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The $100B per year back pain industry is mostly a hoax (qz.com)
355 points by kawera on July 4, 2017 | hide | past | favorite | 332 comments

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.

> 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.

"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.

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.

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

> If your body needs 2500 calories a day and you eat 2000

Very few people require 2500 calories a day, particularly with modern sedentary lifestyles.

Plus, aside from the thermodynamics component, from a nutrition standpoint not all calories are the same.

"Very few people require 2500 calories a day, particularly with modern sedentary lifestyles"

That doesn't have anything to do with my point. (Although mercifully my TDEE is closer to 3kCal)

"Plus, aside from the thermodynamics component, from a nutrition standpoint not all calories are the same."

Again, we're talking about weight loss which pretty much is thermodynamics.

Excellent insights. This is one of those occasional HN comments that everyone should bookmark and revisit from time to time.

>You need to learn to listen to your body.

+1000 for this one!

I'll vouch for the effectiveness of losing 30+kg (65+lb).

Which only reduces the back pain problem for overweight people to a known-intractable weight loss problem... :-/

Agree that weight/load is an issue. In my experience, a measurable side effect of a daily routine is some weight loss, which if nothing else provides motivation for continuing.

Weight loss isn't "known intractable". Physically it's very simple, if an overweight person is physically prevented from eating too much, they'll lose weight, just like physically it's very simple to quit addictive drugs.

And the drug analogy is a good one, because just like quitting drugs, you can't quit overeating (barring the aforementioned option of someone physically preventing you from doing so - which is literally what gastric sleeve surgery and the like are doing) until you actually choose to. When you wake up in the morning, look at yourself in the mirror, and instead of "oh I'm so fat" or "it's not fair" or "I wish I could lose weight", you think "I choose to lose weight by controlling what I eat", then you lose weight. And it stays off for as long as your choice holds.

You're right that weight loss is largely a mental rather than a physical issue, but very, very wrong to suggest it's as simple as making a choice. Mental health issues can prevent someone from making good, rational decisions, and the notion that they're somehow failing to make an "easy" choice shows a contemptuous lack of understanding and compassion.

> very, very wrong to suggest it's as simple as making a choice

taneq didn't suggest that.

  And [the weight] stays off
  for as long as your choice
It looks like that's exactly what taneq is saying.

I said it's a matter of making a choice. I never said making a choice (much less making that choice) was simple.

Constant application of great amounts of willpower against your most basic biological instincts is possible for some individuals, but generally you are really arguing against the dictionary definition [1].

[1] [trak-tuh-buh l] .. easily managed or controlled; docile; yielding:

There's been strong selection, I suspect, for overeating when food is available. Also for focusing utilization on essential stuff when it's limited.

It's not mere availability of food. Obesity rates vary quite widely across OECD countries; the US is at 35%, France/Italy/Spain are at about 5-10%, Korea is below 4%.

Overeating is a stress response for a lot of people, and overeating often occurs among people in high-stress situations. The US is a country that tolerates a very high level of poverty, inequality, and insecurity, and this results in high obesity rates in some sectors. Obesity isn't the same problem for people who shop at Whole Foods and spend hours at the gym on weekends; it's a more severe problem among people who have to work a horrible job 60-80 hours a week to avoid really desperate poverty, live in decrepit housing, spend hours on neglected bus lines, and are physically insecure.

Where are your numbers from? According to Wikipedia's summary of a 2014 WHO report the US is at 33.7%, France is at 24%, and the major Anglo nations in between. There is not nearly the disparity between the US and the rest of the world you claim.

Source: https://en.wikipedia.org/wiki/List_of_countries_by_Body_Mass...

The claim that France/Italy/Spain had obesity rates of 5-10% was a misread of the charts, where I should have said 10-15%. But the OECD reports pretty wide discrepancies among developed nations. http://www.oecd.org/els/health-systems/49716427.pdf http://www.oecd.org/health/health-systems/46044572.pdf

Here's the 2017 update; France and Spain have topped 15%, but Italy dropped below 10%. http://www.oecd.org/health/health-systems/Obesity-Update-201...

I suspect that it's older data. More and more, "We All Live in America" (Rammstein).

Those are good points. Heavy marketing of highly processed food that's loaded with fat and sugars is also an issue. Maybe also because that crap is relatively inexpensive.

This feels only the level of suggesting a person can choose to not be depressed by thinking positive thoughts. Mental issues are 'just choices', yet we aren't sure that free will even exists or if choices can be made. Research on the brain shows it isn't nearly as simple as just choosing to be better. Brain does a great job of tricking us into thinking we have control.

It is not physically simple to quit addictive drugs. It depends on the drug. Even alcohol is not simple to quit, depending on the person: https://en.wikipedia.org/wiki/Delirium_tremens

A few people seem to be reading my comment as "dietary restriction is easy and so is quitting addictive drugs."

I meant the comparison with addictive drugs to illustrate how difficult it is to resist the urge to overeat. And I believe the two cases are essentially the same - you can't save an addict who doesn't want to be saved, and you can't convince a fat person to diet if they don't want to lose weight more than they want to eat food.

TIL what the beer brand is based on, thanks for that :p.

(it's a strong beer with a pink elephant logo, very good stuff)

> Physically it's very simple

Claiming weight loss is "simple" is like claiming that climbing Mount Everest is simple because you simply put one foot in front of the other and repeat until you reach the top

> Weight loss isn't "known intractable".

Indeed, weight loss is "simple", as you said. The problem arises when you have managed to get to your target and you realize that, short of amphetamines or similarly dangerous drugs, there is no known way to keep your weight stable with an acceptable life quality.

Obese people are not stupid when they choose to keep eating; they've just learnt by experience that, unless you solve the hunger problem, loosing weight will not yield a better life.

By the way, surgery actually looks like an option.

> there is no known way to keep your weight stable with an acceptable life quality.

Firstly, why does your weight need to be stable? Personally I tend to go on yearly (maybe biennially) cycles with shifts between 170 and 195 pounds. Basically I force myself to get down in the weight (my weight-loss method is to restrict calories pretty dramatically). After that I will have eating habits that tend to keep me low for a while, but over time as I go back in my regular eating style (I am naturally a bit of glutton), I'll usually go back up in weight. After that the cycle starts again. I think that this is a much easier approach than trying to stick to a target weight. It also allows you to "live" (most people don't want to count calories forever).

Secondly, what is an "acceptable life quality"? Like I said, I lose weight by restricting calories greatly. This leaves me pretty much constantly hungry for a couple months, but I quickly am able to just push it into the background mentally and accept it. For me this is acceptable. But yes if basically any approach that _works_ is considered _unacceptable_ to you, you're basically screwed. (I don't want to sit on a high horse. You might have stress in life or obligations that make it basically impossible for you to be productive and hungry for a couple months, so I can totally understand my method as being unacceptable to many.) In the end, you do need to figure out how to take action somehow, or you'll never solve the problem.

> By the way, surgery actually looks like an option.

Yeah most don't realize how extremely successful gastric bypass is. It's way more successful on average than any popular weight-loss routine. Obese people should seriously consider the possibility. It can be life-changing.

I'd like to clarify: I think that big sacrifices are easily acceptable while you're losing weight. What can make life miserable is the perspective that sacrifices will always be necessary, just to maintain the status quo.

