This, combined with the expense of doing physical therapy is what led me to make MoveWell (https://movewellapp.com).
Most people don't know how good they can actually feel. Sitting down all day isn't natural and taking opioids or expensive surgeries that aren't guaranteed to work (see Steve Kerr's story) aren't great options.
I think most people would be surprised at how good they can feel by just taking 5-10 minutes every day to do mobility work and/or foam rolling as part of their daily work habit. You spend 8 hours a day messing up your posture. You should take 5 minutes to help undo it.
Child's pose helped me too and also helped some insomnia issues. Deep squatting (without weights) also helped me with my spine. However, yoga is not for everyone or better, yoga can be for every one but with modified poses. Beware.. Many people doing yoga hurt themselves attempting to do certain poses, even professional yogis break their backs sometimes..
I've had enough trouble with yoga in the past that I only use a few postures on a regular basis. I think people with persistent/severe issues really need one on one coaching from an experienced teacher. Yoga classes are often crafted more around people's fitness demands than rehabilitation. And people often don't have enough experience with pain to judge the good from the bad during solo practice. I've had better luck with taijiquan, but it's a very different approach. It often makes the pain worse, by way of correcting years of misalignment and poor habits. It builds strength and flexibility very gradually, focusing more on the tendons, ligaments, and fascia, than the large muscle groups.
Exactly. Don’t go to a gym yoga class. Avoid anything yoga that has “power” or “core” in its name. There are specialized therapeutic yoga teachers. Iyengar teachers are usually quite good.
I wouldn't go as far as not trying a yoga class, it may genuinely help. However, I wouldn't try to do everything they are doing in class and wouldn't force my body.
Take it easy and gradually and make sure it's the type of class suited for you. There are beginner/intermediate and advanced classes. If something feels right it is most likely doing good and if something feels wrong don't do it anymore. Yoga could be tremendously helpful but if you don't do it right it could do more harm than good.
Especially don't be competitive and look at other people. Some things may just be out of one's reach. It took me a while (and some injuries) to accept that I will never be able to do what a lot of women in their 20s can do. In the end it's not important to do extreme poses.
Most days I can't even begin to get out of bed without child posing first. I'd rate my physical health in the top 1% of this country, but physical activity needs a similar type of movement therapy (or whatever you want to call it) that sitting around all day needs. Gravity never takes time off.
Well this is timely content for me. I am 32, healthy weight range, and going to have athroplasty next week to replace L5/S1 disc. Information I was told is 9/10 have positive outcome with 1/10 still experiencing pain post recovery.
I implore you not to do this, as a healthy 32 year old, until you have attempted to corset, or lock in place, your disc with your own muscle.
You could do this with a lengthy, complicated series of midsection/trunk exercises, or you could hit every associated muscle in the correct balance and proportion by walking.
Your body was built to walk - you are a walking machine.
I had a blown L4/L5 going into basic training and was immediately walking 5-8 miles per day. It was very painful and debilitating for the first week ... and then it was gone. I believe the muscle action pulls the spine back into proper alignment and gives the disc nowhere else to go but where it belongs.[1]
If you look, you will find this to be a very common anecdote.
[1] IANAD and obviously cannot speak to severe trauma, fractures, etc.
I second this. I am similar age with similar back issues. I focus on core work and strength training. I also run 3-4 miles a few times per week. I am very careful to use proper posture vs speed. I have been able to avoid surgery. I still have bouts of pain and flare ups on occasion. I typically fix them by increasing stretching and better my posture.
>I implore you not to do this, as a healthy 32 year old, until you have attempted to corset, or lock in place, your disc with your own muscle.
This is not advice you should be giving.
You are not his doctor. You don't know the extent or type of his injuries. You have no idea if core workouts will help. You have no idea if he/she even can walk.
90% of herniated discs resolve in 3 months. For the 10% that don't sometimes surgical intervention is needed. Don't muddy the water with vague uninformed advice if you don't know this persons exact medical details.
On one hand I agree, but it is useful advice to say make sure to talk to different doctors. If someone goes to a surgeon, they are likely to lean towards surgery. I'm going to assume the GP has already seen doctors that specialize in non-surgical treatments like steroid injections directly at the site, but for anyone else reading this information could be useful.
And, the OP is right. The doctors I've talked to have all said surgery needs to be the absolute last resort. Many end up worse off or needing more surgery.
I blew out my L5/S1 and I woke up after surgery with almost no pain at all. It depends entirely on the damage. My disc was totally smashed so all the PT in the world wouldn't put it back together.
I was 25 when I had surgery though, so god only knows what kind of shit I'll be in when I'm 45. Hoping those stem cell treatments take off.
I am glad you had a good outcome. I have not taken this decision lightly. I have tried many non-surgical interventions (chiro, physio, walking) for over two years so the time has come. I think for every 'I had back pain and I fixed it with _insert non-surgical solution here_' there is just as many 'I put off surgery for _x_ years and wish I'd done it sooner'.
Anecdotal but walking significantly helped me as well. I did a lot of PT for my back issues and while they were somewhat helpful the only thing that really made it go away for good was several miles of brisk walking every day.
At least for me it's certainly some muscle thing as once winter comes (and I'm walking less) the back problems come back. One of the best things this winter was getting a job in an large sprawling office, which means I'm walking several miles every day at work (all indoors). Haven't had any issues this winter at all.
"At least for me it's certainly some muscle thing..."
Again, I think a good mental model is that of a corset, or a brace. In this case, the corset you are donning is made of your own muscle.
You could attempt to build that own-muscle corset section by section by doing all of the 40 different trunk and midsection rehab exercises, but even then, in what balance or proportion could you hope to execute them ?
Instead, you can hit all of them, in concert, and in appropriate proportions, by walking.
The difficult part is that bad back pain will not make for easy, pain-free walking - at least at first. I found 4-6 mile walks to produce a fair amount of back pain in the year immediately following my initial disc herniation/tear. It took that forced week or so at the beginning of basic training to pull my spine back together.
Whenever I go too long without exercise, I get back pain. It's like clockwork. Then I start exercising and it goes away until I lapse.
Certainly that's not going to be the solution for all cases of back pain, but I do wonder how many are taking painkillers and such when some regular exercise or other physical changes (posture, weight) could do the trick.
Depends on the location and severity. I've found that using a foam roller before and after a workout, or even daily, has pretty much removed any back soreness I used to get.
