
To Prevent Back Pain, Orthotics Are Out, Exercise Is In - adamsi
http://well.blogs.nytimes.com/2016/01/27/to-prevent-back-pain-orthotics-are-out-exercise-is-in/
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RyanMcGreal
I have had intermittent crippling back pain on and off for my entire adult
life, ever since moving an extremely heavy old stove out of a basement when I
was 18 and feeling a bad twinge when the other person carrying it let go of
his end.

I have been free of back pain for close to three years now, ever since I
started exercising regularly, particularly running and cycling. I believe this
has to do with several factors: 1) I've lost around 30 kg (70 lbs) of excess
weight; 2) I regularly do dynamic stretching (before exercise) and static
stretching (afterwards); 3) my posture has improved considerably; and 4) I
transitioned to a standing desk about 15 months ago and no longer slouch for
hours at a time.

~~~
leothekim
I have a similar experience with recovering from back pain. I injured my lower
back years ago and herniated two discs. I would have recurring back spasms and
subsequently had three epidural steroid injections to relieve pain and was
even prescribed orthotics.

The things that prevented back pain the past few years for me were:

\- losing weight (regular exercise and diet)

\- using a standing desk at work

\- year-long physical therapy followed by regular Pilates sessions

\- splurging on a supportive mattress (lots of coils)

If I had to choose one of these, I would opt for the standing desk. Takes a
couple weeks to get used to, but nowadays I feel weird not using one.

~~~
RyanMcGreal
My back was already improving a year before I migrated to a standing desk, but
it has proven to be such a hugely positive change that I find myself wondering
how I was ever able to sit for that long. For me it took about four weeks to
make the adjustment, during which I felt fatigued and sore. After that, I
haven't looked back.

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Xcelerate
Speaking of back pain, I injured my lower back quite badly about a year ago. I
was doing bench press and wasn't able to complete the last rep. Instead of
calling for help, I (stupidly) attempted to roll the weight down to my knees
and then stood up and set it on the ground. I immediately felt a sharp pain,
and for the next week I wasn't able to sit down (I had to constantly stand
since bending was painful).

Ever since then, I haven't quite recovered. My back feels fine most of the
time, but every few days it aches quite a bit. I recently tried to start
working out again and the pain flared up immediately. I've spoken to a few
serious weight lifters, and they've told me that reverse hyper machines can
help rehabilitate mild lumbar disc herniations (which is what I have). I can't
tell if this is "bro-science" though or something that actually works; a quick
search on Google Scholar reveals nothing. Also, most gyms do not have reverse
hyper machines, so I would have to drive out of my way to use one, or purchase
one. Does anyone have any experience with these machines?

~~~
austinjp
It's bro science, ie not science at all.

The truth is simple but boring:
[https://news.ycombinator.com/item?id=10640658](https://news.ycombinator.com/item?id=10640658)

~~~
jclos
Not to take from your point but something can be both broscience and true at
the same time. It just means it hasn't been formally studied within controlled
experiments, which is unfortunately quite common in the S&C world where the
science is often playing catch-up confirming or disproving ideas that
practitioners have been using for decades.

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gautamnarula
I suffered a moderate-to-severe back injury while surfing when I was 19. It
wasn't debilitating, but it regularly affected my quality of life and was
healing very, very slowly (at the rate it was going, it probably would've
taken 6-12 months to fully heal).

I began deadlifting twice a week, and within two weeks my back pain
significantly reduced, and within six weeks my back had healed completely. I
also felt much less back discomfort or pain from activities that would
previous cause discomfort or pain in my lower back (e.g., sleeping on my
stomach).

I think everyone (women included) who is physically able to should lift
weights regularly. Not only for the primary benefits of getting stronger and
looking better, but for all the passive secondary benefits that come with it:
improved posture, permanently increased metabolism (6-10 calories per day per
pound of muscle), reduced risks of osteoporosis, reduced likelihood of injury,
etc.

The important thing is to lift consistently, heavy, and progressively lift
heavier. It can be pretty intimidating for someone who hasn't done it before,
so I recommend a routine like StrongLifts 5x5 or Phrak's variant of Greyskull
LP to start. /r/fitness has lots of good info in its wiki.

~~~
viewer5
> and progressively lift heavier

I assume it varies from person-to-person, but is there some kind of rule-of-
thumb for what rate to increase your weights?

~~~
sturgill
There are lots of strength training programs out there for beginners (Starting
Strength, Stronglifts, Greyskull). Most studies I've read suggest all that
really matters is that you are strict with your form and stick to it. A
program's success depends largely on you showing up...

That said, I'm a big fan of the Greyskull program. You increase the weight 2.5
- 5 lbs per session (provided you hit the goals of your previous session).

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ownedthx
Annecdote time.

My back has hurt for about 15 years, since the age of 18.

I didn't exercise reguraly during that time.