Your method is indeed interesting, as you basically found a way to concentrate "suffering" in few months per year, still it is another example of a cure that lacks an important bullet point: it never ends.

Solving the hunger problem would let obese people loose their excess weight, no matter the sacrifices involved, and then forget they ever were obese.

Yes I guess using your terminology, my method is basically to solve the hunger "problem", by redefining it as not being a problem (and obviously changing my mentality to allow this). So for me hunger isn't really a problem it just becomes a state of being for a while.

But yeah I think the most realistic way to solve the hunger problem en masse* is gastric bypass. It's surgery so it shouldn't be taken lightly, but not weight-loss method even appears to come close when compared to it.

*As I said in another thread in this post, I don't think it's a good idea to focus on finding the best weight-loss plan for everyone, since it's a very personal issue, but everyone has to recognize that if there is such a general solution, it certainly is gastric bypass.

I wish people would be less cavalier with throwing around gastric bypass as a general obesity fix. I know many people that have had gastric bypass, and have considered it for myself as an obese man.

You will absolutely lose weight with gastric bypass. Full stop. And usually a ton of weight. Which is good! And the surgical complications have fallen way down over time. Those are the good bits. The BAD bits that aren't emphasized in the literature (and that a poor doctor will gloss over):

1) A lack of focus. Universally the people I know that have had gastric bypass seem to have a greatly reduced ability to concentrate on complex tasks and recall. Its almost like 'pregnancy brain' but for men and women and seems to persist long after the surgery.

2) Gastric issues. Everyone knows that people that have gastric bypass spend a lot of time vomiting after their surgery while they adjust to what kinds, and volumes, of food that their greatly reduced stomach can handle. What isn't discussed is that often times your stomach is reduced to such a point where food gets into your intestinal track partially digested, leading to diarrhea and a host of other digestive issues. Also, depending on where the band is placed there might not be enough 'drop' in your stomach for food to easy make it further into the digestive tract. This can lead to further surgeries and even shortening of the intestine. I don't know about you, but going through the rest of my life fighting explosive diarrhea. I'd rather be obese then run the risk of vomiting and intestinal distress for the rest of my life.

3) A general listlessness. I don't know what the cause of this is but I've observed it in everyone that I know thats had it done but no one as much as my mom. She was quite overweight my entire life, but almost disgustingly energetic and just generally full of life. She rarely got sick, and could work a full day of manual labor with no complaint or sign of slowing. After her surgery she shrank way down lost all of her, for a lack of better word, vim. After the surgery she didn't seem to have the energy or interest in pursuing any of the pursuits that made her get the surgery in the first place.

4) Long term results. Long term results for gastric bypass are not great. Most people will shrink down over the course of a year or two to a low weight and then will start packing the weight back on. Slowly at first but usually more and more rapid as time goes on.

I'm not trying to say that gastric bypass isn't an option for a lot of people-but I wish people (obese and non-obese) would stop looking at it as a cure all. Its at best a staving off. Lack of willpower, deep seated problems with food, and self-esteem are almost always the demons at the bottom of the obese pyramid and until you exorcize them, surgery is going to just paper over your problems.

The only person I know who had Gastric bypass complains that she cannot eat more than one doughnut at a time anymore. Which is to say if you don't fix your eating it won't help. If you fix your eating you won't need it (though it might be easier to stop afterwards).

It is possible I know more than one person who has had gastric bypass, if the rest have not told me about it.

Do you mean no known way for obese people?

If you're already fit, it's incredibly easy to stay fit.

Also, most of the time, obese people don't only eat to satisfy hunger, but much past that.

> If you're already fit, it's incredibly easy to stay fit.

You are right! Thanks for pointing it out.

> obese people don't only eat to satisfy hunger, but much past that.

They surely don't eat for the pleasure of adding some more fat to their body.

>They surely don't eat for the pleasure of adding some more fat to their body. //

We surely do, isn't that the problem, we're tailored to times of famine & plenty meaning eating is pleasurable even when we're physically sated to allow us to gain weight ready for the next famine?

I'm on the line of obesity, I eat most when I'm lethargic, depressed, bored. I eat less when I'm exercising, occupied mentally, distracted, physically tired.

In case there are obese people here who are looking for other options, I found an obscure one that has stabilized my weight 30lbs below where it had been previously. I found that by doing apnea training that freedivers do to increase their breath-hold times, I naturally dropped the weight and it hasn't come back. The exercise itself can be done in 15-20 min per day and is done in either sitting or lying down, so anyone without respiratory issues can do it.

As I understand it from a study [1] that someone here posted the last time I mentioned it, the training changes our body's way of dealing with oxygen. It basically does naturally what happens to athletes that take EPO, though without the dangers of that rightfully-banned substance. That raises the body's basal metabolic rate, which should help in losing weight and keeping it off.

Like most other things weight-loss-related, it's probably not a magic bullet, so YMMV, but my sample size of one resulted in my accidentally losing 20% of my body weight and keeping it off for about a year now.

[1] https://www.ncbi.nlm.nih.gov/pubmed/19850416

Regarding the hunger problem - is increasing calorie consumption a viable option? A physically active male with significant muscle mass can fairly reasonably find himself needing about 3000 kcal a day without having to be a pro athlete. Would becoming much more active and gaining lean mass help, or would the amount of food needed to feel sated just increase?

I heard a radio program a few years ago about childhood obesity. They had an expert on who said something I'd never really thought of before: They said the conventional causality of sports curing obesity is the wrong way around. The reason you don't see fat marathon runners isn't because running makes you thin, it's because being thin makes it easier to run.

The guy's reasoning was: You exercise for an hour doing something like walking or golf, then reward yourself with a snack? Net intake of calories [1]. And it's easier to cut a snack from your diet than to find the time and motivation to do an hour's exercise.

To put it another way, when you're obese exercising is like a job that pays ten cents an hour.

Of course, once you've become thin and athletic, you gain access to more time-efficient types of exercise. But that snack might still need 15 minutes of vigorous cycling, or competitive soccer or basketball.

[1] e.g. an hour's dog-walking or golf are roughly equivalent to a 16 fl.oz can of Coca-Cola and a 2 oz packet of skittles, respectively.

It's viable, but only if you also adjust your diet. Burning 100kcal / day extra from being buff doesn't do much if you're also eating 100kcal / day extra.

Plus getting buff costs a lot of effort, it's easier to reduce intake.

But, besides weight loss, anyone should probably do both, especially if bound to a computer; back pain isn't primarily caused by obesity, but also due to under or overdevelopment of certain muscles, posture, movement or lack thereof, etc.

And being on a healthy weight whilst still being weak or low in energy is no fun.

You have to be pretty careful. It's actually quite common for people to _gain_ weight when training for a marathon because they often end up eating more than they burn during the runs. For me at about 185 pounds, I'll burn around 870 calories by running 10k:


I could gain those calories back and more in 15 minutes just eating a burger. A lot of people do exactly this and sabotage themselves a bit.

Personally if I bump up my running training and want to lose weight, I can never depend on it happening naturally. I always gain weight if I don't actively try to lose it. So I think no matter what you need to be careful. If you exercise more, you'll be able to eat more, but if you want to lose weight, you'll still need to eat less than your body wants. So I still think fundamentally losing the pounds starts in the kitchen.

