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Amateur thoughts on back pain

I’m definitely not a doctor, but I came within an hour of having surgical intervention on my back years ago, and have, like just about everyone, been dancing with it off and on for a long time. Here are some thoughts, worth talking over with your trained professional… (I’ve shared this with friends over the years to great effect, and I felt like it was worth sharing with a larger audience). Fortunately, my back has been feeling really good for a while now.

Feel better!

Chronic problems often require chronic solutions.

Back pain is isolating, and it can make you feel alone. And yet, almost everyone experiences back pain at some point–if you’re in a group of five people, it’s likely that at least four of them have felt what you’re feeling.

Because back pain is so widespread, so hard to cure and so expensive to our productivity, it’s been fairly well-studied. Here’s some of what we know about getting better:

Back pain is rarely caused by a structural problem. If we take x-rays, cat scans or sonograms of 100 middle-aged adults, just about all of them will present structural spinal challenges that would indicate back pain, but almost none of them are in pain right now. A structural problem might be correlated with your back pain, but it’s not the proximate cause.

Back surgery is almost never a good idea. It can work as a placebo (we know that sham surgery–on knees and backs–is very effective, it’s also an expensive and painful way to get a placebo). But there are far more convenient and powerful placeboes than back surgery that you should try first.

Just because it’s all in your head doesn’t mean it isn’t real. Your head is part of your body, and your brain is engaging with your nerves and your muscles. For most people, most of the time, back pain is a feedback loop of the three systems, one where muscles tense, nerves report, the brain reacts, repeating again and again.

It turns out that our nerves are reporting pain from all over our body all the time, but the brain tunes out the non-useful signals over time. In many cases, back pain is simply a feedback loop gone out of control.

Light massage is at least as effective as strong massage in helping with back pain. That’s because the goal of the massage isn’t to actually knead our muscles like a loaf of dough, but to rewire the signals the brain is getting to break the feedback loop.

In the same way, acupuncture (and sham acupuncture, once again hard to find) are very highly effective on back pain.

One thing to try is an isolation tank, in which you float in 99 degree water, filled with thousands of pounds of epsom salt, in a dark room for an hour or so. It sounds nutty, but the combination of the salts and the warmth and the posture and the relaxation can change things for you.

And a list of things to try:

Wear a different sort of shoes–all the time.

Get insoles for your shoes.

A Chi vibrator for your ankles.

If you carry a purse or briefcase, don’t. Get a roller bag, for a month or so, to see what happens.

Get a new mattress.

Get a new pillow.

Take two hot baths a day.

If you run, stop. Or learn barefoot running.

If you can find a pool, swim.

Learn to stretch.

If you walk with your legs splayed in a V, try to intentionally walk with your feet perfectly straight ahead.

Do very mild yoga.

And the best cheap solution: go outside and walk for an hour a day.

Feel better soon. And don’t get surgery if you can possibly help it.