My friend hurt his back a few weeks ago and while we were catching up commiserating on the literal pains of back pain (specifically lower back pain). I thought it was a good time to share my 8+ years of experience of dealing with lower back pain and all of the tools and wisdom gained from trying almost everything to recover and gain some semblance of normalcy.
Since I started writing this draft, I've had two other friends hurt or reinjure their backs. I also hitched or strained my back! Is there weird energy flowing through the Universe, unchecked with a malicious back-breaking intent? Are we just getting older? Is Mercury in Retrograde? Are we all burnt out and the stress is targeting our weakest link?
This is the fourth time my back has hitched. I use the term "hitch" because when I say "my back has gone out," I refer to laid out and regulated to bed rest and peeing in a cutout gallon water jug (yes, this happened to me the first time). Hitching is just a stuck feeling usually accompanied by annoying pain that subsides over a few days to a week. Thanks to the below routine I've built over the past 8 years of dealing with chronic back pain, each time I've pulled or hitched my back, I've recovered faster.
First, you need to know that you are not alone and that the Universe does not hate you. Unfortunately, we spend most of our time sitting down and being immobile. Sitting shortens the hip flexors, psoas, and other frontal muscles that help keep us balanced; think quads and core. We lose strength and mobility (can you do a full squat like a toddler?) as we are indoctrinated into school and office life.
The second and most crucial point is that this back pain, whether acute or chronic, will heal. While you can never entirely prevent future issues, you can build bodily insurance to reduce risk and increase recovery.
Step 1: Get Help!
If you are in acute pain, go to your doctor, but more importantly, go to physical therapy. Find a physical therapist like you would any other therapist; do not rest until you find one that understands you and your pain and feels right. In 2015, when I first really pulled my back trying to lift and twist my 65-pound dog into the bathtub, I had to go through three different therapists to find the one that ultimately set me on the long-term road to recovery. I've noticed that the rule of three applies to many things in life (like finding bands to play with or test-driving cars). Ask your friends for referrals. If you have perfect friends without the need for physical therapy, ask your local subreddit for referrals.
Step 2: Instant Relief.
Get a foam roller or two
After 9 years of using foam rollers, I was introduced to the RumbleRoller at my gym. It is the absolute best way to get myofascial release over a large area of your body and I love using in on my QL (Quadratus Lumborum), hamstrings and quads.
You can start with a softer foam roller like this if you can't tolerate deep work
Get a myofascial relief ball.
When they invent a time machine, and I go back to my younger self where I'm in some lame ice breaker, and I'm asked, "If you could only take one item with you on a desert island, what would it be?" My answer would be this
This is my second one in 7 years and I never, and I mean NEVER, leave home without it. It is able to instant spot relief any part of my aching body and get me back to some semblance of a functioning human whenever I am sore, tired, or in pain.
Get an inflatable ball to work your adductors.
Your adductors are the muscle in your inner thigh and are very neglected. Remember Suzanne Sommer's Thigh Master?
Well, that was working those adductors and helping your hip flexors and Psoas become stronger to keep your pelvis aligned and your back from doing heavy lifting
Consider a Hip Hook
At $199 (this is the new version; I have the first cheaper version) it's not cheap, but the only other way I've gotten similar psoas release was from a $120 massage, so you do the long-term math. It's a weird tool and a weird sensation, but sitting all day wreaks havoc on your psoas, which then yanks your spine and pelvis out of alignment
Step 3: Strength and Mobility
Did you sign up for PT? Are you doing it? Good. Your PT will give you stretching and strengthening exercises. Do them. Like your (back) life depends on them. Set a reminder. Do the homework. It's the only way you will recover.
Are you totally against seeing a Physical Therapist, or don't want to be around other humans? Get a subscription to Prehab. These PTs know their stuff, have a slick interface, focus on preventative and rehabilitative exercises, and tailor-made programs for what ails you. I used their app and programs before I started working out at the gym with a personal trainer.
Speaking of the gym, you must lift heavy weights. You cannot stretch yourself into recovery. Trust me, I spent years doing all types of yoga: slow yoga, hot yoga, yoga Nidra, recovery yoga, you name it. While yoga is excellent, the focus on stretching will not solve the root cause of your pain. When you have messed your back up, stretching is a small part of the game. The other 80% is correcting your muscle strength imbalances. Squatting like a toddler, something we humans all do naturally and instinctively until we are forced into sitting requires quad and core strength we lose from sitting. And yes, it also involves hip and ankle mobility. But, you can gain some mobility by slowly lifting heavy weights, even if that heavy weight is just your body.
I won't go into specific exercises, but I will say that the big compound ones are a great place to start:
Squats
Deadlifts
Benches
Pullups (or any back exercise)
Birddogs and Deadbugs for core work
There are apps and YouTube videos to help you get started; however, as someone who has done all the long and tortuous work to figure out the best path, please consider finding money in your budget to get a personal trainer. They can guide you into getting stronger safely, and you will save time and headaches from not reinsuring yourself like I did when following an app and squatting with bad form, resulting in completely sidelining my exercise in 2020. It took me 3 years (thanks, COVID) to finally get back to where I don't feel like a jelly doughnut.
Step 4: Do You Even Meditate, Bro?
I almost called this a bonus step, but it is just as essential as strength and mobility. It turns out our mind and body are connecting, who'd have thought?
When I first seriously strained my back in 2015 lifting my big ol' pup, it wasn't just due to bad form (terrible form). We have to step back and take a 20,000-foot view. I had moved to Portland, Oregon, a year earlier. This move meant my wife had no job to start (remote work was just becoming en vogue). Thankfully, she had just started a job (at a lower wage). Un-thankfully, for the first time in my life, I was just laid off. I had a significant strain on a close friendship at the time, and my beloved aforementioned pup was deteriorating physically.
Stress level +1,000
We all know the effects of stress/cortisol on our mindset and mood. It turns out it is also bad for your muscles (ie, increased tension). If you are too tense and you try to force already weakened muscles (or sometimes even strong muscles) to do something big, something has to give, and it's going to be some major joint where muscles connect.
Ok, Ok, so you've heard it before and, yes, I still roll my eyes when some talking head says to reduce your stress levels. My eyeroll is usually followed by the phrase "yeah, I just need to win the lottery first." Well, we ain't winning shit, fam. No one is coming to save us, it is up to us. Some poet once said "emanciapte yourself from mental slavery, none but ourselves can free our minds." You've got to do the hard, good work, and work on chipping away each day, each moment, the bricks in that prison if you want to be truly well.
The nice thing is, like many things in life, you have many options.
Talk therapy
Meditation
Religion
Yoga (I still love you, yoga, you're just better when your muscles aren't noodles)
Long walks in the forest (or if you are lucky, the beach)
Journaling
Or, why not multiples of these!
I chose a few of these, but the one I've seen the best results from is mindfulness meditation. Over the past 18 years I've been practicing, when I am in a solid routine of an hour a day alone and/or a multiple hour group session (meditating in groups is more powerful, promotes a sense of community, and helps you stay honest in your routine) I feel less chronic pain because I am relaxed and better able to handle the day-to-day stressors life constantly throws at us.
You can do this. You are not alone and the pain will pass (even if it doesn't feel that way now). If you are stuck and have questions, I am happy to try to answer them or point you to resources that might help! Now, go out there and move your body and mind forward!