I tried that theory for 20 years, and it didn't work for me. I've always been active, playing lots of sports and going to the gym regularly, hiking, biking, running, etc.. Unless I'm counting calories, I always compensate for exercise by eating more. I finally realized exercise alone wouldn't help me lose weight.

In general, you probably can't get rid of a little hunger. If you want to lose weight and be in a calorie deficit, you might be 500 calories short. If you add 1,000 calories of exercise, and 1,000 calories of food, you're still 500 calories short, and still likely to experience hunger.

I feel stupid for how long it took me to "see" my own evidence. Like many people, I have a mental aversion to paying extreme attention to what I eat, to eating less, and to counting calories. The very idea of doing that is off-putting, and I didn't notice how subconsciously strong that mental aversion is until recently. It wasn't easy, but I did the hard mental work before I started the diet. Once I got going and formed some new habits, I didn't have to think about it much. One of my mental tricks was to realize that a little hunger is exactly how I'm supposed to feel. Rather than focusing willpower on combating my hunger and reminding myself not to eat, I came to the realization that not being hungry at all is the bad state, that is the feeling I have when I've eaten too much. Being a little hungry is a good thing.

Counting calories worked for me relatively quickly, and it worked regardless of whether I was exercising (as long as I tracked my exercise calories too.) It took less time than exercising, and it helped me see the differences more clearly between losing weight and getting strong. Those are two mostly different things. There's some cross-talk between them, but the main way to target each of them is different. Gyms all advertise weight loss, but now I see gyms as a place to get strong, and eating less as the way to lose weight.

I should have been a bit more explicit - I meant life after weight loss. The problem was apparently that maintaining a healthy weight requires being perpetually hungry. I was wondering if being able to afford 3 solid meals and some snacks without gaining weight would help with that appetite issue.

I understand. FWIW, in my mind what I said applies to life after weight loss. I still speculate that exercising more to eat more doesn't solve the appetite issue. At least for me anyway. Here's why. The comment you replied to made the hunger out to be an issue so large that it affects quality of life drastically and negatively, and so significant that the alternatives - not losing weight and the problems that come with that choice - are preferable to the extreme hunger. I have no doubt some people legitimately feel this way.

My experience counting calories and adjusting to the hunger are all about being just a little more hungry. I'm not starving or ravenous at any point, I stay only a sliver shy of satisfied. I don't let the hunger get uncontrollable, and if I'm ever crazy starving, I eat. I never get crazy starving when I'm counting calories, though, because if I exercise a lot I eat a lot, and if I don't work out then I don't get as hungry.

Before I mentioned adjusting mentally to seeing a little hunger as good rather than bad. That helps. Quality of life is a relative and subjective idea, and within reasonable limits, people can and do adjust to being equally happy with less. If weight loss is a goal, then I'm suggesting that seeing a little hunger as a good thing is a way to re-calibrate your quality of life detector, not a way to compromise. If you want to lose weight, then the feeling of being sated, and the weight gain that comes with it, isn't a higher quality of life. It's more than you need and includes potentially negative side effects.

Another mental change I made that I didn't mention before is that when I had success counting calories, I set my calorie limit to what it "should" be forever, based on standard age / height / goal weight charts. I never had a life after weight loss, I didn't temporarily reduce it further than that like most people who diet try to do. I just set it to what it should be for the long term. I knew this would make it take longer to lose weight, but I wanted to form a habit and feel like I was always eating a normal amount, rather than suffering a temporary sacrifice. I wanted to set it and forget it, rather than have to adjust again later. I was still eating 3 solid meals a day, and having snacks. Just a little less than before, controlled and accounted for so I knew when I was about to go over.

I also like to go a little light during the day so I have a calorie budget for a dessert treat after dinner. This way I usually feel like I'm splurging just a little rather than suffering through hunger. Instead of feeling like I need to summon more willpower, I feel like I'm always cheating just a tiny bit.

From my own experience, I didn't find that counting calories and being a little bit hungrier on average than I was before affected my quality of life negatively. Not at all. My appetite changed when I changed my diet. I became more comfortable with being just a little hunger, and perhaps surprisingly, I think I have more energy.

Anyway, it depends, I don't judge anyone's choices, and I think this is a lot more complicated and difficult than having willpower or overcoming hunger. But I also think an adjustment is an adjustment - the steady state of living with weight loss should be expected to feel different than before.

There are foods that help with feeling hungry. High fiber and low calorie foods can be eaten in larger volumes than high fat foods.

One cookie takes 20 minutes of jogging to burn off. Abs are made in the kitchen, not the gym.

I switched to one full meal a day and fruits / salads / soup for the other times. This takes care of hunger issues and helps with losing weight. Change of habit is required and it is not easy. Bariatric surgery can help, but it has it's own annoying side effects and long term (>7 years) reports aren't available widely.

> Change of habit is required

Sure, obesity is clearly (also) a problem of bad habits. The question that still needs an answer is: when will the new habit become natural for me?

Hunger is not like exercising: while a couple years of training can make a marathon feel natural for the body of a former sedentary person, no amount of training (AFAIK) can either ease the feeling of satiety with the correct amount of calories or set your stomach/brain system to "hunger is normal" state.

Edit to add: I'd lovee to be proven wrong :-)

Satiety is apparently a complex mix including mental aspects but also chewing. Have you tried chewing more? Either "over chewing" (just keep each mouthful of food in your mouth longer and chew it to a complete pulp) or lower calorie foods that you physically have to work on more to actually eat (carrots, celery, ...)?

Water before eating may help you slow down too, which means your body can realise you're sated at an earlier point through the meal.

Just suggestions, YMMV, IANADietician and haven't fully researched these ideas scientifically (though they are based on research I've heard about in passing).

The main challenge is that a lot of people try and change too many habits at once - when new year comes around, lots of people go on a diet, go to the gym, etc.

But changing too much at once will only cause people to revert to old behaviours. Change one thing at a time. I started by weaning myself off of sugar in coffee, one step at a time. Stopping candy was easy, I never had a problem with that, the stuff makes my teeth hurt. And stopping friday/saturday/sunday snacking was relatively easy too once I was no longer living with my parents and it was just put on the table.

Current / most recent change is having a big salad for lunch at work, now that I've got a new assignment that has a big salad bar. Making it big is important; there's pretty much no nutritional value in the green stuff, and it helps me get through the afternoon without feeling hungry.

This might sound glib but it's not meant to be; habit and discipline take over after desire fails.

Meaning you need to establish a new normal for yourself. Maybe that means no more soda (not even the sugar free crap) and no ketchup on your fries. After a while weight comes off and stays off without you missing the extra calories.

Why do people consider mild hunger to be something that seriously impacts their quality of life? Hunger is the natural state of all animals.

This is something I've realized as well, AFTER losing weight. It's very difficult to convey the differences between "real hunger" (when you need energy) and "fake hunger" (you want to eat crap because you haven't for a bit) to someone who hasn't gone through that. I think this is an issue everyone needs to learn themselves.

At this point I actually like the feeling of lingering hunger, I focus better, probably a hunting instinct. I've attached it as a pavlovian response to ambition I think. At first knowing I was losing weight, but now detached from that and more general.

