Good Backs, Bad Backs and How to Use Your Back Well

Nick Mellor, Alexander Technique

Myth: A “Good Back” is an Uninjured Back

There's a popular idea that a good back is one that has not yet been injured. This view of the back is misleading and incomplete. How we use our backs is, if anything, a stronger factor in reducing back pain than correcting physical damage.

Here, I want to explore how “using yourself well” helps you overcome or manage back pain, then get beyond pain to revealing your back's extraordinary, inborn strength and flexibility.

A good back is not an uninjured back-- it's a back, injured or uninjured, that you use well.

Using your back well is something that a few people have been able to work out for themselves. Watch these people move: Mohammed Ali,  Rudolf Nureyev, Fred Astaire, Artur Rubinstein and Ian Thorpe. What is common to all these performances is effortlessness. Mohammed Ali floats. Ian Thorpe looks like he's having a swim on a lazy Sunday afternoon even when sprinting flat-out to win an olympic medal. Artur Rubinstein plays a demanding piano study in a huge auditorium, yet he's still, poised, relaxed, his fingers more like feather-dusters than fingers on the keyboard. That's what a strong back is. Those of us who have it either acquired it through birth or they've taught themselves through long self-study. The rest of us can learn how to use our backs well too. It isn't difficult to work for a good back, but it does take time and persistence.

How Many People Have Back Pain?

The short answer is, almost everyone, at one time or another. If you're a westerner, you've a 90% chance of having back pain at some point in your life, a 50% chance of significant pain some time this year and a 25% chance that you're in pain from your back right now.

More back pain statistics can be found at back-pain-self-help.com.

How Bad Is My Back?

It's not a trick question. It's easy to get used to a bad back and accept a much-restricted life. When asked, you might say that you don't have a bad back. But you can't sit for long, so you don't. You can't rough and tumble with your children, so you don't. You walk slowly up the stairs. You can't stand or sit for very long. These are all symptoms of a bad back. My Alexander Technique students often arrive at their first lesson saying "I don't have a bad back." A while later they'll say: "Oh yes, my back does ache in the mornings when I first get out of bed." What is normal no longer seems worth mentioning and we even forget about it ourselves.

You may find it interesting to fill out the Roland-Morris Disability Questionnaire (PDF), a respected measure of how much a bad back affects you. One reason to do this is to remind yourself what compromises you make because of your back.

What is Acute Back Pain Like?

A friend of mine had her first ever episode of acute back pain recently. Earlier in the day she'd picked up her five-year-old at a funny angle in a narrow space and felt a twinge. A while later, in town, she was in town, at the curb waiting to cross the road, and stopped. She couldn't move. She couldn't pick up her two-year-old, who began to scream. As it happened, there was no-one around. She couldn't do anything except phone for help, bursting into tears on the phone. A few minutes later, help came. “Michael? My car's just over there, on the other side of the road. Could you help me get there and put Fynn in his seat?” She'd been stuck 20 metres from her car, for 20 minutes, unable to move when her precious child was needing her. Driving home was difficult and acutely painful. She needed more help to get the baby out of the car seat once home.

She had sprained her lower back. Nothing unusual in that, it's common enough, and it usually doesn't take long to recover. But over the next couple of days this gentle friend of mine was bad-tempered and impatient. That's not surprising. Everything hurt. She could hardly move, couldn't cope with her young children jumping up and down on her any more (which didn't stop them), couldn't carry her two-year-old for three weeks, could barely walk, could barely drive. A day after the minor lifting accident that hurt her back, she said: “I think I've gone into shock.” All she could do was lie down. And lying down wasn't so wonderful either-- after a while, getting up was even worse than before. Her whole body, arms, legs, neck, torso, were stiff with tension and the anticipation of pain at every step. Her breathing got short. Her stomach was twisted in knots.

Going into shock isn't surprising. From one moment to the next, to go from carefree health to serious impairment, wondering what happened to your strong, carefree self. The core of your body, your chassis, seems broken. You quickly learn a painful and frustrating truth: you can't raise your little finger if your back's not willing.

Everything depends on your back. You're a vertebrate. Without a working spine you feel useless, you feel like someone else. Your very identity seems in question.

Bad backs are so common that it's easy to forget what a profound impact they can have.

Are We Badly Designed?

There is always plenty of speculation about why back pain is so common. Are we badly designed? Does our modern, sedentary lifestyle mean more bad backs? Has technology evolved far quicker than our stone-aged bodies? Is it the design of our chairs? Is it chairs themselves-- should we all be sitting on the floor?

All this makes for good column inches if you're a journalist with a quota, or a bunch of friends gossiping in a cafe, but there's a problem. Spines are actually beautifully designed.

The Design of the Spine

A spine is not straight. It's designed as a shock-absorber. It's a complex, articulated moving part and a strong central pillar all at the same time. The bends, joints and discs in your spine are for shock-absorbing, the equivalent of springs in a car's suspension. But the same structure is also acting as a solid, dynamic platform for our heads, arms and legs, without which our limbs have no hope of functioning properly. Our arms and legs need firm support from our spines in order to be able to push, pull, lift, type, play, stroke, walk, run, jump. Every action of our arms and legs needs a reaction from our spine in order for the movement to have confidence, accuracy and strength (or for it to even happen at all.)

