They hurt their back bending over to pick something up. They see one clinician and get told to avoid bending, keep their back straight, and take it easy for a while.

Then the pain hangs around.

So they see someone else, and that person tells them the first advice was terrible. Your spine is designed to bend. Avoiding movement creates fear. Fear keeps pain going. You need to move more, not less.

That second clinician can sound very convincing. And often, a lot of what they are saying is true.

So you start bending again.

Then it hurts.

You flare up. You feel like you have gone backwards. And when you ask about it, you get told something like, “That’s normal. Recovery is not linear.”

Sometimes that is true as well.

But sometimes it is a sign that the advice still does not fit the person in front of you.

That is the danger of general back pain advice. It can be true in a broad sense and still wrong for the individual.

Yes, spines are designed to bend

Spines are absolutely designed to bend.

The stacked vertebrae, discs, joints, ligaments, and muscles of the spine allow us to do a ridiculous range of things. Some people can pick up huge amounts of weight and hold it overhead, supporting an insane amount of load like a steel pylon holding up a bridge. Others can fold themselves into positions that make most of us wonder how they have not snapped in half.

The spine is not a fragile stack of blocks that falls apart the moment it rounds.

But capacity matters.

A powerlifter’s spine may be able to tolerate huge loads in one season of life, and not tolerate the same load after an injury. That does not mean the spine was never designed to bear load. It means something has changed, and the plan needs to account for that.

For a healthy, well-adapted spine, bending is normal. It is necessary. It is part of being human.

This point matters because a lot of people with back pain become scared of normal movement. They are told to keep neutral, brace, avoid bending, protect the spine, and be careful with every little task. Over time, that can turn the back into something they monitor all day.

That is not a good place to live.

People should not be made afraid of every rounded-back movement. They should not be taught that their spine is damaged because it hurts when they bend. They should not leave an appointment thinking they need to move like a robot for the rest of their life.

But that is only one side of the problem.

“Designed to bend” is not a treatment plan

A structure can be designed for a movement and still lose capacity for that movement for a period of time.

An ankle is designed to walk on. But if you have just rolled it badly and torn a ligament, “ankles are designed for walking” is not the whole plan.

You still need to respect the fact that the tissue is irritated. You might use crutches for a few days. You might change how much load you put through it. Then, as it settles, you gradually build walking back up.

The spine is not exactly the same as an ankle, but the principle is similar.

If someone has a back pain pattern that is reliably aggravated by repeated bending, loaded bending, long sitting, coughing, sneezing, and picking things up from the floor, then bending may be part of the problem for that person at that time.

That does not mean bending is bad forever, or that their spine is fragile, or that they should never round their back again.

It means the advice needs to match the stage they are in. The question is not whether the spine is designed to bend. It is whether this person’s back currently has the capacity for the amount, type, and timing of bending they are asking from it.

Telling someone with a bending-sensitive pattern that their spine is designed to bend may be reassuring, but it is not enough. It does not tell them what to do tomorrow morning when putting on socks hurts. It does not tell them whether sitting is helping or aggravating them. It does not tell them how to pick up their child without setting off another flare.

Reassurance is useful. But reassurance without a plan can leave people stuck.

Time alone does not prove the tissue has recovered

A common assumption in back pain is that if enough time has passed, the tissue should be healed.

Maybe it should be.

But how do we know?

If someone hurt their back bending under load, then spent the next three months sitting all day at work, flaring it every time they picked up their kids, and repeatedly provoking the same pain with the same movement, it is a bit strange to assume the original mechanism no longer matters.

Everyone accepts that bending and lifting could have contributed to the original injury. But a few months later, when bending and lifting still reproduce the same symptoms, the explanation often changes completely.

Now the explanation becomes fear, deconditioning, or a nervous system that has stayed sensitive.

Those things can be real. They matter. But they can also become a convenient way to skip the question in front of us.

The point is not that these explanations are wrong. It is that they should not replace looking at what the pain is still doing.

Does the pattern still fit?

If bending under load remains a reliable, specific, repeatable trigger, it deserves to be taken seriously. It may be telling you something about the current capacity of the tissues involved. Not a permanent label. Not a reason to panic. Just a useful clue.

The answer might still be to gradually reintroduce bending. In many cases, that is exactly the goal.

But the dose, timing, and starting point matter.

The same advice can help one person and hurt another

This is where broad back pain advice falls apart.

One person may have a flexion-sensitive pattern where repeated bending and long sitting are still the main aggravators. Telling them to stop worrying and bend more may miss the mark.

Someone else may have pain that has nothing to do with bending. They may be more irritated by standing, walking downhill, arching backwards, or lying flat. If you tell that person to keep their back straight all day, you might actually push them further into the positions that aggravate them.

And then there is the person who has avoided movement for months. Maybe the original injury has settled, but now they are guarded, deconditioned, low on confidence, and reacting to almost everything. That person probably does need to bend more. Not because “bending is always good,” but because avoiding it has become part of the problem.

The advice changes because the pattern changes.

That is the part that often gets lost online. People argue about whether bending is good or bad as if there is one answer. There isn’t.

The better question is:

What happens when this person bends?

Does it hurt during the movement, after the movement, or the next morning? Does sitting make it worse? Does walking ease it? Does coughing or sneezing produce the same pain? Are there leg symptoms? Is there numbness, tingling, or weakness? Has the pattern changed over time? What have they already tried, and what happened?

Details matter more than a slogan.

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What to do instead

Replace broad rules with assessment.

Not a vague assessment where someone says “your glutes are weak” after watching two squats. A useful assessment should look at the actual behaviour of the pain.

What reliably aggravates it?

What reliably settles it?

Which movements are neutral?

Which positions give relief?

What has changed since the first flare?

What does the person actually need to get back to?

I am simplifying. A thorough assessment can involve many things. But the point is once you know the details the advice becomes more specific and individualised and less ideological.

For some people, the first step may be temporarily reducing loaded bending and changing how they sit during the day.

For others, it is the opposite. They have avoided flexion for too long and need to start getting it back.

Someone else may need to get out of excessive extension and learn that rounding their back is not the enemy. And sometimes the right next step is a medical review, because the symptoms do not fit a simple mechanical pattern.

Especially if there is progressive leg weakness, numbness around the saddle area, or changes to bladder or bowel control. Those need prompt medical review, not a self-managed plan.

This is why “your spine is designed to bend” is both true and incomplete.

Your spine is designed to bend.

But your current back pain still has a pattern.

And until you understand that pattern, it is very hard to know which advice belongs to you.

Have you been given completely opposite advice about the same back problem? I’d be interested to hear what you were told, and what actually happened when you tried it.

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If you are trying to work out your own pattern

This is exactly the problem the SpineScribe assessment is built around.

It is not there to tell everyone with back pain the same thing. It asks about your symptoms, triggers, history, aggravating movements, relieving positions, and goals, then turns those answers into a written report that explains what your pattern seems to suggest and what to consider next.

If you are stuck between conflicting advice and want help making sense of which parts apply to your own back, you can start here:

Start the 20-minute SpineScribe assessment

Do I need a New Mattress?

A new mattress isn't necessary or likely to be of benefit to everyone experiencing back pain. Perhaps the best indication that it may be worth getting a new mattress is if your pain is worse first thing in the morning.

If you tend to wake up feeling ok and your pain progressively increases throughout the day, it's unlikely your mattress is playing a significant role in your pain.

However, if the morning is a bad time and you tend to wake up feeling worse than when you first laid down at night, your bed may very well be playing a substantial role in your pain.

Firm Vs. Soft

I'm not sure where the firm mattress for back pain advice comes from. Let me know if you have received this advice and if there was any particular reason for it that was given to you.

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Like all things back pain, there is no one size fits all solution. Variations in things like injuries, pain mechanisms, genetics, body size mean that no one mattress (or style of mattress) is suited for everyone.

However, there is one general trend we can look to help identify whether a firm or soft mattress is likely to be better for you:

Do you have a curvier or a flatter profile?

Those who are more curvy, and have a larger lordosis curve in their lower back, tend to do better with a softer mattress. This allows their hips and shoulder to "sink" into the mattress which then better supports the curvature of their spine.

When a curvier person lies on a firm mattress, there lower back is often less supported leading to increased strain with may provoke various pain mechanisms and lead to not feeling so great first thing in the morning.

In contrast to this, those with smaller curves and flatter spines which have less of a lordosis curve tend to be well-supported by a firm mattress.

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Choosing A Mattress

Unfortunately I don't have any magic brand to recommend that is an ideal choice for those with back pain. I do have a few tips however to help you avoid wasting money and increasing your chance of making a successful purchase when researching what's available to you wherever you happen to live.

No Questions Asked Return Period

Consumer regulation laws vary wildly depending on where you live. Doing your due diligence in whatever capacity you can is worthwhile so that if you do happen to make a mattress purchase that isn't right for you, it can be returned without incurring a significant financial loss. A lot of brands these days in many parts of the world do offer no questions asked return period, which is ideal if it's available to you.

Adjustable Mattresses

If you don't have the luxury of returning whatever mattress you purchase or trying multiple out, buying a mattress the is made up of multiple layers that can be rearranged is another great option. Then you have the ability to rearrange the layers yourself and find the combination that suits you best. If that soft memory foam layer on top that sounded so appealing ends up being a nightmare, no problem, just rearrange the layers and place a firmer layer on top instead.

If you made a successful mattress change or had a positive experience with a particular brand, share your story in the comments to let other back pained individuals know about it.

Frequently Asked Questions

How do I know if my mattress is causing my back pain?
The clearest sign is if your pain is consistently worst first thing in the morning — worse than when you went to bed the night before. If you wake up feeling worse and gradually improve throughout the day, your sleep surface is likely contributing to your pain. On the other hand, if you wake up feeling reasonably ok and your pain builds through the day, your mattress is probably not the main culprit.

Is a firmer mattress always better for back pain?
No — this is one of the most common pieces of back pain advice that doesn’t hold up for everyone. The right firmness depends on your body shape. People with more pronounced spinal curves (larger lumbar lordosis) often do better with a softer mattress that allows the hips and shoulders to sink in and supports the curve. People with a flatter spinal profile generally do better on a firmer surface. One size genuinely does not fit all.

