More perspectives on low back pain
This is not medical advice.
There are now many podcasts by celebrity type doctors and fitness gurus. I generally like some of them, and sometimes you hear some good advice outside of conventional medicine circles.
Sometimes, those on the inside of conventional medicine don’t like alternative opinions, to put it mildly.
There was a recent podcast describing some core/trunk/abdominal bracing exercises to decrease and/or prevent back pain.
The conventional medical circles had a minor stroke. Here is one of their replies;
While there is good evidence for people keeping strong, fit, active and mobile for spine health, there were a number of passages that concerned me - that weren’t evidence based (my bold).
Back pain is not caused by compressed nerves - that causes neurological symptoms.
More stability does NOT = less pain.
People with back pain are actually more stiffer (Beavis and Butthead giggles and snorts…I think it’s more stiff or stiffer…retired grammar teachers, help me out) and are more tense.
No evidence that core exercises are better than general exercise.
Strengthening the back is not a panacea for back pain…sadly.
Back pain is rarely caused by damaged spinal structures.
I watched the video in question. It’s mostly harmless. I would argue these exercises are better than conventional medicine pain killers, expensive imaging, and at times, risky surgeries.
One part I would caution is, back bends are not suitable for every back. But he stated that in the video, everyone is an individual, with individual needs.
I’ll address several of the key rebuttals (“You said butt…”) above;
Science, evidence and objective studies are very important. However, not all theories can be supported by current studies at all times. Studies are corruptible, and sometimes “sponsored.” The new crop of practitioners are over educated with rhetoric and studies, and have far less time spent learning from direct patient contact.
There are many instances (but not all) where back pain is caused by compressed nerves.
Back pain is frequently caused by less than ideal healthy spinal structures. I’m also uncomfortable with the word “damaged.” That can be a relative term that elicits more panic.
In my anecdotal experience, more core stability for patients that have had zero, has helped decrease their back pain. I do like to add some harder exercise that are not specific to core strengthening. This elicits a hormonal response, increasing natural pain killers. However, we prefer to pick an activity that does not increase symptoms.
Studies and science are important, and I am generally a big fan of both. I encourage you to read all sides to protect yourself.
I have not taken the time to delve into this Huberman episode but was not at all surprised to see a lot of the response be similar to what you have shared here.
I agree and appreciate the perspective of your rebuttals. And I think the point about the new crop of practitioners are over educated with rhetoric and studies is great one. We are probably seeing this trend across many domains of science at the moment, but the realm of back pain and PT is certainly a good example of it.
As you mentioned in the article, studies are awesome and we should keep them coming, but I think too many practitioners are so focused on aligning with whatever appears to be the current consensus position on something that they fail to see how that consensus position often lacks all the nuance required to actually treat and make a difference to an individual.
This commonly touted idea that core exercises are no more effective than general exercise for back pain is a clear example of this. Sure, if you look at all the studies on "back pain" and observe overall trends in this data you find no one treatment in particular is better than any other. While this may be true, all the nuance is lost and you are left with a completely unhelpful conclusion. You need to sub-categorize. If a patient walks through your door with a pars defect and instability related pain mechanisms and you don't believe core exercises are any better for that person than yoga, you are going to struggle to make a difference in your patients lives.
"Strong and pain free back" is something probably most young people can enjoy...most of the time. As one gets older it's hard to imagine zero issues at all, if for no other reason natural aging processes change things, like the discs, arthritis in the spine can appear, there are postural changes with advanced age, stenosis and a world of other problems.
The two things should complement each other, but with something like this I tend to be far more interested in people with real world clinical experience than someone just quoting studies.