Injuries are a different case. I'm in the same set as you, and my father as well. As long as he and I do ~20 pushups per day and maintain a bit of focus on improving/maintaining our posture during various activities - backpain is negligible. But neither of us have ever needed to take pain medication for back pain.
A lot of the people I've known over the years who took opiate painkillers for back pain have had injuries to their spine. Some people I know with spinal injuries tried opiate painkillers, found that they were effective for the pain, but the side effects prevented them from being focused at work, so they chose to live with the pain in exchange for mental acuity. I also know others who have tried very high doses of opiates and it did not significantly reduce the pain from their back injuries.
Me too. I think just moving your body around and getting the blood flowing through your muscles tends to loosen things up a bit. Something like yoga can be extremely helpful as well, although I've overdone it and actually hurt my back too, which required two weeks of lots of Advil, ice and heat until it got better.
I'm usually pretty dedicated to my gym time, but recently I've found my interest waning, and this is what surprises me - I've been away for a month-ish, and I find that my back has starting to get twinges. It never got twinges before. It'd be stiff the next morning, but that was due to DOMS, not because I got out of bed funny.
For the past several years I had serious problems with lower back pain, once every few months it would get so bad I couldn't stand/sit/walk without severe pain for at least a week, even painkillers didn't help much. One year ago I started to exercise at gym, twice a week, and it worked wonders - no back pain, except for minor one from time to time if I lift something the wrong way, but overall I feel so, so, so much better (and look too xD).
It's a little terrifying that the article starts with a guy just waking up with a slipped disk one morning, and it seems the most effective takeaway is "learn to live with this pain".
Back pain may fluctuate and spike at certain times. A person needs to find what alleviates the pain without adverse side effects. Exercise needs to be filtered for what works for the individual. Good exercises might be swimming and cross-country skiing. Always seek medical assessment and treatment, while also being willing to take responsibility for own health.
Definitely the worst thing you can do is lay there and do nothing about it. you have to keep moving. Perhaps it has to be done in moderation if you have a lot of pain but the movement seems to be for me the best cure.
I think because of my profession sitting in front of the computer it's easy to get into certain habits that really just are not healthy and there's not enough movement. I don't really get into the hype of the standing desk either. Sure, I can stand up and work but also I just need to move a lot more and it makes things a lot better.
Something I've found is that sitting on a couch for anything more than a couple minutes will leave me with lower back pain for the next day or two.
Much to the dismay of all the older people in my life, we got rid of our couch and have taken to just sitting in solid chairs or on the floor.
We also sleep on a futon mattress directly on the floor. Any time we visit relatives, I wake up with back pain.
Any time the topic comes up, I seriously wonder how many people's pain / mobility problems could be solved by just getting rid of all the furniture in their lives that actively works against the body being able to support and align itself.
I've herniated ('slipped') a disc twice in my twenties, both times when I was in periods where I let my fitness level fall. The pain was absolutely debilitating - you're really not able to do anything. Even with pain meds...standing, walking around, sitting, sleeping...it's all hard to do. Recovery sucks because you have to move around to recover, but it causes unbelievable pain.
I firmly believe for most people slipped discs happen due to a lack of core muscle strength and spending most of our days in terrible postures (sitting at a desk, for example).
I spend at least 50% of my exercise time focusing on my core now. Things like planks, squats, and yoga. My thought being that a strong core keeps everything (eg your spine, discs, and soft-tissue) in place. I have absolutely no scientific backing on this, but it's worked for me so far.
I was experiencing hip pain after too much sitting and not moving enough. Went for some consultations and ended up with a surgeon that wanted to operate because I was told I had a labral tear, amongst other things. I read more about this and it turns out that most people when evaluated with imaging have a variety of indicators that doctors use to suggest that surgical intervention is required to fix. The problem is is that most people don't have any pain associated with the indicators.
Also, the recovery seemed painful and long and from reading around, the outcome seemed dubious, if not net negative. They really put their thumb on the scale in terms of measuring success. Anyways, long story short, I spent about 2 months with a variety of stretches and deep tissue work on the muscles on my legs and hips and the pain completely vanished. I started lifting weights again (squats and deadlifts with plenty of deep tissue work and stretching) and I haven't had hip pain since.
Ha, I had exactly that same experience, with the same injury, no less. The physiologist told me that sure, the surgeon is always going to recommend surgery - but if you’re going to have to do PT, why not do it first and see if it fixes the problem?
PT is the closest I have come to experiencing a miracle cure from modern medicine. Speaking as someone who frequently breaks themselves.
A lot of surgeons only know how to cut so that’s what they will recommend. There is also a lot of money to be made. Better to try physical therapy, therapeutic yoga or similar first and see how that goes.
Try running. It's one of the rare scientifically proven ways to help heal disk problems. It's helped my SO and myself.
But not a lot. 1 to 3 km every day is fine. Walking 1/2 of it is fine. Just go out for 30 min and try to run as much as you can, but go slowly. Just a bit over walking pace is better than short bursts. You really don't need a lot and isn't any better for extreme runners. It'll get better in a week or two and it will start hurting again if you stop for too long before your fully healed (months probably)
It's all about pulsating vertical compression. And even if it does not help due to that, it surely will for other things.
I am a runner, I had slight lower back pain before running that went away in the early days of running. I mostly assumed it was losing weight, which I am sure helped, but there is no doubt both my focus on posture and actual posture improved. So it is a bit of a positive feedback cycle.
To your point about no to much running, after I began running for periods over 2 hours, I would get some back pain during the run and stiffness after. However, I began doing pushups and planks, sure enough I strengthened my core and I don't get backpain on even 4+ hour runs (not to mention I developed a 6/8 pack which I never had in my life, a nice surprise in the mid-30's).
I used to run when I was still losing a lot of weight. I'd still be running except that it seemed to cause an endless series of injuries and pains that no one could tell me how to fix.
I've been guided to instead cycle. If your back pain is caused by muscle imbalance (e.g., another leg longer than the other) or herniated disc, then running will supposedly make it worse. Yet, activity is important, which might be why running works for you.
The advice is very specifically for mild disk problem. Also for light running. You're not going to run any marathons. It's just a little more than walking. Overdoing anything will hurt you.
I had lower back pain for over 2 years. 7months ago I started running. Once every week for 1hour(~10km). First 3-4 runs I took pain killer, because I was ok during a run, but wasn't sure what will happen next day, then I stopped taking all pills and just went for 1-2hours run once a week. After a month or so the lower back pain was almost gone and I run more than 400km since. Of course, my whole body feels significantly better.
edit: You should consult that you wanna start running/swimming with your doctor!