What mattress firmness is best for side sleepers with back pain?
Side sleepers are typically better served by a softer to medium mattress. When lying on your side, your shoulder and hip need to sink into the mattress to keep your spine in a neutral alignment. A mattress that’s too firm won’t accommodate this, which can create lateral stress through the spine overnight.

Is it worth buying an expensive mattress for back pain?
Not necessarily — price alone isn’t a reliable indicator of suitability for your back. What matters most is how well the mattress suits your specific body shape and sleep position. The most important buying consideration is finding a retailer that offers a no-questions-asked return period, or choosing an adjustable layered mattress, so you can trial it and return it if it doesn’t work for you without financial loss.

• Why stretching seems to help some and not others.

• Why stretching can make you worse.

• Why stretching is usually a bad idea for those with sciatica.

• How to assess if you should avoid stretching.

If you have found this article, I'm sure you have also come across a myriad of other sciatica related articles online. Many of these probably mention a particular stretch that is supposed to "treat" your "sciatica".

Check out this article to find out why I am using the quotation marks above.

A small proportion of you reading this will have had great success with these stretches.

For many of you, stretching may have seemed to help a little initially but doesn't seem to improve things in the long run.

For the remainder of you, any attempt to perform these stretches quickly stirs up your symptoms and you just can't find any way to stretch without it causing more problems that it solves.

For the overwhelming majority of sciatica sufferers, stretching is more likely to be harmful than helpful. Lets breakdown each of the above scenarios to understand why.

1. The Therapeutic Stretchers

If you suffer from sciatica and have found stretching has provided you with lasting relief that has contributed to long term improved therapeutic outcomes, you are in the minority. An overwhelming minority in fact.

If this is you, I would wager a guess that your sciatica has little to do with any issue in your spine. For many of you, your sciatica may have been caused by an issue known as piriformis syndrome. And more specifically, piriformis syndrome caused by an overly tight piriformis muscle. However, this is a rare condition that is often misdiagnosed.

If you have had great success in treating sciatica with a stretch that targeted something other than your piriformis, I would love to hear about it.

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2. Temporary Relief...Maybe?

Stretching is commonly promoted as a generally healthful practice. Due to these preconceptions, many people suffering from various injuries are under the belief that they should definitely be stretching to help their recovery. This is often the case when people develop sciatica.

Unfortunately, as I have already indicated, stretching is not always the answer. And sometimes it's counterproductive.

Why is it then so common for people with sciatica to be told they should stretch?

Well, there are a couple of reasons. The second of which I will get to later. The first however, can often create a vicious feedback in which our own actions keep us sensitized and in pain.

Our 'stretch reflex' is responsible for giving us the false feedback that stretching is providing us with benefit. While in fact a lot of the time, it is actually increasing our pain sensitivity.

The stretch reflex refers to an increase in neurological activity that occurs in response to a muscle being stretched. This feeds back to the muscles causing them to contract. This contraction prevents our muscles from over-stretching beyond their limits and causing damage like leading to a joint hyperextending for example.

However, it also has an analgesic (pain relieving) effect as it dulls the pain signal temporarily. This may seem like a good thing, however we commonly stretch into postures that actually aggravate lumbar spine pathologies and dull the signal telling us we shouldn't be doing it. It provides a false feedback loop in which the temporary pain relief encourages us to stretch more, only to further irritate our injury making us feel we need to stretch again

So if stretching seems to provide you with only temporary relief and you find your symptoms return just as bad (or worse) once the effects of this reflex have worn off, this is the reason.

But why oh why does it feel it like I need to stretch so badly? Why do my muscles feel so tight!

Our next subgroup will make this phenomenon clear.

3. The Painful Stretchers

Now for the group that can't handle stretching at all. They often feel a sensation of tightness somewhere along the sciatic nerves distribution (back, butt, hamstrings, calves, etc). But quickly discover that stretching causes more tension and pain and only serves to wind up their symptoms.

The reason this occurs is the same reason the overwhelming majority of sciatica sufferers do not benefit from the stretches they often think they require.

The feeling of "tightness" you experience in your legs, is not muscular tension at all, but rather increased “neural tension”.

Understanding neural tension is the key to overcoming the false pre-conceptions hoisted on your by the industry as well the unfortunate idiosyncrasy of our bodies own systems providing you with the false feedback that something harmful is actually helpful.

So that feeling of tightness is not in the muscle at all. It's in the sciatic nerve itself. When you stretch a muscle along the sciatic nerve's distribution, you're not only stretching the muscle, you also stretch the sciatic nerve.

When the sciatic nerve is irritated as a result of an injury in the lumbar spine, stretching and tensioning it only serves to further irritate it. Additionally, stretching the muscles in your leg usually does nothing to solve the injury in your spine that is creating these symptoms in the first place.

Those sciatica sufferers with very wound up and irritated sciatic nerves often can't handle any amount of additional tension on the sciatic nerve. Pushing through the pain to perhaps receive some temporary relief from activating the stretch reflex can become too painful to even attempt.

This group is the "canary in the coal mine" for those with less significant neural tension issues. Let this group be the clear example of why you shouldn't be stretching an irritated sciatic nerve.

One Time Donation

So, how do you know if your problem is neural tension or muscular tightness?

Well, if you have sciatica the odds are in favor of neural tension being your problem. Regardless, I am going to describe the assessment I use to distinguish if neural tension or muscular tightness is the issue.

(You will need a partner to help you with this one).

Read more

You may closely identify with the following example, or you may not. Regardless, my aim with sharing the following is to provide back pain sufferers with some hope that more than likely your symptoms and quality of life can improve substantially (and it's often not as complicated as it seems).

I recently received a referral for an older man, a veteran, with a history of lower back pain and decreasing leg strength who had begun using a walker to mobilise over longer distances.

If you are experienced in treating back pain, this referral tells you a lot. From this little piece of background, there is one diagnosis that stands out as the likely cause of this man's pain.

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An older man with lower back pain that relies on a walker to mobilise longer distances more often than not has pain caused by stenosis (probably resulting from arthritic changes).

The assessment with this man further confirmed my suspicion. He was able to walk about 50 metres before back pain began to develop. If he continued to walk the pain would get worse. If he stopped and sat down the pain would resolve quite quickly and he could get up and walk another 50 metres. When he used a walker his capacity to walk longer distances was much improved. He also had some occasional radiating pain into his hips and thighs.

This is a classic stenosis presentation. And it stands out like a sore thumb to a therapist who is at least a little bit expertised in treating back pain.

He had a relatively recent MRI report with him, with quite typical changes for a man his age. Nothing that would stand out as a particularly remarkable or of major concern. One finding that was relevant to me was the bilateral foraminal narrowing at L5-S1. This stood out as the likely cause of his pain, as it was a perfect match for his symptoms.

The unfortunate thing about this story is that this man, like many other back pain sufferers, had all but given up on improving his back pain. His main concern was that his legs were getting weaker now that he was relying on the walker to get around, and he wanted help to stay strong and functional so he doesn't struggle to get out of chairs and is able to get up and down from the floor.

The reason he had given up on his back pain is because no one had given him any indication that they understood what was causing his pain or provided treatment to him of any value.

He had seen previous PT's who simply performed some manual therapy (he described massage), which may have felt nice at the time, only for him to walk out the door and be back in the same pain by the time he reached the car.

This PT had no idea what was causing this man's pain and unfortunately probably didn't even bother to try and understand it.

I want to share how stupidly simple it was to make a meaningful difference in this man's life, simply by having an informed indication of what was causing his pain.

The first "treatment" I provided to this man, was simply to tell him to walk with a purpose.

A few additional cues so you understand what I mean by this:

• "swing your arms from your shoulders"

• "take longer strides"

• "take faster steps"

• "pick up the feet and lift your knees a little"

This very simply is just walking like you have someplace to be.

Guess what happened?

He walked 168 metres before his back started to hurt. He said he hadn't walked that far in years.

How ridiculous is that?! He just tripled the distance he has been limited to for years. And while 168 metres may not sound like a lot. This simple change makes an enormous difference to this man's life.

He can now go into the grocery store and buy some milk and bread without pain.
He can park the car down the road and walk to the café with his wife without pain.
He can engage in the community, in things outside his own home, without pain.
And he no longer needs to lug a walking frame around with him to do any of these things.

Now that he no longer relies on the walker as much, the declining leg strength he has been concerned about will start to improve again. This will stave off a decline in function that was hurdling him towards a fall in his own home, in which he wouldn't have had the strength to get himself back up. He will likely live a longer, happier and more functional life as a result of something so stupidly simple.

And the benefits of this to his condition are compounding. Walking alone for many with stenosis related pain is therapeutic. The more he walks in tolerable amounts, the more likely his pain will lessen and his capacity to walk even further distances will improve into the future.

I know many of you are perplexed by your pain, leaving you feeling hopeless about your chances of recovery.

What I often try to encourage in discussions with people online, is to find a therapist that makes it simple.

Back pain is complicated. Spines are complicated.

But if the therapist understands what is likely causing your pain and what should be done about it, it won't seem overly obtuse and complicated. They should answer your questions clearly and leave you confident in the actions they want you to take.

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So, naturally, there is a wealth of information available to educate people about the condition and provide helpful advice and treatments.

Sounds great, right...?

WRONG!

Unfortunately, these commonly praised "sciatica treatments" are often useless at best. Trying to understand and treat "sciatica" often just leads to more confusion.

Let me explain.

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One of the big issues in understanding and effectively treating back pain is that it is such a non-homogeneous diagnosis.

While we tend to broadly refer to it as "back pain" and say things like "I've got a bad back", what that means can vary greatly.

There is a variety of conditions and injuries that can cause back pain. They can occur in different locations in the spine, cause pain through different mechanisms and overall have different effects on your life and function. In some cases, back pain may not be caused by an issue in the back or spine at all!

As a result, the best way to treat your back pain may be completely different to the best way to treat someone else's. This often makes it horribly confusing for someone who has developed back pain and is trying to figure out what the hell is going on and what they should do about it.

Sciatica suffers from these same problems.

Sciatica is not a diagnosis; it's a symptom.

We need stop diagnosing people with sciatica. Sciatica is not a diagnosis; it's a symptom. We need to diagnose the cause of this symptom, not the symptom itself.

This is like your Doctor diagnosing you with a fever.

