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Ask HN: Back problems
34 points by kyro on May 7, 2009 | hide | past | web | favorite | 53 comments
With many of you coding for multiple hours a day, presumably hunched over your keyboards for a portion of that time, I'd imagine back pain being a relatively common problem throughout the hacker community.

For those of you with back pain, knots, lower back pain, etc., how do you deal with it? Are there any exercises or movements that help alleviate whatever pain or soreness your backs might be experiencing? Have chiropractors or acupuncturists helped?

I've had back pain for years now, and although contorting my body to snap my spine provides immediate relief, it hasn't really provided any long term alleviation. In fact the problem has gotten much worse.


Try stretching out your hamstrings. A lot of lower back pain is actually caused by shortened hamstrings pulling the pelvis and lower back out of alignment.

As another comment suggests, there are many muscles acting across the pelvis and trunk that might be contributing. A physical therapist will either correctly identify what specific areas you should focus on, or (more likely) make sure that you work them all.

I've had several acute lumbar disc incidents leading to up to 6 months of sustained sciatica. By the end of that time, my hamstrings were indeed extremely tight, from inactivity and sitting.

This is correct. Even though intuitively it might seem unlikely that hamstrings have anything to do with lower back pain, but they really are linked. There are also other stretches and exercises which help.

For similar "pulling" reasons, make sure your feet reach the ground (or a footrest) - you don't want them dangling in the air.

I would disagree with respect to hamstrings. Hip mobility and glute strengthening should be your focus.

Improve your hip mobility and the strength/activation of your _glutes_.

It takes a bit of reading to understand whats happening to your body but essentially sitting for long periods of time weakens your glutes and also the mobility of your hip. This in turn causes your lower back to compensate (flexion) in any movement requiring glutes/hip movement. Since the back wasnt designed for that movement, you tend to get hurt.

Start with these 2 articles and you'll understand what I mean:



I'm a programmer too but I've had no back problems as soon as I started fixing my glutes/hip-mobility.

I have 3 squashed discs in my lower back from a skateboarding injury. I've tried everything for back pain. Before I share what works for me, I'll say that if you don't have a structural injury you probably just have very weak "core" muscles and the best thing you can do is get into a general state of good fitness and then add in some core strengthening exercises.

After doing tons of PT, and trying everything from yoga to pilates to accupuncture to cyclobenzeprine, I figured out three main exercises that strengthen the muscles in the lower back:

- "superman": lay on your stomach on the floor. raise your left arm and right leg up at the same time. hold for a count of five. repeat on other side. do this 10 times for each side.

- "planks": this is like a pushup but you're on your elbows and instead of doing a pushup, you just hold in that position. It sounds easy but is very hard if you don't have strong abs. try to work up to 3-5 sets of 60 seconds at a time.

- "bird dog": like the superman but you're on your knees and hands, doggy style. raise left leg and right arm at the same time, hold for count of 5. alternate. do 10.

Those three things, and being generally in shape have helped my back more than anything else I've tried. You can find videos of them on youtube if you google those exercise names with "core fitness" or similar search strings added in.

Other lifestyle changes are good, too. Don't sit down in a pile for 8 hours at a time. Get up and move around, even if you're just getting out of your chair at least once an hour. Change your position. Sit on an exercise ball for a while, lie down on a couch with a laptop for a while, work standing up for a while. Go for a walk at least an hour a day.

I've found that pilates is much better for back care than yoga. many of the yoga moves are not good for your back if you have slipped discs. in particular, "downward dog" which is the staple move of most yogas is not good if you actually have a back injury like mine. Pilates arose out of rehab so most of the moves are safer for your back. I mention these activities because one of the side effects of back problems (or sometimes the cause of back problems) is very tight hamstrings. You'll need to do some sort of stretching to get the hamstrings back in order and I've found this easier to do in a structured, class context.

I'll be semi controversial and say that you want to have strong abs, but you DON'T want to do situps. do planks instead. Situps strengthen your abs while pulling your back into the same position that makes it hurt. planks strengthen your abs but you're also extended and working all your stabilization muscles at the same time.