Spines are unbelievably hard to damage. Do you have a bad back? I wonder how long it is since you thought of your spine as being tough. But if you were to take a spine out of a living person and tried to harm it, you almost couldn't. You might do it some damage if you laid it between two chairs and two of you jumped up and down on it in the middle. Anything much less than this kind of abuse is water off a duck's back to a spine. So what goes wrong that so many of us have trouble with our backs? How do our nearly-indestructible spines get damaged? How, for example, can sitting on a chair for 10 hours a day harm your spine?

One answer is that we're all equipped with powerful back muscles that can generate compressive forces of up to 10 times our body weight. If we misapply these back muscles, our own behaviour can put enormous, persistent pressure on our spinal column, bones, discs, nerves, fascia, ligaments and tendons.

Years of Pressure

People who have had accidents and damaged their backs make up the bulk of an Alexander Technique teaching practice. One of the great moments in teaching is when a person makes a connection between their injury and how they behaved before the accident. One woman who had a lifting accident in her started becoming aware of an intense pressure at the base of her spine while walking and began to remember this intense pressure stretching back to her teens. She began to see how walking had been showing her not a structural fault in her back, but the way she was misusing it, even as a fourteen-year-old. She saw that that same part of her back ultimately gave way to injury.  She saw all this for herself, without my help. It was a difficult lift on top of years of prior self-imposed pressure that injured her.

During her Alexander Technique lessons she was able to learn to stop imposing that pressure on her lower back. As a result, long-term chronic lower back pain became a thing of the past and the injury's significance was reduced almost to zero. Her back now works a great deal better than it did before she injured it. Better, in fact, than when she was 14.

Faulty Sensory Feedback and Back Pain

In “The Man Who Mistook His Wife for a Hat”, neurologist Oliver Sacks writes about one of his patients who loses her sense of where her limbs are in space. In her twenties she has a dream about losing control of her body and wakes up to find that it's literally true: her body is out of control. Her arms go wandering all over the place unless she monitors them with her eyes. Stop watching her left arm for 10 seconds and it wanders off. She had entirely lost the kinaesthetic sense that told her where her arms and legs were in space.

Have you ever caught sight of yourself in a mirror or a shop window and been mildly shocked by what you see? Who is that strange, stiff man or that stooped woman in the window? They're both mild versions of the woman who lost control of her limbs: he's stiff, and doesn't know it until the shop window shows him. She's stooped and doesn't know it, until the shop window shows her.

Here's the kicker: in the absence of severe spinal disease it's he himself who is stiffening his body, and it's she herself who is bending her back. (And if you do have spinal disease, you'll be stiffening or bending out of habit too, even if it's making your condition worse.)

The experience of Alexander Technique teachers for more than a hundred years is that, to make a lasting change in how someone uses themselves, sensory feedback needs to be challenged and improved: if you can't feel accurately what you're doing, it's very hard to change it.

We all have mildly faulty feedback. Many of us lean forwards or backwards from our hips as we stand and walk without knowing we're doing it. We're unaware of the habitual tension necessary to maintain ourselves off-balance. If the sensory feedback is faulty we misjudge how much effort is necessary to carry out ordinary movements and put a lot of mechanical and psychological stress on ourselves.

I'm not blaming anyone here, I'm saying that if you want to rediscover your good back, it's not enough to visit a manual therapist such as a physiotherapist, an osteopath or a chiropractor. Once they've got you out of acute pain, which they're very good at, there is one more step. You need to re-learn how to look after your back, how to use enough effort, but no more. You're the one with the strong back muscles. It's up to you to make sure that, far from reasserting, maintaining and worsening your injuries, or putting you in the way of injuring yourself in the future, these back muscles become a force for good, for long-term happiness, strength, vitality and flexibility.

The benefits of educative processes like the Alexander Technique are that you learn a lesson that will benefit your back for a very long time, not just until your next appointment.

Exercises

There are a suite of exercises for improving sensory feedback at www.back-pain-self-help.com.

The Expanding Self

In the Alexander Technique, the head-neck-back relationship is seen as being of primary importance, and is sometimes called the Primary Control. The Alexander Technique aims to help undo the shortening and narrowing effects of stress, injury and other life events to allow you to expand to your full capacity and stature as a human being. Central to this effort is to get your spine working properly again, your back lengthening and widening under a free neck and a head that floats free of the spinal column. In the most common form of words, “Let the neck be free, to let the head go forward and up, to let the whole back lengthen and widen (and to let the knees go forward and away.)”
The aim is simply to maintain this thinking into and through each of your daily activities. The difficulties are two-fold: (1) most people find it hard to maintain a decision into and through an activity without falling into an old habit (2) that your faulty feedback tells you things couldn't possibly be worse at the very moment when things are improving. It will tell you, for example:

• that your legs are about to collapse when they're the strongest they've been for years
• that your back is short when you've just got the best bit of lengthening yet
• that your neck is stiff when it's the freest it's ever been

An Alexander Technique teacher can step you round these volleys of misinformation quickly. Without a teacher, it's easy to become discouraged.