Imagine going to see your Doctor because you are feeling unwell, and they diagnose you with a fever. You would be thinking, "NO SH*T SHERLOCK... What's causing it!? What should I do about it!?"

Is it an infection? Do I need antibiotics, or is it viral? Should I medicate the fever, or let it run its course?
And so on...

Beginning to see how insane this is? It's no wonder people with sciatica struggle to get relief.

We need to identify the cause of the sciatica.

I continue to be shocked and disheartened as I repeatedly encounter concerned people that are told they have sciatica and are terrified about what this may mean. There is so much baggage associated with the term now that it has become such a confusing mess, particularly for people who may have just developed this pain for the first time.

I regularly read and hear things like:

The equation in their heads seems to go something like: sciatica = permanent, incurable nerve damage and pain.

Sciatica does not mean any of these things. The only thing it refers to is radiating pain felt in the sciatic nerve.

While this pain is commonly caused by a lower back injury (such as a disc bulge), it isn't always. And the overwhelming majority of sciatica causes are very treatable without major intervention or lifelong pain and disability.

There is a big difference between telling someone:

1. You have sciatica... caused by severe spine cord compression that could lead to permanent loss of function if we don't operate immediately, and,

2. you have sciatica... caused by mild disc bulge, take it easy and it will probably resolve itself in 8 weeks or so.

This is just a ridiculous situation to be putting clients and patients in, and I believe it initially stems from diagnosing people with something that isn't a diagnosis.

Frequently Asked Questions

What is sciatica, exactly?

Sciatica means pain travelling along the sciatic nerve pathway, usually from the lower back or buttock down the back of the leg, and sometimes into the foot. It describes where the pain goes. It does not explain why the nerve is irritated. That is why treating “sciatica” as the diagnosis often leads people in circles.

What are the most common causes of sciatica?

The most common cause is irritation of one of the lumbar nerve roots that forms the sciatic nerve. A disc bulge or herniation at L4-L5 or L5-S1 is a common example. Other possibilities include spinal stenosis, facet-related irritation, and less commonly, piriformis syndrome. The right treatment depends on which structure is involved and what is aggravating it.

Does sciatica go away on its own?

Often, yes, especially when the cause is a disc irritation that is given time to settle. Load management, movement modification, and avoiding repeated aggravation can make a big difference. If symptoms are worsening, spreading, or associated with weakness, numbness in the saddle area, or bladder or bowel changes, get medical advice promptly.

Is sciatica the same as a pinched nerve?

They overlap, but they are not quite the same. “Pinched nerve” is a broad term for a nerve being compressed or irritated. Sciatica refers specifically to symptoms along the sciatic nerve pathway, or the lumbar nerve roots that feed into it. It is a more useful description than a diagnosis, but it still leaves the main question unanswered: what is irritating the nerve?

There are many mechanisms by which an activity can lead to back pain, and writers are very susceptible to one of these.

The most common mechanism by which writers (and desk workers in general) develop back pain is through spending too much time in prolonged postures.

Prolonged slouched sitting in particular is a significant driver of disc injuries — the most common structural cause of back pain.

First, let's get something clear...

There is no perfect posture.

Every posture has its upsides and its downsides. Every posture is placing more stress on certain tissues and structures compared to others.

When we feel the need to move or adjust our posture, this is our bodies' way of telling us that certain tissues have had enough and it's time to make someone else pick up the slack for a while.

You may have already spent hours building out the ergonomic setup of your dreams. While I am certainly not suggesting that was wasted effort, sitting even in a “perfect” posture for a long enough period of time will eventually lead to stress concentrations in certain tissues.

Don't believe me? Give it a go. Force yourself to remain in that one “perfect” posture for as long as you can. Eventually you will start to develop pain somewhere as a result of the stress this prolonged posture is placing on certain tissues.

So how do we avoid back pain as writers?

We need to implement strategies that regularly migrate these stress concentrations so we can avoid over-stressing particular tissues in ways that lead to injuries and pain.

After all, how effectively will you be able to follow your passion if every time you sit down to write you're in agony?

If you can't look after your own health and happiness, your writing will be good to no one.

My Top 3 Strategies to Avoid Back Pain as a Writer

Back pained writers sometimes find themselves at a bit of an impasse.

You work hard to develop the ability to get into a flow state with your writing, with a true flow state involving a total loss of your sense of time. Hours pass as your mind and fingers meld in a beautiful and friction-less symbiotic relationship.

You have probably had an experience where you suddenly notice the room getting a littler darker. You look outside and realise the sun is setting. The entire afternoon passed by in an instant and you didn't even consider if you needed to eat...drink...use the bathroom...or MOVE.

This is a beautiful experience and if I were to suggest you avoid it, you would probably stop reading this immediately. So I am not going to do that. And I hope you are not experiencing some significant back pain issue that prevents you from having some long writing sessions like this.

I will suggest however, that when not in a flow state you should implement a regular practice of the following strategies. Doing so would enhance your capacity to sit for a long period of time when you actually do get into a flow state!

So take care of your body, keeping it healthy and capable so you can make use of it when you need it.

1. Motion is Lotion

Nothing beats regular movement to support our health in a myriad of ways, including mitigating physical stress concentrations and keeping our spines happy.

It doesn't need to be complicated. Walking is a core component of my treatment for almost every back pained client I see.

Walking is very therapeutic to our spines, which shouldn't be surprising really. It may perhaps be the most fundamental physical activity we perform. It might be the one activity we are the most optimised for. It certainly is not up for debate that it is almost always a beneficial activity for us to perform.

Take regular breaks from your writing to go for a walk. Make walking a default activity you turn to when you need to step away. Whenever you hit a mental block and want to give yourself a break, go for a walk! Even a few minutes at a time can go a long way.

2. Do the Opposite

Writing usually involves a lot flexion (forward bending) or ‘hunched’ postures. In fact, even if you think you are sitting with good posture, the bottom of our lumbosacral spine is essentially always in some amount of flexion when sitting in a conventional chair.

Remember, spend enough time in any one posture and eventually it will cause you problems. We can mitigate the issues of prolonged flexion postures in our spine by taking purposeful breaks to do the opposite. That is, to extend our spines.

An effective strategy that is used when improving the safety of workplaces that involve a lot of manual labour is to develop systems that break activities up and avoid a worker performing repeated movements and postures.

This is sometimes something as simple as switching from performing X task for 2 hours then Y task for 2 hours, to performming X for 1, Y for 1, X for 1, Y for 1 instead. I am obviously leaving out plenty of nuances here in workplace health and safety, but you get the concept. Simple changes like this can often greatly reduce the risk of an injury occurring.

While writing may not be as physically demanding as manual labour, it does still come with physical risks. So we should mitigate them in just the same way.

My favourite option for a writer is to make use of the following standing extension stretch every 20 or 30 minutes. Here's how to do it:

1. Stand up and raise your arms over your head. Hold them there for 10 seconds.

2. Then extend your arms further back and push your palms up toward the ceiling. Hold this for another 10 seconds.

3. While keeping your arms pressing up to the sky, extend your neck to also look up towards the ceiling. Hold this for a final 10 seconds.

Take a deep breath and feel your chest and rib cage lift. Then exhale, lower your arms and allow your body to relax into a nice upright posture.

This simple 30-second strategy helps to extend and decompress your spine. It "neutralises” some of the stress certain structures were experiencing from the prolonged flexion posture you have been in.

One Time Donation

3. Regular Posture Alterations

The core concept remains the same here. You are probably beginning to get a good grasp on the importance of changing our posture regularly. Let's just add some specific strategies to make it more intentional.

Standing desks are great, but most don't know the real reason why. I hope you now know having read this far into the article.

It isn't that standing is somehow magically better for your health than sitting. Too much of either can potentially lead to problems. But in particular, having a standing desk that moves up and down and promotes you to alter your posture more regularly throughout the day is a huge boost for many in supporting their spine health.

A chair can funnily enough be used for the same purpose. Not every chair, but some. Many ergonomic chairs have functions to change various adjustments like seat depth, lumbar support, seat tilt, back tilt, etc.

These adjustments are helpful to find the posture you feel most comfortable in, sure. But remember, that “perfect” posture isn't going to stay perfect forever. So don't feel bad about mixing it up throughout the day and playing around with these adjustments. These chairs allow you to significantly vary your posture while still remaining supported.

Remember, you’re a writer! Take these principles and use your creativity to apply them to your life, your body and your routine. You should be empowered to design health practices that support your career.

Here’s my personal prescription to get you started:

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For some, this will come from the suggestion of a PT that this may be the cause of your pain. For others, it may the result of you conducting your own online research and stumbling across a post about SIJ that sounds very similar to your experience.

Regardless, most who begin to investigate the idea of SIJ related pain will quickly be overwhelmed with the myriad of opinions on the topic.

Some people will tell you SIJ pain is so rare you probably shouldn't even worry about it. Others may suggest there is no way for you to know if SIJ is even causing your pain. And then there are those that believe SIJ dysfunction is a common cause of back pain and their brand of treatment, whether it be exercise, massage, manipulation or something else, will be the cure to your problems.

You will likely begin to wonder things like: Is SIJ pain even a real thing? How do I found out if SIJ is the cause of my pain? Is it one of many things causing my pain? What do I even do about it? Is it treatable? Should I see a PT, Chiro, Neurologist or someone else? Is there a simple exercise to help with this?

This article aims to demystify the confusion around SIJ related pain. I want to help you understand what we know (and what we don't know) about SIJ pain, so that you can decide if it is worth your time to even think about it any further. I want to help you make informed decisions about your back pain so you can get on the right journey for you, back to comfort and pain free living.

What are our SI joints?

Our sacroiliac joints (SIJ for short) are the joints that connect between the spine and pelvis.

"Sacro" refers to sacrum = the bottom section of our spine, below our lumbar section.

"Iliac" refers to ilium = is the largest uppermost portion of our pelvis. It's the large, flaring 'wing-like' portion that you can feel when you place your hands on your hips.

You can identify these joints on many people from the back. They are the dimples on either side of the base of the spine.

These are very strong joints designed to transmit forces between our legs and spine. As a result, there is very little movement at these joints. However, a very small amount of gliding and rotation can occur.

How do our SI joints cause pain?

This isn't a straightforward answer, unfortunately. It is generally accepted that SI joints can be a source of pain, but why pain occurs in them is less clear.

