The first thing I would like you to know is I have not had back surgery.
I have experienced a level of back pain that a surgical procedure could have been recommended. It’s been over two decades since I explored non-surgical alternatives for back pain.
If you think you know all there is to know about joint mechanics, muscle anatomy, and how all of that can contribute to the pain you feel in your back, what you are about to read isn’t written for you.
For those of you who are willing to ask bigger questions that go beyond the conventional wisdom on back pain – I wrote this for you.
Given what’s at stake over the long-term, I think it’s worth keeping one fact in mind: Once you go under the knife for back pain, what’s done is done. You cannot go back and undo any of it.
More recently, there is evidence to show that, in most cases, surgery for back pain is not necessary.
Plenty of people are walking around with a postural alignment that doesn’t look anything like what a textbook would describe as the gold standard.
Many of those people have degeneration of spinal joints, and the health of their discs is far from stellar.
But yet, they are capable of functioning without pain. Nobody is telling this percentage of the population they need “traction”, spinal adjustments, and all the other nonsense that goes along with those things.
Every year, billions of dollars are thrown at back pain. If you zoom in on where that money goes, you’ll find most of it goes to the sunk cost of addressing symptoms and chasing pain.
I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.
— Abraham Maslow
So what is missing?
The role of your muscular system is ignored. Taking time to improve how your muscles function is passed over for treatments that are drawn out over many appointments.
Most of what takes place in these appointments will look a lot like throwing a bunch of stuff at pain; while experts cross their fingers and hope something sticks.
Since we are on the subject of under-delivering on a promise; the number of times I have heard an expert or some form of media suggest that people can exercise their way out of back pain is too many to count.
Ninety-nine percent of experts are still under the impression that they are going to exercise people out of pain. And let’s not forget about how often stretching and foam rolling are recommended.
If you didn’t know any better, you would think dynamic exercise and stretching weren’t recommended prior to the billions of dollars that’s been spent on back pain.
This, without considering the protective mechanism that’s built into your brain (and nervous system).
…it’s really compelling that if you don’t have a brain, you can’t have any pain. Pain is the most powerful protective mechanism we have, a harm alarm.
– Melanie Warner, author of The Magic Feather Effect (affiliat)
What the majority of experts are not taking into consideration; nothing is done to clear the pre-existing compensations you had prior to experiencing back pain.
Your brain’s top priority is to protect you. Ignoring that fact doesn’t make it any less imperative.
Dynamic exercise is not going to change your brain for the better.
You will find plenty of people who are under the impression that the exercises they performed over many appointments are what cleared them of back pain.
Upon further examination, you will notice that there is a flip side. (Because there is always a flip side.)
Case in point, many people have done clamshells as part of their rehab. They were also religious about doing all the other exercises that are not well thought out. Those people did not have success with dynamic exercise. That begs the question, Why didn’t the cookie-cutter dynamic exercises play out in their favor?
Why does exercise work for some people and not others?
First, it’s essential to drill down on what “worked” actually means. People are going to be convinced that exercise is the answer. The same goes for back surgery. When exercise or back surgery feels like they worked, what people don’t realize is that they got lucky. Meaning their bodies found different ways to compensate (and protect).
Albeit, in their minds, it was the exercise or the surgery that worked.
This is where going by feel can get you into trouble.
After exercise, it is entirely possible for you to feel stronger and no longer have back pain.
Truth be told, you are stronger. It is just that muscles that were strong prior to the pain or injury are even stronger.
So, where does that leave muscles that are underperforming?
Because you feel what you feel, you aren’t aware of what’s not taken into account.
If you feel like you’ve had success with dynamic exercise, I promise you this: you aren’t functioning better than you were before the pain in your back showed up.
Along the same lines, it’s also not uncommon for people who think exercise worked to leave out the part where they haven’t been able to return to the activities they were doing before the back pain settled in.
There’s a valid reason for that.
When you factor in how much stress your body has been forced to take on with dynamic exercise, stretching, foam rolling, and all the other stuff that is thrown at symptoms, there is a strong possibility that there are even more muscles underperforming than when you first walked into rehab.
(Principles)
If we are being honest, after rehab is completed, rarely are muscles prepared to deal with the amount of stress they were able to take on prior to the back pain.
What you’re left with is a false sense of strength. In other words, it is more strength with a lot of spinal joint instability to go along with it.