OMG! This is so timely because someone asked on Twitter, what is one thing you wish you could've learned 10 years ago? My answer was taking care of posture. This is so epidemic, IMO. This is the closest I have come to feeling chronic pain that I had no control over.
I tried never ending solutions including Physical Therapy but nothing helped.
But I finally got control over it by doing TWO things:
1. Reading 8 steps to a pain free back by Susan Adams and putting lessons in action right away.
2. Performing THORACIC MOBILITY WORK
I have back pain problems right now that go away only when I stop exercising and stretching. I found this out when I broke my ankle and couldn't do anything. Back pain gone!
Sounds like you need to stretch correctly after exercising. I had the exact same experience, and it wasn’t until I began focusing my stretching on my hamstrings that I saw immediate and significant relief. It’s the holy grail to a back pain free life for me now.
I love how everyone immediately goes to "you were doing it wrong". Gee thanks. It could also be you perform at a very high level and your body is aging, you have an underlying condition that had never had a chance to fully heal, or many other nuanced reasons.
So, in other words... he's doing it wrong. Perhaps "wrong" is "pushing too hard given age or some underlying condition", but the fact is that exercise and stretching should never make you worse off... assuming you're doing it correctly.
In my weight training class, we always avoided the deadlift due to the high risk of injury. Now I'm in middle age and starting to feel back pain, I picked it up, and performing this exercise completely fixes my back pain.
I did once throw out my back while deadlifting. It was completely preventable, but it turns out that the consequences were minimal. I've become a lot less worried about my back since then.
It was the day after a hard 20 mile run, and I stupidly tried to deadlift my 1 rep max in that fatigued state. Something popped and I felt a sharp pain in my lower back. It hurt really badly for about 3 days, and made it difficult to put on socks and pants. And then it healed right up. No pain ever since, and I went right back to deadlifting.
It was probably a back strain/sprain. Before going through that, I expected that a deadlifting injury would be debilitating and would take months to heal from. The reality was... different. That's my point.
As an aside, there is almost zero reason to PR on any exercise unless it's for a competition. The risk of injury at a PR load is simply too high for recreation. Your 3RM is a good indicator where PR lies, and carries far less risk of injury.
I'm saying this as someone who loves the dead lift and picking up heavy things.
Good advice here. 3RM in my opinion is even pushing it and not something you want to do often. 5RM is probably more ideal to do on a semi-regular basis.
Form is critical too, so with every single lift that you do, make sure you're using the correct form first, otherwise you're potentially wasting your time and putting yourself at risk of injury.
Agreed. Even a 3RM is something that I would no more than 2x/year. As I've gotten older I don't even do that. My workout weight goes up over time which means I'm getting stronger. But I'm not a complete young idiot anymore, and know avoiding injury is job one.
It's a common misconception about dead lifts. So common, that some 'experts' even say to avoid the dead lift. The problem, as you point out, is that lifting things from the ground is a common every day occurrence. Learning how to lift things properly and add some strength around that movement in fact lowers risk of injury.
Chances are you were lifting the toddler or sandbag with ho hum form. You aren't going to hurt yourself lifting 50 pounds like that. You try ho hum form with 400lbs on a barbell and your body is not going to be very happy with you.
You’ve got it backward. More people hurt themselves lifting weight around 50 than 400. It’s easy to not consider form and pick up 50 pounds, rounding the back. Most people that can pull 4 plates seem to know what they’re doing.
Does ho hum mean bad? Couldn't really find it, just that it means routine/dull.
But if good form, then I find it unlikely that you hurt yourself with 400lbs if you progressed to that.
In this case I mean OK form, not proper form since you are just thinking about moving a sandbag on the truck bed and not the angle of your back and where your weight is positioned over the knees. Weightlifters get bad injuries even if they know good form in and out, it only takes a small movement to fall out of form and seriously hurt yourself while lifting heavy weight and can happen under supervision, which you should have already in the form of a spotter for heavy lifts.
Deadlifts are so safe that... there are hundreds of deadlift safety tutorials on Youtube, where poor form and a bad instructor can cause irreversible damage very abruptly.
Notice how this doesn't apply to jumping jacks or the plank.
That you always have to couch the benefits of deadlifts in the "when done properly" disclaimer should be a hint as to what they're talking about. Hell, even lifting with one's legs instead of one's back comes so unnaturally to some that my refrigerator's box came with "lift with legs" instructions stamped onto it complete with a series of pictograms.
The key thing that he calls out in this and other videos is that most people do not have sufficient hamstring flexibility to safely deadlift off the ground (lack of flexibility will force your back out of a neutral position "rounding of the lower back"). There is certainly no shame in starting your deadlift from an elevated position by stacking plates underneath the barbell or pulling off rack pins while you work long-term on improving flexibility.
I highly recommend watching any of his videos before attempting any exercise, even ones that you think you know how to do well, e.g., bench press :)
Jeff is a strength and conditioning trainer (formerly with the Mets before becoming what looks like a full-time YouTuber). Ignore the click-bait titles and the fact that he doesn't wear a shirt - that's all part of the YouTube game. His content is consistently excellent.
My experience exactly, although I can't narrow it down to the deadlift. I had occasional but regular low back pain starting in my early-to-mid twenties. There wasn't a consistent relationship with my level of activity or inactivity, the type of exercise I did, or with my weight, all of which fluctuated quite a lot over the years. Back pain was just something I got regularly, like colds or headaches. I've had virtually no back pain (other than muscle soreness and a couple of sports injuries) since I started lifting heavy weights, which is not the usual progression for somebody from their twenties to their forties.
It's incredibly counterintuitive. Everyone's assumption, if they don't lift weights themselves, is that my case is some kind of weird exception or coincidence, and I can't really blame them. I have no idea how to explain that there's a good chance that they are misusing their back, and that they would be more comfortable sitting, standing, walking around, and lying down if they strengthened the muscles in their back. First of all, why in the world would we need to learn how to use our own bodies as adults; don't we figure this out as toddlers? And second of all, if we spend hours every day sitting down, hours every night lying down, and maybe hours every day walking around and jogging, why in the world would our backs not be strong enough to do those things safely and comfortably? Isn't doing something for hours at a time exactly the right signal to prepare your body for doing that thing?
But it seems to be a very common experience for people who try lifting weights: they find that they are much more comfortable sitting at their desk at work and lying down in their bed at home if they lift heavy things on their feet at the gym. I wish I knew how to convince people to try it.
