No More Back Pain by Dr. Jolie Bookspan – Part 1

You Don’t “Just Have To Live With It”

The Diving Doc that Harvard University calls “The St. Jude of the Joints” shows you how to save your back from common bad practices

Eight of ten people get back pain at some time in their lives. Back pain is the second most usual reason for doctor visits. Stores are filled with expensive back pain potions, pills, gimmicks, books, machines and special beds. Back pain is made to seem like a mysterious, long-term condition that you need special devices, strange exercise plans, and medicines or surgery to relieve. Worse, many people are told to stop favorite activities and to accept pain as part of life. A cycle grows of doing less activity, feeling lousy, and being less able to do less. This is tragic because most back and neck pain is simple and easy to reverse.

You Don’t Have To Just “Live With It”
The good news is that back pain is not a normal part of getting older. It’s not because we walk upright on two legs or from lifting something wrong one day. Bed rest and inactivity make back pain worse. Doing abdominal crunches is not a good remedy for back pain. Surgery is rarely needed. Most of all, you do not need to “learn to live with pain.” This article will first teach you the concepts of how back pain often develops and continues. With that knowledge you can apply several easy techniques to reverse pain and keep it away on your own.

An Injury, Not A Condition
The real cause of most back and neck pain may surprise you. Back and neck pain usually develop slowly over time without your knowing it, just as smoking one cigarette at a time eventually can cause trouble. Even when pain comes on suddenly, or starts after an accident, pain was almost always brewing from many simple bad habits. The sudden onset is like a heart attack developing over years, that suddenly occurs with one more aggravating factor. This is important to know. Just as after a sprained ankle or broken arm, you can heal from back pain (without surgery) and resume your normal life – better than before. The key is to identify and modify abusive patterns.

How You Get Back Pain
The majority of back pain, even pain from arthritis, curvatures, structures not being where they should, and bad discs, comes from tight weak muscles and bad standing, sitting, and bending habits that mechanically abrade, strain, degenerate, and push structures out of place.

Tight, Weak Muscles. Tight, weak muscles cannot do their job and easily cry out in fatigue and stress during motions that in-shape muscles easily support. Properly strengthening and stretching then applying the retrained muscles to hold your body in proper ways does away with most pain.

Strengthening And Stretching Is Crucial But Not The Whole Answer
Strengthening muscles through general exercises alone doesn’t automatically “give” you good posture or remind you to bend properly. Plenty of muscular people have terrible posture and lifting habits, and the back pain that comes with it.

Bad Posture. Most people have heard that poor posture is the root of most back pain. It’s true. The relentless pull of bad mechanical use of your body every day, will eventually strain, squash, tear, degenerate, and injure you in the same way that parts in your car that are rubbing, tilting, or not seating properly will cause early wear and tear.

The irony is that most people won’t stand properly even knowing this will fix most, even all of their pain. There are three main reasons. First, they don’t like this idea. Slouching is easier than using your muscles to support your body. Next, most people are so tight and weak that they can’t stand properly – it doesn’t feel natural anymore. If you can’t stand against a wall with your heels, hips, upper back and the back of your head comfortably touching without raising your chin or arching your back, then your chest and hip are probably too tight. Tight, weak muscles pull you into slouching positions, further tightening and weakening your muscles. A third and unfortunate reason is that bad posture is so pervasive that people think it’s normal, even desirable.

Chronic Bad Bending and Lifting. You know not to lift things by bending over at the waist. But you do it – dozens and dozens of times every day – from picking up socks to petting the dog. From laundry, trash, making the bed, and looking in the refrigerator, to all the dozens of times you bend over things. The weight of your upper body constantly banging on and hanging over your low back and discs is enough to strain and degenerate structures. Then you go to the gym and lift weights like that, then lift tanks and gear like that. No wonder your back hurts. Forward bending squeezes the discs that are between your vertebrae, like squeezing the front of a water balloon. When a disc finally pushes outward to the back (herniates) from all the squeezing and squashing sin front from forward bending, it can press on nearby nerves, sending pain down the back of your leg. Tight muscles can also press on the same nerves mimicking this kind of pain, called sciatica. A degenerating disc is not a disease, but a simple, mechanical injury that can heal, if you just stop grinding it up and pushing it out of place with terrible habits.

Inactivity and Sedentary Lifestyle. Even though it’s been long known that inactivity is detrimental for back pain, many practitioners still prescribe rest. With inactivity, posture and physical condition deteriorates. Calcium is lost from bones. Tight, weak muscles further tighten and weaken. Joints normally have poor blood supply. The way joints move nutrients in and wastes out is physical movement which acts like a pump. Frequent physical movement of the right kind is crucial for the health of your spine and discs.