I think there are more types of hunger than just "real" and "fake". The body has needs and you can attune yourself to them. "Cravings" seem to be real psychological signals for certain sorts of nutrition. I've been trying to pay closer attention to them ever since losing a significant amount of weight on keto a few years ago and starting to exercise more seriously.

For example, after a strength workout, I experience a different kind of hunger than "morning hunger" (protein craving, the urge very consistently appears about a half hour after my workout, vs something small to start the day), which is in itself distinct from hunger around lunchtime (habit-formed hunger, you ate at this time yesterday). Also, thirst sometimes seems to manifest itself as another sort of hunger, or else a craving for salt/electrolytes (especially after a sweaty cardio workout).

Listening to your body is a curious exercise to do while you're sick. Your body really tells you what you need, if you're willing to listen. But too often it's like, well, you have this lunch meeting, and you're not hungry but you can't miss it/don't want to miss the social interaction. And suddenly you're ignoring your body again and eating because it's convenient...

There is difference between 'Hunger' and 'Appetite'... A simple solution prescribed by my physician was 'just sip warm water (not too hot)' and if your stomach feels good, it was your appetite which got satiated at that time DON'T EAT anything. After 1/2 sips if there is still feeling of emptiness, it means your body really needs something.

Indeed all animals' life is a constant battle against hunger. No brain evolved to accept hunger, but to recognize it and fight it as the no. 1 priority.

No, you're describing the intense hunger associated with starvation, not the mild hunger associated with gradual weight loss. If you're doing other stuff then mild hunger is easy to ignore. It's an alert, not a command.

Mine is a honest question, no rudeness intended: do you know what you're talking about? Have you experienced it first person?

Yes of course I've experienced it. Being a little hungry is just like being a little too cold or feeling minor pain. Put it aside and get on with life.

Thanks for replying. Now it's clear that you don't know what you are talking about.

Rudeness intended :-)

Apparently you don't know what you're talking about, and just want to whine and complain. Too bad.

You come off sounding like all of the whiners on various Reddit fitness subs complaining about how they can't lose weight, or their lift numbers aren't going up just looking for someone to tell them that's it ok to quit or ease-up. To steal from fitit, have you tried trying.

rudeness intended.

If my house were not a constant 73F, it would seriously impact my quality of life - at least for a while - because it's my long-standing definition of normal. That is what people do: seek comfort, then take it for granted.

"Holds" implies something a lot more passive than it is. Losing weight is a full-time job, harder than anything else I've done. I've succeeded over the last couple of years but only because I'm in the privileged position of literally everything else in my life going well enough that I can focus all my willpower on it.

you do not even need that. just set appetite = 80 in the human source code so you start eating 80÷ of your daily caloric use. the pounds will melt off. when you have a goal weight set appetite = 100÷ and you will simply stay at that weight.

it is very simple physically.

as for where to set it, I have nothing to say about it just as you have nothing to say about how to make a choice.


The fact is, a choice fat people can make is "I will get gastric sleeve surgery" and this "commit" is statistically enough.

the "commit" that parent suggests is the same as my suggestion at the top. I give no practical advice at the top of this comment and neither does parent comment.

if there were a variable that would set someone's appetite and saciety then it would work. if there were a variable for commitment then parent's advice would work.

parent ignores the hard work of finding and setting that variable, and parent ignores statistics that most fat people have spent a few dozen hours looking for how to set that variable and have failed to do so.

your advice is as bad as when people defend some totally useless setup on the grounds that it's turing complete. yes, you can make a social media app with a custom backend written in C++. No that does not work statistically and most people who set out to do so fail.

but physically it's very simple.

reasonable people don't ignore the statistics.


Apparently, boffins are starting to realise it's not that simple.

A neuroscientist claims neuroscience is the key component that makes weight loss difficult. Colour me sceptical.

"physically it's very simple to quit addictive drugs"

Quitting some drugs cold turkey can be dangerous, so "simple" isn't quite correct.

>Weight loss isn't "known intractable". Physically it's very simple, if an overweight person is physically prevented from eating too much, they'll lose weight, just like physically it's very simple to quit addictive drugs.

Locking people up away from food is even more intractable!

> Physically it's very simple

So is cutting your arm off with a hacksaw. "Simple" does not mean "easy."

And that is exactly taneq's point.

Then he made it very poorly, as the other responses here attest.

I have a spinal condition (syringomyelia), I lost a similar amount of weight (250 -> 185).

Started exercising gently and worked up to a fairly intensive callisthenics (starting with basic stuff and using a pull-up bar, pressups handles). Takes me 40mins every other day to do a full 'routine' (quoted routine because it varies every time).

The end result was that I only take my medication on a night to sleep now, during the day I'm drug free which is fantastic because the medication wrecked my ability to focus.

The funny part is I didn't lose the weight because of my back but because I was having other health issue (and had metabolic syndrome, a big warning sign for diabetes), at my last checkup all my results where slap bang center of normal for my age.

My doctor told me pretty much the same thing when I asked him about exercise "listen to your body, if it increases the pain the next day back off that exercise".

For the first time in 3 years my health is level enough to live a completely normal life, I will never put the weight back on (kept it off for nearly 2 years now by calorie counting and using an accurate scale tied to my phone, I get weight every morning and night at the same time and it shows me a nice graph).

I'm a healthy athletic 20 year old and I was having back pain for a while, and when I finally went to the doctor they suggested it may just be an imbalance in the strength of different muscles in my back that I didn't properly train for the sports I participate in.

Gave me some exercises, and a month later back pain was all gone and my back felt stronger, with better posture. Crazy what can be done when you just have go for it

Got any links to similar exercises? I'm also early 20s, spend most of my day sitting at a desk, have dealt with backpain for a few years. Pullups (especially wide-grip) have helped but I'd like to know some stretches, too.

I'm in my 30s, but get most of my exercise from cycling, which doesn't exercise the back much. My back pain problems have been increasing over recent years, but I've had good success in the last few months with 15-20 minutes a night of yoga. I'm doing regular plank, bridge, locust, and downward dog poses for back strength, and cat/cow, sphinx, and forward fold poses for back stretches. I like a lot of the leg and hip stretches, too.

Exercises I was given were lunges - https://www.youtube.com/watch?v=COKYKgQ8KR0 hip raises - https://www.youtube.com/watch?v=fDP6O_aJpDg

Start in a crawling position. The purpose of this is to give you more control of the pelvic position with independence from the chest. Quote from the PDF: Start in a crawling position. Without moving your head and shoulders, roll your hips so that you arch your lower back. Do not push into pain. Only go as far as you feel comfortable with, then relax. Try not to move your upper body & chest. If this is difficult, rest your shoulders, chest and ribs on the couch or bed, keeping your tummy clear. This will help to restrict the movement higher up and help you to localize the movement to the pelvis.

The other thing my physio did was sat with me and showed me what my posture _should_ be like, and made me sit like that for an hour or so. It was then up to me to keep sitting/standing like that outside the office. The first day, I was exhausted after about 2 hours. Now, it's painful to sit slouched.

EDIT: Even though this is a thread about the industry being a scam, I'd still recommend seeing a professional (even just your GP). As other people here have alluded to, you'll probably get some drugs to get you to be able to exercise pain free, but it could also rule out other issues (kidney problems being a good example), and ensure that there's nothing more serious going on.