One potential reason is the presence of an inflammatory condition within the joint itself, causing pain.

Another potential cause may be related to joint instability. This instability may be caused by an injury such as a tear in the joint capsule or laxity in the ligaments that surround and support the joint.

Another possibility that has been discussed in the literature is that perhaps pain in this region can be a musculature issue. This belief comes from the fact that the origin of many muscle attachments are in this region.

How do I know if SIJ is the cause of my pain?

Firstly, I want you to understand that it is very difficult to ever be 100% certain that SIJ is the cause of your pain.

I do however, want to lay out some common patterns and observations that we usually see with SIJ pain. Hopefully this will give you some quick insight whether it is worth your time to bother pursuing the possibility that SIJ is the cause of your pain.

Identifying SIJ pain

The following are some general observations we usually see associated with SIJ related pain:

Pain can be present in back, buttock, groin and legs

The location of the pain can be experienced in the same locations as many other more common lumbo-sacral pain sources. Making it difficult to distinguish based on the presence of pain alone.

Symptoms are rarely felt above the L5 level of the spine

If you are experiencing pain above this level of your spine it is unlikely to be cause by your SIJ.

Symptoms are rarely experienced bilaterally

Most of the time SIJ pain is only experienced on one side. If you have pain in the region SIJ pain is commonly experienced, but it is on both sides of your back, the pain is less likely to actually be coming from your SI joints.

Symptoms rarely experience along the spine's midline

SIJ pain is rarely felt in the middle of your spine. It is usually a few centimetres lateral (to the side) of your spine.

Pain when walking a specific distance

If pain is initially tolerable but soon becomes painful AND you are a younger person, this can indicate towards a joint (such as the SIJ) being the cause of your pain. Remember, this is only one consideration of many, and you would also need to rule out that the pain is not caused by a different joint other than the SIJ.

Pain exacerbated when standing up and when performing lunges

Therapists can perform a number of assessments that 'stress' the SI joints to see if provoking them replicates your symptoms. Standing up and split lunges are two common movements of daily life that people with painful SI joints often notice aggravate their symptoms.

May be related to a history of trauma

Meaning a traumatic physical injury seems to be related to the onset of SIJ pain in some people.

Excluding other causes

Firstly, if the patterns detailed above do not seem to fit your pain experience, I encourage you to check out my other articles to see if I have described another pathology that is more fitting of your pain mechanism.

When trying to identify SIJ pain, it is common for disc injuries to provide false positive results. This means it is important to rule out that a disc injury is not causing your symptoms as it commonly presents with a similar pain experience (this even confuses therapists who are physically assessing people's SI joints, as attempting to provoke the SI joints often causes symptoms in those who actually have disc injuries).

One commonly utilised way of identifying if a disc is the cause of your pain is whether there is "centralisation" or "peripheralisation" of your symptoms.

These two terms describe changes in someone's pain experience.

Centralisation refers to the phenomenon where pain that was initially felt over a wide area or at various distant parts of the body starts to recede towards the spine or becomes localised to a more central area. Imagine you have pain that starts in your lower back and extends down your leg. If the pain starts to move up your leg and gets closer to your lower back, it's considered to be centralising.

Peripheralisation is when the pain moves away from the midline or central part of the spine outwards to the more distant areas of the body.

You have probably noticed in your own research that the field of back pain is a hotly contested topic, full of many mixed opinions. If you look further into the concepts of centralisation and peripheralisation, you find them to be no different.

While the usefulness of these pain experiences as a diagnostic indicator is contested, I want to point them out to you regardless as one additional data point for your own self-investigation.

If your pain tends to "centralise" or "peripheralise" in response to different movements and postures, it becomes *more likely* that your pain is caused by a disc rather than SI joints.

If you would like to confirm whether a disc bulge is the cause of your pain, check out my Differential Diagnosis article on disc bulges here.

Another indication that your pain is not caused by SIJ is the presence of signs relating to nerve root compression. If you notice things like a loss in strength and motor function, or a loss of sensation like a numb toe or foot, those are not symptoms that are caused by SI joints.

Physical assessments for SIJ pain

There are a number of physical assessments therapists can use to try and provoke your SI joints and assess if this provocation replications your pain experiences. Even in the case of true SIJ pain, not all SIJ provocation tests will cause pain. So the commonly accepted wisdom is that if at least 3 SIJ provocations replicate your familiar pain symptoms, a positive SIJ pain source is indicated.

These tests require a skilled therapist to perform them. I think describing them here is probably beyond the scope of this article. Let me know if you are interested in understanding the physical assessments that can be involved in assessing SIJ pain and I might do a follow-up on the topic!

I hope atleast you can use this information to consider the assessments you may have had thus far. Or it may equip you with the knowledge to ask more specific questions of your therapists when trying to understand what is going on with your pain.

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What to do about it

If you have been paying attention thus far, you are probably wondering how in the hell I could give you a clear answer to solving SIJ pain.

You are right to be sceptical. While plenty of clinicians out there have successfully treated people with SIJ pain, in the broader scheme of things we don't particularly have any definitively confirmed treatments for SIJ pain.

As I have already discussed, we often are not even particularly sure what causes SIJ pain, so how could we be confident in the correct treatment?

Don't lose hope, however. There are options out there and suggestions in literature about the direction treatment should take.

From a physical therapy point of you, the treatment with perhaps the strongest evidence and likelihood of success is stabilisation based exercises.

A few other existing treatment that are outside my wheelhouse include corticosteroid, phenol and prolotherapy injections. Or in more extreme cases, fusion surgery. I'll let you research these on your own and find experts more qualified on these treatments to learn from.

What if there are multiple things wrong with me

There exists the very real possibility you have SIJ pain as well a spine pathology. While less common, it is the case for some with back pain to also have a comorbid hip or SI pain source. If this is the case for you, a physical assessment with a skilled therapist may be helpful to tease out those pain mechanisms and provide appropriate treatment advice.

How confident can we be

So if the experience of your pain tends to line up with the patterns I described above + other possible causes have been excluded as best as possible + 3 or more SIJ provocations tests were positive for you pain = we can be fairly confident (likely 80+%) that the SIJ is the source of your pain.

This may not seem like a great result. And this probably contributes to why many find it difficult to recover with an SIJ pain diagnosis. However, if you have found yourself at this level of confidence, it probably becomes worth your time (and money) to follow through on some SIJ focused treatment.

To be any more confident than this requires a diagnostic injection. This can involve different products being used, but often involves injecting your SIJ with an anaesthetic solution to gauge your response. If the act of injecting the solution into your SIJ produces a familiar pain, that is one indication to help confirm SIJ as the pain source. If in addition after receiving the injection a significant reduction in your symptoms occurs, this tends to confirm SIJ as the pain source. However, sometimes multiple injections are used in this diagnostic process.

Stabilisation exercises for SIJ

I considered dicussing some options for stabilisation based exercises that I like to use personally. I think this article may be getting a bit long however. Let me know if this would be a valuable to you and I will aim to do a follow up detailing some of these exercises.

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Frequently Asked Questions

What does SI joint pain feel like?

SI joint pain is usually felt low down, around one side of the lower back, buttock, groin, or upper thigh. It is less likely to sit right on the spine’s midline, and it rarely travels below the knee. Common triggers include standing up from a chair, getting in or out of a car, rolling in bed, or split-stance movements like lunges.

How do I know if my SI joint is causing my pain?

There is no single home test that confirms SI joint pain. The pattern matters more. One-sided pain near the back of the pelvis, pain with transitional movements, and no clear numbness or tingling can point toward the SI joint. In clinic, therapists usually look for a cluster of positive provocation tests rather than relying on one movement.

Is SI joint pain the same as lower back pain?

SI joint pain is one possible source of lower-back or pelvic-region pain. It can overlap with disc and facet joint pain, which is why it is often mislabelled. Disc-related pain can even mimic SI joint pain during testing, so the diagnosis should be made carefully.

Can SI joint pain go away on its own?

It depends on the cause. Some SI joint pain settles as irritation reduces and strength returns around the pelvis. Postpartum pelvic girdle pain, for example, often improves with time and the right stabilising exercises. Inflammatory SI joint conditions need a different pathway and may require medical management. If pain is persistent, worsening, or associated with systemic symptoms, it is worth getting assessed.

Or perhaps you can remember measuring yourself against the wall as a kid and noticed something was off one day as you seemingly managed to grow or shrink magically overnight.

Well it is in fact true that we get a little bit taller every night.

Don't get too excited thinking a late growth spurt might be on the cards for you though. All the height we gain overnight, we lose again throughout the day.

So how is this diurnal rhythm of height change possible?

Our spines provide the answer.

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Our intervertebral discs are made of rings of cartilage that contain a gel nucleus within its centre. This gel substance is made with a significant proportion of water.

This water is critical to the function of the disc as it helps to pressurise the disc, allowing it to absorb shock and withstand various forces so that we can move and bend our spine in lots of wonderful ways.

The water content of our discs however is not a stable amount. Our discs “leak” water throughout the day and then “refill” overnight. Depending on the time of day, genetics might not be the only explanation for your struggle to reach the top cabinet shelf.

So next time you go trying to blame your parents for your short stature, there is one more person you need to add to your naughty list... Sir Isaac Newton.

Yes, that pesky thing called gravity is limiting your potential! Perhaps if you took a quick trip to space you could gain the inches required to land that hot date...

See, gravity is what gives us our weight. The more gravity pulls you back to earth, the higher the number on the scale while you're standing on it.

This effect also creates a compressive force on our spines as it squishes us down into the earth. During the day, while we are standing and moving around, our intervertebral discs are being squished under this compression. This causes some of the water to be “squeezed” out, leading to our discs (and subsequently, us) losing height.

Another component of the gel substance within our disc's nucleus are proteins referred to as proteoglycans. These proteins are hydrophilic, meaning they love water.

Or in other words, they are chemically attracted to water molecules.

When we lay down overnight the mechanical forces on our spines change. The amount of compressive force that gravity is placing on our spines is reduced. Our spines are able to "decompress".

This decompression allows these proteoglycans to fulfill their deepest desires. They attract water molecules back into the disc, allowing it rehydrate or "refill".

As the discs rehydrate, they swell and gain their height back. So you gradually grow overnight as your discs rehydrate, leading to you being at your tallest first thing in the morning.

