The Younger Next Year Back Book

Back pain is the monster in most of our lives. The ogre under the bed. The ogre that lands you in bed all too often. Or on the floor . . . flopping around in pain. Like a sunfish on a hot cement dock.

Most Americans know that pain well. Know the agony, the sudden sickening return after it's been gone for a while. The canceling of plans, the loss of a job. Everything. They cannot live with it—not really live—and they would do anything for relief. But there is no relief. They've tried everything, and nothing works. Nothing meaningful, anyway. Back pain sufferers spend an average of $2,500 a year for palliative "fixes," but they get precious little in return. They'd spend more—they'd spend anything—if the fixes really worked. But most don't. Or not very well. Or not for long. People structure their lives around the pain as best they can, but that doesn't work either, because you never know when it's going to hit.

And when it comes, it's not like a sore shoulder or a bum leg; you can't use the other arm instead. You can't limp along with a cane, relying on the good leg. When your back is the problem, everything goes, and you're cooked. When your back hurts, your life hurts. And you can't do a damned thing.

The Promise

That is about to end. You are going to have trouble believing that sentence, but it's true. That pain is about to go away or be sharply reduced. And the change is going to be permanent. For about 80 percent of you, anyway. That's an astonishing promise, and it's absolutely true. We know of nothing else in the field that comes close.

"Success" means either the permanent elimination of pain (the result for most of you) or a reduction of its severity from the 7–10 level—on a scale of 1–10 (that's agony)—to the 1–3 level (that's a nuisance). Blessed, blessed relief, either way. As I say, it is only going to work for about 80 percent of you, but that's a near-miracle. And Jeremy has solid suggestions for the rest of you, too. (See Chapter 4 to learn if you're in the 20 percent and find out what to do.) But remember the main point: For 80 percent of you, the pain stops here.

We hope that the "you" in that sentence is an enormous number of people. Jeremy is a modest man but he knows what he can do—what he has done—and he is ambitious about taking his protocol to a much broader audience. Indeed, he wants to start a revolution in back pain care in America, starting with you, and he wants it to be universal and cheap. He thinks—he and I think—that it can be done in a book. That sounds wild—that this horrendous problem can be fixed with such a modest tool. But it's not. Because back pain is all about behavior, and you can deal with behavior in a book. As you will learn in a moment, the vast majority of you created your back pain with your own, long-term behavior. And only you can fix it, with profound changes in that behavior. It is a matter of showing you what you did before that made a mess of your back, and teaching you what you have to do now. And then you doing it. Jeremy explains, and he shows you how. You do the work. You will succeed. A surprise, perhaps one you will have trouble getting your head around at first. But it's true: You will succeed.

So how bad is the problem? Pretty bad, as most of you know. Four out of five of us have back pain so bad we seek help from health care professionals. The nation as a whole spends $100 billion on the problem. It does more to disrupt business than anything else. And, of course, it raises hell with millions of lives. For some, it is a recurring nuisance, something that takes the joy out of the day, the week, the month. For more of us, it is an intermittent horror, with the pain at the agony level and we just can't move. Your wife calls your host for dinner: "Bill is flat on his back on the floor. We may have to go to the hospital. Sorry." You can't go out to dinner; you can't perform your duties. Hell, you can't get off the floor! It ruins careers, messes up companies, trashes marriages, and raises holy hell with just about everything else. For most, it comes and goes, but when it comes . . . it's just god-awful. Oh lord! What do you do?

Not much, until now. There's conventional medicine—which is such a blessing in so many areas of our lives—but it is apt not to be great for back pain. For extreme cases (the 20 percent we mentioned), there is surgery, and for them it may be the only option; Jeremy will alert those who should be thinking about it. But surgery—tremendously important and successful for some—is not the answer for most of you. It is well known, for example, that at least one popular operation—spinal fusion—is one of the most overprescribed operations in the country. It is a serious operation (it costs about $100,000), it is often unnecessary, and it often doesn't work. Not for long, anyway, and sometimes not at all. That is scary. Jeremy, and the best surgeons, all say that surgery should be a last resort. There are other "medical" steps, like cortisone or other shots, but, once again, relief is temporary, there can be serious side effects, and there are limits to how often you can go there. The basic problem with traditional medicine and back pain is that they are not a very good fit. Western medicine is not heavily focused on behavioral problems and behavioral change; it simply did not grow up that way. And back pain is primarily a behavioral problem. Which means that, ultimately, only you can fix it.

