An Exploration of Back Pain Cures: What Worked & What Didn’t

There are few certainties in life. Proverbial wisdom counts death and taxes among them, but back pain should be on that list. Everyone seems to suffer it at some point, and it can be incredibly debilitating because our backs are involved in almost everything we do.

This article is an exploration of all the things I tried to heal back pain. What finally worked was completely rethinking how I use my back, and, surprisingly, heavy resistance training—specifically progressive range of motion squats and deadlifts.

Lumbar spine

Contents

The Thirties’ Welcome Gift of Pain

The third decade of life is heralded by a noticeable change in recovery ability for many people. Some of the idiocy you used to be able to get away with in youth now results in sore joints and tendons (as in golfer’s and tennis elbow for instance, which I outline how I dealt with here) and of course the sore lower back.

I actually had low grade back pain throughout my twenties, but it became more pronounced in my thirties. I suspected it was the result of minor injuries incurred in the gym due to bad exercise technique*, such as letting my back round when deadlifting. In hindsight this was partly true, but not the whole picture—my issues ran deeper.

Regardless, the pain was such that I could no longer ignore it and hope it miraculously disappeared. It was time to look for cures.

* One time in particular on the leg press after bringing my knees right down to my chest and making my back round badly as usual I felt a distinct pop and intense pain. I had to drag myself up with my arms and hobble home, and was out of commission for at least a week—even sleeping was painful. Fortunately it didn’t seem to cause major long term damage, but it probably contributed to the general degradation leading to the constant pain I got later.

The Lifting Belt

The first go-to for many of us is the lifting belt. I don’t need to say much about this—in short it was useless if not downright detrimental. A lifting belt provides a false sense of security without addressing underlying issues, and the extra load I could use with one meant that I stressed and hurt my back even more.

To be clear, I don’t think there’s anything wrong with a lifting belt per se, just that it’s not useful for the specific purpose of preventing or healing back pain.

Rest, Ice, Anti-Inflammatories, Massage

Common wisdom prescribes inflammation reduction and rest for injuries. Once the inflammation subsides, you might introduce some type of massage.

These were the next things I tried for my back. I applied ice, took anti-inflammatories and avoided any activity that seemed to exacerbate the injury. Once the worst of the sting seemed to have subsided after a flare-up, I foam-rolled the affected area, and graduated to rolling around on a couple of tennis balls. And when even the tennis balls didn’t seem to be applying enough pressure, I tried hard field hockey balls.

This all seemed helpful right up until I went back to regular activity and pain came back. Even then I kept up the self-massage if the pain wasn’t too acute, and while that felt good, it only helped for minutes, after which the pain and stiffness came right back.

It was only later I learned that applying that type of pressure to the spine can actually be dangerous. Further, science indicates that inflammation is an integral part of the healing process, and getting rid of it is probably not a good idea. Suffice it to say this whole approach wasn’t cutting it.

Hamstring and Hip Flexor Stretches

You don’t have to spend long hunting the internet before you find the theory that short, tight hamstrings and hip-flexors are the issue. Apparently they make the lumbar spine round, and that leads to subsequent injury and pain.

Fantastic, I just had to lengthen my hamstrings and hip flexors, then.

To this end I undertook a stretching program. Every morning and night I’d spend minutes stretching my hip flexors and hamstrings. It was incredibly boring, but if it would fix my back problems it was worth it.

Like magic my flexibility improved out of sight; after barely being able to touch my toes I could now bend over and, with straight legs, almost get my palms on the floor. For about five minutes after stretching, that is. Annoyingly, after five months of my stretching program, my back was just as sore.

The thing about that type of passive stretching is that it’s mostly neurological. That is, it doesn’t result in any real lengthening of tissue, it just temporarily permits more movement. And it turns out that even if you can permanently lengthen these muscles and increase flexibility, it’s not necessarily going to help your back pain.

So temporary and even permanent flexibility increases are useless on their own. Great. Back to the drawing board.

Ab Training

Another common theory is that back injury is caused by strength imbalance in the core, and that by improving the strength of the abdominal musculature in particular, you’ll fix the problem.

On its face it seems reasonable, and I’d never been in the habit of training my abs so it was worth a try. I set up a routine of weighted ab work every time I worked out. I’d hold a 20 kg (45 lb) plate over my chest and do full sit ups (some advise against this exercise, but I’ve never had an issue with it). I also did leg-raises, and occasionally cable crunches.

In time my abdominal strength increased a lot. My back pain, however, remained. Another avenue exhausted.

Deeper Causes

A lot has been made of the importance of the gluteus muscles in recent years, and the idea that modern humans tend to underutilize them because of excessive sitting and sedentary lifestyle.

Setting aside some of the more controversial claims, my research of this topic made me realize I was underusing my hips, and that by treating lower back as my body’s central pivot point, I was overusing it an unhealthy way. Any forward or backward movement of my upper body came from articulation of the lumbar spine, a role for which it’s not well-suited.