What To Do

Back pain often comes and goes. People desperate for relief during an acute episode often try the strangest things. In that way, many false cures become mistaken for back pain cures. Don’t fall for snake oil. Most back pain is simple mechanics, and just as simply remedied if you stop the constant and injurious process of bad body mechanics. Read part I first. Don’t skip to these exercises. Doing back exercises a few times a week but not understanding the concepts, and keeping old, bad postures and habits that hurt your back in the first place is like eating cake and ice cream morning, noon, and night, then doing your “exercises.” You are not balancing out the harm.
Bad Posture 1 – Arching When Standing and Carrying Gear: Allowing your low back to sway, exaggerating the normal inward curve when standing, walking, and reaching overhead allows the weight of your upper body to grind down on your low back. “Sway back,” also called lordosis, is not a structural condition you are born with or “just have” (or want to have). It is a bad and lazy posture. This is covered more in Parts II and III of this back pain series. Even if you have a condition called spondylolisthesis, which makes one back bone slip forward on the next bone, adding to back arching, this is all the more reason not to allow yourself to slouch more this way. Standing with your back arched and your behind stuck out or drooping forward is seen in every magazine from fashion to fitness. It is bad posture, not cute, jaunty, relaxed, or sexy. Advertising for everything, even fitness products, uses this terrible posture because “sex sells.” So does heroin. There’s no excuse to stand this way.
What To Do Instead: Reduce the large curve in your low back as if you are starting to do a crunch. Tuck your hips under you slightly, but don’t push them forward, which only makes another bad posture. Don’t curl your upper body forward. Just use your muscles to straighten your spine enough to stand with a small inward low back curve and good upright posture. Don’t allow your behind to stick out or your neck to crane forward. This is how you use your abs and other trunk muscles to maintain good, easy, straight posture to stand up.

Maintain this posture when carrying gear. Don’t allow your tanks to pull you into an arch. Don’t lean back, hunch forward, or hike your body to the sides to carry your gear. Use your muscles. Use this ab technique all the time when standing and walking with tanks, climbing the boat ladder, and particularly when reaching and lifting overhead. Your gear could be a built-in ab exercise.

Bad Posture 2 – Forward Head: Standing and sitting with your head and chin jutting forward is bad posture called a “forward head.” It looks old and will contribute to most neck and upper back pain, and tension headache. Do you let your head fall forward when walking and carrying tanks? Are you sitting with your head forward right now reading this?

What To Do Instead: Pull your chin in, gently and easily, not stiffly. It shouldn’t hurt. Don’t tip your chin up or down. Learn this “chin-in” as your daily posture, not as an “exercise” you do a few times. Lie on the floor without a pillow or stand with your back and the back of your head against a wall to feel where straight head position should be. If you can’t do this comfortably, you are too tight to stand up straight. This is all too common. Hold both arms up, bent at the elbows, as if you are in “a stick up.” Don’t let your back arch (see Bad Posture 1, above.) Pull your elbows back or gently push them back, one at a time using a wall. This should stretch the front of your chest enough to help you stand with better head and upper body posture. Stretch like this many times a day.

Bad Posture 3 – Round Back: Holding your back and shoulders rounded forward is bad posture. Walking with back and shoulders hunched forward while carrying scuba tanks is worse. Slouching when you stand, sit and bend so that your back overly curves, like an “old person” eventually pushes discs outward. It overstretches the long ligament down the back of your spine, weakening your back and allowing discs more room to protrude. Disc herniations are not mysterious – they are usually a direct result of simple mechanical forces. Are you sitting with your back rounded right now reading this?

What To Do Instead: Sit and stand up straight. Do the chest stretch (described in Bad Posture 2 above) to help you stand up straight. When carrying gear, use your torso muscles to keep you in good straight posture, don’t let your gear pull you. It is not the tank on your back making you stand slouched. Not using your ab muscles to counter the pull is the problem.

Try this to identify how your body segments line up:
-Stand very near a wall, facing away from the wall, but not touching it.
-Assume a posture that you feel is normal.
-Slowly back up and contact the wall.
-Did your behind touch first? You probably slouch forward. You need to train your upper back muscles to pull you upright. Did your shoulders touch first? You might be arching backwards and need to use abdominal muscles, as if starting a “crunch” to take the arch out of your back and pull you upright. Did the back of your head never touch? You might have a forward head. Slide your head back until it touches the wall with the rest of your body. Did your head, shoulders, back, behind, calves, and heels all touch at once? Good posture.