If this sounds "cool/lucky" for most people. It is in reality a nightmare if you are office worker.
Everything is in your environment generally lower, shorter or inappropriate for you... This trigger improper posture and inevitable backpain.... Chronic backpain in my case.
After passing through everything, including painkiller, osteopathy, chiropractic, surgery (back bone injection) without any better results I tried (pure amator) weight lifting and this was a miracle for me.
My situation get much better, in just a matter of few months.
My 2 cents on that is weight lifting force you to fix your posture and imbalance when you practice it. Muscles have Memory, and this, even if it is counterintuitive, help a lot.
I've had back pain for about 2 years, up until recently. I did weekly physiotherapy for an extended amount of time until my doctor recommended neurodynamic exercises. It's basically focusing on stretching your nerves. I did that daily for 6 weeks and my pain was mostly gone. When I feel it's coming back, I do the exercise maybe once a week and I'm good. On top of that I can now focus on improving core strength. It's a huge motivator knowing how bad it feels, but that you have it under control (which was a huuuge relief).
Edit: my back pain was caused by bad posture, which was caused by pain from an untreated slightly ruptured intervertebral disc.
My PT didn't mention much about posture like the book did. The book covers a lot of detail on how to sit, sleep, stretch, lift, breath and other basic human activities. Sleep was a huge win because I would wake up with pain most of the time but the moment I learned how to sleep properly and put those lessons in action, I woke up without any pain. I was sore the first day (a good sign, IMO). It is sad that I am old enough but my body has forgotten to perform these basic activities.
My PT did not mention anything about thoracic mobility exercises either. Book also covered chin tucks and shoulder rolls but it didn't stop there. These are some of the common exercises you find on internet and are recommended by mostly all of PTs. But when you are done with your sessions, there is no one to tell you at home about not exaggerating your neck while doing chin tucks. But the book did with amazing visuals.
PT (4.5 yelp reviews) did lot of trial and error solutions focusing on strengthening and mobility exercises. Great, if something worked, otherwise continue trying different solutions.
I also had to meet $1500 deductible for my insurance to cover these PT sessions but I could only afford 2 sessions a week. This point was not an obstacle but I wanted results from PT after 3-4 sessions to justify the cost which didn't happen to be the case for me.
Yea, L5/S1 pain here for years. Finally started seeing a chiropractor.
So far, I've gone from constant pain to occasional pain, so that's an improvement. I've had to make some lifestyle changes too. No more lifting with heavy free weights. No squats or deadlifts. Ah well.
I have personally been involved with a woman who was almost killed by a chiropractor. The guy cracked her neck, did damage to the underlying veins, which caused a blot clot and a brain-stem stroke. She lost the ability to balance, loss of heat/cold detection, slightly droopy side of her face, and more. It nearly ruined her life and though she won a settlement, it was far lower than you'd think it'd be for such a huge loss of functionality.
This of course is just anecdotal evidence, but it's 100% true (I'm not an anonymous dude on the Internet, this is my name, and I stand by my words). Do yourself a favor and stay as far away from chiropractors as you can. They're not doctors and what they do can have serious consequences.
Though, I've had my neck cracked several times now, so a little late to be doing research. There seems to be a suggestion in that paper that perhaps these injuries are a result of a chiropractor aggravating an already weakened/injured artery. I remember hearing a story of someone having a stroke after cracking their own neck :O
Do yourself a favor and see a real doctor about it and try Physical Therapy. I always had my doubts about chiropractors but I tried one for a month and like you went from constant to occasional pain but never any better. I went to PT and they taught me exercises for my core and stretches that have me pain free to this day.
Have you tried mackenzie method stretches? I had L5/S1 disc bulge and pain for over a year. After a few days of Mackenzie I was pain free, and now use the stretches as needed but probably 4 times a week.
I went to a Chiropractor for a few weeks but it never helped my lower back, but did help the upper back a bit.
Back pain is a tough nut primarily because it varies so much from person to person. Depending on the anatomy of the injury and the post-injury healing the symptoms and severity can change drastically.
Sometimes the best prescription is time. Sometimes you need surgery to save yourself from paralysis. Sometimes surgery puts you in worse pain, sometimes it fixes you for the rest of your life. It's frustrating, and each patient needs to become their own best advocate.
Running was actually the cause of my herniated disc. Well probably weakened over the years by slouching forward at the computer and not building a strong core. But after recovering from one huge bout of back pain I started running again and a few days later I had sciatica and foot drop. I still have nerve damage.
Doing the McKenzie back exercises every morning for the past five years is the reason I’m able to still function I think.
I can’t say if the pain from sciatica caused by a disc herniation is the worst pain I will ever feel, but it would be hard to imagine worse.
my thoughts exactly. I recently re-injured my back with a muscle spasm caused by DDD and the PT tried cupping. this led to unimaginable nerve pain. I can't imagine worse pain than that
I herniated a disc while playing basketball. The herniation didn't hurt my back, but pinched my sciatic nerve. This led to my left leg literally feeling like it was being cut off my body. I've torn my ACL and had appendicitis. The pain from those was not even in the same universe as the nerve pain.
I have sciatic issues--my leg feels either numb, or on fire when it acts up.
I bought an inversion table. I get in it backwards and hang from the affected leg (the other I leave free) for about a 40 count. It brings me from pain to fine in usually a single session. Mind you, I don't have anything herniated and I think scoliosis is pinching the nerve in my case. I am not a doctor, and try this at your own risk. For me it is life changing.
I received an injection in my back to get the initial pain under control and then let inflammation go down over time. To prevent further issues I stopped playing basketball and spend more time doing yoga, spin, strength training and jiu-jitsu. My doctor and I posited it was the impact from the running/jumping/cutting in basketball that led my initial problem.
Over 10 years of terrible back pain, tried all kind of things. At some point, I was prescribed painkillers, tried PT, yoga, everything.
Turned out that the “glutes/hip weakness” approach was correct. Changed my life - not a single issue since years of muscle reinforcement in the posterior/hip area with a focus on posture.
My dad was a great athlete growing up, and a common way that athletes deal with pain is to rest for a while and then gradually return to exercise.
As he got older, he followed the same routine, except like many aging Americans, he basically stopped exercising. Whenever he had pain, he would rest the affected area, but there was never a return to exercise.
