TREATING BACK PAIN USING JUST POSTURE

N.T. Thẩn - Exryu Toronto (*)

Introduction 

Based on the most conservative estimates, one in 4 people have lower back pains at some point in their lives. By using the materials referred to in this guide to practice good postures, back pain sufferers should gain significant relief or total cure.  For those who do not suffer back pains, even though it’s not as critical, much is gained by assuming good postures, or at least by avoiding terribly bad postures. 

I’m attaching 2 U-tube videos that teach good posture, one is about standing posture, and the other, sitting. 

Kathleen Porter, How to treat Kyphosis: preventing and correcting the dowager’s hump (10’)

Esther Gokhale, Sitting: the good, the bad and the ugly (1 hour)   

Applying the instructions in the 2 videos studiously might be, in some cases, enough for getting rid of pains.  But the books listed below offer more thorough instructions and might be required when the videos alone are not enough. There should be many more books about treating back pains, but I have studied only these four books and it was sufficient to overcome my very bad sciatica 3 years ago. 

The 4 books are:

--Kathleen Porter, Natural Posture for Pain-free Living: The Practice of Mindful Alignment

--Esther Gokhale, 8 Steps to a Pain-free Back

--Stuart McGill, Back Mechanic

--Jack Stern, Ending Back Pain: 5 Powerful Steps to Diagnose, Understand and Treat Your Ailing Back 

The first two books are exclusively for training toward “good” postures (thus the books are similar to the videos, but with richer details). The postures taught in these two books are very similar to each other.  The differences are in the explanations/illustrations as how to learn the (“good”) posture, and where the emphasis should be.  As such, studying one book should suffice, even though studying both gives deeper understanding of posture, and therefore is even of more help. 

Back Mechanic shows how we can maintain good postures while performing daily activities such as: tie shoes, stand in front of the sink to brush teeth, to wash dishes, lean to take laundry in and out of machines, push the vacuum cleaner, sit in the morning (sit on the toilet seat), bend down to pick up small objects, bend down to lift heavy objects, open heavy doors, get up from lying position, etc. McGill calls these habits "spine hygiene"--just as flossing & brushing teeth are oral hygiene. His advice is condensed in the analogy he uses, “Don’t pick the scabs”, meaning do not re-injure yourself with movement patterns or postures that cause pains—let the injuries heal. The book has sections on training to achieve athlete-caliber (i.e. strong) body and back. (The author has trained Olympians)  

The fourth book, Ending Back Pain, represents a comprehensive discussion of all cases (causes) of, and treatment options for back pains.  It aims to help the readers avoiding bad “paths” to a treatment course--paths that lead to worse back problems. (Jack Stern is a neurosurgeon.) 

Before practicing with the videos 

Regarding the videos, before you practice with them I would like to add some suggestions, gained from my understanding and experiences. 

Firstly, make sure that whatever the videos suggest, if it BEGINS to hurt, you should stop doing it; or, if you do not want to stop all together, moderate it, or temporarily stop it and try it some weeks/months later when your pains lessen (hopefully). 

As a principle, always investigate the pains (especially new ones), identify what moves hurt and avoid these moves to see if the pain stops/improves. Note that sometimes it doesn't hurt right away, but it hurts after some days/weeks of practicing or doing certain activities.  So be aware of that too. 

This advice applies to all actions/moves in your daily life (not only when exercising): when some actions cause pains, it is important to stop doing it, if possible.  When it’s not possible to stop, try to come up with a different way to do the tasks (see S. McGill), or take rests (i.e. to pause) between repetitive movements; movements such as chopping, scrubbing, standing for a long time, bending repeatedly, etc.. It is smart to take rests/pauses before the pains become so noticeable/severe—then it will be more difficult to treat it. For example, as advised in Back Mechanic: if you know that walking for 5 minutes causes pains, plan your route and walk for 4 minutes at a time. 

Secondly, the postures suggested in the videos will not feel "natural" to most of us when we first try; but they ARE proven good postures for a vast majority of cases.  However, if these postures don’t work for you, needless to say, you should endeavor to investigate other ways to help with your pains. You may need to see a back doctor; but don’t rush to one, check Ending Back Pain, on how to find a good back doctor.  

Lastly, while assuming good postures or doing the exercises (to be introduced in a moment), try to relax.  Relaxing helps toward avoiding muscle strain, while achieving more in anything you try to achieve.  To relax, in my simple view, means not using (i.e. let loose) any muscles that are not needed for the actions you are performing. (It will be an advice easier said than done—it needs practicing.) 