Understanding how these discs work is also key to understanding one of the most common causes of back pain. This article breaks down exactly how disc injuries develop.

As a bit of a bonus fact, this is also why we can feel a bit stiff and sore first thing in the morning. It also can explain some of the back pain we experience when we are sick and stuck lying in bed for a few days.

You see, as our discs swell and grow in height, our spine gets longer along its entire length. This causes some tissues like ligaments and tendons that attach to our vertebra, to be pulled a little more taut, giving a feeling of stiffness and reduced flexibility first thing in the morning. You will notice this wears off once you get up and get going. This wearing off occurs as your spine shrinks back down under the compression of gravity.

So should you stretch first thing in the morning? Probably not...

It's probably a good idea to give yourself time to wake up, “shrink” a little and improve your mobility before doing that morning yoga routine. The bending stressors on your spine are much higher first thing in the morning while you're that little bit taller.

Don't think your swollen morning discs or lack of afternoon height are any cause for concern though. Nature made you this way for reason - and she rarely makes mistakes.

Our spines follow a diurnal rhythm just like the rest of our bodily processes do. This hydration cycle in the disc allows for things like nutrient uptake and delivery and helps promote the regeneration and overall health of the disc.

So like everything in life, balance is key. Don't forget, your discs need those 8 hours as well!

Was I able to help you learn something today with this article?

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Let's set the scene on a common experience many people with back pain go through.

You develop some lower back pain. It may have developed gradually or resulted from an injury, such as lifting something heavy or while bending over.

It begins to really affect your day-to-day life. You struggle to control the pain and it's getting in the way of your ability to perform all the normal daily tasks of work and life.

You go to the Doctor seeking answers to your pain. They send you to get an MRI of your spine.

The results come in. You have "Degenerative Disc Disease".

Your concern grows...

What does this mean? Are you broken? Is it all downhill from here? Is the pain just going to get worse?

Maybe you are only young. Perhaps even in your 20's. How could you already have a degenerative disease? How are you going to avoid a life of pain and disability?

One of These Things is Not Like the Other

I hear this story play on repeat all the time. And it really is an indictment of the way our current health care system treats back pain.

When we hear the term "degenerative disc disease" (otherwise referred to as DDD), the very normal response many people have is to associate it with other degenerative conditions, such as Parkinson's disease or Multiple Sclerosis. These are conditions that will lead to progressive degeneration, loss of function and increased disability.

They are horrible conditions to be diagnosed with. Due to our capacity for 'Hedonic Adaptation', degenerative conditions often lead to a lower perceived quality of life compared to many significant acute traumatic injuries.

Hedonic adaptation refers to the observed tendency of humans to quickly return to a relatively stable level of happiness despite major positive or negative events or life changes.

Humans are wired to always want to move onwards and upwards. We have an innate desire to make progress (perhaps sometimes to our own detriment). So it isn't hard to see why someone being told they are going to 'degenerate' can have a really negative effect on their lives.

The problem though, is that "degenerative disc disease" is no more a disease than 'ageing' is. It is not in the same class as other degenerative diseases. But our health system often leads (or at the very least allows) people to believe that it is.

DDD is a Useless Diagnosis

So what IS degenerative disc disease (DDD)?

Well that question is exactly the problem. DDD is a completely non-specific diagnosis.

To illustrate this, here is a snippet from radiopedia.org:

Wide variations exist in the reported prevalence of degenerative changes in the spine, likely related to differences in populations studied and variable definitions of what constitutes degenerative change. Additionally, because degenerative disc disease encompasses such a wide variety of individually defined entities, it is hard to make broad statements about its incidence and related symptomatology. 

Vertebral osteophytes, disc height loss, disc signal intensity loss, and disc bulging increase in frequency with age in a nearly linear fashion, but to different degrees, with disc signal loss and vertebral osteophytes increasing the most with age.

That's quite a mouthful to try and digest. But the main takeaway I'm sure you can get a sense of is that DDD does not really have a specific definition, and all the possible changes that can be related to a DDD diagnosis are common changes that occur with ageing.

And the really key point to note here is that all of these age related changes do not necessarily cause pain.

That doesn't mean they can't cause pain. In some people, one or multiple of these changes can absolutely be involved in a pain mechanism they are experiencing.

But this does illustrate how degenerative disc disease is no more a disease than ageing is a disease. And a diagnosis of DDD is mostly meaningless and unhelpful.

Many adults will eventually develop changes that would constitute a DDD diagnosis, but most of them will not have pain.

What you need is a diagnosis of the specific pain mechanism that's occurring in your spine and what structures are related to that pain mechanism. Then can you take actionable steps to get out of pain.

If a disc injury is the likely culprit, this article explains exactly how disc bulges develop and what you can do about it.

(Check out the Differential Diagnosis series I’m working on to get some help identifying your pain mechanism.)

Because you really shouldn't care what your spine looks like on an MRI. Most people spines will look pretty horrible by the time it's all said and done.

What you really care about is whether you are in pain, and whether you can enjoy your life without pain. Degenerative disc disease is completely hopeless in predicting whether you will have pain or informing you on what to do about it.

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Healing Vs Degeneration

A MRI finding that often leads to a DDD diagnosis is a loss of disc height. As we have well established though, this is NOT a disease. But rather a natural response to injury.

It's very common following disc injuries (particularly those that have been poorly managed) to eventually lead to a loss of disc height. This loss of height may or may not cause symptoms. When it does, it often relates to a loss of stability at that level of your spine which can cause painful micromovements.

A flattened disc is a bit like trying to drive a car with a flat tyre.

A flattened disc can also cause the facet joints that link between our vertebrae to rub together more than they should. This can create some extra friction leading to inflammatory changes at and around these joints. This again, may or may not be associated with pain.

Now what I have just described in many ways IS degeneration. However... it is not a disease. It's our bodies natural healing response. And may actually be our body doing exactly what it is supposed to.

You see, these inflammatory changes will eventually lead to stiffness and reduced mobility in the spine. That might sound like a bad thing, but what problem will that be solving?

The instability caused by the flattened disc. We tend to always think of arthritis as a bad thing (and often it is). But we are missing some nuance by only seeing it as a negative. Arthritis is caused by an inflammatory response, which is how our body heals.

If you had significant instability and pain in your spine and went to see the surgeon for a solution, what would they do? They would perform spinal fusion surgery.

OR,

The other option is to learn to control your pain mechanism, enhance your core stiffness and stability, manage your pain for a few years, and eventually nature will perform its own spinal fusion.

Arthritis isn't necessarily always a bad thing. For some people a little bit of arthritis causes the stiffness they need to prevent their pain mechanism.

You will lose some mobility, and need to give up any dreams of becoming an Olympic gymnast. But a bit of mobility loss in exchange for taking away your pain is an amazing deal for most of us.

Don't Let a Silly Diagnosis Get You Down

So, as crazy as this may sound, perhaps 'degeneration' in your spine can sometimes even be a good thing?

The main takeaway to remember at the very least, is not to confuse ageing and healing with a disease.

I hope you learnt something from this article and if you were someone who was terrified by a DDD diagnosis, I hope this has improved your outlook.

Consider subscribing for future articles and please comment if you found this article helpful or wanted to share any experiences.

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If you know someone who has been told they have degenerative disc disease then please send them this article so they are not left feeling hopeless about a silly diagnosis.

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• What is piriformis syndrome

• Why it is such a common diagnosis and discussed online

• Why you probably don’t have piriformis syndrome

• Why the treatments often recommended aren’t helping you

• How to diagnose piriformis syndrome yourself

• Which type of piriformis syndrome your have (Hint: there is more than one)

• How to treat your piriformis syndrome

Many people experience sciatic nerve pain that feels as though it begins in the hip joint and then travels down into the buttock and possibly all the way down the back of the leg and into the toes. When the pain seems to originate in the hip, these symptoms are often diagnosed as piriformis syndrome. If you search online for these symptoms, there is a good chance you will come across plenty of information online that gives you the impression this is a common condition and is likely the cause of your pain. However, piriformis syndrome is actually very rare and most of the time a misdiagnosis.

If you're experiencing sciatic nerve pain, this article explains why "sciatica" is a symptom rather than a diagnosis — and what's more likely causing it.

The fitness and fashion industries actually share some commonalities. Similarly to the cycles we see in the fashion industry with different styles falling in and out of favour, the health and fitness industry also experiences cycles as different conditions and treatment approaches become a common diagnoses or focus in the industry.

Often this stems from a new piece of research that happens to pick up a lot of traction. It begins to shape the industry, possibly affecting diagnostic assessments or influencing common treatment protocols. As the new research trickles down through the industry, we often "lose sight of the forest for the trees". We become myopic in our focus on the new information that's gaining popularity and lose sight of the true breadth of the field. This tends to lead to a lot of nuance and detail lost along the way.

Piriformis syndrome is an example of a condition that's popularity outpaced its true prevalence. If you have been diagnosed with piriformis syndrome (without an MRI to confirm and/or a thorough physical assessment of your hip and lumbar spine), or you have been researching for yourself and have come across information leading you to believe it may be the cause of your pain, chances are, you don't have piriformis syndrome.

In this article, I will explain why this is the case and explain why there are more common causes of sciatica.

What is Piriformis Syndrome?

The piriformis muscle is a thick, flat muscle. It is one of our deep hip muscles that are found underneath your larger glute (buttock) muscles. Its main role is in lateral rotation of the hip.

Lateral rotation of the hip is when the hip rotates outward, away from the middle of the body. Imagine standing up straight and then turning one of your feet outward, so your toes point away from your other foot. This motion involves rotating your thigh bone (femur) in the hip socket to move your leg and foot outward.

Piriformis syndrome occurs when the piriformis muscle irritates the sciatic nerve and causes pain. The sciatic nerve typically runs underneath the piriformis and then carries on down the leg. However, in about 12% of the population, the sciatic nerve actually runs through the piriformis muscle instead. Making it more prone to irritation from certain changes in the piriformis muscle.

The commonly believed cause of piriformis syndrome is when the piriformis muscle spasms or becomes excessively tight and compresses the sciatic nerve. You can see how in people with a sciatic nerve running through the muscle belly this could obviously cause some discomfort.