This is excellent advice. I still play sport at a high level at the moment and being 6'6, I was getting back pain. Superman, plank and bird dog are all excellent exercises to help strengthen your back and core. Since I've been doing them, I've alleviated all the back pain which I used to get after training and matches.

The only thing I'd say is that the plank exercises may not be the best exercises for people with a reall weak core. You may want to start at something lower (bird dog and other light core exercises might be better).

Exercise - it works.

No kidding! I used to have frequent back pain, with aches that wouldn't go away even after an age of stretching.

Six years ago I started on the RCAF's old 5BX program (a quick Google search will lead you to the booklet that describes it -- dead simple) and, in exchange for 11 minutes of exercise a day on an open floor, had the body I've always wanted within a year.

I've since moved on to weights and other gym-like stuff and have not had back pain in years.

It's so stupidly obvious I'm kicking myself for it now: If you have decent muscle to support all those bones and tendons up your back, they won't be straining themselves to the point of pain while supporting your body.

Yeah, yeah, 5BX is great! While a certain rare exercise machine gives the most relief, one simple 5BX back exercise (chart 1, exercise 3) is as effective, provided I do it regularly.

I do other exercises too: stationary cycling, rowing and treadmill with some weight work. All necessary because I enjoy food!

I agree, but I wish I could caution my younger self about the risk of low back injuries from certain weightlifting activities

1) You can develop very strong lower back muscles (primarily the extensors), but don't challenge those muscles when they're nearing their endurance limit.

2) If your femurs are long relative to your tibia, don't try to force yourself to perform as heavy or with the same form and depth on squats, deadlifts, or cleans, as more normal folks. At low depth, your back will consistently be more parallel to the floor than upright, dramatically increasing shear across your spine.

Of course, it goes without saying that you shouldn't round your back excessively while bearing significant load, especially if it's far (horizontally) from your hips. It's not necessarily that a rounded back is automatically dangerous, but in general, if you're bracing your abdominal/back muscles (which will prevent rounding), you're less at risk of injury.

I started having pretty severe back pain in my early 20s - in my youth I really abused my body in some serious sports training.

The only thing that has helped is exercise. Strengthening your back (especially lower) is probably going to help more than anything else. Squats and deadlifts in particular.

Pull ups will do wonders as well.

You should lift weights, but you should also get a trainer to help show you how to do it correctly and safely. Don't just rely on pictures in books or on the net -- if you screw up your back or knees, it can be permanent and debilitating.

That being said, lifting weights is great for you, doesn't take much time (you can do a very complete job in 4 hours per week), and has significantly helped me with back pain.

At work, I try to remember to stand up and stretch periodically. Drinking a lot of water forces me to get up out my chair regularly and go for a short walk down the hall.

When not at work, I try to take care of my back by wearing a back brace when doing heavy work or home improvement tasks and try to remember to lift with my knees, not my back.

Look into the ideas and books of John Sarno. He believes that many chronic pain "syndromes" that resist treatment are actually psychological in origin.

I discovered Sarno when I came down with untreatable "RSI". Eventually I got better using his approach. My story is similar to Rachels (google for others):


Sarno originally worked with people who had chronic untreatable back pain.

All that said, if you're not getting any exercise I would try that first. But if you have tried that and a bunch of other things and nothing works, look at Sarno.

I read Sarno when I was suffering from "carpal tunnel" like symptoms that wouldn't heal. I didn't believe his claims, but his argument about the possibility of self-perpetuating psychosomatic pain made me put more effort into being happy, which was valuable.

In cases where you have inflamed or slipped disks pushing on the spinal nerve (e.g. sciatica), Sarno is completely inappropriate.

Of course, bulging or not-perfectly straight disks in an MRI or xray do not mean the pain should be solved by an operation - most symptom free people have some irregularities that will show up.

Stuart McGill's http://www.amazon.com/Low-Back-Disorders-Evidence-based-Reha... is a good textbook. It's not for the layperson looking for quick recommendations, but he does give some recommendations based on physical and computer models of the spine under various exercises (and traumas).

In a vulnerable state (from athletic wear and tear), I've incurred unexpected sharp nerve compression pain (feeling like part of my spine crunching against the nerve, maybe some minor lumbar disk slip) from things like kicking a lid shut on a trash can, or crouching down to open a cabinet - in those cases, conscious bracing (or just being more cautious when not feeling 100%) would likely have avoided the irritation altogether.

