Fixing Back Pain Permanently

Chronic back pain is incredibly limiting, and is more and more common—even with younger people. I've kept a short guide to solving back pain issues for a couple years, and a friend requested that I publish this publicly. Around 80% of people who have used this guide have told me that it fixed their issues permanently. Since publishing this here, several dozen people have emailed me saying this was the thing that helped them find a back pain solution. In February 2024, I slightly revised this to be more clear and add one more recommendation.

This is a sort of maximalist approach to fixing back pain issues: I don't have my own one-weird-trick protocol. Instead, I point you to several resources that are exceedingly effective. This guide is unusual in that it's agnostic about what's actually causing your pain, and thus what the fixes may be. The resources here all have very different models of back pain, and I have no idea which is correct. Each of them has been the key for someone that has used this guide, so I keep them all here. You may need to try all before you know which will work best for you.

First, a pitch: if you have chronic back pain (not from a known injury), consider trying to fix it. This seems obvious, but many people live their lives with chronic pain, feeling helpless. The ideas here have worked on people just like you, and taking the small bit of effort to fix chronic pain will massively improve your quality of life.

If you look around online, you'll find many very different methods that people claim work. The secret seems to me that different methods work for different people, and you should try several before giving up. These method are all low-risk and safe, assuming you're otherwise healthy. If you have pain caused by—oh, I don't know—an acute injury, don't rely on guides on the internet. Listen to yourself and talk to someone more qualified then me. That said, most back pain can be fixed with the approaches I list here without surgery or intense physical therapy. Use your best judgment.

Read the book, pain goes away

My single best recommendation is Healing Back Pain: The Mind-Body Connection, because it is the easiest — no stretching, surgery, or workouts. Read the book, and for many people, their pain is gone. In fact, I know someone who's back pain was fixed by reading the Amazon reviews. The proposed mechanism, in short, is that your pain could have started by an injury or similar, but is chronic as a somatic expression of emotional distress. This does not mean the pain is "in your head"; the pain is very real. But just like you can have an upset stomach when you're nervous, Healing Back Pain (which works on all sorts of pain, including RSI) models the most common back pain as a similar manifestation. Yes, it sounds far fetched, but this has been the most successful route, so I do recommend that you try it. Patterns of people who this has worked especially well for: people who often feel stress in their bodies, and people without an existing somatic-release practice (such as yoga, meditation).

Mobility training + posture re-wiring

Another popular mechanism of back pain is that we sit all day, so we have under-developed muscles, which get strained over time by needing to act in non-optimal ways. This approach is a non-targeted approach, in that it offers highly effective generalized back-strengthening exercises, coupled with posture techniques. This recommendation comes next because it's simple, and exceedingly effective.

The exercise is this video:

This is a re-make of an older version; they're similar (for me, the newer version is easier). The workout is 12 minutes, and unless you're quite fit already, will be a challenge. It's fantastic at opening up your movement and mobility, even if you have no pain. If you need inspiration, read the YouTube comments. This workout works.

Additionally, with your stronger core and back, this approach benefits from re-wiring the movement patterns you're used to. Under this model, your weaker back promotes suboptimal ways of movement, which should also be corrected. There's a few options here. The first, to give you an idea of what I'm talking about, is this video:

The best approach I've found that directly addresses this is the Feldenkrais Method. This series is quite good:

(Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8)

The core ideas:

1. Use your skeleton to support weight, not muscle
2. Move from the hips! Less back bending
3. Use gravity to your advantage
4. The core is about stability, transmitting force
5. Distribute weight/force evenly

Importantly, addressing these points involves changing how you move. It takes cognitive awareness and practice.

Another approach is unrelated to posture, per se, and more related to effortlessness. Your skeletal system can nearly effortlessly support your body, without needing to "strain" towards good posture. (This perspective is core to the Feldenkrais Method as well.) The Alexander Technique is an incredibly effective approach to re-wiring how your body sits and moves through space. It's usually taught with a teacher, but if none is available, Michael Ashcroft's course Expanding Awareness is very good.

A mechanistic, targeted stretching program

Your issue may be quite targeted in a way that a generic mobility exercise may not address. This route is the most work, but for people where the previous methods didn't help, may be the solution.

Treat Your Own Back is the best resource of this variety. It has a clear mechanism for chronic back pain, with prescribed stretches to address the underlying issues. 8 Steps to a Pain-Free Back is similar, and also quite good. You will learn movement patterns that a (good) physical therapist would teach. Read the reviews if you want inspiration; this approach has helped many thousands of people.

The wildcard: targeted intensity

This approach involves sending very intense neurological signals in the problematic area — basically, causing intense stimulation. The low-tech route is to lay on an acupressure mat. For me, within 1-2 days of 10-15 minutes twice a day does the trick. If you want more intensity, consider this one.

Several readers recommended using a TENS unit, which provides rapid waves of electrostimulation that cause the muscles to tense and release involuntarily. From my brief survey, these TENS units may be more effective than the spike mats, so it's certainly worth trying. Don't bother getting an expensive one: the cheaper ones work just as well.

I only have vague guesses about the mechanisms: something about promoting blood flow locally, getting muscles to release, etc. I personally think it feels great—in a cold plunge sort of way—but not everyone agrees. It's a wildcard because this method has never fixed longer term back pain from anyone I know, though the Amazon reviews have plenty of people who it did help. My suspicion is that it doesn't fix the root issue, and works best if you have occasional flare ups.

Expert Intervention

When I published this guide in early 2023, I focused on DIY approaches. It's now early 2024, and I've continued to confirm that these work, as evidenced by all the kind people who have sent me messages about their success. However, I think there's room for tailored approaches from experts. Fixing chronic pain meaningfully changes the quality of your life.

The variance of skill in physical therapy is massive. This is frustrating because most patients can't evaluate the skill of their physical therapist. The median physical therapist may do literally nothing for you, and the best may entirely and permanently fix your problem. He doesn't know I'm sending people his way, but if you want someone to talk to who I know is top decile in skill and outcome, reach out to Sam Martin at Move Better Project. He offers cost-effective programs that are tailored to your needs, and the results I've seen from his work is astounding.

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That's it. I've ordered the approaches in the order that I'd consider them to fix chronic back pain. One more helpful resource is my internet friend Max Langenkamp's Exploring and Dissolving Chronic Pain.

​Max Langenkamp suffered from chronic wrist pain. He tried physical therapy to no avail. Finally, he was able to resolve his pain completely by using the science of pain via (John Sarno, Lorimer Moseley, Fan Wang, and others). Max was able to resolve his pain without surgery or any invasive interventions.
Max was not unique. There are 600 million people who suffer from non-specific lower back pain. Max thinks that most of this pain could be resolved through non-invasive, short-term interventions.

Disclaimer: if you don't have chronic back pain (i.e., you just injured yourself), I doubt any of these will help. You probably just need to heal. And none of this is medical advice, of course. Please make good decisions about health issues.