Every muscle/skeletal problem he had seemed to become chronic as the muscles got weaker and weaker. I could tell he was nervous to exercise because he didn't want to injure himself and he wasn't in very good shape, but it was obvious that rest was doing him no good whatsoever, but to his last day, he thought that if he just rested, he would start feeling better.
What's surprising to me is how often rest is recommended as treatment for people whose entire existence is characterized by a lack of intense physical movement.
So there are a lot of comments here about it, but going to give one of my own -
I've had back pain for the past year. Still trying to figure out the right treatment. But what ALWAYS helps, is a Lagree fitness class (and by extension I'd say pilates would too). Some of hte moves help more than others, but I can go with my back hurting, and I quickly get to where I don't even notice it in the class (because everything is engaging muscles and taking pressure off my back), and by the end of the class I feel great. Two days later it will be back, but, that's also when I take the next class. Still trying to figure out what to do on off days to keep it from returning, and so hopefully able to heal, but, yes. Find something that will keep your back protected, but still work it (and the rest of you).
It's tricky right, because if you are an active athlete, then you may make an injury worse. In martial arts this was a common issue where someone would have a minor injury, aim to "work through it" and make it much more severe.
At the same time, simply sitting around binging Netflix is probably the wrong call in many situations.
What my reading of the current research indicates (and, this stuff tends to evolve regularly) is that a short period of rest (two or three days) followed by light activity for a short phase tends to be the best course of action. To the extent that RICE (Rest, Ice, Compress, Elevate) has become MICE (Move, Ice, Compress, Elevate).
This is the standard recommendation for many injuries. Are there any controlled studies which demonstrate that injuries treated with ice resolve more quickly than without using ice?
Let's stipulate that this reader is an idiot who didn't think to do that before asking. Is there a single reference you can provide from the exhaustive entries?
Is there a single reference you can provide from the exhaustive entries?
I didn't think so.
Though no doubt not as thorough and exhaustive as your putative literature search, this humble reader was able to discover at least a few NIH publications which suggest that the issue is not completely settled. Viz.:
"This review explored the effects of ice treatment upon pain, swelling and range of movement after acute soft-tissue injuries. The authors found little evidence that adding ice to compression increased its effectiveness." [1]
"The aim of this study was to examine the effects of icing soon after muscle contusion injury on subsequent inflammation, angiogenesis, revascularization, and myofiber regeneration. Our study is the first to demonstrate that icing delayed and/or attenuated the expression of proangiogenic factors and changes in vessel volume in regenerating muscle in the first 7 d after injury. Despite these differences, capillary density and the cross-sectional area of myofibers did not differ significantly between the icing and sham groups. These findings suggest that, although icing may mildly suppress inflammation and some aspects of angiogenesis/revascularization, these effects are not sufficient to retard muscle regeneration after contusion injury."[2]
"The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known."[3]
The modern view of it seems to be that none of it is needed and can even be counterproductive. Compression can sometimes be useful to reduce swelling. Swelling can be unpractical, but is not bad in itself. Rest, ice and elevation will in general make recovery slower.
The best thing to remember about back pain is that most of the time the pain is not due to a problem in your back, but a problem elsewhere on your body. This is commonly referred to in the medical field as referred pain.
So if your feet are fucked up, the rest of your body is going to be fucked up. If your calves are tight, they will cause issues up the chain and it will/can eventually lead to pain in the back. If your thigh muscles are too tight, same thing happens.
For those of us who sit often, we tend to get what is called an anterior pelvic tilt -- or in plain english a pelvis that is rotated or tilted slightly forward. This ends up causing your lower back to pick up the slack and curve more than it is supposed to, and on and on up the chain.
The single best thing I have found for releasing a tight psoas (to remove the tension and allow your pelvis to orient itself correctly) is to use a ~20lb slam ball and basically lie directly on top of it with it lodged right in the trinagle area that is below your belly button and to the side of your groin. Shove it in there, take a deep breath, lean into it and you will really feel it loosen the tension on your posas. This is makes a profound difference in my hip flexibility and usually does a killer job eliminating lower back pain.
This. Back when I was overweight I had a fair amount of back pain. Once I started lifting (and foam rolling) I discovered one day that spending 10 minutes foam-rolling my glutes caused 100% relief in my back for a day or two.
A few years of squats and my back pain is now non-existent. Not because my back is "stronger", but rather it seems because of the increased flexibility from the waist down.
Squats and deadlifting is what got rid of my back pain, which had been mild to moderate for years. Highly recommended, as long as you are VERY mindful of your form.
To people maybe not confident with their form: you can do free weight squats (deadlifts too, I suppose, with empty hands). Just get the form right, then add a small amount of weight. Then, in small increments, add more weight.
Very frequently one part of your body compensates for a failure in another part of your body. As a result the bit that hurts can be surprisingly far from and the part where the underlying problem exists.
That said, the principle is simpler to apply in theory than practice. There really are people who understand the human body well enough to debug it. Their results demonstrate that they aren't making it up, but I have no idea how they actually do it.
Thank you for sharing. I'm having a little bit of difficult time imagining your recommendation in the last paragraph above. Is there a video online that kind of shows what you've written above? Thanks in advance!
I use a slam ball but a soccer ball or volleyball that is adequately inflated would probably work too. If you are tough and flexible you can use a softball or something much firmer but it will hurt a lot more if you are not ready for it.
I regularly roll out my ass and upper back with a lacrosse ball or softball, but haven't tried it on my psoas yet.
What a coincidence. I was searching YouTube for exercise for back pain. I actually have pain in my left side of body. Some pain is in back and some in leg.
And this dude's (jujitsu master) exercise was the only thing to help with my pain
I know it seems ridiculous to spend $50-100 on a piece of injection molded plastic, but this thing[0] has been the best I've found for getting deep enough into my abdomen to loosen my psoas.
I simulate that with a lacrosse ball and a kettle-bell. I lay on my back, and put the ball about 2 inches to the outside of my belly button and then place the kettle-bell atop the ball. From there, I move it slowly down passed my hip/groin. Don't go too heavy on the kettle-bell. I don't go over 35# usually.
> The single best thing I have found for releasing a tight psoas (to remove the tension and allow your pelvis to orient itself correctly)
Funny you mention psoas. PRI[0] + Stott Pilates[1] has been life changing for me because its basically all about getting your psoas muscles strong and limber. Anyone with back pain, I highly recommend.
> This is commonly referred to in the medical field as referred pain.