Those minor tweaks have always resulted in at least a few days or weeks of pain, which seems a little ridiculous, but one of the unfortunate things about back pain (not muscle strain or soreness, but actual spinal soft tissue incidents) is the increased likelihood of reinjury later in life. For many of us, there's a direct and obvious spinal trauma causing a few weeks or months of injury, followed by seemingly normal function, but with (lifelong?) heightened risk of reinjury from more minor strains.

I'm going to have to go with the AOL comment on this one. I had both upper and lower back pain. A proper understanding of how my back can get pulled into awkward positions and what stretches/posture corrections are necessary to prevent this has eliminated it thus far without having to make any equipment changes (buying new chairs, desk trays, etc.).

Tim Ferris also recommends changing your shoes (http://www.fourhourworkweek.com/blog/2009/05/07/vibram-five-...) or your chair (http://www.fourhourworkweek.com/blog/2009/01/27/office-chair...) if stretches/exercise doesn't cut it for you.

* Abs and Back Strengthening *

- These are simple and only need a yoga mat and 10 minutes 3 times week. Even 1 session a week will kill a lot of back pain

- I will ignore situps here, because they're simple

- Get yoga mat.

- Lie _face down_, legs and arms outstretched

- Raise your _left_ arm and _right_ leg, so your body evens out

- Lower left arm / right leg

- Raise right arm, raise right leg

- Lower and repeat ~ 20 times

- Now switch to the situps and do 20 of one of the many varieties you can do.

- Alternate situps with prone swim, as the core muscles exhaust after 20 repititions. Keep both abs and back at same level to prevent hunching.

* Ergonomics *

- Get a foot rest

- Get an Aeron chair

- If you're right-handed get a left handed keyboard so that your hand does not have to travel over the numpad to reach the mouse. This extra travel distance can really hurt over time

I have a Evuloent http://www.evoluent.com/kb1.html

* Stretching *

Mentioned elsewhere, do your quads as much as possible

James Hong recently wrote a blog post containing a video and excerpts from a book by Esther Gokhale called "8 steps to a pain free back". It's worth a look, helped me.


Fix your posture (most likely bad), stretch your psoas and hamstrings, and go and have an ART or deep tissue massage done. You might also want to invest in a foam roller for self-myofascial release and then use a tennis / lacrosse ball once that's not enough.

I'd recommend buying this book: http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr.... It shows you the trigger points which cause referred pain. I reference this book quite frequently and would also recommend (no joke) taking a woman's nylon and putting a tennis ball in it. You can then hold the open end of the nylon and hang the tennis ball over your shoulder with your back towards a wall. By applying pressure (by leaning) on the tennis ball for a few seconds, you can alleviate trigger points or sore muscles.

- Sports

- Try not to code on a Laptop or use a clever setup to avoid problems. E.g. see here for some details http://www.nhs.uk/Livewell/workplacehealth/Pages/Laptophealt...

- The chair you sit in. It makes sense to buy a good chair if you spend all day in it.

- Sitting angle. Interestingly a angle of 90 deg has shown to have more "sitting pressure" than 110-135 degrees. http://news.bbc.co.uk/2/hi/health/6187080.stm more details here http://www.springerlink.com/content/w3k042u614x16900/

I recommend the StrongLifts 5x5 program. It's 5 exercises per workout (45 mins), 3x a week.


Yeah -- chair, general ergonomics, excercise, stretching, massage. All good. All mostly missing the real point.

Unless you've suffered a real back injury, your pain is probably at least partly psychosomatic. That doesn't mean "in your head", but "FROM your head" -- there is real physical pain caused by real physiological phenomena, but the major contributing factor is unnecessary muscular tension. BLOW OFF STRESS. Laugh. With friends if possible. Hit things that are designed to be hit and don't mind it at all. Drink in moderation if it's safe for you to do so.

These two books are essential reading for people with back problems and should be reasonably accessible to anyone with both an athletic background and an advanced high school understanding of anatomy and physiology.