Don't worry if this concept doesn't quite sink in at the first reading. It's what the whole book is about. We'll get there. Together.

A Younger Next Year Book

I say "we'll get there together," and that's an important part of the book and the cure. This is "a Younger Next Year" book. That means several things, as some of you know. First, it means there is a presentation by two writers, a deadly serious professional scientist (that's Jeremy for this book . . . it was Harry Lodge in the first Younger Next Year books) and a layman (me). As I used to say of Harry and as I now say of Jeremy: "He's young and smart, and I'm old and funny." The pairing is supposed to make the book easier to follow (and maybe just a teeny bit fun to read) without losing a whisper of scientific integrity. The scientist is in charge throughout, but reading the book should not make your teeth hurt. Not hurt badly, anyway.

It also means that the core idea is that behavioral change can have a profound effect on your wellness and quality of life. Far more of an effect, in important areas, than the best conventional medicine. The "modest" boast in the original Younger Next Year book was that behavioral change could put off 70 percent of aging until close to the end of life, and eliminate 50 percent of the most serious diseases completely. Which was absolutely true; no one has ever disagreed. Over 2 million people bought Younger Next Year (in twenty-three languages) and made it a cult book for those over forty, many thousands of whom profoundly changed their lives. A huge number of people have come up to me and Harry over the years to say, "Hey, man, thanks for writing that book; it changed my life." Nice.

The Younger Next Year Back Book is a little more specific: Behavioral change—spelled out by Jeremy—can end or radically reduce back pain. But the consequences for back pain sufferers are every bit as important. I was with Jeremy recently when a guy in his fifties said to me that he'd come to Jeremy the previous summer, after a lifetime of serious back pain: "I could not bend over to lace my own shoes. I'd been in agony for decades. And Jeremy simply fixed it. Jeremy gave me my life back." Jeremy has a thousand stories like that. More than a thousand. We hope to have a million before we're done.

Finally, it means that the book has a certain integrity. Harry and I went to great lengths to make Younger Next Year solid—conservative, if anything. To the best of our knowledge, there was not a single exaggeration, and certainly not a single misstatement. Jeremy and I have done the same here. Dealing with back pain is an evolving field, and some things we say may turn out to be wrong as people learn more. But not the basic lines and not the major claims. The book is as solid as we can make it, and it will stand up. As Younger Next Year has done, strikingly.

Jeremy came to me with the idea for doing this book together because he thought YNY and his story had "the same genes." Which was quite right. Beyond that, Jeremy is a "good guy"; he wants to do good in this world, and the fact that back pain makes such a mess of so many lives—unnecessarily in his view—makes him crazy. He knew how successful the Younger Next Year books had been, he knew me, and he thought that maybe the two of us could pair up and get the word out . . . change the world of back pain.

So that's our modest goal here—first Jeremy's and now mine: We just want to, you know, change the world. And eliminate back pain for millions. Hey, couldn't hurt. Along the way we hope to make a couple of billion dollars ourselves but Jeremy's great motivation is to change the world of back pain. Pretty good guy, Jeremy.

Now, let's have a quiet word about some things this book won't do. It won't do any good if you just stick it under your pillow, for example. You have to read it. Closely. We'll make that as easy as we can but it ain't always going to be a walk on the beach. Then, by heaven, you have to go to work yourself on the cure. You have to do the initial fixes yourself. And then you have to adopt Jeremy's carefully tailored exercise regimen to make the cure permanent, and that's not always easy. Well, it's easy if you know how, and we work like crazy to show you how in the book (and in videos we'll refer to in a minute).

Finally, you have to know—as I said before—that the book may not work for some of you. You're too far gone. Awfully damn sorry about that but about 20 percent of you—Jeremy estimates, conservatively—are going to have progressed to a stage where you are probably going to need traditional medical help, possibly including surgery. He'll tell you how to know if that means you. And a few more of you—with back pain that is rooted primarily in muscle "trigger points" (there's a terrific chapter on that)—may need to turn to a chiropractor or physical therapist, at least briefly, to show you how to find and release muscle spasms. Then you come back to the book to lock in the change and make it permanent. But the basic claim—that some 80 percent of you can get complete or significant pain relief permanently—is solid.