Line yourself up against a wall each chance you get – in the elevator, on the door jam going into meetings, against the wall while waiting. When you walk away from the wall, keep your great new posture.

You say it feels comfortable to slouch? When your muscles are so weak and tight that good posture feels unnatural, that means you need to strengthen and stretch to be comfortable, not slouch to be comfortable. Is it natural to slouch? As natural as wetting your pants, but you learn to hold it even when you don’t feel like it.

Bad Bending and Lifting. People go to the gym and pay a trainer big money to make them do squats and lunges with an upright back and properly bent knees. At the end of the hour, they bend over at the waist and pick up their gym bag to go home with no carry-over of the muscular skills learned.

What To Do Instead: Bend properly for everything, even over the water fountain. Everyone knows you should never lean over and lift packages with straight legs, so why does it magically become all right to do that in a gym? Straight-legged dead lifting can seriously injure your back. Don’t do that with tanks and gear either, or anything else you ever bend for. Most people do bad lifting dozens and dozens of times a day, every day, year after year. Keep your torso upright and bend your knees. Keep your knees over your feet, not slumping forward, which is hard on the knees.

Don’t Make Things Worse With Bad Stretches. Most people spend their days round shouldered and hunched forward at a desk, lift wrong by bending over from the waist, then do stretches that are more forward bending like toe-touches, knee-to-chest, and do bent-over rows for weight lifting in a gym, and others exercises that promote more rounding and more pressure on your back. Your posture become stuck slouched. Your discs eventually bulge under the relentless push.

Don’t Do Crunches. Most people are conditioned to believe that abdominal crunches are the answer to training your “core” and helping back pain. But when closely examined, this turns out not be true at all. Crunches promote bad posture, even when done correctly. They don’t train you how to use your abs when standing up carrying tanks, swimming, lifting gear, or any of your normal daily activities. Just strengthening muscles, explained in Part I, won’t automatically give you good posture or make you lift and carry properly. See the previous article on Abs in this column for more on what exercises better work your abs for pain control and posture when conducting your real life. The book “The Ab Revolution” can be found on

What to Do First Thing In The Morning. When you first wake up, turn facedown and lie slightly propped on your elbows for a few moments, instead of sitting. If it hurts, don’t do this, but for most people, it’s better for your discs.

Shock Absorption. Good shock absorption is important to healthy backs and necks. Wear shoes with low or no heels, padded insoles, and soft soles. Remember that your most important shock absorption should come from your own muscles and gait. Walk softly. Descend stairs and boat ladders by stepping down lightly, decelerating using your leg muscles, don’t clomp down hard jolting your spine with each step. Do you let yourself flop down in your chair without using your leg muscles to decelerate? That jolts your spine and loads your discs. Lower yourself with strength and ease. If your legs are too weak to hold you, strengthen them. Don’t walk duck footed (toe-out) or toe-in. Those are bad leg postures. If it doesn’t feel normal to walk straight, that is a clue that your bad gait and leg tightness can be making problems.

Fix Your Own Pain
Of course not all back pain is mechanics. An often overlooked cause of back pain is medicines like Lipitor (Atorvastatin calcium), a cholesterol-lowering medicine, and Allegra (fexofenadine HCl) for allergy relief. Check with your doctor if you use them.

Most back and neck pain comes from daily bad sitting, standing, and bending postures and not enough of the right exercise. The average person does so many things every day to damage their back and neck, it is amazing they don’t hurt more.

Notice how often poor posture is represented in popular magazines, not only by models who do it as an art-form, but by people shown in athletic activities. Realize how the poor postures put strain on their joints during their activity.

As a child you were told “If you make a funny face it will stick like that.”
That means if you spend your daily activities with your head and shoulders hunched forward, and your back arched, your body will eventually tighten up and stick like that. “As bent the twig, so grows the tree.”

Relieving back and neck pain does not mean giving up activities you love, or sitting and standing stiffly like a soldier. You need physical activity and flexible posture. Good muscle support for your joints comes from proper use, and educating the muscles how to support the area, not by stopping your activities and “resting it.” Don’t let bad postural mechanics grind your back structures down to where it will be harder to fix later. Posture and proper lifting are conscious muscular activities. You’ll burn calories and get great exercise without going to a gym. You’ll be straighter and taller. You’ll be a better diver. You can fix your own back pain.


Dr. Jolie Bookspan is a career military scientist with a private practice in Sports Medicine in Philadelphia.


Ernest S. Campbell, M.D., FACS

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