I'd also recommend taking up a pilates class.

yes! this. the problem is, there are a lot of people that are told to lose weight to cure back pain, they lose enough weight for it to alter their posture, and they experience new back pain. of course it's temporary, and if their doctor had told them about it ahead of time and offered appropriate physical therapy when it happened they'd work right through it, but that doesn't seem to happen. all they know is the doctor told them to lose weight for their back pain but losing weight made it worse, so they stopped.

I've had back pain on and off over the years. Usually due to muscle cramping from poor posture. I had to make a conscious effort not to slouch at my desk.

What I've found helps with back pain, sciatica, knee pain, are stretches, and free weights. Then again, I've been lifting for about 41 years, so its not a surprise to me that changing my regimen provides positive outcomes.

Specifically, for me, dead lifts for lower back, squats and leg presses for legs and knees.

Speak to your physician first about whether you can do this. Speak to a PT person about what stretches/weights you should do, and what you should avoid.

I struggled for ages with trying to keep "good posture", trying to position each part of my body correctly (shoulders back, etc). Once the importance of core muscles was pointed out to me, I saw that all I need to do was "turn on" my pelvic muscles and the other bits of my body fell into place without thinking about them individually. As the strength of these muscles improved due to a regular exercise routine, I found that I didn't have to consciously "turn on" pelvic muscles and they were strong enough to keep things in position by themselves.

I have also found sleeping on a hard floor very effective in preventing back pain.

Laying on a hard floor with my arms above my head has been my near-term way of coping with back pain. But a little isometric back strength exercises like a nightly plank have helped with prevention over the past few weeks.

there are firm mattresses :)

I tried a solid wooden bed platform with about 2 inches of foam mattress topper. If nothing else, it makes you really good at camping - sleeping on the hard ground is so much more comfortable when you're used to it.

Piggybacking on this - basic mobility exercises can free up a lot of your muscles from regular pain. You end up doing this a lot when you go see a physical therapist.

This was part of the reason we bootstrapped our app - MoveWellApp.com - to give people easy-to-understand routines to stay mobile and pain free at home.

It's a free download at http://MoveWellApp.com/download for iOS, so if you have any specific feedback, I'd love to hear it.


No comment to its quality, but it's pretty ballsy to piggy-back on a thread talking about a $100B/yr industry being "mostly a scam" to promote your app :)

Obviously he has the spine to do so :)

On a more serious note, I think an app that motivates people to be more active isn't a bad thing or scam per se, though I can't speak to the quality of this particular one.

Except instead of charging hundreds of thousands for pills or surgery, we're showing people how to do basic exercises at home for free.

Take a look at the app for 5 seconds ;)

Is your doc Sydney based? Mind sharing the contact info?

I've sent an email to the address in your profile.

>I can personally vouch

Which is the opposite of science. What other 15m routines have you tried, in a double-blinded manner?

Something can help you, and still be a hoax. No contradiction.

I don't know why this is being downvoted -- it's the first sensible thing that I've seen here. For example, from the article:

> Spinal fusion surgery, for instance ... costing a total of $40 billion per year ... ... with a price tag averaging $80,000, [and] has a success rate of about 35%.

That's not a success rate of 0%. If you look around, you'll find tons of people (175k/year if my math is right with the numbers above) who have had success with spinal fusion surgery -- one such person actually posted below!

At least this particular approach (light mat exercises) can't be properly called a scam, since it doesn't really try to trick you out of money. The fact of the matter is that the back is tremendously complex, and this approach, when analyzed across a large sample of back pain sufferers, might have an even worse success rate, especially considering the symptomatic divergence of people reporting back pain.

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.

> 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 :-)

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

> 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.

The insurance provider (or management / shareholders) probably get a kickback from the pharmaceutical industry.

Do you have any evidence that this ever happens?

That's because PT is evidence-based: http://www.apta.org/EvidenceResearch/

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.


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.

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.

I went through the PT option for many many years. It definitely helped, but never provided lasting relief. Finally, after a period of nearly a year without any pain relief at all (I now have extreme empathy for people who suffer chronic pain), a microdiscectomy/laminectomy resolved everything. After 2 weeks I could go back to work, after 3-6 months I felt fairly normal, and after a year I felt better than I could ever remember.

I kept seeing experts, getting more opinions, and aggressively pursuing all options. Eventually I was referred to an amazing back doctor who took me through all my options - first PT, then a series of epidural cortisone injections, and finally surgery.

Worth noting though, I did a ton of research about failed back surgeries (it has its own name - "Failed Back Surgery Syndrome"), and while you can put the odds in your favour, there's no sure thing. However, getting a highly rated doctor and surgeon working together to get a very accurate diagnosis, combined with the latest surgical techniques will maximise your odds of success. The microdiscectomy with metrx is pretty incredible for being minimally invasive and keeping recovery time as short as possible.

I am sorry to hear your in pain. I know how debilitating it can be.

Hospital for Special Surgery in NYC is consistently ranked number 1 in orthopedics in the US. They have spine surgeons and neurosurgeons who excel in implementing mechanical solutions. Perhaps I should have mentioned first that the pain clinic at HSS is fabulous for diagnostics and they are extremely conservative when it comes to opioids.

Getting a proper diagnosis is essential. I was diagnosed incorrectly for years before learning my underlying problem was a spondylolisthesis. Appropriate imaging studies (x-ray, MRI, CT, myelogram as needed) read by superb radiologists will get you a clearer picture of what is really going on.

Surgery may or may not be required. It all depends on the cause. If your doctor recommends diet and exercise/PT be relentless with your implementation of the program (being mindful of what your body tells you).

Finally I would have to say that my sister who is an MD helped me realize one very important thing. The susceptible human back gets "tweaked" from time to time. If your back goes into spasm for a couple of days once in a while (and deelowe I am speaking more generally here than of your specific circumstance) you could spend tons of time running it to ground, when it the long run a form of radical acceptance may bring greater peace of mind. Accepting - I am a person whose back fails me from time to time forcing me to be debilitated for a few days may be less anxiety provoking and frustrating. Good doctors can help you decide what option is best. As Aaron Sorkin said in the Steve Jobs meeting, and I think it applies to all of us, accepting "I am not well made" can be useful to all of us.

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/

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).

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.


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.

I've been a back pain sufferer for most of my adult life (I'm 45, this started at 20) after being attacked and having my back bent badly backwards (with a knee placed in the small of my back). I know how you feel in terms of wanting help, so here's my (anecdotal!!!) experience.

I'll spare you the full story, but I've tried just about everything - Chiropractor, Osteopath, Yoga, Pilates, Exercise of all sorts, Physio (NHS in the UK), etc. Nothing has really helped - more paper the cracks than fix the wall.

Very little worked, and the pain has increased in frequency and intensity over the past 10 years or so - culminating in a prolapsed L4-L5 disc, and some nasty sciatic pain episodes around 7 years ago. The NHS treatment (pain killers and exercises) didn't help. I did all the exercises they gave me, and they did nothing. They discharged me without any improvement.

Three things HAVE really helped. Firstly, learning Alexander Technique [1] which got rid of the sciatica (and the need for daily pain killers) in a couple of weeks. Much later (in the last 6 months) some really specific exercises targeting the multifidus muscles [2], and reading "The back pain bible" [3] was eye-opening - having a good idea of what's going on in the back helped, and there were some exercises in there which with hindsight did help. I read somewhere (can't find it now) that once you lose the tone in your multifidus muscles, you don't spontaneously regain the tone/strength in them; other muscles cover for them and then you're in trouble.

