Spine Doctors Share What Not To Do For Back Pain

An estimated 8% of American adults suffer from persistent or chronic back pain that limits their daily activities. Spine doctors have a very specific message for people walking around with back pain: Don’t push through.

This is especially true with one specific combination of movements, according to Dr. Arthur Jenkins, a spine surgeon and neurosurgeon for the New York Jets and the NFL Retired Players Program. Jenkins has an initialism for back pain sufferers: BLT, or bending, lifting and twisting. It’s a dangerous combination when done all at once for those with preexisting back pain, he explained.

Experts would avoid doing this at all costs if they’re dealing with back pain. Here’s what to know:

According to the American Association of Neurological Surgeons, people with back pain might be at risk for a disk herniation, which is when the disks that provide cushion between the vertebrae in the spine tear or rupture. This can occur after the disks have been bulging first, and that herniation puts pressure on the nerves in the spinal canal.

“Many patients walking around with back pain likely already have damage to their disks in their back. They may not have as much … damage that qualifies them as having a disk herniation, but they are certainly at risk of developing one,” Jenkins said. “A disk herniation typically happens when the outer ring of the disk is damaged, allowing the inner nucleus to squeeze out under pressure. So having existing damage to the annulus certainly predisposes you to more disk herniations, but sometimes it happens all at once.”

Bending, lifting and twisting can increase this risk. “Each type of movement increases the pressure in the disk space and can lead to a disk herniation, but all three at once is the worst,” Jenkins said.

Take shoveling snow, for example. This “involves lifting and usually a twisting movement where the snow is picked up in one place and thrown off to the side,” Jenkins said. “The person usually has to bend over to put the shovel into the snow, and then … [when] this weight is heavier than anticipated, such as when the snow is wet, that puts even more stress on the spine.”

You may not even realize how often you execute this motion in your everyday life.

“Other common examples include lifting a child car seat out of a car door,” Jenkins said. “In this case, the parent has to stand somewhat crooked because of the way the door opens, and often when wedged in next to another car. They have to lift the car seat … twist out, and there is usually some bending involved since the car seat is usually below the chest level.”

Moving luggage when traveling is another example. Pretty much anytime you need to contort your body, it can cause problems “if the weight is not adequately anticipated and the lifter was not engaging their core in a conscious and thoughtful way to reduce the stress on the spine itself,” Jenkins said.

Instead of a BLT, follow Jenkins’ personal method for lifting instead:

• Directly face what you’re lifting instead of turning or twisting toward it. Then shuffle around to adjust, still facing forward and keeping your spine straight.
• Use your legs — not your back — to lift, and engage the abdominal muscles at the same time.
• When picking something up off the floor, stabilize yourself. Put your hands on something nearby if you can, and put one leg out straight behind you, which will reduce the amount that your spine bends.

Engaging your core is key to protecting your back. The core muscles, namely the abdominals, work with back muscles to stabilize the back itself, Jenkins explained.

“Muscles opposing from both the front and the back give a balance of support, and they prevent any and all of the spine levels from moving too much when a force is applied to them,” he said.

He recommended that back pain sufferers keep their back and abs as strong as their body will allow.

“I find that my back tends to hurt less when I do my core exercises regularly,” he said. “Sometimes if I have forgotten for a week or so, my back will remind me. And then once I start doing the back exercises again, I feel better.”

Core moves like plank variations, bridges and dead bugs are all stabilizing exercises you can try. These might be done on your own, or with the help of a trainer or physical therapist, depending on the extent of your injuries and pain.

You can engage your core far beyond the gym for extra stability and protection, though, especially if you find yourself in a BLT-type situation. Simply contract your abdominal muscles by pulling your bellybutton toward your spine. With practice, it might even become a natural posture for you.

“If you are lifting, keep the load close to the core and use the legs,” said Dr. Meredith Warner, an orthopedic surgeon, an author and the founder of Well Theory. “One way to help your back out is to get strong quadriceps muscles. This allows you to use your legs to lift more easily.”

She added: “For loads a bit away from the core that must be lifted off a floor, putting a leg behind you as a counterbalance helps, too. This works if one has balance, obviously.”

Twisting by itself is a natural motion for the spine and critical to human function, she noted.

In addition to the back and abs, consider adjacent muscles that you need to strengthen.

“Hip strength is important as well,” Warner said. “Strong hips can take some stress away from the lumbar muscles.”

Many people worry that the only way to find relief from herniated disks is through surgery. While surgery is an option, Warner said that various cases of back pain can also be managed without it ― and not all back pain is caused by disk issues. Up to 90% of Americans can expect to deal with back pain at some point, making it a somewhat annoying but normal part of aging in many instances, she noted.

“Many people begin to have pain during adolescence or the early 20s,” Warner said. “Back pain is now understood as a chronic condition with normal episodes of waxing and waning discomfort. Rarely is there a true injury.”

She added, “Most of the pain is due to the very complex interactions between the musculoskeletal system, human physiology, the brain and other factors.”

If you are having a pain episode, Warner said that bed rest is rarely the answer — instead, she suggested seeking out “functional, active, rehabilitation.” This could include activities like yoga and interventions like physical therapy.

That said, if a disk is herniated and compressing a nerve, don’t delay in seeing a back surgeon or spine physician. In the meantime, reduce or avoid your BLTs to stay as healthy as possible.