Back Health

This is a writeup of solutions to pain I had which was caused by a lumbar disc impinging on a nerve in 2024. I'm posting this info in hopes it will help others.

Background

After spending a beautiful month hiking in New England states (150 miles + 15,000 feet elevation gain), I spent too many hours bent over catching up on weeding at home. This caused four of my discs to bulge, two of them pretty severely. I had so much pain in my hip that I thought something was wrong with it, but eventually an MRI revealed that a nerve was being pinched by one of the discs in my lower back -- it was "referred" pain. I also felt referred pain in my shin, along with a little lower back pain, all on the same side. This went on for about 11 months and the pain was sometimes severe, shooting down my leg. I had two spinal steroid injections which eased the pain for seven weeks each time, but then the pain worsened quickly again both times.

How I got Past Eleven Months of Pain

I tried all sorts of things for the pain, but in the end, I'm quite certain that what helped the most was the advice given in the book Back Mechanic by renowned back specialist Professor Stuart McGill. I highly recommend the book and his approach. 

Avoiding pain was the most important takeaway for me. The goal is to "build" an ever-growing pain-free buffer. I did this in the following ways. Most of these are from McGill's book and are explained in it.

• Find a position where you have no pain. Laying on your stomach with a pillow or two under you was recommended and worked for me. But don't stay there for hours on end.

• Don't sleep on your stomach. Sleeping on your side is best.

• Practice good spine hygiene... sit up straight. If you're using a laptop, use it with an external keyboard and elevate the screen to head height (or use an elevated external screen). When sitting, always use a lumbar support (I like McGill's inflatable lumbar support because it's adjustable for different chairs).

• When sitting, stand up and stretch every 20-30 minutes. Specifically, stand with arms overhead for ten seconds. Then inhale and really stretch upwards for another ten seconds.

• Don't sit on "comfy" (soft) furniture. A firm chair is best, perhaps with a thin layer of padding.

• Walk fast; slow "mall walking" is more painful since you spend more time with weight on your spine.  Walk leading with your chest and your shoulders on your back, but without your chin jutting out.

• Stop things that cause immediate pain, even a slight amount. Ideally, stop before reaching the pain point. For me, that meant stopping most of my PT.

• Don't stretch hamstrings, even if it feels good (which it did). The already irritated nerve will become more irritated (even though I didn't feel it in the moment) and I ultimately felt more pain in my hip and shin.

The McKenzie Method (MM) has helped many people get over their back pain quickly. I bought his  Treat Your Own Back book first and encourage you to look into it. However, as we age our discs shrink and the MM becomes less effective and eventually might do more harm than good. In a Huberman Lab podcast, McGill said you could damage your facet joints with the MM when one of your discs is less than 70% of its original size. I was 64 at the time and from looking at the MRI I think at least one of my discs had shrunk to about that size. I did the MM method for months and I think it helped, but in the end when I was avoiding all pain, I stopped it.

After about two weeks of avoiding pain, my shin pain decreased (which meant the disc was backing off of the nerve) and I was starting to have more pain-free hours during the day. After another two weeks, I had my first pain-free day (but my pain-free buffer was still small). After that, as the weeks went on I could do more. I'm still having occasional setbacks (four months later), when I expand my activity too quickly or do something that I haven't done recently (like sitting on the floor with my legs extended for too long).

Preventing Back Pain

If you're reading this page, it's probably too late to take any preventative actions. But once you're past the pain, to prevent future episodes I recommend McGill's "Big 3" exercises. McGill says you can even do the Big 3 while you have back pain, but I didn't try this. They're explained in his book and demo'd here.

Good luck!