The Pyramid of Chronic Lower Back Pain
It is often thrown around that lower back pain is the leading cause work loss. I don’t know if this statistic is actually true or not. It seems plausible given the amount of people we meet and know that are afflicted with it, myself included. Chronic lower back pain has bothered me since I was a teenager. Never had any acute injury, it just seemed to appear. I was finally able to “conquer” chronic back pain accidently in 2019.
In 2019 with the help of my Crossfit coach, I started to control and schedule when and how much I drank alcohol. An amazing thing happened that I only realized later in retrospect: I didn’t have back pain any more. The chiropractor visits, the inversion tables, the specific postural and glute exercise, my standing desk, I even have those boots that let you hang upside down from a bar; none of them rid me of my back pain. Not drinking and eating like an asshole did.
In the subsequent years I can see what has staved off the back pain and what can trigger it again. I’ve figured out the most important factors and turned them into the pyramid seen above.
Inflammation
Time and time again I have seen the evidence that what we consume has the greatest effect on our back pain. To put it simply, eating and drinking shit inflames our backs. If your back pain is constant, this will just prolong it or make it worse. If your back pain is under control, this will make you significantly more susceptible to injury if you exercise. An inordinate amount of the injuries in our gym are people coming back from a vacation. They come in looking to work off their indulgences. They are already stiff from a week of not exercising so they only do an abbreviated warmup. Then they attempt to squat, deadlift or clean and strain their back.
Bodyweight
This is bodyweight and not body fat for a reason. The heavier you are the more strain you will put on your back when you move around (or don’t move around). If you lower your bodyweight you will see a commensurate reduction in back pain over time.
Bodyweight and inflammation are the lowest two steps on the pyramid for a reason. You will see as you climb the period the the more time something impacts your day the more important it is to your back health. Inflammation and bodyweight affect you 24 hours a day.
Sleep
Lack thereof and positioning play a large role in your back health. I have found that switching from being a belly sleeper to a back sleeper has made a large difference. Even more helpful is the stack of foam I attached to each other that I lay my legs on to create a 90/90 positioning. I have found this position to relieve pressure from my lumbar and make my breathing more relaxed. A side been fit is that it also blocks the TV screen to make it easier for me fall asleep while my wife watches her serial killer documentaries.
I’ve seen belly sleeping recommended for people with back pain. The thought process seems to be; if press-ups are good because they put you into extension, then sleeping on your stomach should also put you in extension for a longer period of time. In practice I don’t believe this works. When you sleep on your stomach on a mattress, the mattress creates a pinching at the two ends of your back that are arched. This is not the same relief that you get when pressing up on a solid floor.
Sitting
Most of us will be sitting or sleeping around 6–8 hours daily each. That is why they are the next two platforms on the Pyramid of Lower Chronic Lower Back Pain. There is a couple ways to combat shitty sitting. None of these are perfect and I have found it best to employ a bunch of them daily. Sitting sucks; there isn’t much we can do about it.
Standing desks are probably the best weapon. If you have a Varidesk or similar, don’t be lazy and just sit all the time. Also swap back and forth often. Does it annoy the person in the cubicle next to you? Tough shit, tell Gary to mind his fucking business, you got back pain to fix. Be mindful to not stand the same way all day either. You’ll find that you start to lean to one side for hours and that can be just as bad as sitting. Bad posture is bad posture whether you are sitting or standing. I used to employ a small wood block on the ground that I could put my feet on or do calf raises. That work really well. In preparation for my first Spartan Ultra Beast race I built up to 1000 daily.
Strength
Strength takes up approximately 1–2 hours of our day, but the reason it is included here is mostly for the instant that you need it. Building strength will not relieve back pain. In fact the pursuit of strength; if done incorrectly, will just make it worse. What strength will do is prevent exasperations of back pain. A fall, a twist, picking up a box the wrong way can all trigger the really bad bouts of back pain that last weeks or months. Building strength makes those bouts much less frequent and less severe. It is your body’s insurance policy against all-cause back pain.