You can do two things: - ensure you have proper posture - strengthen your "core"

First, do a web search for ergonomics and posture to make sure you're sitting in a neutral position. If you're not, you will be constantly using your back muscles (and neck, shoulders, etc) to maintain your posture when you sit, which will lead to pain.

Second, search for exercises to strengthen your "core". You should strive for simple exercises to maintain your muscles. Back pain is related to weak back and abdominal muscles.

I would have assumed that the reverse would be true: people who mostly sit all day should have less back pain. In my personal (apparently anomalous, given the posts here) experience, this is the case. When I worked in manufacturing 12 years ago, putting commercial refrigerators together, I had back pain quite a lot, even to missing some work due to it, but since I switched to desk jobs, it just went away.

I get back pain every once in awhile and it tends to linger for 1-4 weeks. Then it goes away for a month or two.

I try to work my abs and lower back, as well as stretch my hamstrings.

As for sitting up straight, I think the most recent guidance is that a 120-135 degree thigh-to-back angle is optimal: http://news.bbc.co.uk/2/hi/health/6187080.stm

This is a repost of some advice I've offered here before, but doing them really helped me out.

Outside of seeing a doctor to see if there's something seriously screwed up with your back, I'd offer these 3 pieces of advice I had to learn about the hard way.

1.) Massage.

You may not think it's the manliest thing ever, but if you can afford it you should find a good local masseuse and get yourself an hour session. Even if you go once and never go again, you'll get an education in just how kinked up your back and shoulders probably are.

I tweaked my back lifting a lawn mower out of my car a few years ago and didn't think much of it at the time. Over the next few weeks I started to have all kinds of shoulder problems and other various pain to the point where my arms were getting tingly and I couldn't sit and code for more than 30 minutes at a time.

Long story short, I went through a few doctors before I finally just decided to see a masseuse and see if it helped. I was lucky to find someone that knew what they were doing and helped get me straightened out. It took about 5 sessions over 5 weeks, but I've never had problems since.

2.) Trigger points.

Learn what they are and how you can fix them. This was my problem that the masseuse turned me on to. Trigger points are essentially little micro-knots in your muscle fibers that can add up to cause big problems for you. For me, lifting that mower was really just the straw that broke the camel's back. It just exacerbated all the trigger point problems I'd been creating over years of coding and not stretching out my back and shoulders properly.

If you know where the common trigger points creep up and how to get rid of them you can save yourself a lot of pain and downtime (not to mention massage bills).

Buy these two things: The Trigger Point Therapy Workbook (http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...) and a TheraCane (http://www.amazon.com/Thera-Cane-Theracane-TheraCane/dp/B000...)

The book will show you how to identify and treat the trigger points all over your body, and the TheraCane will help you reach the places on your back that you can't reach yourself.

3.) Yoga.

Once you get all your issues straightened out, yoga and/or a good daily stretching regimen can help keep you kink free.

Hopefully some of this advice is helpful. I was really messed up for a while until I figured all this out.

I used to have terrible back, shoulder, and wrist problems.

Then I bought a Herman Miller Mirra, got decent wrist-rests^ for mouse and keyboard, and took up bike riding and other forms of exercise.

I can't say for sure which of those three had the biggest effect, as I made all those changes at once, but I definitely don't hurt anymore.


^ Definitely recommend the IMAK ergoBeads products for this!

i used to get back pain from working too much as well, but a chair solved that. i think i take more breaks now too, which was a factor as well, but the chair upgrades made the biggest difference. i love my freedom chair: http://www.humanscale.com/products/freedom_index.cfm

if an expensive chair isnt an option, figure out how to get good lumbar support in some other way, and make it easy for you to slouch, distribute pressure, etc....prob is , slouching in most chairs will result in pain, but when you work this much, sitting upright can only be sometimes -- thus the freedom chair. ted talk on the chair: http://www.ted.com/index.php/talks/niels_diffrient_rethinks_...

squats and deadlifts!

worked for me.

This is good advice, but it needs to be followed only after you know EXACTLY how to perform these exercises. Doing them improperly is just asking for trouble.

