My path to a massage career began with recurring bouts of severe low-back pain many years ago. I would routinely get clobbered by episodes of pain that would put me in bed for days at a time.
One of the reasons I ended up in bed is because that’s what my doctor recommended. Back then, the conventional wisdom was to treat severe back pain with bed rest.
Orthopedists and other health-care experts now know that bedrest is probably the last thing you want to do.
In most cases, when your back is aching it makes more sense to get moving as much as you can.
(IMPORTANT: Some conditions and injuries that can cause low-back pain definitely do call for bed rest and limited movement; check with your doctor if you have any concerns about how you should care for your back pain.)
A Reminder of the Bad Old Days
A few weeks ago I awoke with stiff hips and an all-too-familiar ache in my low back. At breakfast, I squirmed at the table trying to find a comfortable position. When I put on my socks and tied my shoes, I felt pangs of pain deep in the middle of my low back. Bending forward was very uncomfortable and reminded me of the bad old days, raising danger flags in my mind.
Twenty years ago, I might have just popped a handful of ibuprofen and crawled back into bed.
I know better now.
Self-Healing Low-Back Pain
Instead of meekly succumbing to my low-back pain, I used my back pain self-care method:
- I started moving as much as I could, and in ways that I knew were likely to moderate the pain. I made several gratuitous trips up and down the stairs. Did several body-weight squats. Adopted a half-squatting horse stance at my standing desk. Got down on all fours and did some gentle cat-cow yoga moves and some light leg extension exercises. Did some lateral stretches to open up the space between my hips and rib cage.
- I also played with several body-awareness techniques that I have learned and developed over the years, scanning my body from top to bottom. Swaying a little at the ankles. Locking and unlocking my knees. Tilting my pelvis forward and backward. Flexing and extending each pair of vertebrae in my spine. Retracting my shoulders. Making sure my head was tucked back over the center of my torso.
- Throughout all of this, I tried to be as curious and objective as possible as I assessed my pain levels and movement restrictions. There’s a natural temptation to clamp down and stop moving a body part that aches, to flinch and recoil when a movement or position hurts. By staying non-attached to, and curious about, my discomfort, I found that could move more than I might have thought at first and that I could almost always squirm or wiggle or otherwise reposition myself in a way that reduced the pain.
There’s a more detailed explanation of this approach in my Self-Healing Mind Trick for Low-Back Pain post.
What Caused This Back Pain?
Sometimes back pain is set off by an obvious cause – picking up a box awkwardly or slipping on an icy sidewalk. But just as often it is triggered by some seemingly benign event, like a sneeze or simply standing up from a chair. Sometimes it just comes out of nowhere.
I don’t know what caused this episode.
Was It My Behavior?
Earlier in the week I had returned from a trip to Nashville. The flights were about as comfortable as they can be nowadays. My AirBnB had a firm-enough mattress. I was at a conference moving around and standing most of the time. I had intentionally booked a room about a mile and half from the conference center so I could take a nice walk each day. So that trip probably wasn’t the cause.
It’s the holiday season, so I’ve been eating a lot more sugary treats and junk food than usual. One likely factor in low-back pain onset is inflammation. Your body can get systemically touchy when it’s in an inflammatory-response mode, and there appear to be links between sweets and carbs and inflammation. So maybe that was a factor.
I’ve also been less active lately. “Motion is lotion,” as they say, and I haven’t been keeping my back and hips and legs as lubricated with movement as usual. So that may have played into it, too.
Still, as if often the case with low-back pain, there was no obvious cause.
Was It an Injury?
Nor do I know exactly what was going on pathologically. It’s hard to ever know. With back-pain episodes like this, even if you could watch real-time fMRI results and peruse on-the-spot CT scans, you’d be unlikely to discern the exact injury or dysfunction that set off a low-back pain pattern. There are just too many possibilities.
About ten years ago, I took a continuing-ed course on low-back pain with the late, great massage educator Bob King. At the start of the class, Bob rattled off a long list of possible causes of low-back pain, including:
- intervertebral disk bulging or herniation
- strains to muscles like the multifidi and erector spinae
- sprains of spinal ligaments
- “suppressed infantile rage” (a reference to John Sarno’s hypothesis that most low-back pain originates in the psyche)
- and a host of other possible sources
Most of these sources are hard to identify. And even if you could identify the strain or sprain or inflammation that set off your low-back pain, there’s not a whole lot you could do with that information.
Because whatever the original cause, your low back and hips quickly get caught up in a vicious cycle.
The Pain-Spasm-Pain Cycle
As soon as any injury or irritation occurs in the low back, your body goes into a protective mode that tries to prevent further injury. Muscles around the injured area clamp down, splinting and supporting the injured area, but also reducing local blood flow (a condition known as ischemia).
But even when you’re hurting you still need to move. So nearby muscles are recruited to do the work that the clamped-down muscles usually do. These recruits, being less adept at those motions and being undernourished due to ischemia, can then be strained and injured as they try to pick up the slack. Each instance of pain can cause another group of muscles to clamp down, which causes more pain, which causes other muscles to clamp down. And on and on.
This dynamic is sometimes called the pain-spasm-pain cycle. It’s the best model I’ve found for understanding low-back pain. This cycle can also explain that unnerving sensation of your low-back pain spreading out beyond its original location.
The best way to break this cycle is with movement. I list some safe, low-impact exercises you can try in my back pain self-care post.
Lessons I Learned (or Was Reminded of) from This Episode
- keep moving – motion is lotion – human bodies love to move
- pay attention – listen to your body – think about possible causes of your back pain
- break the cycle – the pain-spasm-pain cycle is insidious and can persist if you don’t get moving again as soon as possible
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