To be a bit pedantic I don't think this is correct--"referred pain" specifically refers to a quirk of the nervous system where acute pain is perceived in a spot that is NOT actually undergoing the harmful stimulus, as when a heart attack causes pain in the arm (rather than around the heart/chest) or acid reflux in the esophagus manifesting as pain/pressure in the chest (rather than the throat).
What you're describing seems more like your back is actually traumatized and therefore in pain, but there's some underlying chronic issue outside the back which has, over a longer period of time, led to said trauma.
In other words, referred pain means trauma in locus A causes pain in locus B, whereas what you're talking about is trauma in locus A causes trauma in locus B causes pain in locus B.
Mobilize (stretch, foam roll, hard ball) the posterior chain, i.e. the back of your body, especially the glutes, hamstrings, hips, calves, and the back muscles. This is a CHAIN, the links are connected, feed slack into the painful areas by loosening up the whole chain.
287 comments
[ 2.3 ms ] story [ 219 ms ] threadMost people don't know how good they can actually feel. Sitting down all day isn't natural and taking opioids or expensive surgeries that aren't guaranteed to work (see Steve Kerr's story) aren't great options.
I think most people would be surprised at how good they can feel by just taking 5-10 minutes every day to do mobility work and/or foam rolling as part of their daily work habit. You spend 8 hours a day messing up your posture. You should take 5 minutes to help undo it.
Not only not work but make things worse or irreversibly damage the body.
Take it easy and gradually and make sure it's the type of class suited for you. There are beginner/intermediate and advanced classes. If something feels right it is most likely doing good and if something feels wrong don't do it anymore. Yoga could be tremendously helpful but if you don't do it right it could do more harm than good.
You could do this with a lengthy, complicated series of midsection/trunk exercises, or you could hit every associated muscle in the correct balance and proportion by walking.
Your body was built to walk - you are a walking machine.
I had a blown L4/L5 going into basic training and was immediately walking 5-8 miles per day. It was very painful and debilitating for the first week ... and then it was gone. I believe the muscle action pulls the spine back into proper alignment and gives the disc nowhere else to go but where it belongs.[1]
If you look, you will find this to be a very common anecdote.
[1] IANAD and obviously cannot speak to severe trauma, fractures, etc.
This is not advice you should be giving.
You are not his doctor. You don't know the extent or type of his injuries. You have no idea if core workouts will help. You have no idea if he/she even can walk.
90% of herniated discs resolve in 3 months. For the 10% that don't sometimes surgical intervention is needed. Don't muddy the water with vague uninformed advice if you don't know this persons exact medical details.
On one hand I agree, but it is useful advice to say make sure to talk to different doctors. If someone goes to a surgeon, they are likely to lean towards surgery. I'm going to assume the GP has already seen doctors that specialize in non-surgical treatments like steroid injections directly at the site, but for anyone else reading this information could be useful.
And, the OP is right. The doctors I've talked to have all said surgery needs to be the absolute last resort. Many end up worse off or needing more surgery.
I was 25 when I had surgery though, so god only knows what kind of shit I'll be in when I'm 45. Hoping those stem cell treatments take off.
At least for me it's certainly some muscle thing as once winter comes (and I'm walking less) the back problems come back. One of the best things this winter was getting a job in an large sprawling office, which means I'm walking several miles every day at work (all indoors). Haven't had any issues this winter at all.
Again, I think a good mental model is that of a corset, or a brace. In this case, the corset you are donning is made of your own muscle.
You could attempt to build that own-muscle corset section by section by doing all of the 40 different trunk and midsection rehab exercises, but even then, in what balance or proportion could you hope to execute them ?
Instead, you can hit all of them, in concert, and in appropriate proportions, by walking.
The difficult part is that bad back pain will not make for easy, pain-free walking - at least at first. I found 4-6 mile walks to produce a fair amount of back pain in the year immediately following my initial disc herniation/tear. It took that forced week or so at the beginning of basic training to pull my spine back together.
Certainly that's not going to be the solution for all cases of back pain, but I do wonder how many are taking painkillers and such when some regular exercise or other physical changes (posture, weight) could do the trick.
A lot of the people I've known over the years who took opiate painkillers for back pain have had injuries to their spine. Some people I know with spinal injuries tried opiate painkillers, found that they were effective for the pain, but the side effects prevented them from being focused at work, so they chose to live with the pain in exchange for mental acuity. I also know others who have tried very high doses of opiates and it did not significantly reduce the pain from their back injuries.
I think because of my profession sitting in front of the computer it's easy to get into certain habits that really just are not healthy and there's not enough movement. I don't really get into the hype of the standing desk either. Sure, I can stand up and work but also I just need to move a lot more and it makes things a lot better.
Much to the dismay of all the older people in my life, we got rid of our couch and have taken to just sitting in solid chairs or on the floor.
We also sleep on a futon mattress directly on the floor. Any time we visit relatives, I wake up with back pain.
Any time the topic comes up, I seriously wonder how many people's pain / mobility problems could be solved by just getting rid of all the furniture in their lives that actively works against the body being able to support and align itself.
I firmly believe for most people slipped discs happen due to a lack of core muscle strength and spending most of our days in terrible postures (sitting at a desk, for example).
I spend at least 50% of my exercise time focusing on my core now. Things like planks, squats, and yoga. My thought being that a strong core keeps everything (eg your spine, discs, and soft-tissue) in place. I have absolutely no scientific backing on this, but it's worked for me so far.
PT is the closest I have come to experiencing a miracle cure from modern medicine. Speaking as someone who frequently breaks themselves.
But not a lot. 1 to 3 km every day is fine. Walking 1/2 of it is fine. Just go out for 30 min and try to run as much as you can, but go slowly. Just a bit over walking pace is better than short bursts. You really don't need a lot and isn't any better for extreme runners. It'll get better in a week or two and it will start hurting again if you stop for too long before your fully healed (months probably)
It's all about pulsating vertical compression. And even if it does not help due to that, it surely will for other things.
Good luck! I hope it helps.
I think there was a meta review, but will have to ask my SO, it was her research that lead us to it.
To your point about no to much running, after I began running for periods over 2 hours, I would get some back pain during the run and stiffness after. However, I began doing pushups and planks, sure enough I strengthened my core and I don't get backpain on even 4+ hour runs (not to mention I developed a 6/8 pack which I never had in my life, a nice surprise in the mid-30's).
Be cautious about this advice.
edit: You should consult that you wanna start running/swimming with your doctor!