You can start by reading "Starting Strength" by Mark Rippetoe. If you don't feel confident that your form is correct, you can join a forum like the one over at stronglifts.com. They will probably be happy to review a video of you doing the lifts to let you know if you're doing things right or wrong (and what to fix, if it's not right).

Although, if you can swing it, I'd recommend finding a trainer to start you off.

I second the recommendation for Starting Strength. Strengthening your entire posterior chain (hamstrings, "glutes", lower back and upper back will do wonders for your back problems.

Having said that, spending 1 hour a day fixing your problem won't be enough when you're spending the other 23 hours undoing it. Sit up straight or do as I did and get a stand-up desk.

This is good advice BUT you really need to increase your joint mobility before attempting these lifts.

I would recommend this series of articles to understand the theory behind bad posture and how to fix it.


I would spend at least 2 months just improving your joint mobility (especially hip + ankle) before attempting deadlifts. And even then you should really have someone who knows how to do them correctly to coach you.

Else you'll seriously hurt yourself.

I mentioned this already, but be cautious of full depth if your femurs (upper leg) are relatively long (to your lower leg, not your whole body). Those lengths affect your hip angle in keeping your center of mass (including the hopefully heavy weight you're lifting) over your feet. To get the weight low, long-femured folk are more bent at the hip (back more horizontal).

Enjoy the fact that you have a mechanical advantage in cycling when you're feeling lame for not going as deep.

Yoga has made all the difference for me. It is a great way to unwind for a short period of time and with practice it will greatly improve your core strength and relieve your back pain. It doesn't help that it is also a wonderful opportunity to meet new people, especially flexible girls. :)

I am religious about ergonomics.

1. I spent $300 on a herman miller ergonomic chair that forces you to sit up-right.

2. Use a keyboard tray to force you to lean back against your chair when you're coding.

3. Stretch and walk around once an hour.

4. Do back exercises at the gym everytime you go.

I get horrible back pain if my chair is not positioned correctly(it doesn't take much maybe an inch off and I start to feel it). Find a guide on correct positioning and try to follow it.

Or when at work: see if your company has a department for such problem. (SAP had one, when I was an intern there. They adjusted my desk and chair.)

Find a Tai Chi studio and learn the short form. It is a complete set of exercises for back, legs and shoulders that takes about 5-10 minutes to complete. And it is fun to do.

An Aeron. They aren't cheap, but for something that you sit in 10+ hours/day, you want something that's good for your back.

Exercise, stretching, rowing, etc..

Use a standing desk. Odds are your body evolved to spend more time standing than sitting in a chair.

a lot of back pain is caused by weakness in other areas and your posture muscles trying to make up for it. do an ab routine and hyper extensions for a strong core and most problems should go away.

I have had a chronic pain in my upper back right above my right shoulder blade, below my neck, and a little to the right of my spinal cord (the area is about two square inches in size). I got this injury from (surprise surprise) a marathon coding session (40 hours straight) sitting in an uncomfortable chair without taking enough breaks, and it has been plaguing me for about six years now. It used to be a very sharp shooting pain, but now the area is somewhat numb and mostly gives me sharp pains if I do certain awkward motions (like turning my head too rapidly), lifting heavy objects using that particular part of my back, or coding for long stretches of time.

I have tried just about everything from traditional back exercises to acupuncture to cure this, and up until recently, nothing really worked. I finally went to some doctor in India who gave me a different type of exercise that made a lot of sense. Normally, chiropractors will tell you to do things like rotate your head or stretch your neck by looking up and down for 10 seconds at a time - basically minor motions that put minimal stress on your back in the hopes that it will strengthen the back. The doctor in India said my problem was not that my upper back muscles had grown weak from RSI, but that my particular injury had caused some muscles to start pressing down on a nerve there, which is why I have such a local pain and why that area has started going numb. So, exercises putting more strain on that area were in fact worse for me.

To get to the point, the "exercise" works as follows: 1) Stand up straight and straighten up your neck. 2) Gently press on your forehead with your two hands such that the force is pointing behind you. While doing so, press forward with your head against your two hands so that your neck stays straight (very important that the neck stays straight the entire time). 3) Do this for 30 seconds (I started off with 10 seconds). 4) Repeat steps 1-3, but instead of pressing on your forehead, I press on the right side of your head, the left side of your head, and then the back of your head. 5) Repeat steps 1-4 three times, and then do the whole thing 3-5 times a day.

