On Listening to My Back
Thinking back on how I sat in elementary school, I may have had back pain since Grade 5. What I’ve done to cope evolved as I learned more about human anatomy.
Back pain is a nearly universal part of the human condition—80-90% of us will experience it in our lifetime. I discovered back pain in Grade 5 when we sat at tables and chairs instead of one-piece desks, and felt relief when I balanced my chair on its back legs. My father often held his knees to his chest and rocked on his back on the living room carpet, so I knew my weak back was probably genetic.
My first major back injury was at nineteen when I lifted a heavy patient from her bed into her wheelchair using only my arms—we didn’t have patient lifts back then, and they employed tall young nursing assistants to do the dangerous lifting. It took two weeks for my back to feel normal again, but I kept working because I needed the money.
Fast forward to age thirty-four, a few months after moving to Canada, Sarah and I were at Cypress Mountain to ski, and as I stood in the parking lot, pulling on my ski boots, I felt my back “go out” for the first time. At a walk-in clinic the next day, the doctor had me bend over and try to touch my toes. When I touched my upper shins, she declared I wasn’t in enough pain to warrant further care and sent me home without advice.
That first back spasm took me by surprise, triggered by hours sitting at my office desk, the twisting motion of getting in and out of the car, and the frosty mountain air chilling my back muscles. From that point on, my back went into spasm at least twice a year, often triggered by the same sequence of events and delayed by a few days as if to heighten the element of surprise. Like when I lifted heavy bags of gravel on Tuesday, and bent down to pick up my soap in the shower on Friday and couldn’t get back up again. Naked, with the water beating down on me, I pictured the hot water running out and dying of hypothermia before Sarah found me. I escaped by flopping onto my side, then onto my back, and reaching up to turn off the water.
I noticed later that my back felt great for a couple of weeks after I moved soil in the backyard with a shovel. It was the first connection I made between a back exercise and reducing back pain. When I read the literature, I found a paper where researchers divided back pain sufferers into two groups: they gave the first group a set of back exercises to do, and they gave the second group instructions to avoid sitting before noon. The second group recovered faster.[i] I can’t find the paper now, but it helped me notice the strain in my injured back when I sat too soon after getting up in the morning. I finally listened to my back.
With those two pieces of information, I built my back care routine. Despite my best efforts, I injured myself tying our kayaks onto our car’s roof rack and couldn’t relieve my pain with any combination of exercises. My doctor reminded me that back pain can form a continuous loop if medication doesn’t interrupt it and suggested I take a muscle relaxer and try exercises to strengthen my back and other core muscles. The pain loop started with injury, then nerves responded by contracting my back muscles to protect my back from further injury. Unfortunately, it was those protective muscle spasms that caused more pain and activated more nerves to continue the loop.
When I asked her which exercises she recommended, she said that Pilates and “McGill’s Big Three” were good for core strengthening. McGill’s three included side planks, and they hurt while I was doing them, slowing my recovery, so I kept looking. I needed something that wouldn’t exacerbate my unique injury and embarked on an ongoing, iterative, scientific process. I saw the value of strengthening my back muscles, weakened by years of sitting. Gentle exercise also provided a psychological benefit where I felt in control of my recovery, while my back recovered on its own timeline.
Relaxing back muscles with methocarbamol, available over the counter as store brands or Robax, may not interrupt the pain loop on its own, so it’s often combined with ibuprofen, acetaminophen, or acetylsalicylic acid.[ii] When my back feels better, I get lazy, don’t exercise regularly enough, and injure it again with avoidable maneuvers, so I’m in a constant cycle with varying levels of injury and rehabilitative exercise—the worse the injury, the more frequently I need to exercise. Sitting while writing is one of the many injurious things I do to my back. Oh, the irony.
Here’s my recipe for keeping my back pain at bay.[iii]
1. Avoid injury: Lifting and twisting are the worst, but twisting with arms raised will do it too, as will simply twisting to get into a car. Even lifting over forty pounds without bending or twisting is a problem for me now. I have a pull-behind grocery cart to roll groceries home or from the car. I feel so old when I drag it behind me, and when I have to get into a car ass-first and carefully move both legs in after me! How long ago was it I last stepped into a car with my right leg first, ducked my head under the roof, and sat before my left leg cleared the ground?
2. Listen to my back: I learned to listen to my back, where I’d ignored its cries, year after year. Bending forward while sitting, like when I reach for something when I’m in a chair, or pull on socks or shoes, causes a pulling sensation in my back. If my back is in spasm, I can’t do it at all. So, I put on my socks while standing and drop to my butt to tie my shoes. I’ve learned to accept the look of surprise when I do it in front of strangers or friends for the first time. Sitting in soft chairs puts my pack in the same straining position, so I avoid sitting on anything but firm chairs, even if it means being “difficult” in cafes or friends’ houses.
3. Don’t sit before noon: I do my aerobic exercise in the morning to warm up my back muscles and use a standing desk to do any work before noon. I usually eat breakfast standing, and commute via a bike with a tall seat that doesn’t strain my back.
4. Take medication at the first twinge of a back spasm.
5. Strengthen my back muscles to prevent injury and speed recovery: I wouldn’t have written this piece without hours spent sitting, and everywhere you look, it says that the best solution is to take frequent breaks. But I can’t write that way, so I exercise before I write and write sitting after noon. More strengthening exercises after writing and before bed help, too.
If you’re curious which exercises I settled on, I’ll post my bespoke back exercise guide next week (or email me for the secret preview link). For a relaxing pairing, listen to George Michael sing “Heal the Pain.”
Any thoughts? How are you doing? Let me know…
[i] Let me know if you find a copy.
[ii] Choice of meds for back pain is complicated. I usually take the combination of methocarbamol and ibuprofen, available over the counter in Canada as “Platinum” muscle relaxant.
[iii] The information on this website does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.