Many in the industry are also however finding that this syndrome may be caused by a piriformis muscle that is excessively stretched. This causes excessive strain on the muscle during certain movements that can lead to inflammation that affects the nearby sciatic nerve and causes pain.

(I will explain how you can tell the difference between a tight or stretched piriformis muscle later in the article.)

Why you probably don't have piriformis syndrome

When you combine the relative rarity of the anatomical variation that increases susceptibility to this syndrome with the requirement for a muscular pathology to be present in a specific hip muscle, you can see why the real world prevalence of piriformis syndrome would be very low. Studies attempting to identify how often sciatic symptoms are caused by piriformis syndrome have found it to be between 0.3-6% of sciatica cases.

Additionally, not only is true piriformis syndrome very rare, but the prevalence of lumbar spine pathologies that have the potential to cause sciatic symptoms are extremely common. About 80% of us will experience at least one episode of lower back pain over our lifetime. Of all the potential causes of low back pain, the most common is a disc injury. And of all the discogenic injuries that occur in the lower back, the overwhelming majority occur at the level of the spine in which the sciatic nerve roots exit.

So you can clearly see why if you are experiencing sciatica, the likelihood that your piriformis muscle is the cause rather than a lumbar spine injury is extremely low.

Anecdotally, in clinical practice, I have encountered very few true piriformis syndrome cases. In the overwhelming majority of people experiencing radiating pain that appears to be emanating from their hip, I am able to demonstrate that the actual cause of their pain is triggered by changes in the lower back rather than their piriformis muscle.

Now if you're someone that says "be damned with statistics, I want to know for sure that I don't have piriformis syndrome", then let's dive a little deeper.

Frequently Asked Questions

How do I know if I have piriformis syndrome?
The key test is hip internal rotation: lie on your back, have someone bend your knee to 60 degrees, then rotate your lower leg outward (which rotates your thigh inward). If this recreates deep pain in the back of your hip, piriformis syndrome may be worth investigating. If it doesn’t cause your familiar pain, your symptoms are much more likely coming from your lumbar spine — which is the case the vast majority of the time.

Is piriformis syndrome the same as sciatica?
No. Sciatica is a symptom (pain along the sciatic nerve), not a diagnosis. Piriformis syndrome is one possible cause of sciatic nerve irritation, but it’s actually quite rare — accounting for only 0.3–6% of sciatica cases. The far more common cause of sciatica is a lumbar disc injury irritating the sciatic nerve roots as they exit the spine.

Should I stretch for piriformis syndrome?
Only if you’ve confirmed you actually have it — and even then, it depends on whether your piriformis is tight or overly stretched. A tight piriformis may benefit from careful stretching. But a stretched or lengthened piriformis (which also causes pain) will only get worse with more stretching. In both cases, if your symptoms are actually coming from your lumbar spine, stretching your piriformis won’t help at all and may aggravate your nerve further.

Can piriformis syndrome go away on its own?
If you’ve confirmed true piriformis syndrome, it often responds well to targeted treatment — either stretching (for a tight piriformis) or strengthening exercises like clamshells and banded glute bridges (for a lengthened piriformis). Many cases do resolve with conservative treatment. The more important question is first making sure piriformis syndrome is actually what you have.

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How to assess for piriformis syndrome

When assessing someone in person, it would typically involve lengthy testing of their lumbar spine and hip to confirm the pain mechanism and exclude other possibilities. Trying to explain all of that would have both of us wishing there was a TL;DR.

So instead I am just going to describe one simple test for you to help you point in the right direction.

Hip Internal Rotation

(You will need a friend to help you with this one)

• While lying on your back, your friend is going to grab your ankle with one hand and hold under your leg, just below the knee, with the other.

• Then they will raise bend your knee and raise your leg until your thigh is 60 degrees off the floor.

• Now your friend is going to pull your ankle, while stabilising your leg around your knee, to rotate your lower leg away from your body.

• This causes your thigh bone to rotate inwards toward the middle of your body, with the head of your femur rotating inside your hip joint.

• Repeat this on both legs and compare if one side is more restricted than the other, while also taking note of pain symptoms.

If you have piriformis syndrome, this movement will very likely cause pain to be felt deep in the back of your hip.

If this test does not cause your pain. Then it is definitely worth it to thoroughly investigate your lower back and confirm if a lumbar pathology is actually the cause of your pain.

If you know someone that has been told they have piriformis syndrome, share this article with them and ask them how they performed in this test.

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To stretch, or not to stretch

It depends...

Many people with sciatica experience a feeling of tightness in their glutes, hamstrings and/or calf muscles. However, this almost always has nothing to do with muscular tightness. And rather is related to sciatic nerve root irritation. Stretching these muscles will likely also increase tension on the sciatic nerve - which will only irritate it further. You may experience temporary relief as a result of stimulating your stretch-reflex, giving you the false feedback that stretching is benefiting you. But if the pain continues to return, it is much more likely that stretching is merely masquerading the repeated irritation you are placing your sciatic nerve.

BONUS INFO: The stretch reflex refers to an increase in neurological activity that occurs in response to a muscle being stretched. This feeds back to the muscles causing them to contract. This contraction prevents our muscles from over-stretching beyond their limits and causing damage like leading to a joint hyper-extending for example.

However, it also has an analgesic (pain relieving) effect as it dulls the pain signal temporarily. This may seem like a good thing, however we commonly stretch into postures that actually aggravate lumbar spine pathologies and dull the signal telling us we shouldn't be doing it. It provides a false feedback loop in which the temporary pain relief encourages us to stretch more, only to further irritate our injury making us feel we need to stretch again.

Just consider, if your sciatic nerve pain is caused by a pathology in your lumbar spine, how is stretching your hamstring going to positively impact that injury?

So when is stretching a good idea?

If you the hip internal rotation test did cause you pain deep in the back of your hip, then your piriformis muscle may be the cause of your symptoms and stretching might be a good idea. However, before you rush off to stretch your tightness away (probably sick of me telling you stretching isn't a good idea), we need to determine if you have a tight piriformis, or a stretched piriformis.

A tight piriformis will benefit from stretching. But stretching an already lengthened piriformis will only make your symptoms worse.

When you performed the above test. I mentioned to notice if one side was more restricted than the other.

If your painful side was more restricted, i.e. you thigh was unable to rotate inwards enough (your friend was unable to pull your lower leg as far away from your body), then you have a tight piriformis. And it's worth giving stretching a go.

However, if you were less restricted on your painful side. Then you have have a stretched (or lengthened) piriformis. And stretching would be counterproductive. Instead you would need to strengthen you lengthened piriformis to help prevent it becoming irritated and inflamed.

Let me know what you found with this test. Did it replicate your pain? Was there a difference in the range of motion between your painful side and non-painful side?

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Well if you have made this far and I still haven't convinced your that piriformis syndrome and stretching are probably not the cause or solution to your problems, then I will spend the rest of this article giving you a treatment options for both a tight and a stretched piriformis.

So only continue with this article if you feel very confident that piriformis is the source of your problem.

And if you have any other questions or queries about the information in this article, I wanna hear them! Let me know how can I improve this article to more clearly provide this information to you.

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For many people with back pain, spine flexion (bending forward) aggravates their condition.

This is a hallmark pattern of disc injuries, which are among the most common causes of back pain.

When we sneeze, we tend to bend our lower backs into flexion very suddenly. If spine flexion causes you problems, then you may find sneezing is associated with your back pain.

You may experience this as a sudden, sharp stab or "catch" in your lower back.

If this sounds familiar, here's the fix:

Next you time you feel a sneeze coming on, prepare your body to avoid bending your lower back.

You are going to lift your chest and raise your head about 45 degrees to gaze upwards towards the sky. Hold this position through the sneeze. Instead of bending over and directing the sneeze towards the ground, you will remain in an elevated position and direct the sneeze upwards toward the sky.

This approach will help prevent your lower back from flexing and triggering your pain.

Please give this tip and try and come back to let me know how it goes.

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Included in this article:

• What is a disc bulge.

• What causes a disc bulge.

• Who gets disc bulges.

• What it feels like to develop a disc bulge.

• 6 questions you can answer to help determine if a bulge is causing your pain.

Before we begin, I want to highlight that this article focuses on the most common type of disc bulge: a small focal bulge. However, there are three categories of disc bulge which I discuss here. If you believe you suffer from one of the other types of disc bulge, I would love to hear from you and I will make it more of a priority to cover those as well in a future article.

What is a disc bulge?

Our intervertebral discs are made up of an outer ring (annulus fibrosis), that contains a gel like substance within its centre (nucleus pulposus). The annulus is formed by concentric rings of collagen that are woven together to form a biological fabric. This fabric can become weakened causing it to stretch and "bulge" outwards into the spinal canal. If the bulge presses on a nerve root it can cause pain.

The key distinction between a disc bulge and a disc herniation, is that in the case of a bulge the disc annulus remains intact. A herniation occurs when a gap in the annulus opens up and allows the gel substance usually contained to the nucleus to leak out of the disc and into the surrounding area. This generally causes more painful and complex symptoms (but that's a discussion for another article).

What causes a disc bulge?

The biomechanical cause of a disc bulge almost sounds too simple for a condition that so many people struggle with and that therapists often have such difficulty identifying accurately and treating appropriately.

A disc bulge is caused by repeated bending under load.

I break down exactly what this means in my article here. The linked article will provide you with a practical understanding of the anatomy of a disc and the mechanical influences that lead to a disc bulge occurring. In clinical practice, I tend to observe that the more a person understands about the nature of their injury, the more empowered they become to take the appropriate steps to heal. If you have a disc bulge, taking the time to read that article will be worthwhile to support your recovery.

Briefly, when we apply repeated strain to our disc annulus, the collagen fibres begin to separate. This weakens the overall structure and allows it to stretch and bulge.

(Again, if you really want to understand this process, read this article.)

BONUS INFO: If the fibres separate too much a big enough gap will open and allow the nucleus to leak through and out of the disc - a disc herniation.

Who gets disc bulges?

Age is a factor in the type of back injuries people are susceptible to. Disc related injuries are more common among younger and middle-aged people. Elderly populations tend to suffer from arthritic and stenotic conditions more commonly, however.

