] 0.55, 95%
> confidence interval [CI] 0.51 to 0.58), osteoarthritis (SMD 0.57, 95% CI
> 0.50 to 0.64) and headache (SMD 0.42, 95% CI 0.37 to 0.46).

Also, the comparisons to acupuncture vs sham acupuncture...is this implying
that acupunture has some validity (meridians etc.) or just that the sham
wasn't convincing enough? Why would acupuncture perform better when meridians
have no scientific plausibility?

I've no doubt an elaborate procedure such as acupuncture produces a strong
placebo effect but something that isn't better than a placebo shouldn't be
considered as working in my opinion.