At the end of last year I was at my wits' end - pain all day every day, no-one understanding what was going on, and being told by the chief physio of my NHS trust that "this is just how life is now" - despite me being the kind of obsessive person who actually does the exercises I've been set. So I decided to try things for a month and see what helped - some things did, some didn't (including a very expensive piece of mobilisation equipment). And the multifidus exercises (with leg weights) seemed to just 'switch on' the rest of me, allowing me to maintain good posture and protect my spine. I'm definitely not fixed yet, but I'm not in pain all the time - in fact I had a nearly 3 week period without a twinge last month, which was like being on holiday away from the usual hell. I really think the weakness in those muscles is the key to me actually improving for the first time in a decade (they were pitifully weak initially, and I'm sure there will be other areas where that's true). Maybe something that specific could help you?

For context, I'm 6'1 and around 90Kg with a fairly muscly build - I -look- fit and I'm certainly not overweight, but there's more to bad backs than appearances.

Anyway, hope that helps someone.

[1] - http://www.alexandertechnique.com/ [2] - https://www.amazon.co.uk/Multifidus-Back-Pain-Solution-Exerc... [3] - https://www.amazon.co.uk/Sarah-Keys-Back-Sufferers-Bible/dp/...

Would love to learn more about the activities or structural issues that led to getting the surgery. Also, what were the types of things you heard over 10 years (or treatments you attempted) before getting the surgery? Basically, would love to hear your story / more details here - thanks :)

My ultimate correct diagnosis was a cluster of a few interrelated issues. Bilateral defects in the pars interarticularis around L4-L5 led to chronic degenerative changes at that level as well as a grade one spondylolisthesis. This was coupled with sclerotic changes in a spinal canal that was congenitally narrow leading to impingement.

My earlier incorrect diagnoses included many of the usual suspects. Bulging disc, piriformis muscle entrapment/impingement, muscle strain, somatization etc.

Treatments attempted included injections, muscle relaxers, tens unit, NSAIDS, opioids, PT, and other things like spinal cord stimulators were recommended but not implemented.

2011 and 2013 fusion, laminectomy, foraminotomy, discectomy, placement of hardware.

And the story has a happy ending. Scuba, hiking, touring all successfully re-integrated into life. Hopefully it will last a lifetime but all this taught me that every pain free day is gravy.

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.

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.

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.

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.

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_...

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.

The Trigger Point Therapy workbook has helped me quite a few times. I learned about it from a fictional character in a book called Sex Drugs and Blueberries, which is also a good read.

Your muscles are locked in spasm because they’re insufficient to carry the load. The long term solution to that is not acupuncture, it’s building up those muscles through exercise, and in particular through training with free weights.

Well yeah, but it's no good lifting weights with muscles that are locked in spasm.


My physiotherapist's approach is to engage in a variety of horribly painful activities to get those muscles to unlock, and then teach you how to do the exercises that will help you stop it happening again.

That's pretty much what I did, modulo the physiotherapist. I would lift, get punished for it with brutal back pain, wait for a few days for it to subside, then do it again. I was free of back pain within a month.

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

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?

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.

You might want to look for a better example.

Even before prices for HCV drugs went down due to competition, they offered a cure for a life threatening disease for less than $100K in the US with minimal side effects, typically in 8 weeks, and with 95% effectiveness. The agent is a small pill taken twice a day. Price is scaled to personal income in country of treatment.

That's more like 1/10 of the monetary cost of a transplant, which is a scarce and rationed treatment.

What argument of mine are you attempting to rebut?

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.

It's a very cynical argument, I'll give you that, and I'm certainly biased by wasting a bunch of time & money on x-rays and drugs and acupuncture. A slight more realistic explanation may involve liability - twisting and stretching someone who complains of back pain may be hard to teach / accredit at scale in a way that doesn't sometimes end disastrously, and MDs prescribing meds eliminates those cases of extreme liability.

Not sure about Malaria or stomach ulcers, but likely because those who developed the drugs were not acting to maximize their economic interests? Malaria seems like a relatively well understood parasite, whereas "back pain" could really be a symptom of nobody-really-knows-what.

> 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?

Yeah, surely if you were the first company to work out how to cure e.g. back pain or cancer you'd make an insane amount of money so you wouldn't keep it under wraps. Who exactly would stop you going to market with it? It's a silly conspiracy theory in my opinion.

It's funny that we have billions poured into cancer research yet we still can't find that cure.

I guess we need another cure cancer walkathon with pink ribbons cause those smart scientists almost have that cure...

Perhaps there is a cure (or at least the causes are well-known), but it's being withheld from the public. Why would we ever want to fix problems that employ so many people & give them nice houses & yachts?

Actually, cancer treatment has made huge progress in the last decade or so. Melanoma, in particular, has gone from a virtual death sentence to being one of the more treatable forms.

The idea that we haven't found "the cure" to cancer is silly because cancer isn't one disease, it's many, down to the point of everyone's cancer being genetically different, and in fact different cancer cells being genetically different within an individual.

Cancer is all statistics. You slowly accumulate mutations in your tissues over your life time and if you accumulate enough mutations (especially in oncogenes[1]) you will get cancer. The only way to avoid it is to die of something else first.


Yeah, a log/log plot of incidence of cancer against age shows that about 6 mutations are needed in a cell to result in cancer. A decent cancer needs invasiveness, metastases, vascularization and evasion of the immune system. The last two are especially important and that's where current research is directed.

I'm not going to argue against the complexity of cancer, just as the effects of a complex system is more complicated compared to the inputs (i.e. a fractal).

What is not emphasized is nutrition, environmental toxins, bioaccumulative effects of "safe" compounds that we interact with daily (plastics, chemicals, hormonal (estrogen) mimickers, Electromagnetic pollution, Stress, side effects of drugs) & their effects throwing monkey wrenches into biological processes & causing these mutations.

We can study the effects & create drugs to combat the effects or we can address the causes. One strategy is more profitable, has a more defensible market position, & creates a more dependent consumer base than the other.

This will be my last post as I've already done enough damage to my HN karma on this topic. It's a pretty obvious argument if one takes an honest look at motivations of the different parties. It's all too easy to get bogged down & distracted by the details at the tail end of the system; when it's the inputs that really matter.

The issue is a multi-domain systemic issue that we are trying to solve in a single domain (pharmaceutical drugs/medical procedures). A Belief system is a great tool to handle the complexities of life & choosing an effective Belief System is a tool that will help one achieve optimal results. Our culture has atomized existence into domains & degenerated holistic belief systems to our detriment.

"Electromagnetic pollution"? Are you seriously arguing wifi causes cancer?

Being charitable, he might mean sunlight.

> Are you seriously arguing wifi causes cancer

> Being charitable, he might mean sunlight.

I'm talking about the broad concept of Electromagnetic Pollution, including effects known & unknown. I'm not convinced of the "proof" that Electromagnetic pollution does not cause cancer, as there are secondary effects (i.e. Melatonin).


Putting cell phones next to you head is not a good idea. We aren't going to hear about the effects from the "scientific consensus" until there's a market solution though.