Keeping the habit of good postures 

If you are one in the vast majority, where the postures in the attached videos do not cause pains, then it’s a very good news for you. “Unfortunately”, you need to practice using these postures “religiously” to see the improvement. 

Practice often is key.

At the beginning, your postures are most likely not “perfect”, but it really suffices to assume/use the newly learned postures (even though they are not perfect) as often as you can.  This is a direct relationship: the days that I assume good postures more often are the days that my sciatica feels better, and vice versa!  It looks like I need to consciously maintain good posture forever.  I envy those for them good postures are second nature!  

The best way to remind yourself to maintain good postures as often as possible is to follow an exercise/fitness program on a video (a 15' program, twice a day is perhaps sufficient for most cases).  You can choose any program suitable to your ability.  The choice of a program is not so important because the main purpose of doing the exercise routine is to dedicate that 15' for applying your postures (learned from the attached videos).  For example when the video shows a kick, you first check your posture really well, maintain that bone alignment, then you kick; the same with raising arms, turning heads, etc.  In other words, you use the program as a “frame” to practice your learned postures; any other benefits, related to cardio-vascular or flexibility are of secondary importance during this exercise.  Do not sacrifice good postures for speed (number of repetitions): I find I finish one repetition when the video completes 3- 4 reps. 

So, “Focused” exercises serve both as

--a traning for good postures while we are doing the exercises, and

--a reminder that we should be aware of our postures for the rest of the day when: driving, sitting on office chairs working, sitting of standing doing kitchen work, standing waiting in line in grocery stores, waiting for the bus, etc. 

Stop on tracks to adjust posture.

In addition to dedicating time for “focused” exercises, you can try this: while going about with your daily activities, the minute you feel your back is stiff, or you walk as if waddling (because you are NOT able maintaining good posture), just stop on tracks (if possible), and assume your good posture, or do a few moves from your exercise program, just for one minute or two.  People do this all the time: they stretch their back, their shoulders.  But I propose that you do it in a bit more “organized” fashion (or should I say “postural fashion”?), as just explained.  

The wedge

We sit for more hours than we stand, and I find that I absolutely need chairs that support good sitting postures.  This is clearly discussed in both books, by K. Porter & E. Gokhale, respectively. They recommend using a “wedge” (to put on chairs—this is not the one you put on the back to lean your back against it) to provide support when sitting.  Even though wholeheartedly agreeing with that, I found that I need a decent chair to start with, because if the chair is “wrong”, a wedge is only a “half-way” solution, and in “fixing” back pains, you need a “total” solution, meaning that you need to avoid any postures/actions that cause any pains, big or small (because some pains start as small, being just a discomfort, but balloon into big pains, much harder to treat).  

For me, who had a crippling sciatica, I had to replace 2 chairs and make four wedges of suitable inclines (“slopes”) for my different chairs.  The four wedges are for: the seat in the car, the office chair, the sofa and one “travel” wedge for rides in public transit. 

Bringing along a wedge when riding in public transit is such a nuisance that at one point, when I thought my sciatica was so much better, I stopped using the wedge (even though I sat in a way that largely kept the pelvic at a healthy angle).  For a few weeks it seemed alright, but, no, insidious pains snuck back. At first I didn’t know why the pains were back, but one day, when I just sat down on a seat on a bus, at the very moment of touching the seat, I noticed a small pain, which lingered on throughout the ride.  Then I realized that this experience had started weeks ago whenever I rode the transit, but it escaped my awareness (or may be I didn’t want to acknowledge it) and it only became more noticeable as the weeks went by.  Needless to say, I reverted to using my wedge on buses and trains, and created a new motto (for myself, of course) “Don’t leave home without the wedge”! 

I might add that in addition to wedges to sit on, when at home I also use footrests so that when I sit, my legs (feet) are not dangling.  You probably know that dangling legs (when sitting for a long time) is not good for your back.  

Conclusion 

It is commonly suggested that 80% of back pains are "curable", at least manageable. This includes the cases where back pains go away on their own or with minimum intervention.  The point I would like to make here is, when the pains does not go away on their own, and a treatment course is called for, without exception, good postures are the single most crucial element.  The two “gurus” of postures, Porter and Gokhale cannot give enough credits to good postures for back health, and beyond.  For McGill and Stern, even though their books are not exclusively about postures, these authors place good postures on top of their lists for treating back pains (even though they do not point to the specific postures advanced by the two posture “gurus”).  

In Back Mechanic (p. 74), the number 1 in the list of things that one should do when having back pains is to “Eliminate the cause of pain and find pain-free postures (lying, sitting, standing).”