I haven't had any pain for the past 2 years... The change us definitely tied
to this: I started working out reguraly (HIIT style in my case).

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kendallpark
I see a lot of posts about back exercises, I would just like to add that ab
exercises are JUST as important in preventing back pain. Your trunk muscles
play a huge role in supporting your spine. A strong core pulls your spine and
pelvis into a more optimal angle for weight bearing. A weak core will produce
a bad angle in your lumbar region (which can compress the nerves exiting the
spinal tract in a number of ways).

[http://www.somastruct.com/wp-
content/uploads/2012/07/anterio...](http://www.somastruct.com/wp-
content/uploads/2012/07/anterior-pelvic-tilt.jpg)

Experience: athlete + med student

Personal anecdote: Used to skip ab exercises during lifting. Had lower back
pain during football. Decided to stop skipping ab exercises. Lower back pain
disappeared.

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teekert
Like most people here it seems, I can confirm this. Had back pains on and off
every since I carried my sun around the city for an hour. It vanished when I
started weekly (1 hour) boxing training (it's not about fighting but there are
a lot of push-ups, sit-ups, punching bags and other people's gloves, and 10
min of rope jumping.)

~~~
teekert
Sun = son, 2 hours, so can't edit anymore :|

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h43k3r
Any good link for the back exercises? I do aerobics regularly, play football 3
hours a week and hit gym twice a week. I still feel sometimes that I need a
more stronger back.

~~~
rsync
Male, age 39, with one completely "blown" disc in my back and another that is
probably bulging.

I am completely asymptomatic, pain free, and perform extremely high stress and
high flexibility athletics. Here's how I do it:

\- hip raises on the ball[1] 20-30 reps.

\- scorpion stretch[2] - 20-30 reps, back and forth.

\- roman chair[3] - 40-50 reps, some with a weight across chest

\- plain old straight leg deadlifts with dumbbells

\- and of course, balance it all out with ab and trunk strengthening

But, BUT ... the real key is walking. Your body is a machine built for
walking. You may scoff, but nothing _nothing_ will tighten and straighten up
your back, and all of its supporting muscles, and erase the imbalances and
create the alignment you need more than walking.

Walking will heal you. The first week or so might make things worse - a LOT
worse. Just keep it up. The walking will heal you.

[1] [http://reach-yourpeak.com/tag/glute-strength/](http://reach-
yourpeak.com/tag/glute-strength/)

[2]
[http://www.jsonline.com/multimedia/video/?bctid=64438317001](http://www.jsonline.com/multimedia/video/?bctid=64438317001)

[3]
[https://en.wikipedia.org/wiki/Roman_chair](https://en.wikipedia.org/wiki/Roman_chair)

~~~
hepta
How much walking works for you?

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stephengillie
> _However, the protective effects typically wore off after that, with
> recurrences rising after 12 months,_ probably _because many of the people
> who’d been involved in the studies stopped exercising, Dr. Maher said, and
> their back problems returned._

Ah, speculation. In 5 years, we'll be hearing how exercise causes chronic back
pain, and the solution is to exercise for 6 months, then take 6 months off,
because some other highly-decorated surgeon thinks it _probably_ makes sense.

~~~
jschwartzi
If the back pain is caused by weak postural muscles or a muscular imbalance,
then it's possible that exercise is correcting those deficiencies. Your
muscles adapt to whatever loads they routinely bear. If you spend most of your
time with a supported posture then your postural muscles will naturally weaken
over time. I used to have neck and back and knee pain until I started lifting
regularly.

In my experience, it hurts differently when you're damaging your body versus
training your muscles. It is possible to seriously injure yourself a little at
a time if you're not cognizant of this, and it's much better to err on the
side of caution and progress slower than to ignore your body and risk a
serious injury.

If we see a study like you say, it will almost certainly fail to control for
the confounding effect of a cautious or incautious approach on injury rates.

~~~
RyanMcGreal
> it hurts differently when you're damaging your body versus training your
> muscles

In my experience it's the difference between _soreness_ and _pain_.

~~~
jdbernard
Yes, but to someone unaccustomed to it, soreness is pain.

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achow
A little surprised that Yoga did not get any mention.

[http://www.nih.gov/news-events/nih-research-matters/yoga-
or-...](http://www.nih.gov/news-events/nih-research-matters/yoga-or-
stretching-eases-low-back-pain)

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rsync
Here's a rule of thumb that will serve you well:

If you brace something[1], the thing being braced will become weaker.

It will happen almost immediately. Your body is very, very good at efficiently
allocating resources in as miserly a fashion as possible.

[1] In your body, that is.

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mattiemass
Same experience as most commenters here. Back pain developed suddenly,
reoccurred later on in the year. Began regular light exercise, and now zero
pain and no relapse.

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anentropic
this [http://www.kieser-training.co.uk/](http://www.kieser-training.co.uk/)

