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What you can learn from one guy's astonishing misadventures in the land of back pain
John (name changed) came walking into my office with one of the worst medical histories that I've ever encountered. I'll give you a brief rundown here. It's going to sound like I made this case up, but I promise this is an actual guy, and what you're about to read actually happened.
Several years ago, John had enough of putting up with back pain. He went to his doctor, who works for a large HMO. I'll call it HMO-X. His doctor sent him to physical therapy for 3 months. John got worse. He went back to his HMO-X doctor, who then sent him for an MRI to look for a bulging disc..
The MRI showed no signs of disc bulges, and nothing else appeared unusual. Other than a moderate scoliosis (curvature of the spine), there seemed to be nothing wrong with John, so the doctor prescribed some pain medications.
After 3 more months of pain along with drug-induced grogginess, John went back to the doctor. (Buckle up your seatbelt, because here's where things get bumpy.)
The doctor sent John to an orthopedic surgeon at the HMO, who told John that he needed to have a rod surgically inserted into his back to stabilize his moderate scoliosis. So, in went the rod. After a few more months of PT, John was released from care. His back pain was diminished, but certainly not gone. And of course, his lifestyle was pretty limited. A few years went by.
The back pain started to re-develop and intensify. Week after week, it got worse and worse. Back to the HMO-X doctor John went. Back to the surgeon he was referred. Can you guess what happened next?
This is a re-creation of the conversation between John and the surgeon. Now, this story does have a relatively happy ending, so forgive me if my tone here seems a little obnoxious, but what happened to this guy was truly ridiculous. Maybe outrageous is a better word. Anyway...
Surgeon: "Well John, your pain is so bad, you must have a blown disc."
John: "That's not what I want to hear."
Surgeon: "We're going to need to get an MRI."
John: "Um, I have a metal rod in my back, I can't have an MRI."
Surgeon: "Yes, that's true, you do have a rod in your back. I know because I put it there. But we need to get that MRI to see if you need surgery for the blown disc that I think you might have."
John (exceedingly upset): "You're not saying that I need surgery to take the rod out are you?"
Surgeon: "Yes, I am. We're going to have to do surgery to undo the last surgery so you can get an MRI to determine whether you'll need another surgery."
And so he did. John had a surgery to remove the rod, went through rehab and got his MRI. The MRI showed no blown-out discs. He still had back pain. The surgeon told John there was nothing wrong with him. (!?!)
Several years had gone down the drain. As you can imagine, John was pissed. This kind of protracted medical drama takes a toll on a person. It affects his job, his marriage, his kids, his every waking day. It happens to women, too.
Now, you're probably thinking I'm about to tell you what a genius I am because I helped him. Well, I did help him. But I'm no genius. Like always, I tried the easiest and most obvious thing first, and it worked.
I'll explain why. If there's one determining factor that seems to separate people who have back problems from those who don't, it's this: People with back problems are either unable or unwilling to squat. Now, I'm not talking about barbell squats, smith machine squats, or even my beloved kettlebell squats. Most people with back problems can't or won't do a simple bodyweight squat. Over time, this squat-aversion is a reliable recipe for chronic back pain.
So after John came in and told me the whole story, I tried one simple test. I took my keys out of my pocket and threw them on the floor.
"Let me see how you pick those keys up," I said.
John's reply was pretty typical. "Well, I do whatever I can to avoid picking things up from the floor, but when I have to, I do something like this..."
John proceeded to complete a bizarre maneuver that involved keeping his back bolt upright, moving his knees forward, and reaching to one side.
"Can you pick them up like this?" I went down into a full third-world-style squat.
John was horrified. "No, I can't do that! Even if I could, I wouldn't. Squatting is bad for your back, and my physical therapists all told me I should never squat." He looked at me like he thought I was a complete jackass for even suggesting it.
This kind of misconception is widespread, and unwarranted. A healthy human body should be able to squat down to the ground and get back up with ease. This involves putting your hips through a full, healthy range of motion and using healthy abdominal muscles to support your back. This kind of normal human movement is critical for shifting stresses away from the spine.
Humans (and our proto-human ancestors) have been squatting for millions of years, and today billions of people across the planet continue to put their bodies into full bodyweight squats. Only in developed countries loaded with obese, sedentary people has squatting somehow become "bad".
In John's case, it was his simple failure to use his hips and squat down to the ground, over a period of years, that wore out the pain-sensitive structures in his low back. (In his case the culprits were the sacroiliac ligaments.)
First I explained to John why it was crucial for him to learn how to do a full-range bodyweight squat. In three progressive lessons, I showed him how. With about a week of practice, John was able to dramatically improve his back.
OK, I did do some Active Release® to break up the scarring in his sacroiliac ligaments and hamstrings, but the bulk of the credit goes to John for doing his homework.
He was thrilled to finally take back control of his back. But, yes, he was also very upset that after years of failed medical treatment he was helped in ten days by a chiropractor with no receptionist; a guy who was wearing jeans and a Russian Kettlebell T-shirt.
This was all going on during my cancer drama (if you missed that newsletter, it's on my Stronger Leaner Better website). A couple weeks after I released him I got a very nice card from John, thanking me and telling me that I saved his marriage because he's not walking around grumpy about his back pain anymore. So, thanks John, that little gesture meant a hell of a lot during a tough time.
So, back to my point about my not being a genius. Our bodies are designed to squat. Obviously, someone with degenerating knees, or a physically devastated back should modify this movement to his or her own abilities. For instance, you could practice squatting into and back out of a chair. Squatting is one of your body's Primary Movement Patterns, which are the building blocks of all human movements.
Anyway, if you're relatively healthy, and can't (or won't) squat, it's time to take steps to learn how. Of course, you should clear this and any other form of movement with your doctor first. I don't want to hear from your lawyer if you have some pre-existing medical condition that I don't know about.
This is what a full-range bodyweight squat looks like.
Here's a simple test. Just look at the picture before you give it a try. If your reaction involves fear, revulsion, or nausea; you'd better call me. I can help you overcome that fear and teach you how to squat down in healthy way.
If you're up to trying the squat test, do it next to a mirror. If you can't get down easily and smoothly, with your feet flat on the floor, call me. You likely have some sort of muscle restriction that can be easily fixed. If you can get down & get back up, get in the habit of doing this regularly. It's one of the best ways to preserve your back over the long-haul, and is also good for hips, knees, and ankles, as well as the lungs. Enjoy!
Hey, before I sign off on this issue of the Dr. Glenn Report, I want to thank all of you who called, emailed, and sent cards and letters after the last issue. The congratulations for the baby and the concern about me were both very much appreciated. Andrew's doing great and getting bigger, around 15 pounds as I write this. And according to my last CT scan, I'm still doing just fine. (Dr. Glenn Report, November, 2005)
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