Back Pain and Back Strength

There are times when The Conventional Wisdom and The Reality of the Situation are at odds. Our recent presidential election provides a poignant example, as does the idea that running makes you skinny, that little kids always tell the truth, and that we have to pass another law so you'll stop doing things we don't like.

Here's another one: Your back hurts, so you have to rest it, stretch it, go to the chiropractor for 30 visits, and then get your “core” stronger with situps and various odd-looking movements performed on a balance ball, and if that doesn't work, surgery will. The reality is that your back hurts because you are a bipedal, upright human over the age of 30, you can't alter this fact, and the best way to make it stop hurting is to make it stronger with squats and deadlifts.

Deadlifts and barbell squats for a low back in pain sounds like the stupidest idea that has ever appeared on PJ Media, I know. It flies in the face of The Conventional Wisdom. The fact is that it works nearly 100% of the time if you do it correctly, and that 90% of the time a stronger back not only stops hurting but also returns you to full unencumbered activity in less than a month.

Some background information: back pain is the Number One (#1!) cause of missed workdays in the U.S. -- and by extension the rest of the planet. This is because back pain is the common denominator of human existence, and has been for quite some time. Our spines are wonderful structures that provide flexibility to our torsos while protecting the major non-brain part of our nervous system. All vertebrates share this structure, from fish to felines to Freemasons -- and Freemasons have the most problems with their backs.

This is because their spines are all constructed the same basic way, while they occupy different mechanical environments. The repetitive-looking segments of their spines are composed of bony blocks (the vertebral bodies) and flexible blocks (the intervertebral discs). These blocks are sequentially arranged so that the protective bony segments are separated by flexible segments, so that the fish can swim, the feline can curl up in your lap, and the Freemason can genuflect when it's appropriate.

We're all subject to the same gravity – at least until Elon Musk gets his Mars project sorted out. Fish are suspended in water, and the vertebral segments that compose their spines are essentially unloaded by gravity. The cat stands on four feet, and her spine is loaded in shear, with the force of gravity applied to the weight of her body perpendicular to her back. Our Freemason stands on two feet, upright as an oak tree, and this applies the force of gravity to his back in compression – parallel to his spine, essentially squishing his intervertebral discs between his bony vertebral bodies. Same discs as the fish and kitty, different mechanical history because he's a biped.

Fish and quadrupeds have been around a lot longer than we have, and our spines are basically just upright versions of structures that were not designed to function in compression, but which have to do so anyway. We can handle shear pretty well when we pick things up from the ground, since our muscles protect this position, and most of us are never in a bent-over position all day long. Upright is our normal posture between naps and shoeing horses. So here we are, upright with a vertical spine that still wants to be horizontal, with all the problems that come along with it, and a very good reason to solve these problems.

The primary problem with this anatomical variation is that human spines degenerate under their compressive environment over time – all of them. If you do an MRI study of 1000 adults over the age of 30, virtually all of them will read positive for some type of spinal degeneration pathology. By the time you are a full-grown adult, something will have changed in your back that can be interpreted as a potential cause of back pain. This is an unfortunate fact, and it has several interesting implications.

  1. If you are over 30 and have back pain and you go to the doctor and the doctor orders a diagnostic test – an x-ray, CT, or MRI – he will find something wrong with your back. But the thing he finds wrong may or may not be the cause of the pain, since everybody will have something wrong whether they have back pain or not.

It is important to understand that every adult has degenerative spinal changes, but not every adult has back pain.

  1. Some backs that are badly degenerative on the MRI do not hurt, while some backs that are not terribly screwed up hurt all the time, and maybe hurt in places where there is nothing on the MRI that explains the pain. This means that “degenerative disc disease” may be the cause of your back pain, and it also may not be the cause of your back pain. Not everybody with a positive MRI for DDD has pain, and some people with only very mild degeneration are crippled with the pain.

This is because back pain is not always explained as damage or inflammation within the structures of the spine. It may have to do with an individual's interpretation of what pain is, which may explain why exercise is often effective in teaching people that pain has a lot to do with perception.