Chronic-pain sufferer Cathryn Ramin advocates exercise for sore backs rather than medical intervention.
The bad news is that it will take a lot of time and effort to recondition the muscles associated with chronic lower back pain – the glutes, the pelvic muscles, the thighs, the knees and the feet. It will also be painful – at least initially – and you’ll need to keep at it. If you don’t, your symptoms will probably return.
“As I say to people, it didn’t take you five minutes to get to where you are, and it’s going to be hard work and going to take you time to get out of it,” says Ramin, the US author of Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.
Ramin, who suffered from chronic lower-back pain for years, credits her recovery to a series of “back whisperers”. They include personal trainers, Iyengar yoga teachers and, most recently, postural therapy classes known as Egoscue.
She also regularly does three spine-stabilising exercises developed by Canadian spine specialist Stuart McGill – even when, as she was recently, she’s staying in remote huts in the South Island. “I just need to find enough floor space to do them.”
Like many of the estimated 10% of people who suffer from chronic lower-back pain (pain that lasts for three months or longer), Ramin was seduced by the promises of what she calls the back pain industry. MRI scans revealed she had something called “degenerative disc disease” – an ominous-sounding condition that she later discovered is common in all older people.
She eventually had minor back surgery, but her pain didn’t go away.
That failure spurred the long-time journalist to start a six-year investigation into what works – and what doesn’t – when it comes to treating chronic back pain. She concluded that unless your pain is caused by something like cancer or by obvious trauma such as a car accident, you’re better off strengthening the relevant muscles than attempting a “quick fix” through surgery or other medical means.
That means getting rid of a few preconceptions. The first is that your pain is the result of one very specific event.
“People are constantly looking for the pain generator. People say, ‘I leant over to pick up the newspaper and I hurt my back’, or ‘I took the luggage out of the car and hurt my back’. But you’ve done those things hundreds of times before and you didn’t do any serious damage to your musculoskeletal system.”
In most cases, she says, pain is the final stage of a cumulative process of deconditioning, often caused by too much sitting. Ramin says chronic lower-back pain doesn’t exist in countries where people use stools instead of chairs and squatting is common. “It’s very much an industrialised-society problem.”
The second preconception to put aside is that you should avoid activities and exercises that cause pain. “You need to get over the idea that hurt means harm.”
As real as your pain feels, she says, it’s not caused by tissue damage but by something called central sensitisation. Essentially, your nervous system has gone into a state of high alert and started responding in a disproportionate way to minor stimuli.
Enter the back whisperer, someone who can help you persevere despite the pain. In most cases they’ll be a personal trainer, though lower-cost alternatives include taking Feldenkrais or Alexander Technique classes, signing up for Iyengar yoga (“it’s a purely orthopaedic style of yoga”) and doing tai chi or qigong.
Ramin has a few tips on how to find the right person. Good bets include those who have heard of the work of McGill and Australian pain expert Lorimer Moseley and are familiar with and experienced in strengthening the muscles associated with back pain.
You might want to reconsider if they chuck a medicine ball at you or suggest you do sit-ups – which are bad for your back – or forward-bend from the hips to “stretch” your back. “They’re never a good idea.”
Cathryn Ramin will talk about her research at Functional Physio in Auckland on April 16.
This article was first published in the April 7, 2018 issue of the New Zealand Listener.