The number 2 in the list is to “Develop posture and movement patterns that enable you to function pain-free.” 

In “Ending Back Pain”(p.228), the number 1 is “Maintaining good posture 

I’m aware that there can be OTHER good postures that I am not aware of.  However the postures advanced in the first two books (and the attached videos) have worked for thousands of people, and they certainly have worked for me. 

Good postures not only help with back pains, but should help with shoulder and neck pains as well. In addition you can probably see for yourself that they create room in the chest and abdominal cavities, allowing, respectively, heart & lungs and the digestive systems function better.  So good postures are beneficial even if you don't have back issues. 

I venture to say that if one wants balance (stability) and power, one needs to start with posture.  Watching sports, I notice that invariably the athletes have the “ideal” postures (postures that are advanced by Porter & Gokhale).  The only exception I find is with speed skaters who “round” their shoulders (and bending body forward), but this is for reducing friction against the wind. 

Lastly, good postures go hand-in-hand with confidence and, in no small measures, physical attractiveness in people of all ages.  

Addendum 

I thought of stopping at the above paragraph, but that would mean my report is incomplete. So let’s cover the whole story, once and for all. 

After about 2 years of practicing good postures as often as I could, my back was feeling, I would say, 90%, better.  But still usually at the end of the day, my pains creep up (most likely because of bad postures during the day).  If at that time I do not feel like doing the 15’ fitness exercises again, I use a combination of two exercises that are performed lying down (on a not-so-hard surface), are totally pleasant, and could give instant relief.  These very simple exercises prove to be surprisingly effective in some cases, but bring no results in other cases (though they will cause no harm). I strongly believe it is worth a try.  

The first method is called the MELT method, explained in a book entitled MELT Method, by Sue Hitzmann.  I chose, however, to follow only one exercise (notably the “rest assess”) in the book.  Rest assess involves mentally assessing any tensions/pains in your body, but not taking any actions to relieve them (please refer to the book for full instructions).  

The second method, “relaxing tension without stretching” is from a very short U-tube video of that title, by Feldenkrais (video is not attached).  I also use only the first exercise in the video.  

I use these two in the following sequence, where the sequence is important

2-3 minutes of “rest assess”

3-5 minutes of “relaxing muscles without stretching”

2-3 minutes of “rest assess” (again) 

I resort to these two methods to relieve pains, as needed.  I believe practicing good posture is an indispensable part of treating and curing back pains in the long term, however. 

Note that all the methods brought up in this guide are non-invasive, painless, and very difficult to cause any harm.  However it does take time to gradually “perfecting” our posture, and perhaps the more demanding “ingredient” of the program is persistence. Persistence to apply the learned posture nearly all the time--even when results are not shown sometimes months later.  This persistence is something that (only?) pains will be able to force on us, but improvements will make it happen, joyfully.  

It has been a long road to recovery in my case, and it has not been an “even”, or linear, road: two steps forward, one step back.  Eventhough long and bumpy, this road is heavenly good compared to the “alternative road” (remaining in pains).  So I am forever grateful that there is such a road.  These days, by very best efforts to keep good postures all day long (efforts that are successful only partially), I can walk anywhere I want (with rests in between); I can do whatever I want (but not lifting heavy weights): I got back what I feel is my dignity (even though one should not loose dignity just because (s)he lost independence); and it’s priceless. 

A Summary 

These last paragraphs summarize the various activities/exercises that I was or am doing.

At the beginning when my pains were crippling, I coped with it the best I could, which was between rests and minimum movements (but moved, I did).  I did not know any of the materials that I eventually knew and have referred to in this “guide”.  As my pains improved--ever so little every month (not every day, not even every week)—I was able to take on more exercises.  The process of learning and practicing that has led to my current, much better state, involves the following. 

--Learning the “technique” of good postures as taught by Porter, Gokhale, and McGill.

--Throughout the day, as much as possible, use only the good postures.

--Do an exercise (fitness) program of my choice at least 15’ a day, keeping good postures when doing it.

--Whever I feel some pains, if I have only 1 or 2 minutes, and I cannot lie down, I stop on track in whatever I’m doing, and “fix”/adjust my postures (or do a few moves in the fitness program).

--Whenever I have some pains, if I have 10-15’ and can lie down, I do my routine of rest assess (from the MELT method) and “relaxing without stretching”.   

 

Than Nguyen, June 2020

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* Bị chú của ERCT : Chị Nguyễn Thị Thần - Exryu 64 (Todai - Hitotsubashi-dai)

 

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