Dont wear it all the time - but it helps to remind yourself of your posture and put your awareness on your spine.
Wear around the lower back.
Now it won't go away no matter how much physical therapy I get or other exercises I do.
I can do 20 pullups, I can deadlift 500lbs, but every ~3 years my back flares up doing somethiing like standing up and I can't walk for 3 days.
I tried never ending solutions including Physical Therapy but nothing helped.
But I finally got control over it by doing TWO things: 1. Reading 8 steps to a pain free back by Susan Adams and putting lessons in action right away. 2. Performing THORACIC MOBILITY WORK
I can't speak for you but this CHANGED MY LIFE! I am back at it again with no pain. If you would like to read my experience dealing with the pain check out this thread https://twitter.com/mihirchronicles/status/12174493172015964....
It was the day after a hard 20 mile run, and I stupidly tried to deadlift my 1 rep max in that fatigued state. Something popped and I felt a sharp pain in my lower back. It hurt really badly for about 3 days, and made it difficult to put on socks and pants. And then it healed right up. No pain ever since, and I went right back to deadlifting.
So.. don't assume that your results are predictive of the results for everyone (typical mind fallacy/typical body fallacy?)
I'm saying this as someone who loves the dead lift and picking up heavy things.
Form is critical too, so with every single lift that you do, make sure you're using the correct form first, otherwise you're potentially wasting your time and putting yourself at risk of injury.
But doing a deadlift properly is the most natural type of movement.
Like lifting your child off the ground. Or putting a sandbag in the back of the truck. I've done thousands and thousands deadlifts with no injury.
Can you provide a reference for your assertion?
As to whether the deadlift in fact has a high risk of injury, it would seem he agrees with you (and myself, for what that's worth): not really.
Notice how this doesn't apply to jumping jacks or the plank.
That you always have to couch the benefits of deadlifts in the "when done properly" disclaimer should be a hint as to what they're talking about. Hell, even lifting with one's legs instead of one's back comes so unnaturally to some that my refrigerator's box came with "lift with legs" instructions stamped onto it complete with a series of pictograms.
The key thing that he calls out in this and other videos is that most people do not have sufficient hamstring flexibility to safely deadlift off the ground (lack of flexibility will force your back out of a neutral position "rounding of the lower back"). There is certainly no shame in starting your deadlift from an elevated position by stacking plates underneath the barbell or pulling off rack pins while you work long-term on improving flexibility.
I highly recommend watching any of his videos before attempting any exercise, even ones that you think you know how to do well, e.g., bench press :)
It's incredibly counterintuitive. Everyone's assumption, if they don't lift weights themselves, is that my case is some kind of weird exception or coincidence, and I can't really blame them. I have no idea how to explain that there's a good chance that they are misusing their back, and that they would be more comfortable sitting, standing, walking around, and lying down if they strengthened the muscles in their back. First of all, why in the world would we need to learn how to use our own bodies as adults; don't we figure this out as toddlers? And second of all, if we spend hours every day sitting down, hours every night lying down, and maybe hours every day walking around and jogging, why in the world would our backs not be strong enough to do those things safely and comfortably? Isn't doing something for hours at a time exactly the right signal to prepare your body for doing that thing?
But it seems to be a very common experience for people who try lifting weights: they find that they are much more comfortable sitting at their desk at work and lying down in their bed at home if they lift heavy things on their feet at the gym. I wish I knew how to convince people to try it.
I am over 2m00 high.
If this sounds "cool/lucky" for most people. It is in reality a nightmare if you are office worker. Everything is in your environment generally lower, shorter or inappropriate for you... This trigger improper posture and inevitable backpain.... Chronic backpain in my case.
After passing through everything, including painkiller, osteopathy, chiropractic, surgery (back bone injection) without any better results I tried (pure amator) weight lifting and this was a miracle for me.
My situation get much better, in just a matter of few months.
My 2 cents on that is weight lifting force you to fix your posture and imbalance when you practice it. Muscles have Memory, and this, even if it is counterintuitive, help a lot.
I've had back pain for about 2 years, up until recently. I did weekly physiotherapy for an extended amount of time until my doctor recommended neurodynamic exercises. It's basically focusing on stretching your nerves. I did that daily for 6 weeks and my pain was mostly gone. When I feel it's coming back, I do the exercise maybe once a week and I'm good. On top of that I can now focus on improving core strength. It's a huge motivator knowing how bad it feels, but that you have it under control (which was a huuuge relief).
Edit: my back pain was caused by bad posture, which was caused by pain from an untreated slightly ruptured intervertebral disc.
My PT did not mention anything about thoracic mobility exercises either. Book also covered chin tucks and shoulder rolls but it didn't stop there. These are some of the common exercises you find on internet and are recommended by mostly all of PTs. But when you are done with your sessions, there is no one to tell you at home about not exaggerating your neck while doing chin tucks. But the book did with amazing visuals.
PT (4.5 yelp reviews) did lot of trial and error solutions focusing on strengthening and mobility exercises. Great, if something worked, otherwise continue trying different solutions.
I also had to meet $1500 deductible for my insurance to cover these PT sessions but I could only afford 2 sessions a week. This point was not an obstacle but I wanted results from PT after 3-4 sessions to justify the cost which didn't happen to be the case for me.
So far, I've gone from constant pain to occasional pain, so that's an improvement. I've had to make some lifestyle changes too. No more lifting with heavy free weights. No squats or deadlifts. Ah well.
This of course is just anecdotal evidence, but it's 100% true (I'm not an anonymous dude on the Internet, this is my name, and I stand by my words). Do yourself a favor and stay as far away from chiropractors as you can. They're not doctors and what they do can have serious consequences.
> Do yourself a favor and stay as far away from chiropractors as you can. They're not doctors and what they do can have serious consequences.
I've heard of one or two malpractice suits against MDs. Do you blanketly recommend avoiding hospitals as well?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016850/
Though, I've had my neck cracked several times now, so a little late to be doing research. There seems to be a suggestion in that paper that perhaps these injuries are a result of a chiropractor aggravating an already weakened/injured artery. I remember hearing a story of someone having a stroke after cracking their own neck :O
I went to a Chiropractor for a few weeks but it never helped my lower back, but did help the upper back a bit.
Sometimes the best prescription is time. Sometimes you need surgery to save yourself from paralysis. Sometimes surgery puts you in worse pain, sometimes it fixes you for the rest of your life. It's frustrating, and each patient needs to become their own best advocate.