This has helped tremendously in getting feeling back and reducing pain. Apparently, this part of your back is usually under some minor stress from holding up your head (and this strain is increased when you hunch). So, after my muscles started squeezing down on my nerve in whatever awkward way, this minor stress that is otherwise normal was pressing down on my nerve all the time, causing it to hurt. This exercise will, five times a day, take the pressure off my back and into my hands and let the nerve have some time to slowly get back into place.

Also, I have started using a standing desk for at least some time a day and it has done wonders to keep me from hunching while working (which in turn has also made my back feel much better).

There has to be a name for that condition. I've had it as well, though it started in me in my early teen years practicing piano and got progressively worse throughout my 20s (marathon coding sessions...and I never did give up piano) The exercise you mentioned was the fix. In my case, my Chiropractor was the one who recommended it.

I'm not a big Chiropractic fan, I went to various practitioners and have received various pieces of advice ranging from "non-exercises" to goofy expensive vitimins. I started getting regular adjustments with this guy only after I noticed the pain in my neck was going away due to the exercises he recommended.

He's since also helped me with wrist and finger pain not uncommon to those in my profession.

The only thing I'd add to your recommendations (haven't tried the standing desk) is to take "second hand smoke breaks". I get up from my desk twice a day and walk around the building outside when the weather is tolerable. That tends to get the blood flowing. I've also found when debugging or troubleshooting a problem, stepping away and getting some fresh air tends to result in better solutions.

One word - Yoga

I used to sit for more than 12 hours continuously. I also used to be the default "mover" for my friends.

i have had back pain for last 5 years and never knew it. Twice a year, I would have lower back pain and I would take rest for couple of days and pain seemed to vanish. Last year, I joined the gymn to do some weight reduction focussing more on cardio, less on weights. At some point(i think i picked more weight than I could munch) my lower back gave off(not literally). There was no pain. Couple of days later, I felt some pain in my left calf, which I passed as musle pain. Then the intensity of pain increased and my butt and thigh started to ache. Hey but no back pain!!

So off I went to meet a doctor-to ellaborate my story- I love US doctors-I explain my emergency and all they had to say is "oh wait, if you have an emergency, you'd better go to the emergency to this hospital i am affliated with, hmmm but I think you'd better take an x-ray first"; I say "doctor- i have no broken bones.no" doctor"i understand, but if i don't go thru procedure, the insurance won't pay me!!!!" So I bore the pain for a week and took my blood-test/x-ray! and meet the doctor. Obviously nothing to see there. So now he says "Hmmm, why don't we don't I refer you to a specialist- would you prefer a neurosurgeon or a pain specialist" I say "You're the doctor? no?" AND he refers me to the neurosurgeon.

3 weeks have passed- Still I have no back pain-but to put in words, you take a needle and poke it the part where your butt meets the spine. poked? now remove it and run it down the rear thigh, calf and stop near the ankle and then run it along the outer part of the feet and stop at your little finger on the foot - all the while applying pressure. When you reach there, poke once more - just for fun. This is a bit of what I was experiencing.

I could go on and on - but everyone here is busy- I had to go thru the loops of the neurosurgeon too - this time on 1 week on pain killers and another on testing my muscles(i forget the medical term used) and finall after 2 months - an MRI - something that could have been done the first week. MRI showed that I had two ruptured discs on my lower back. I was "threatened" by the doctors for an operation to which I said "f@k you" in a more subtle way.

In the end, accupuncture helped ease the pain. I also tried the Indian style - Ayurveda - something that revealed the spiritual part of life to me.

The funny thing at the end of all this is not posture that caused pain to me in the first case. It was constipation. Once my bowel movements were (made) normal along with medicated oil massages and few other things (include enema of oils)

The treatment/healing made me consider my revaluation of "east" vs "west" in many ways and varied thoughts about modern medicine "industry" considering the threats of operation vs what doctors perceive vs doctors as businessmen etc.

Oh! one more thing - Swimming helps! I can jog for a few minutes beside the sea, a privilege for me now!

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