If you’ve been curious as to why (?) you haven’t been able to return to the activities you were able to do before back pain, now you have the answer.
When so many experts who work with the musculoskeletal system r working within the confines of a business model that requires seeing multiple patients in the same hour, I imagine it’s difficult to cultivate ability to stay eager, connect to another human being… #PhysicalTherapy pic.twitter.com/yGBDY05Zsk
— Engaging Muscles (@rickmerriam) November 24, 2019
Do you see a pattern?
In the process of throwing more money at chasing the pain, you’ll get to a point where it feels like you’ve explored all your options. With little to no leverage, back surgery starts to look more and more promising.
When you feel you are at the end of your rope with conventional methods, more invasive procedures can seem like the only way out.
History has shown that if anybody is going to change course, it has to be you (i.e., the consumer).
Human beings are far from rational. With untrained minds, we take a stance or make decisions with levels of thinking that are far from accurate (or productive.)
Experts are no exception to this. (emphasis added)
It is also not uncommon to make bad decisions under stressful conditions.
If you’ve ever experienced chronic back pain, I think you would agree that it is physically and emotionally draining. Combine all of what comes from the sensation of pain, and what you have is a tremendous amount of stress.
Given the billions of dollars that’s been thrown at neck and back pain thus far, I choose to believe that people are interested in exploring possibilities that don’t look and feel like the next best guess.
Choices that allow for antifragility.
By now, you might be thinking I have overreached on what I’ve written here.
Before the Resistance kicks into overdrive, remember this: Ninety-nine percent of the experts you will come across will pretend that your muscles are functioning to the best of their ability. With the reach that social media can provide, pretending is more prevalent than ever.
Going above and beyond the status quo and delivering on a promise on a consistent basis is what’s missing.
Prior to recommending back surgery, experts are like you and me – they are human.
While they continue to repeat the same things that happen to add up to billions of dollars annually, what they continue to not factor in is how many local and global stabilizing muscles aren’t capable of playing their role.
Of course, that is also the case with experts who regularly tell people that spinal adjustments and releasing muscles are the way to relieve back pain.
When push comes to shove, all of these experts have one thing in common: They don’t own an accurate method for determining which muscles are tight. The same goes for knowing which muscles are underperforming.
If you were to take a class on muscle anatomy, at some point, you would hear the professor say, “Muscles pull. When a muscle pulls, it also generates tension. That tension allows for a certain amount of stiffening of the muscle.”
Loosey-goosey muscles can’t provide stability because they are unable to pull at the right time.
Your best bet is to stand guard at the door of your mind.
If you want to bank on one thing when it comes to back pain, bank on this: most experts aren’t thinking about how many of your muscles are not capable of providing stability.
There is a good reason why your muscles continue to be tight.
It is due to muscles not performing to the best of their ability. Because they are underperforming, those same muscles are not capable of providing stability.
If you don’t take the reins, somebody with more leverage will.
You have a built-in protective mechanism that resides in the space between your ears.
You also have a bunch of spinal joints that rely on muscles for stability. Every one of those spinal joints is supposed to move at a certain time.
Given what you’re likely to hear from experts, you could easily talk yourself into believing that the human spine is much less complicated than it is.
Not to mention the complexity of all the muscles that allow for less wear and tear on the spinal joints.
When muscles are capable of pulling to the best of their ability, together, they are capable of providing stability.
All of that stability that’s provided by your muscles allows for motion at each level of your vertebral column. By increasing mobility with muscles that are capable of providing stability, your spinal joints are no longer taking on the stress that goes along with instability.
The timing at which pronation and supination take place throughout your chain comes down to the muscles’ ability to provide stability.
Restoring stability is the key to getting back to a place where you’re capable of functioning to the best of your ability (and without back pain).
Improving the underperforming muscle’s ability to pull is the way.
SHIP.
(Art)
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Book mentioned:
The Magic Feather Effect by Melanie Warner (affiliate)
I have held a license to practice massage therapy for thirty years. For eighteen of those years, I was a nationally certified personal trainer. During that time, I completed thousands of one-on-one personalized fitness training sessions. I went on to teach the biomechanics of exercise to personal trainers, group exercise instructors, and physical therapists throughout New England. Teaching exercise biomechanics led to consulting for The Greenbrier, Canyon Ranch, and ESPN, which evolved into providing deep tissue and sports massage for four years at ESPN.