Doing the McKenzie back exercises every morning for the past five years is the reason I’m able to still function I think.
I can’t say if the pain from sciatica caused by a disc herniation is the worst pain I will ever feel, but it would be hard to imagine worse.
I bought an inversion table. I get in it backwards and hang from the affected leg (the other I leave free) for about a 40 count. It brings me from pain to fine in usually a single session. Mind you, I don't have anything herniated and I think scoliosis is pinching the nerve in my case. I am not a doctor, and try this at your own risk. For me it is life changing.
https://www.dickssportinggoods.com/p/teeter-nxt-s-inversion-...
The first thing he bought after he got paid was an extremely nice office chair, soon followed by a nice desk.
I didn't quite catch on until 5 years later, but I can attest to being blessed with near 0 back pain so far. (Fingers crossed.)
Turned out that the “glutes/hip weakness” approach was correct. Changed my life - not a single issue since years of muscle reinforcement in the posterior/hip area with a focus on posture.
As he got older, he followed the same routine, except like many aging Americans, he basically stopped exercising. Whenever he had pain, he would rest the affected area, but there was never a return to exercise.
Every muscle/skeletal problem he had seemed to become chronic as the muscles got weaker and weaker. I could tell he was nervous to exercise because he didn't want to injure himself and he wasn't in very good shape, but it was obvious that rest was doing him no good whatsoever, but to his last day, he thought that if he just rested, he would start feeling better.
What's surprising to me is how often rest is recommended as treatment for people whose entire existence is characterized by a lack of intense physical movement.
I do exercise, but I avoid exercise while uncomfortable from back pain. Clearly, if I keep not exercising, I'll eventually only get worse...
I've had back pain for the past year. Still trying to figure out the right treatment. But what ALWAYS helps, is a Lagree fitness class (and by extension I'd say pilates would too). Some of hte moves help more than others, but I can go with my back hurting, and I quickly get to where I don't even notice it in the class (because everything is engaging muscles and taking pressure off my back), and by the end of the class I feel great. Two days later it will be back, but, that's also when I take the next class. Still trying to figure out what to do on off days to keep it from returning, and so hopefully able to heal, but, yes. Find something that will keep your back protected, but still work it (and the rest of you).
At the same time, simply sitting around binging Netflix is probably the wrong call in many situations.
What my reading of the current research indicates (and, this stuff tends to evolve regularly) is that a short period of rest (two or three days) followed by light activity for a short phase tends to be the best course of action. To the extent that RICE (Rest, Ice, Compress, Elevate) has become MICE (Move, Ice, Compress, Elevate).
I didn't think so.
Though no doubt not as thorough and exhaustive as your putative literature search, this humble reader was able to discover at least a few NIH publications which suggest that the issue is not completely settled. Viz.:
"This review explored the effects of ice treatment upon pain, swelling and range of movement after acute soft-tissue injuries. The authors found little evidence that adding ice to compression increased its effectiveness." [1]
"The aim of this study was to examine the effects of icing soon after muscle contusion injury on subsequent inflammation, angiogenesis, revascularization, and myofiber regeneration. Our study is the first to demonstrate that icing delayed and/or attenuated the expression of proangiogenic factors and changes in vessel volume in regenerating muscle in the first 7 d after injury. Despite these differences, capillary density and the cross-sectional area of myofibers did not differ significantly between the icing and sham groups. These findings suggest that, although icing may mildly suppress inflammation and some aspects of angiogenesis/revascularization, these effects are not sufficient to retard muscle regeneration after contusion injury."[2]
"The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known."[3]
[1] https://www.ncbi.nlm.nih.gov/books/NBK70552/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339266/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579462/
So if your feet are fucked up, the rest of your body is going to be fucked up. If your calves are tight, they will cause issues up the chain and it will/can eventually lead to pain in the back. If your thigh muscles are too tight, same thing happens.
For those of us who sit often, we tend to get what is called an anterior pelvic tilt -- or in plain english a pelvis that is rotated or tilted slightly forward. This ends up causing your lower back to pick up the slack and curve more than it is supposed to, and on and on up the chain.
The single best thing I have found for releasing a tight psoas (to remove the tension and allow your pelvis to orient itself correctly) is to use a ~20lb slam ball and basically lie directly on top of it with it lodged right in the trinagle area that is below your belly button and to the side of your groin. Shove it in there, take a deep breath, lean into it and you will really feel it loosen the tension on your posas. This is makes a profound difference in my hip flexibility and usually does a killer job eliminating lower back pain.
For a good video demo of the psoas release I do often: https://www.youtube.com/watch?v=_F-0rtFbOgI @ 1:15 is the pose that I use.
A few years of squats and my back pain is now non-existent. Not because my back is "stronger", but rather it seems because of the increased flexibility from the waist down.
That said, the principle is simpler to apply in theory than practice. There really are people who understand the human body well enough to debug it. Their results demonstrate that they aren't making it up, but I have no idea how they actually do it.
Here is a video using a much smaller ball: https://www.youtube.com/watch?v=OQuQ_aKlDjI
Here is another one: https://www.youtube.com/watch?v=_F-0rtFbOgI @ 1:15 is about the position that I use. Lying down, one leg out to the side and one leg straight back.
I use a slam ball but a soccer ball or volleyball that is adequately inflated would probably work too. If you are tough and flexible you can use a softball or something much firmer but it will hurt a lot more if you are not ready for it.
I regularly roll out my ass and upper back with a lacrosse ball or softball, but haven't tried it on my psoas yet.
[0] https://pso-rite.com/
Funny you mention psoas. PRI[0] + Stott Pilates[1] has been life changing for me because its basically all about getting your psoas muscles strong and limber. Anyone with back pain, I highly recommend.
[0] - https://www.posturalrestoration.com/
[1] - https://en.wikipedia.org/wiki/Stott_Pilates
To be a bit pedantic I don't think this is correct--"referred pain" specifically refers to a quirk of the nervous system where acute pain is perceived in a spot that is NOT actually undergoing the harmful stimulus, as when a heart attack causes pain in the arm (rather than around the heart/chest) or acid reflux in the esophagus manifesting as pain/pressure in the chest (rather than the throat).
What you're describing seems more like your back is actually traumatized and therefore in pain, but there's some underlying chronic issue outside the back which has, over a longer period of time, led to said trauma.
In other words, referred pain means trauma in locus A causes pain in locus B, whereas what you're talking about is trauma in locus A causes trauma in locus B causes pain in locus B.