Individual anatomy also plays a role. It’s no accident that 16 year old girls make the best gymnasts but you would never see them in a powerlifting competition. Similarly, try to imagine a 250 pound powerlifter doing a floor routine. It just wouldn’t work. Different people do indeed have different capacities for bending. One reason for this the variation in the shape of our discs.

The disc of a gymnast tends to be more oval in shape where a powerlifters is more limacon (kidney shaped). The disc of a powerlifter tends to become stressed much more easily with bending movements whereas the disc of a gymnast can tolerate lot’s of bending.

We all have individual and genetic variabilities that influence how prone we are to developing a particular injury or illness. However, anyone regularly engaging in the causative mechanism of repeated bending under load could develop a disc bulge eventually. There is generally two patterns commonly observed in the onset of disc bulge related pain.

1. The first is a slow onset that builds up and gets worse over time. This is seen in people that engage in chronic spine flexion (forward bending) postures over a longer period of time. An example of this would be an office worker that sits hunched at a desk all day. They don't necessarily need to be bending over and picking up heavy things. Simply sitting with a flexed spine over a long period of time can lead to the weakening of our disc annulus causing it to bulge.

2. The second pattern of onset is more sudden. These are the people that experience a sharp "stabbing" pain that began abruptly when bending forward. When we perform bending movements in our spine under a greater amount of load, it takes less time for our disc annulus to weaken. Some people may develop a disc bulge from a single event. For example, a weightlifter might lose form while going for a personal best on a heavy lift. The additional load on their spine from the weight could cause the annulus to weaken and develop a bulge very quickly.

You may identify more with one of these patterns or may be some combination of the two. An office worker may be gradually weakening their annulus without having any symptoms to make them aware of the changes that are occurring. Then one day they bend over to tie their shoes and get a sudden sharp pain in their back. It wasn't just the act of bending over to pick up the pencil that caused their injury. But rather the progressive damage to their disc that occurred over a long period of time that they didn't notice until performing a certain bending activity, and a bulge developed that caused pain. In other words, it was "the straw that broke the camel's back".

FUN FACT: Disc bulges don’t always cause pain. Some studies analysing MRI finding has estimated that somewhere between 10-30% of the population are walking around with asymptomatic disc bulges.

The common patterns of a disc bulge

People with the same injury tend to have similar experiences with their symptoms. Individual variability does of course exist. However, there are some targeted questions that can be asked to determine the injury a person likely has. I am going to break down 6 of these questions and the answers people with disc bulges tend to give. You can compare this to your own experience to either increase or decrease the likelihood that what you are experiencing is a disc bulge.

1. Does the pain increase or decrease with fast walking?

People with disc injuries tend to have less pain when walking quickly compared to walking slowly.

When we walk quickly and swing our arms, the compressive load on our spines is lessened. This is usually beneficial for people with disc injuries. Other conditions such as stenosis generally don't experience this same benefit. Walking for them will become progressively more painful regardless of the walking speed.

2. Does the pain change with different movements and postures?

People with disc bulges will tend to experience variability in their symptoms with different movements and postures. You may find certain positions to lay in that lead to a reduction in the radiating symptoms going down your legs, for example.

Conversely a certain activity you perform or a posture like bending forward may increase your symptoms and increase the radiating symptoms down your leg.

3. Is your pain aggravated by forward bending activities such as slouched sitting, gardening, cycling, vacuuming, sneezing?

Carrying on from the above question. It is most common for disc bulges to be aggravated by spine flexion postures. If your symptoms are uniquely aggravated by activities that involve flexion postures there is a good chance a disc injury is involved.

4. Does the pain come and go? How long does an acute episode last?

Some people with disc bulges will go extended periods without any pain. They may have recurring episodes of acute back pain.

An acute episode of a bulging disc often triggers an inflammatory process that lasts about 2 weeks.

5. Do you ever step down an uneven section of ground and get a painful "catch" in your spine?

Over time its common for people with disc bulges to lose some height in their disc. This leads to some instability at that level in your spine when performing certain activities that can cause pain.

People with more acute disc bulges may not have lost any height in their disc and therefor not experience any instability related symptoms.

6. Where is the pain located? Is their any radiating symptoms?

Pain usually is usually present in the lower back, however can also cause radiating symptoms across the back, into the groin, down the buttock, or down the legs. An example of these radiating symptoms being the common sciatica symptoms people experience.

Wrapping up

I hope you have found this article insightful to assist in identifying the cause of your back pain. What were your answers to the questions? Is there anything that stood out or something you would like to clarify? Please let me know in the comments!

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If you know someone that thinks they have a disc bulge, send them this article and see how they answer the 6 questions.

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If you're on the journey to overcoming disc bulge discomfort, you're not alone. Make sure you subscribe so together, we can navigate the path to a stronger, healthier back.

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And if the explanations provided in this article don't seem to fit the pattern of your pain then stay tuned or future articles in this series covering other causes of back pain. Comment with the injury you would like covered next!

Frequently Asked Questions

What does a disc bulge feel like?

A symptomatic disc bulge often causes lower-back pain that changes with posture and movement. It may be worse with slouched sitting, bending, gardening, cycling, vacuuming, or long periods in one position. Some people also feel symptoms into the buttock, groin, thigh, calf, or foot. The pattern often fluctuates: quiet periods, then sharper flare-ups when the disc is irritated again.

Is a disc bulge the same as a herniated disc?

Not exactly. In a disc bulge, the outer ring of the disc is still containing the inner gel, but part of the disc protrudes outward. In a herniation, the outer ring has torn enough for some of the inner material to escape. A herniation is usually more irritable, but both can be painful if they affect nearby nerves or pain-sensitive structures.

Will a disc bulge heal on its own?

Many do improve without surgery. The key is giving the irritated disc enough time and the right conditions to settle. That usually means reducing repeated aggravating movements, especially repeated bending if that is your trigger, then gradually rebuilding tolerance. Healing is not just waiting. It is removing the thing that keeps reopening the problem.

How long does a disc bulge take to heal?

It varies. Some people feel a clear improvement within 6 to 12 weeks once they stop aggravating it. More significant disc injuries can take months to become reliable again. If symptoms are spreading, strength is changing, or bladder or bowel symptoms appear, that needs medical attention rather than watchful waiting.

1. Small Focused Bulge

The first and most common type is a focused disc bulge. This is caused by repeatedly bending your spine in the direction away from the bulge. For example, if the bulge is on the posterior side of your disc and towards the right side then bending forward and to the left would promote the bulge (see my article here for a thorough breakdown of how and why bending leads to disc bulges).

People with this type of bulge generally can perform a certain number of tolerable bends before their pain occurs. The more load that is involved in bending (e.g. bending over to pick up something heavy), the less tolerable bends you can perform before the onset of symptoms.

To recover from this type of bulge you need to stop aggravating the bulge and allow it to shrink down in size. Learning to spare your spine and bend with your hips are important strategies to avoid aggravating this type of bulge and allow it to heal. Again, see my previously mentioned article for a more detailed breakdown of this pathology and the strategies to recover.

2. Reduced Disc Height

A different type of bulge can occur when a disc loses height. It is common for disc to lose height following certain injuries (such as damage to a vertebral endplate). Rather than the above type of bulge that only bulges out in one small location, reduced disc height can cause a disc to bulge out on all sides. Imagine letting some air out of a car tyre causing the flattened tyre to bulge under the weight of the car.

Another key difference between this type of bulge and a focused bulge is that bending does not promote this bulge. Instead, applying compression ("squishing" force) will cause the disc to bulge on all sides. For example, if you are carrying shopping bags or lifting something over your head this will add some compressive force to your spine. You can again imagine a car tyre that has had some air taken out of it. If you held this tyre up in the air it wouldn't be obvious that air had been taken out of it. However, the empty space inside the type will compress causing it to bulge under the weight of a car.

We can again continue with our tyre analogy to understand the consequences this type of bulge has. What does it feel like to drive a car with a flat tyre? You feel a bit unstable on the road, like you are not in complete control. The same thing is occurring in your spine. A flattened disc can cause instability and increased motion in your spine leading to pain. Symptoms can vary with this type of bulge and include central back pain as well as pain down different legs.

With this type of bulge, we need to identify the activities causing symptoms and eliminate them to get out of pain. Then we can build pain-free movement patterns and train improved stiffness and control.

3. Disc Tear

The third and final type of disc bulge is an annular tear. Our annulus is the outer ring of our discs that contains the gel like substance within the discs centre. The annulus is made up of concentric rings of collagen that are woven together into a biological fabric. The many layers of this fabric can separate which allows the gel substance from the middle of the disc to leak into the spaces between the layers.

This type of bulge usually occurs with excessive twisting motions. To recover it is important to avoid twisting and with time the disc annulus will heal, and symptoms will reduce. The McKenzie side glide exercise can be effective in treating this bulge and reducing symptoms, however if significant height has been lost from the disc than it is often ineffective. If you are not noticing significant improvement after performing a side glide, it may be best avoided.

Do you dread seeing the grass in your yard get too long, knowing you are going to spend next Saturday pushing the lawn mower around only to have the rest of your weekend ruined by your back pain flaring up.

Maybe you decide to take it easy instead and get some paperwork done. But you find after sitting at your desk for a while your pain seems to be just as bad.

Do you tend to feel better when you walk quickly but walking slowly makes you feel worse.

Sometimes your pain may not be there at all. You may go weeks at a time and begin to forget you were even in pain. You feel confident, ready to take on the world again and get back to doing the things you love.

And then one day, perhaps while doing something as trivial as bending over to tie your shoes... Your jolted by stab in your spine.

Perhaps it's not just your back either. Maybe your pain radiates across your back, down your buttocks, into your groin, or down your legs. You might spend the next two weeks in agony until you start to be able to function normally again.

If some or all of this sounds like you, then there is a good chance your pain is caused by a bulging disc.

And I am going to tell you exactly how you got it.

Why is it important that you understand how you got a disc bulge?

Once you know why a disc bulge occurs, you will be able to understand how to heal it, prevent it, and get out of pain for good. Don't waste your limited time putting up with pain that can be easily solved if you take some time to understand it.

Most clinicians and therapists fail to assess and understand the exact nature and mechanism of people's back pain. If you are struggling with back pain and not being given clear guidance on how to get out of pain, then this is for you. Empower yourself with the knowledge of what is causing your pain so you can be in control of your recovery and prevent it from coming back.

