Tips for overcoming low back pain

By Magnus Vinding @ 2020-03-24T16:41 (+71)

Low back pain (lumbago) is a leading cause of disability and reduced productivity around the world, and the EA community seems no exception. Since I have had quite a bit of back pain, and spent hundreds of hours searching for solutions, I thought I might as well share some of the many useful tips and resources I've found.

Thanks to the hacks I list below, I've gone from having intense, crippling low back pain to maximizing my wellbeing in an Epicurean sense. (Needless to say, what follows is not medical advice, and may not work for everyone; low back pain can have many causes, and you should probably consult a doctor if you have severe back pain.)

Exercise

Key stretches 🧘🏾‍♀️

Stretch your psoas. A tight psoas muscle can lead to an unhealthy posture that can cause pain in the low back.

Stretching your hamstrings can also be surprisingly helpful. A nice compilation of stretching exercises for low back pain are found here.

Important to note is that the time you spend stretching matters a lot. Don't make the mistake of assuming that the value of stretching must have diminishing returns in a way that renders it pointless to stretch for more than ten seconds.

In other words, even if ten seconds of stretching your hamstrings on each leg does not make your pain go away, two minutes might. And if not, try ten; you can do other things while you do it.

The good thing about the stretches above is that, at least for many people, they can provide instant relief even in fairly bad cases of low back pain (I've tried that many times). But ideally one should adopt a daily stretching routine as a preventive measure so the pain never emerges in the first place.

Key exercises 🏋🏿‍♀️

If you have low back pain, it may be because you are too weak in key areas, especially your core.

For me, the two most important exercises for preventing back pain appear to be the squat and the deadlift. Squats need not be done with weights; just do more reps and you may still see great benefits. I encourage everyone with low back pain to at least try this: do 100 squats every day — say, 4 x 25 — for a week and see how it works.

I can also recommend back extensions.

Note that the exercises listed above can make things much worse if done wrong. For example, when doing back extensions, overextending your back so it is beyond parallel with your legs can really exacerbate back pain. When doing squats, make sure your feet are aligned with your knees.

Ordinary jogging can also be good. It feels like it stimulates the low back in a good way, a way it's probably "meant" to be stimulated, yet which it often isn't in people with a sedentary lifestyle.

Postures to avoid

Watch the way you sit 🐒

Avoid slouching hard in the c-shape. Laziness in this regard will be punished — and not in a kinky way. Please don't be fooled just because it feels okay while you're doing it. In my experience, sofas are especially bad, so do not indulge in the couch slouch.

In terms of work positions, many people find it helpful to work at a standing desk, or to alternate between sitting and standing. A treadmill desk may also be good, though some are critical of this setup.

Watch the way you stand 🕴

Don’t bend over. Or at least don't bend over in the c-shape. For example, if you have a low sink, try to bend in your knees while you keep a straight back rather than bending forward with a slouched back.

Like slouched sitting, bending over to reach a low sink or to vacuum can be insidious in that you may only feel pain afterwards. Consequently, discipline may be required to prevent pain due to bending (it makes sense if we have not evolved adequate pain responses to weird positions that our ancestors probably seldom found themselves in).

Also, avoid walking with a heavy load on your back. Carry heavy loads in your arms when possible.

Watch the way you lie 🛌

Don’t lie in a sofa or bed with your head tilted forward in a strained way. That may sound obvious, but this bad Netflix posture is nonetheless common.

In terms of sleeping positions, some advice can be found here. However, in my own case, finding a mattress that works for me has been much more important than these tips, which leads to the next point.

Your junk

Invest in a new mattress 🛏

Sleep is important, and hence very much worth investing in — even for frugal EAs. In my case, getting the right mattress has probably been the single most important factor for overcoming low back pain.

How do you find the right mattress for you? This can be tricky, and also very frustrating. In terms of firmness, a medium-firm mattress may be optimal:

Research is limited, but in one study, researchers assigned new mattresses to more than 300 people with low back pain. They used either "medium-firm" or "firm" mattresses for 90 days. Those in the medium group reported the least amount of discomfort.