Wellness and Strong Backs

A good back is more than an absence of pain. It's a magnificent organ for life, energy and living, and can be positively worked for. The most important thing to know about good backs: even if your back has been injured, in almost all cases you can still have a good back. That potential is still there in the vast majority of people.
Even paralysis isn't the end of a “good back”. Here's a moving and inspiring audio interview with Matthew Sanford, a Yoga teacher who broke his spine in two places as a teenager, and teaches Yoga from a wheelchair.

Injured or not, backs are beautiful, capable, powerful structures.

The spinal column is the root of our power. We are vertebrates-- everything we are and can do is based on our spine, whether it's body movement, digestion, the functioning of our nervous system, even thinking. The spine IS our nervous system. Many cultures have understood the transformative power of work on the spine, whether it's Kundalini in Yoga, Primary Control in the Alexander Technique or a component of the Central Nervous System in Western medicine.

 

What Does a Good Back Feel Like?

Let's start with feeling light. If you're using your back well, you float to your feet like thistledown. There's no sense of effort at all, no loss of balance at any point, no pressure in the neck. Your legs hardly have to work because your lower back and hips are working properly.

You Love to Move

Walking, running and lifting feel light and easy. You want to move because it's such a pleasure to move. You enjoy being out and about, enjoy sports. To have a body and to use it is beautiful. It's what we want and need to do.

You Know What You Need and What You Stand For

If you have a strong back, you have a strong sense of your own needs and you stand up for yourself. You are more resilient than someone with a weak or painful back and less likely to submit to work that is beyond your capacity, or that is likely to injure you. Perhaps this is behind the English language's use of the word “spineless” to mean cowardly or easily swayed.

A Good Back Has Great Stamina and Responds Well to Stress

You have enormous stamina, whether it's for physical activity or for getting the annual report written by Monday. When you have to work hard, the capacity is there. You respond well to stress. But you also know your limits: people with strong backs rarely allow themselves to be injured by overworking.

A Good Back is a Good Breather

You can breathe without effort. If your spine is free, strong and flexible, so is your breathing. Your voice will be rich and won't tire easily. (Think of a baby—babies have very good backs, and they use their voices to the limit!—and think how often you've heard a baby get hoarse.)

A Good Back is Creative and Energetic, a Good Learner

When you use your back well, you're creative and playful, you learn well. Playfulness comes about because you trust your own sense of balance and can move further from your centre of gravity or your comfort zone without feeling disturbed. Balance comes from a good head-neck-back relationship and gives you confidence in your ability to try something new. You know you will not be unbalanced by new experiences.

A Good Back Is Interested and Curious

Your eyes are bright and alert. With a good strong back you don't stagnate or get bored. You're acutely aware of and curious about your surroundings. As my own back strengthened and recovered and I used it better, I began to notice how much fun it was even standing at a bus stop. Standing is fascinating, whether it's listening to and enjoying the subtleties of your own body, or watching and listening to everything around you.

A Good Back Means Better Digestion

If your back's strong, you will tend to have good digestion. Look at the picture to the right. If I told you that many people with lower back pain have digestive problems too, would you find that hard to believe? And when something changes in your lower back during an Alexander Technique lesson, stomach rumbling is extremely common.

A Good Back is Playful, Carefree and Strong

If your back's strong you can play with your children, throw them up over your head without effort and without pain. As my friend discovered, a bad back doesn't like being bounced on, climbed on or a boisterous five-year-old suddenly launching himself at you. A good back laughs it off.

A Good Back is Good for Birthing and Parenting

You can give birth, not without pain, but with greater ease and without injury. One reason is that, if you're free, flexible and strong in your lower back, it allows your sacrum and tailbone (coccyx) to move out of the baby's way during birth (some birth stories here.) For both men and women, the benefits to parents are obvious: being able to lift your children, throw them around, be jumped on and join in their activities like football, tree climbing, creeping into small spaces. And let's not forget simply coping with non-stop activity from morning til night.

A Good Back Reduces Injuries

You are less likely to injure yourself. If you have a strong, flexible back you will be less tense and breakable elsewhere in your body. You'll feel more confident roughing and tumbling. You'll be less subject to repetitive strain injuries because your back is the solid ground out of which your arms and legs grow and they can stay loose and supple. Here's a video of a musician with a beautiful spine, the pianist Artur Rubinstein. Because his spine is strong, see how little effort there is in his hands and arms as he plays.

A Good Back Often Goes With Self-Respect

You have respect for yourself and your many abilities. There's a sense of wonder at how dependable, how flexible, how powerful and intelligent your body is. An intelligent body is organised around an intelligent spine.

Conclusion

Back pain is extremely common in Australia and other western countries. Many people put up with painful backs because they don't understand that a good back is something you learn, not something you're (usually) born with. Spines have the intelligence to heal beautifully if they're given the smallest chance. The Alexander Technique aims to give a person's spine the chance to recover and take an active, robust part in their lives again.