I asked Jeremy, early on, if he could back up that number by going through his records. He said he could not. (Oh, lord!) But, he said, he could remember every single one of the handful of patients he thought he could help who in fact he could not (excluding the ones he sent on for conventional medical help). He could count them on his fingers. I thought that was good enough. So, that 80 percent claim is not just solid, it is conservative.

Basic Insight: You Got Yourself into This Mess, and Only You Can Get Yourself Out

Jeremy's success has been based on two great insights. The first was to realize (along with a handful of others, including Bill Fabrocini, who wrote the Introduction) that your own long-term behavior (how you carry yourself, your posture, and certain repetitive movements) is almost always the cause of your back pain. Sometimes it's trauma or a weird event but not often. And only changing behavior is going to effect a permanent cure. In other words, it's going to be up to you in the end. Jeremy will point the way and tell you exactly what to do: first to effect the cure and then to do maintenance. But you do the hard work. And—as in the other Younger Next Year books—exercise is going to be at the heart of it. Steady, whole-body exercise for the rest of your life. If you're new to all this, that may sound alarming—steady exercise forever—but it's not. In this, as in other things, exercise is going to turn out to be the key to the good life.

The second great insight was to realize that, while back pain seems local and specific, it is almost always a whole-body or at least whole-core problem in the end (we'll tell you all about the core in a bit). And a whole-body approach is indispensable to its cure. Drawing on those two insights, on his review of the available science, and on his own vast, clinical experience (he has been doing nothing but treating back pain his whole adult life), Jeremy has developed a technique that has had unprecedented success.

You are probably a bit of a student of back pain yourself if you've had it for a while, but you are about to learn some new things. You will learn, for example, that back pain is not a "disease," as some doctors say. Nor, in most cases, is it the result of an accident or trauma. Or bad genes or bad luck. Or (mostly) psychological issues. Sometimes, but mostly not. And it is not from rolling over "funny" in the night or picking up something heavy, carelessly. Or making love in some goofy and disgusting way. It's not the malfunction of a particular disc or vertebra or a spasm in a particular muscle, although it almost always "reads" that way. A particular disc, spasm, or whatnot is the immediate source of the pain. But that's not what it's all about. Almost all back pain is a "whole-body" problem, certainly a "whole-spine and core" problem, caused by the way we live and move, over time. Caused by our rotten posture, by sitting curled over a computer eight hours a day for years and years, by our idleness, by the shameful weakness of our core. And—a close corollary of the foregoing—by the foolish ways we move, day in and day out. Fix those big problems carefully and the little problems, which actually cause the specific pain, go away.

What we are going to do first, after giving you a background tour of your spine and its discontents, is teach you to find and maintain a neutral spine (the position that allows your spine to do its job with the least amount of stress and load–and the least damage) all the time. Don't worry if that term doesn't mean anything to you now; it will mean a lot by the time we're done. It is the first and last key to your recovery. Then we're going to show you how to use the core to support the neutral spine. Next, we're going to teach you exercises to increase the strength and endurance of the core so it can do its primary job, which turns out to be supporting the neutral spine in the long term and keeping it stable. Finally, we're going to teach you to avoid triggering behaviors (like playing golf a certain way or bending over your computer for twenty years). Teach you how to move correctly, so that you maintain a neutral and stable spine all the time, even when doing the complex lifting and rotating motions that are part of daily life and exercise. We're going to teach you how to behave, frankly. And back pain will significantly go away. Easy-peasy.

You will want to know that Jeremy understands the specific problems—the disc bulges, the "pinched" nerves, the muscle spasms, and all that—as well as anyone in the professions, and we'll talk a good deal about those along the way. But his overarching insight is that it is a mistake to focus on those. Rather, he wants us to make fundamental (but manageable) behavioral changes that affect our entire core, our entire body. Then the specific problems that are making us crazy go away. Indeed,
fundamental behavioral change is the only way to effect permanent change. Otherwise, local "fixes"—like spinal fusions, laminectomies, discectomies . . . all the stuff you've heard about from your medical doctor—will usually offer only temporary relief. Blessed relief but temporary. The overall problem persists. And it will turn up in the abutting vertebrae or at another place down the kinetic chain (the complex chain of joints, discs, and connective tissue in and around the spine). Conventional medicine performs wonders. Obviously. And it has a huge role in acute situations. But it generally cannot achieve lifelong cures for chronic back pain. Only you can do that, and only with behavioral change and a certain exercise regimen. Jeremy can show you how.