In my experience, soft mattresses are the worst for low back pain, especially if you sleep on your back.

Simply getting a new bed or mattress may be helpful:

When researchers from Oklahoma State University randomly assigned 62 people to sleep in a variety of new beds for 28 days, they found that almost everyone started to sleep better. That was true regardless of which model they were given, though people who slept in the cheapest beds did report more lower back pain than those in the medium- and higher-priced beds.

The solution I have landed on after having tried a wide variety of beds and mattresses is a fairly minimalist one: to lie on two medium thick mattress toppers on the floor, memory foam at the bottom and latex on top. With this configuration, I always sleep on my back (on some mattresses, I need to sleep on the side). My back has never been better than after I started sleeping like this.

Get a good chair 💺

Getting the right chair is also crucial. Unfortunately, I don't have much specific advice on how to find a good chair — there is a lot of advice out there on optimal chairs and sitting postures, and a lot of it is contradictory. It seems there is just a lot of variation* in terms of what works for people, and trying many different chairs to see what works might just be the best you can do.

What I can say, though, is that you might not know if your chair is a big problem. Again, the pain may only emerge later, and then it can be difficult to know for sure whether it's your chair, your sitting posture, or something else that causes your problem. So even if you are unsure, it can pay to try different styles and positions.

You may also find it useful to invest in an iamcomfi pillow or a similar product.

Good Bikes Bad Bikes 🚴🏽‍♀️

I'd recommend not driving on a racing bike. It almost forces you to be in a strained c-shape position, and can cause severe back pain lasting for days even after a single trip (that has been my experience).

Better to drive a classic city bike that allows you to sit up straight. This may have the additional benefit of being safer, as it naturally leads you to drive more slowly and less recklessly.

Avoid bad shoes 👟

Shoes can make a big difference. Trainers are probably best, yet of high quality and proper fit, as bad trainers can make things worse. The worst shoes are very inflexible ones with hard soles — think stiff, fancy shoes. It's possible to find smart shoes that are decently ergonomic.

Finally, adopt a healthy attitude 🧠

Back pain appears strongly influenced by our mentality, as reported by doctor Mike Evans:

[Y]our attitude is actually very important to outcomes in low back pain. What we don’t want is people saying to themselves “oh, I have back disease so I better stop exercising”. Or every time they feel a twinge they feel they have an “illness”.

He goes on to list four factors that predict an increased risk that a patient's acute low back pain will become chronic:

#1: the belief that back pain is harmful or potentially severely disabling.

#2: fear and avoidance of activity or movement because of back pain. 

#3: a tendency towards low mood and isolation.

#4: a strong expectation that passive rather than active treatments will help — believing you just need to sit there and have therapists work on you rather than owning the fact that it’s not just the therapists that need to do the work, you do too.

As Evans summarizes a study in which two groups of workers were given different instructions that produced markedly different outcomes: "It was mind over matter. If the worker didn’t mind some pain, the back pain actually didn’t matter." Relatedly, he lists CBT as potentially effective against low back pain.

Of course, the significance of your mindset is not wholly independent of the other things listed above. One of the reasons your mindset is so important is that it determines whether you will exercise and do stretches.

So when you feel back pain, you might want to frame it as your body's primitive way of begging for exercise, "please strengthen your core", or "please stretch your hamstrings and psoas, even if it feels a little uncomfortable in the moment". Or perhaps you should see it as a cry for a new mattress and chair. You don't want to frame it as "ah, there is something wrong and this is all hopeless".

Feel free to share any additional tips you may have in the comments.

* The linked article says slouching need not be bad, which is consistent with my experience, at least in the case of mild slouching. However, it is also my experience that certain kinds of slouching are very bad, such as the couch slouch and a hard forward-slouch that has your face hovering millimeters above your dinner plate. Such hard slouching does invariably lead to pain in my case.

The article also says that carrying something heavy on your back is not a risk, which seems to contradict what I said above concerning backpacks. I think the article makes a rather strong claim here, and one that is transparently false in my own case: carrying heavy loads on my back (more than 5 kg) consistently leads to soreness.