The cause of your disc bulge

So, let's dive in. What causes a disc bulge? There's a simple biomechanical explanation: repeated bending under load.

Now, as simple as that may be, I know you are here for deeper insights than that. I'm going to explain exactly what this explanation means and guide you through how to turn it into practical solutions to your pain.

First, what exactly is bending? It's not complicated. You are probably imagining someone bending over right now, and that's pretty much it. To be more specific though, the bending we are concerned about is the bending occurring in your spine and the effect that bending has on your disc. To illustrate this, let's take a brief anatomy lesson:

Your spine is made up of bony segments called vertebrae that are stacked on top of one another. If our spines were made up of only these bones, then we would all be walking around very awkwardly with a stiff rod through our torso. This would have some advantages. We would be very rigid and strong - a bit like those giant strongman athletes you see that look sort of stiff and robotic when they walk. As helpful as it may be at times to have spines that were that strong, trying to bend over far enough to tie your shoes would be a nightmare. Having such restricted movement in our spines certainly isn't for everyone. Fortunately for us, in between each of the bony segments in our spine is an intervertebral disc.

Inter (between) vertebral (vertebrae) disc - a disc between the vertebrae.

Our discs are made up of an outer ring (annulus) that contains a gel like substance within its centre (nucleus).

The outer ring is a biological fabric. It is made of a fibrous material (collagen) that's woven together to form concentric rings. It is not too dissimilar to the fibres in your cotton shirt that are woven together, making a stronger material that holds its shape so you can wear it.

The nucleus containing the gel-like substance is pressurised, which allows it to withstand various forces so that we can move in all sorts of wonderful ways. A bit like how a car tyre is pressurised with air, allowing it to withstand the weight of the car and all the forces applied to it when driving.

When we bend our spine, the bony segments will compress the discs in different ways depending on the direction we bend. For example, when we bend forward, the front of our vertebrae will squish closer together, and the back of the vertebrae will open and spread further apart. Follow along with this for me - while sitting in your chair, slump over into a slouched posture. Notice how the angle at the front of your body has become closer together, while your back is stretched out. That same shape is occurring at each segment of your spine as you bend. This is important to understand due to the effect these bending postures have on our discs.

When our spine bends, the bony segments compress the discs into a wedge shape. This causes the gel substance in the nucleus to move in response to the changing shape of the disc.

Let's use an analogy to provide some insight into these mechanisms occurring within your spine. Think back to when you were a kid playing with water balloons in the backyard. What would happen if you squished one end of the balloon? How would the water inside the balloon respond to the compression you just created?

You reduced the space at one of the balloon, so the water is forced to move to the other end. But now what happens to the balloon at the other end? The material of the balloon becomes strained. This water has nowhere to go, so it is pushing hard up against one end of the balloon and it's working overtime to contain it within the reduced space.

The same thing occurs in our spines when we bend. Our vertebrae create a wedge shape that compresses our discs at one end, causing the gel nucleus to move to the opposite end and strain that fibrous material of the disc annulus.

This is how our spines are designed to work. Our discs are designed to become strained in this way as we move through a range of motion in our spines. The strain on the disc annulus provides some stiffness which helps us control our movements. It helps us to stop moving once we have bent over far enough, taking some of the workload of our muscles and helping us move efficiently through the world.

So, if this is how we are designed, why does this process lead to debilitating injuries?

Think back to that mechanical definition we started with. It is not bending alone that causes disc bulges but repeated bending.

We didn't evolve spending 8 hours a day loading boxes into a moving van or hunched over a keyboard staring down at our screens. In fact, a lot of the repeated movement patterns we follow in our modern lives may be inconsistent with how our bodies evolved to function.

Our biology evolved to withstand certain stressors. In many ways stress is necessary to live a healthy life. When you lift weights in the gym your muscles are placed under significant stress and become sore and inflamed for a period of time afterwards. However, with enough rest they will recover and adapt to become stronger. If you didn't give your muscles the rest they required, however and returned to the gym day after day performing the same exercises, the outcome wouldn't look so bright. Your muscles would remain sore, and their performance would decline until eventually they can no longer cope with the stress, resulting in an injury such as a strain or tear.

For a lot of us, the movement patterns of modern life repeatedly assault our discs with stress. Unfortunately, our discs don't always give us the early warning signs of damage like we receive from our muscles after a hard workout.

So what happens to the disc when we repeatedly stress it in this way? Before I give you the answer, let's go back to our water balloon. In this example, we are compressing one end of the balloon so all the water is forced to push up against the other end. The rubber material at that end becomes stretched and strained. Now imagine we repeatedly squeeze the balloon in this way over and over and over again. What do you imagine would happen? The material being strained is gradually weakened. If weakened too much, it will no longer be able to withstand the stress caused by the water, and the balloon will pop. There is a material difference between a balloon and our discs. However, the processes leading to a disc bulge is essentially analogous to what I have just described.

When we repeatedly stress our disc this way, the fibres that make up the disc annulus begin to delaminate. Meaning the fibres begin to divide into their individual layers.

If you have one, grab an old shirt that you don't mind damaging a little. If not, try to imagine this along with me:

Pick a spot on that old shirt and hold it between your thumb and index finder with both hands. Now stretch that spot by pulling your shirt in opposite directions with each hand. Then repeat the stretch but this time along the opposite axis (i.e. stretch is up and down and then side to side). Continue repeating this over and over, moving between up and down and side to side stretches. Pay attention to what's happening to the fibres in your shirt. Can you see how as they are repeatedly stretched, that spot on your shirt is beginning to lose its structure. The fibres are starting to delaminate and divide apart. You may even notice that spot starting to bulge out a little from the rest of the shirt. If you have the time and inclination keep going. You will see the fibres continue to separate until eventually there is a hole in your shirt big enough to poke a finger through.

This is what led to your disc bulge. You repeatedly bent your spine in a way that stressed your disc annulus to cause the fibres to separate until there was enough space for the gel substance in the nucleus that is supposed to remain contained by the annulus to bulge out. And if you have been in pain then it's likely when the disc bulges in this way it pushes on a nerve root that causes your symptoms.

The Solution

Now here's the exciting part of the story...

That shirt you put a hole in may be a lost cause. Unless you stitch it up that hole will be there forever and probably just get bigger. We can't stitch up a disc like we can with a shirt, but we also don't need to. Our biology is often much smarter than we are, and it has immense capacity to regenerate. We just need to learn to stop repeatedly straining our disc. When we do, with enough time the disc annulus will heal and stiffen. If you allow your disc to stiffen, it will help prevent the bulge from occurring that is causing you pain.

So let's get you out of pain. Think back to the water balloon. What do we need to do to take the stress off the disc annulus?

The gel nucleus has migrated to the back of the disc causing the annulus to bulge. We need to encourage the gel to move back to the centre and take the pressure of the bulge that's causing you pain. And I am going to give you a strategy to do just that.

If you're having symptoms right now, I want you to try something. If not, take note and give this a try next time your pain flares up. The aim of the following is to take compressive pressure off the disc and gently extend your lower back to encourage the gel to move in the right direction.

Go to your bed or find a comfortable spot on the floor and lay on your tummy.

Now find the most comfortable position for your head. Try turning it to face the left and then the right and notice if one direction is more comfortable. Try stacking your hands under your forehead. Try making a fist and resting your chin on top of it to extend your neck. Find whichever variation of these postures is most comfortable for you.

Then take some deep breaths and allow your body to soften. With every out breath relax your muscles a little more. Allow your abdomen to sink into the floor beneath you.

Notice your symptoms. You are likely still in pain but are things moving in the right direction? If so, spend the next 5–10 minutes in this position.

Then get back up and compare your symptoms to before you laid down. Has your pain significantly improved? Have the radiating symptoms that were shooting down your leg ceased? Perhaps there is some remaining discomfort in your back, but overall did that wind things down?

If so, congratulations! You now have a method to deal with your symptoms, and you understand exactly why it works. You no longer need to guess what you should or shouldn't be doing when your pain flare's up.

Share this strategy with someone you know that may also find it helpful!

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If this did not help or certainly if this made you feel worse than you likely have other factors contributing to your pain than a typical disc bulge. Unfortunately, distilling all the variations of back pain pathologies into one article is a feat beyond my limits. But hopefully you can find a pattern of symptoms that fits you better in another article, along with the solution to your pain.

For those that did find success you may still have lingering concerns that I would like to resolve. You now have a strategy to reduce your symptoms when they occur, but how do you stop them from occurring in the first place?

As I mentioned above, for the disc to heal we need to stop the repeated stress we are putting it under. Continue reading so I can guide you through some movement strategies to avoid stressing the disc, prevent your symptoms, and allow it to heal.

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Dealing with my own chronic illness, for which modern medicine had no answers, helped me to see the systemic failings of the health system I was a part of. The field of back pain is an unfortunate example of these broader problems. This recognition inspired me to be better. Due to my background and expertise, back pain became a field worth focusing my career on, knowing could make a difference in it.

A broader issue in the health and medical fields are that they have become "protocolised". The system is designed like a conveyor belt, where we tick boxes to send patients down the line, allowing us to swap the therapists or Doctors working the line in and out without anyone noticing. This system has some benefits but also has downsides. One of which being that we lose the skill of individual assessments.

We rarely treat and assess individuals anymore. When you see a therapist for back pain, more than likely they are going to follow the same "back pain protocol” they follow with all their patients. They rarely take the time to perform an accurate assessment of YOU and determine exactly what's causing YOUR pain. It is much easier to teach and repeat protocols than to treat individuals and give individualised therapy and advice.

Once a protocol is put in place for a particular treatment, it takes a huge amount of inertia to change it. Most people do not want to step out from the status quo, and the same is true of your health care professionals.

So how do we get out of pain? We need to break free of this inertia and get back to basics. With an understanding of the fundamental anatomy and biomechanics of the spine and how they relate to spinal pathologies, we can perform thorough investigations into the cause of your back pain and provide practical advice and therapy to reduce it.

Now, if you already have a therapist that does this, great. You're one of the lucky ones. But for most people out there, bouncing from therapist to therapist without ever being given a real answer as to what is causing your pain, let this blog be your own backdoor access to a back pain specialist that cares about treating the person, rather than the protocol. I want you to get off that conveyor belt and empower yourself with knowledge and understanding to live a life free of back pain.

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