The result was lower back and quadriceps dominance, and those areas taking some of the work that should have been going to the gluteus muscles. This not only overworks the lower back muscles, but also tends to result in loading the lumbar spine in the dreaded rounded position.

Gluing the Lumbar Spine

Mentally reframing the lumbar spine as strictly a static supportive structure instead of a bending joint was a massive factor in healing my lower back. I stopped thinking of it as an articulating joint and consciously tried to keep it neutrally set in a slight curve—any hinging forward or backward was initiated at the hips and upper back.

Rethinking the role of the lower back in this way shifts the excess work it was doing back to the glutes where it belongs, plus eliminates the rounded lumbar spine loading that is largely responsible for back pain in the first place.

This applies not just in the gym, but in general life. So now even when I bend over to pick something up or tie my shoelaces, instead of hinging at the lower back, I’ll be consciously trying to leave it set and pivot mostly at the hips and upper back.

Of course we can’t entirely eliminate bending in the lower spine, and nor would we want to, but the emphasis needs to be on the hips and upper back.

Mobility

Relearning how to use my hips and lumbar spine was hugely beneficial, but my back still gave me problems in the gym. I took some video of my training and noticed my lumbar spine was still rounding on some exercises.

The neutral, set spine position I was trying to maintain was collapsing, particularly at the bottom position of squats and deadlifts. The use of my lower back as a hinge for most of my life meant I was short on hip mobility (which is basically the ability to maintain optimal position during movement, being made up of flexibility, but also sufficient strength and coordination of the surrounding muscles).

Clearly I needed the extra strength and flexibility that would increase my mobility and enable maintenance of a neutral spine, but how?

Progressive Squats & Deadlifts

I’d recently read some scientific papers indicating that one of the only ways to make permanent physical changes to tissue that allow increases in range of motion is with stretching and moving under load. It seemed like there had to be a way to leverage this information to increase my mobility.

Two of the worst culprits for inducing my poor spinal alignment were squats and deadlifts. When I tried to do them with a full range of motion, I’d get into that rounded, startled-cat position every time. That was actually part of the reason they’d never been a regular part of my routine—I just thought I wasn’t built to do them, and whenever I tried I hurt my back even more than normal.

I came up with a plan to do both movements with a partial range of motion—ie, only as much movement as I could do while maintaining a good back position. This meant deadlifting off blocks, and not going the whole way down during squats.

To generate real changes in mobility it seemed reasonable that slowly increasing range of motion on these exercises might work. Just enough to challenge current limitations, but not so much that I overdid it and ended up in the old pattern of loading up my back in the rounded position.

As such, over time I’d progressively lower the blocks I deadlifted off, and go down a bit further when squatting.

Progression: How Much and How Fast?

I kept taking video footage of my exercises on my cell phone. I could see when my spine got out of position, so I learned how the right neutral-spine position should feel. This meant I also learned how it felt when it was out of position.

As such, the question of how much and how fast to increase the range of motion on my squats and deadlifts was a matter of trial and error. Increases were based on how much I could tolerate while basically maintaining the right spine position.

If lowering the blocks I deadlifted from or going a bit lower on squats meant excessive flexion (AKA rounding) in my spine, I added a bit of height back to both, and just waited a few more weeks till my body adjusted and permitted the increases.

I’m not sure exactly how long the whole process took, but I’d estimate about six months.

Result

In short, it worked. My strength greatly improved, and so did my mobility/functional range of motion. I can now deadlift off the floor and squat to a rock bottom, butt-to-heals position with a neutral spine.

Interestingly, without warming up or prior stretching, I can also bend down with straight legs much further than I’ve ever been able to. I seem to have made permanent changes to my flexibility.

No More Sore Back

The whole approach of rethinking the role of my lumbar spine to be a support instead of a hinge, and increasing my mobility with progressive range of motion squats and deadlifts was magic. My back pain has gone. Totally.

Summary: What Worked & What Didn’t

What didn’t work (or provided temporary benefit at best):

  • Using a lifting belt
  • Rest
  • Ice
  • Anti-inflammatories
  • Massage, including foam-rolling and rolling on tennis and field hockey balls
  • Abdominal exercises
  • Hamstring and hip flexor stretches

What worked:

  • Relearning to use my lumbar spine as a static supportive structure rather than a hinge. I trained myself to use my hips and upper back to do the hinging I previously used my lower back for.
  • A program of partial range of motion squats and deadlifts. Over time as my body adjusted, I gradually increased the range of motion until I could do both movements with a full range of motion and neutral spine position.

Back pain can be a strange thing, and sometimes the cause is unknown. I tried a few common fixes that people swear by but they proved ineffectual. My back pain turned out to be the result of inappropriately using my lumbar spine as a hinge and poor spine position during exercise. I completely eliminated my pain by reframing the role of my back and increasing mobility so that I could exercise with correct technique.

Comments and questions welcome, I’d love to hear about your experiences. Just use the comments box below or send me an email.

Image credit: see page for author [CC BY 4.0], via Wikimedia Commons