Jeremy wants me to stress that we are most assuredly not putting down modern medicine. He comes from a long line of doctors, and he has the liveliest sense that modern medicine is miraculous. But there are areas where medicine is limited to fixing but not curing problems, areas where behavioral change matters much more. Heart disease is one of them, interestingly enough. And back pain is another.

A closing word: Trees are bent by prevailing winds. Bodies are bent by prevailing postures and movements. Trees can live in their contorted condition. Bodies cannot. Our bodies are meant to stand erect on the earth. When they do not, they cry out to us. They cry out in pain.

A Note About Videos

If you are a visual learner, you may want to take a look at Jeremy's program of streamed videos (BackForever.com) on aspects of back pain. See the appendix for information. BackForever.com is by no means a substitute for the book, but it offers a different angle on the subject and some additional information that may be helpful.

I got into the business of healing back pain because I had serious back pain myself, as a young man, caused by a series of athletic injuries. I got into chiropractic and related whole-body disciplines because nothing else worked for me. I went on to develop my own, very different variations on familiar chiropractic practices over time. I do not "pop" backs or any of that, but I draw heavily on the basic elements of the discipline, as well as my reading of the scientific literature generally and my own considerable experience as a practitioner.

I grew up in a traditional medical household, and fully expected to go to medical school and then into practice. My grandfather was a medical doctor, my father is a medical doctor, my mom is a nurse, my aunt is a nurse, my uncle was a pharmaceutical salesman. I was as deeply immersed in traditional Western medicine as one could possibly be, and I had—and still have—tremendous respect for it. When I was little, I was used to having people come up to me and tell me how much my grandfather had done to save this or that child from some grim fate. He was one of those doctors that they don't really make anymore. He performed surgeries, delivered babies, made house calls, and was a master diagnostician. And he was also a terrific guy whom I admired a lot. Later I heard the same things about my parents from their patients.

So I grew up believing there wasn't much that modern medicine could not fix, and I couldn't wait to become a part of it. I emphasize all this because, eventually, I am going to sound a bit reserved about traditional Western medicine and back pain, and I don't want you to be confused: I revere traditional medicine and understand it better than most. It's just that it generally isn't great at curing back pain. And back pain is what I had as a young man . . . a lot of it. And it has been my life ever since.

My Personal Pain: Part One

When I was a teenager, I thought I was going to be a professional skateboarder. If you are over fifty, do not snap the book closed at this point; skateboarding is a terrific sport. But it is a slightly dangerous sport and I took many, many falls, some of them pretty bad. I did not become a professional skateboarder; I might have been good enough, but long before that could happen I became a very young man with extremely serious back pain. When that happened, I went the traditional medical route. I went to regular doctors (good ones, as you'd expect) and was poked and prodded; I had ultrasounds and MRIs and blood tests and you-name-it. They talked about an extraordinary range of possible causes, including "slipped discs," "ruptured discs," "pinched nerves," maybe cancer. Wow! But they could not fix my pain. I was somewhat medically astute, even as a kid, and I became increasingly convinced that a lot of these well-meaning, well-trained doctors didn't really know an awful lot about my back pain. Sounds harsh, but it has turned out to be true of quite a few conventional doctors.

In near desperation, I turned to less traditional medicine—to chiropractors. And darned if I didn't find at least some symptomatic relief. That was huge, and it opened my head to the possibility of going in that direction. I should mention that those particular chiropractors weren't perfect, either. They didn't begin to teach me how to make fundamental changes. They didn't talk about changing my own behaviors or suggest how to take control of my own health or do any of the things that are at the heart of my practice today. But they did show me that the pain could be affected with simple muscle and joint work, and I was deeply impressed by that. Chiropractic treatment has its place in back care and offers many benefits when done properly. Skilled chiropractors use manual (with their hands) therapy to restore normal joint movement and muscle function through chiropractic adjustments and other techniques such as stretching and joint mobilization. This therapy can be invaluable, especially in the short term. But even today many chiropractors do not teach their patients how to make the necessary behavioral changes to permanently relieve back pain.

I decided to train in chiropractic, because I wanted to dig deeper into what I already recognized as the real causes—and perhaps the real treatment—of serious back pain: behavior and behavioral change. That drove my very medical family crazy, as you can imagine, but in retrospect it was exactly the right decision.