Sunlight is good for you & will reduce cancer.

Perhaps you should research Electromagnetic Hypersensitivity Syndrome. Many of the former engineers from Ericsson have this disease. Perhaps you can visit a United States National Radio Quiet Zone & see if you feel different...



Indeed, and it is surely for the same reason that there isn't yet a pill I can take to make me 7'5" tall.

But of course we're left with the same conundrum: why has the modern pharmaceutical industry cured any disease? Every time they do, they kill another cash cow.

I do half an hour of yoga postures almost every morning. When I don't do them for a few days I get pretty bad back pain and migraines. when I am doing them, no problems at all.

Before doing that doctors would give me injections and muscle relaxers all the time. I am pretty sure I either would already had had surgery or would get it at some point if I had followed doctors' advice.

The trick is that you have to adjust your exercise routine to your specific problem and adapt constantly. This is not easy.

What part of your back? Is there a name or website for the routine you follow?

For me it's the sacro illiac joint. It tends to get misaligned and then I get headaches. A yoga teacher gave me a series of exercises that bring it back into alignment and also strengthen the surrounding muscles.

This is very individual and probably won't work for other people.

In general look at the DVDs by Gary Kraftsov. His stuff is very simple but very effective.

Many will do McKenzie Method work ($10-15 book on Amazon, Treat Your Own Back) for lumbar pain in flexion. It is very specifically good for that and that alone, which is the most common form of low back pain. I found a lot of relief using the tools in the book (yoga-type postures) and weight lifting.

> why would anyone ever fix it in a for-profit system?

For the same reason any other problem gets solved in a for-profit system; the best solver of problems will be the best getter of dollars. See for instance Apple, Honda, Nike, Harvard, etc.

Except that's not what's happening. There's a massive pile of patients who will try literally anything, they are a price and solution inelastic market, and like they say, there's a sucker born every minute. Except the sucker is a patient that isn't ever allowed, by this particular market, to get a refund for bad advice and procedures. You have to basically be injured by the doctor to have standing to sue.

The idea of health care as a product like a jug of milk is just ignorant, idealist, nonsense.

Counterpoint: hundreds of effective medical treatments for a variety of problems exist. Even in the joint pain market, compare today with 30 years ago. What would be career-ending injuries in the 80s are now resolved in time to return for next year. And these treatments are available to normal people too.

Edit: see the linked article on ACLs.


Well, let's say that medical ethics is a thing, and ethics in used-car sales is not. I'm attached to a medical school in a Southern state, and Trump was ahead in my neck of the woods with 2/3 of the vote, and it's taken seriously here by the physicians.

Partisan political tangents aren't acceptable on this site.

Apple kickstarted the smartphone market with one good product and went downhill from there in terms of making anything worth buying. Otherwise the only problem they're best at solving is marketing.

Apple actually supports the argument. Why innovate when you can make more profit removing functionality and releasing new colors while coasting on brand recognition?

A wilfully ignorant an elitist view of why people buy Apple products. A logical fallacy that anyone who makes a different decision to you is less intelligent than you.

I mean, given enough competition (which I accept isn't a given), someone will decide getting all of the profit from a cure is worth more than competing for a slice of the treatment market.

The problem with doing exercises is it's not as simple as a pill or a surgery - it's a lifestyle change.

Don't want to spam HN with this as I mentioned it earlier, but this is one of the issues we're trying to address with http://MoveWellApp.com - which is basically a personal mobility coach.

Get a dog instead. Unlike a stupid app you can't ignore the animal once you got it. I wouldn't have believed it, but walking the dog has improved my physical and psychological health considerably.

> you can't ignore the animal once you got it

Sadly you can, and many people do.

Thanks for taking the time to give such helpfully feedback.

Quick note here: an Android app would go a long way to encouraging takeup in the HN crowd, I suspect.

I'm already a big fan of mobilisation exercises, so my thought process went "sounds great - where do I download?"..."iPhone only. Meh. Oh well."

I know you're working on it, just wanted to give you some feedback to help prioritise.

Thanks - we're working on it.

We usually build iOS first for the reasons outlined here - https://impossiblex.com/ios-first/

Nice thanks for the rec

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.

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

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

Been squatting for years, and finally got around to dropping the weight 50% and attempting to work back with perfect form. A bunch of flexibility and pain issues have disappeared as if by magic

Squatting, deadlifting, and don't forget Rippetoe's favorite accessory exercise - back extensions, or reverse hypers if you can find the setup - do wonders.

Pairing weightlifting with McKenzie Method work is great if you suffer from lumbar flexion back pain; the most common out there. Also, weightlifting works best for that type of pain as well due to it getting rid of anterior pelvic tilt over time and reinforcing a neutral spine, to say nothing of the increased muscle gain and postural support you get from pushing iron.

Same for me (I'm late 30's). Heavy dead lifts, squats and a standing desk. Starting strength training/powerlifting a few years ago was the best thing I ever did for my mental health :)

I'm with a personal trainer atm, he screwed up his back with poor deadlifts and/or squats. The posture thing was probably a very subtle thing, but it accumulates when you do it often and with heavier weights. The guy's not even mid-20's yet.

>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."

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.

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.

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.

NHS doctors as gatekeepers works both ways. I've had to beg and beg for referrals to specialists for things that clearly required them before. Once you get past that stage though, care is top notch.

It doesn't say that they are spinal surgeons.

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...

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

Another Sarno cure checking in. Debilitating "RSI" in wrists/arms and back pain. I tried everything (lots of rest, ergonomic keyboards, cold compresses, NSAIDs, physical therapy), but nothing I did seemed to make any difference. Eventually, after two years of arm pain and half a year of back pain, I read Sarno's book "The Mindbody Prescription". I was very skeptical, but I was desperate. Within a couple of days I felt better, even better after a week, then a month. That was two and a half years ago. Today I have no back pain and I can type all day pain free.

Occasionally I get flare ups where I'll feel a little discomfort in my arms, but reminding me of the lessons within Sarno's books makes it go away within a day at most, and ever since I read Sarno I have never felt that I was in too much pain to work on a computer.

I don't know if Sarno got everything right, but typing this comment without pain proves to me that he is on to something.

Don't suffer for years like I did! If you are interested, I would recommend watching this 20/20 segment with Dr. Sarno: https://www.youtube.com/watch?v=vsR4wydiIBI (13m35s). If you search for "RSI" on Hacker News, there are some great threads in which Sarno's theory is discussed.

See also https://en.wikipedia.org/wiki/Tension_myositis_syndrome

Wait, the process of thinking through the book's contents itself healed the pain?

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.

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.

Having read the book, and done the course, the very first thing it tells you to do is visit a doctor to rule out any physical cause for your symptoms. This person it seems skipped that step.

Most pain treatment in the hands of professionals would seek to establish there is no mechanical aspect to the pain, go and see a doctor first, then read books.

Fakespot's score is a decent indicator of the quality of product reviews over at Amazon: http://fakespot.com/product/healing-back-pain-the-mind-body-...

You need to read the book and his work to understand that bit.

It's not just reading the book. "Reading the book" makes you understand the way the brain works and can induce and "help" sustain "real pain" in places you think it to be. He also makes it clear that the advice "it's all in your mind" is just not going to help and only an insult to the sufferer.