My education was a long and complex process. I took guidance from a range of experts in the chiropractic and other fields. But I eventually developed my own analyses and my own approach to permanently ending back pain in my patients. Traditional medicine takes a basically deconstructivist approach: It generally takes complex problems apart, analyzes the pieces with exquisite care, then identifies and cures the particular problem. That deconstructivist approach works miraculously for many, many medical problems, but not for back pain. For back pain you want an integrationist approach. You want whole-body solutions.

My Personal Pain: Part Two

I had a second round of back pain, long after I should have known better, and I want to tell you that embarrassing story for several reasons. First, because the pain was so dreadful, and I want you to know just how deeply I understand and empathize with significant pain. Second, I want to stress just how vulnerable all of us are to default behaviors that can raise holy hell with our backs, including people like me, who surely should have known better. And third, I want to show how quickly and effectively you can deal with even the gravest back pain, once you know what you're doing.

The time is seven years ago. I was working part of the time on a very promising medical start-up venture. For six months, I was absolutely obsessed with it. I worked regular ten- and twelve-hour days with few breaks for leisure or exercise. Most of the time, I was bent over my computer. I worked like an absolute lunatic and did not think twice about my back. Pathetic.

One morning, after a particularly grueling stretch of days and nights, I woke up at six and started to sit up to go to the john. I was smacked by the most ferocious pain I've ever had in my life, even worse than anything from my skateboarding days. I was knocked flat on my back and could not budge. Even when I was lying absolutely still, the pain continued, unabated, at a fierce level. If I tried to move, it was much, much worse. I lived alone back then, and all I could do was lie there and wonder, in near panic: What in the world is going on? Just how bad is this? Am I going to die, for heaven's sake? Not only was I in terrible pain; I was seriously scared.

I remembered how "normal" back pain felt, a bad spasm or whatever. But this seemed to be way beyond that. So what was it? A ruptured disc would be the good news. At the other end of the spectrum, perhaps it was some weird cancer, somewhere in my spine.

That was ridiculous, but truly severe pain leads to some wild and unpredictable thoughts. I was sweating and breathing hard and was on the edge of panic. And that went on for what seemed like forever. At last my long scientific training and experience took over. The first step was to ask myself the questions I ask all my patients: How did this happen? What "behavior" might have caused this? It's interesting just how often the sufferer knows intuitively what he or she had done (at least the triggering event) and I was no different. It did not take long to conclude that it was probably those months of nonstop work, bent over a computer. Of course! For someone with my history, that was nuts. And step one was to stop doing what had caused the pain in the first place. (If I ever managed to sit or stand again.) The problem right now was to ease the pain and move. With more than a little agony, I rolled onto my side to see if I could stand. I couldn't. The pain ratcheted up to new levels and slapped me flat on my back again. It felt as if someone were stabbing me in my kidneys and dragging the knife down into my buttocks. It literally took my breath away.

Then it was back to basics: I did what I always do in those relatively rare cases when I'm there during a patient's attack. I told myself to tense my abdominal muscles a little and slowly pick up my left foot. I am lying flat in bed and picking up one foot, just a little bit. That simple first step, which I have counseled so many times, was bearable. It almost always is. I set that foot down and picked up the right foot, continuing to tense my abdominal muscles. That also was doable. Good. Then on to the next phase: I walked carefully, very gently, in place—lying on my back and not lifting my feet very far—for perhaps five minutes. The pain slowly lessened. I stopped, and did it again several times. I was "walking off" the pain. And I was easing what almost certainly was a particularly bad muscle spasm, somewhere near my lumbar spine.

Eventually, I felt ready to stand. I lightly tensed the muscles in my abdomen to support my spine and keep it still and rolled onto my side. As you will soon learn, this tensing of those muscles is called locking down or engaging your core. This time I could do it. I was careful to keep my lower back still and my abdomen braced throughout the movement. It was not pain-free, but I made it to my knees, then my feet. I was mighty careful to keep my lumbar spine still and my core engaged throughout, because I knew that, in the wake of an attack like this, the spasm and the pain were just waiting to come roaring back. Then I tried walking erect. And, yes, I could walk. I walked back and forth across the room carefully, keeping my core tight. I did that for quite a while and the spasm and pain calmed down.