If I understand correctly, he does not exclude physical examinations and advises to go through scans to determine anything serious and attend immediately. For the rest, he outlines the process by which, your brain can trick you into "induce real pain" and sustain real pain.

Any kind of relaxation or - a) reading the book = understanding the process b) relaxation/ meditation which takes away your concentration away c) letting out your aggression on some contact sports etc., can help.

Here's some words on Neuropathic pain, as opposed to nociceptive pain which is what you would feel if someone stuck a fork in your leg, the next day, when I remind you of the fork incident, and you wince, that's an example of neuropathic pain, the same area of the brain lights up either way.


Think of all the physiological responses attributed to nervousness (e.g. before public speaking): muscle tension, raised heart rate, sweating, need to urinate/defecate, insomnia, nausea.

Given that, why are we so convinced that our mind (i.e. our prefrontal cortex, seat of "high level" thinking) _couldn't_ be the cause of persistent inflammatory pain? Do not ideas and stressors persist in our mind, just as pain might?

Sarno's simple thesis is that stress in our daily life could, in fact, be the underlying trigger for inflammatory pain. The mere realization of this, for many people, can resolve chronic pain problems that last years and are resistant to treatments that assume the cause of the issue is structural.

Here's a success story from one of the creators of EtherPad (acquired by Google) on his recovery from wrist pain (diagnosed as RSI) from reading Dr. Sarno's book:


Just curious: What did you learn from that book? I read through it halfways and gave up because I couldn't make sense of it.

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...

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.

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.

I sleep on an 'ultra firm' mattress but every now and then I get the urge to spend a night on a hard surface setup similar (though a little thinner with the padding) to yours.

No idea if it's good, bad or neutral for my back health overall. Doesn't seem to be hurting and I've no history or experience of back pain, but like you say, single data point here too.

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.

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.

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.

Had a similar story. After having kids and carrying them around a lot, coupled with no exercise at all, I had an episode of intense lower back pain. After an xray, any structural problem was discarded, I needed exercise to keep my posture.

I then decided that I need to carry on working on a desk for decades ahead (I'm on early 30s) so I had to tackle the problem.

Was recommended by my daughter's pediatrician to look into Pilates classes. I'm now pain free and results came very early on in practice.

Also, random pain spots that appeared frequently (for instance knee pain while driving) are mostly gone too.

I had some issues myself and after some reasearch found that exercise is the best pescription.

I actually started weight training and cycleing and feel much better.

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.

Sure it's an engineering problem but why not dive into imagining a solution now, no reason to wait 'till your ancestors evolve wheels (or whatever).

The spine is similar to a set of disks stacked on top of each other. There's no reason that sort of structure can't be fairly stable when held upright. A wide variety of movement arts, martial arts and healing arts mention the damage involved in letting one's spine sag forward (or backward).

Of course getting the spine, neck and head to work together harmoniously is more complex than just "holding yourself upright". Just willing one's body to hold particular relaxed, upright stance can often result in the opposite.

That's why a lot of body work, body awareness, martial arts and etc work on an indirect principle. Meditate so your conscious mind stops screwing up your body and mind. Allow another person to show you the right stance and accept it without judgment.

Which is to say the process of trying to practically engineer the body to work effectively has been going on for a long time. Unlike a cure or prescription, this kind of engineering pretty has to be specific to the person, requires the person's active participation. And so-forth.

See, Tai Chi, qigong, the Alexander Technique, the FeldenKrais method, etc, etc, etc, etc...

It's funny 'cause it's true. I wish more doctors, physical therapists, and other related care givers would just get real about the limits of what they can and can't do. There are so many things they do skillfully and reliably, why pretend about the others? I always wonder if maybe it's just the doctors I have access to via insurance. All the ones I've ever gone to seem like body mechanics with a questionable grasp on the scientific method yet they patronize you like you're an eight year old if you question their approach at all. Sorry to get ranty -- had a year long bout with back pain that I ultimately fixed myself with intense lifting (squats and deadlifts) that my care givers repeatedly told me to avoid. It wasn't until I ignored them that I got any better.

Unless humans with back pain procreate less than those without, then I doubt it's going to get any better in 20,000 years. At least not due to evolution of the human skeleton.

Technology may help though, assuming we don't do something stupid and stop our technological progress. (like, for example, electing a president that thinks saving money in the short term is more important than long term sustainability)

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.

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:


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.

It's "directionally" true, but it's a simplification. Our spines have evolved slightly to accomodate an upright posture. The human spine is curved to accomodate weight bearing while upright, and this particular curvature is not seen in other mammals, including other great apes like chimps and gorillas.

Ref: https://en.m.wikipedia.org/wiki/Lordosis

Yes, humans evolved from an animal whose back was horizontal, parallel with the ground. Our spines are not an optimal solution.

Ultimately the spine was designed to give structural integrity to aquatic animals.

So, lay down more.

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.

> 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.

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.

Deadlifting heavy loads improve hypertrophy and muscle; this definitely helps. People seem to understand that. But those reading this may also be swayed by the fact that properly performed deadlifts (and squats) increase proprioception around the back and also stimulate osteoblasts and bone growth, while killing - over time - anterior pelvic tilt, which contributes to low back pain.

It's more than just muscle. Deadlifts really do a hell of a lot for the body. (They also stimulate growth hormone!)

this was true for my Mon in her 70s. Her back problem got a lot better when she started doing exercise and gained more muscle mass around her back.

Same here. Went from being unable to lift even 100 lbs without pain to 495lbs. I don’t recommend going quite that far to everyone, but 315lbs should not be a problem at all for men.

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

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.

I've fixed my bouts of lower back muscle spasms by strengthening my abs.

The core is so important. Core + breathing exercises will improve any other activity.

But please don't use this argument to justify avoiding a little home exercise.

Perhaps, but exercise has so many other contingent benefits with so few comparable risks, not to mention it can be low cost of free that it's not really fair to compare the two.

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.

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?

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.

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.

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.

That makes two of us (my comment is along the same lines).

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.

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.

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.

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.

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.

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

Water is an interesting piece of our diets and lives. One thing I've noticed is that people seem to love ice-cold, filtered water (even in NYC, where we have exceptionally good tap water, my roommate bought a water filter and keeps it in the refrigerator). I personally like the idea of cold water but I realized I can't stand drinking it -- I'd rather have cool/room temperature tap water 9 times out of 10 times. People always give me funny looks when I say that or ask for it, though.

I'd totally believe that different mineral concentrations in water could lead us to different health outcomes. I also started taking a (highly bioavailable, to avoid diarrhea) magnesium supplement occasionally and the first time I tried it, I recall waking up the next morning feeling more relaxed than I'd felt in years. Maybe I'll try calcium, although I do consume a pretty solid quantity of dairy.

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

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

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

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.

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.

"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.

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_Downloa...

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.

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.

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.

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.

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.)


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.

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.

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.

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

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 :)

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.

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

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.

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.

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!

I probably should have stated that at least with running your mileage my vary. (pun intended)

The elliptical machine gives me shin splints and I don't get a really good cardio work out.

You are right swimming works wonders as well.

Never had any doctor told me not to run, but they all told me to have surgery?

My personal experience is that with some proper exercise and corrective action, the majority of people can beat the need to have significant back surgery. I just want people to know there can be alternatives out there.

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

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

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.

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

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.

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