How to Treat Low-Back Pain

Back Anatomy

If you’ve ever had back pain, you’re not alone.

For many people, low-back pain becomes a chronic problem that can resurface at any moment. In a previous podcast, you learned why most treatments for low-back pain don’t work. In this episode, you’ll learn about a simple, safe, and cheap treatment method for low-back pain that might actually work.

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Show Notes

Save Yourself from Low Back Pain by Paul Ingraham

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**Armi Legge:** There are a lot of misconceptions about what causes low-back pain. Luckily there is good research on how to treat low-back plan. It’s just not very well known. You learned about the most common low-back pain myths in the previous podcast. At the end of the show, you may have been thinking, “Great, so what am I supposed to do? Live in Pain?” Well, no. In the second installment of this two-part series, you will again hear from Paul Ingraham, a science writer, former registered massage therapist, and adviser about what may be the single most common, underrated, and treatable cause of low-back pain and what to do about it.

You’re listening to episode two of Impruvism Radio, the podcast that uses science to help you become more awesome. I’m your host, Armi Legge. You can find links to the studies we mention on your iPod or music playing device as you listen. A list of selected references and links to everything mentioned during this episode can also be found in the show notes on

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In the last podcast, we talked about the top five myths about low-back pain but we didn’t really tell our listeners what they could do about it. What is the most common cause of low-back pain in all your experience and what are the main treatments that actually work to cure it?

**Paul Ingraham:** That’s a really tough question because, as we discussed in the fifth myth last time, there is no particularly good treatment for low-back pain, so we’re choosing from imperfect options. They’re very awkwardly imperfect options. The fact that we can’t actually find a particularly good, reliable treatment means that we don’t know what ultimately is the main or most important cause of low-back pain.

I have a working hypothesis about it and I make it a bit part of my book. I’ll explain that in a moment, but it’s really an important disclaimer, preamble, covering my butt that I don’t know. Nobody knows. Anybody who is claiming to know is overconfident. Back pain is clearly extremely sensitive to all kinds of unusual factors, stuff that we didn’t really see coming 50 years ago or 30 years ago. We’ve really come to understand how little we understand about it. That’s kind of the science story of low-back pain over the last couple decades, “Wow, this condition is really full of surprises and behaves in all kinds of different ways we didn’t expect.”

There was a time when anybody studying back pain assumed that it was just going to be a matter of finding the tissue with the issue, the specific, meaty source of the pain. That’s just not panning out. Here’s my best guess at what most back pain most of the time is about. It’s based on what seems to be the most effective of the kinda underwhelming options, which is massage.

People first started noticing that massage was pretty helpful for back pain long before it was studied and some very serious, incredible medical authorities and skeptics were kinda giving massage a pass and nod and saying, “Yeah, there might be something there.”

Long ago, back when they were already dissing just about everything else and saying, “Yeah, nothing else seems to really work,” particularly in the alternative therapies, there was a lot of skepticism about anything working, but massage would get a bit of a pass. Over time, there has been some study and the results are kinda promising. Not fantastic, but when you study this stuff regularly and deal with it all the time, it’s really quite disheartening how much bad news there is. There is so much bad news. There are so many things that don’t pan out. It always turns out to be more complicated than we thought and oh, my gosh. There are days when I pull my hair and I think, “There’s not enough good news in this business.”

In that context, some kind of decent results, some not too bad results for massage are actually kind of encouraging. It’s pretty great to have anything like good news.

So massage. Massage seems to work at least reasonably well for a fair number of low-back pain patients. Why? Probably because the problem has something to do with muscle pain. Most people, when they get a massage, what everyone remembers, feels, and experiences is how incredibly satisfying it can feel. It’s like scratching an itch, that intense sensation of relief as the thumbs or the elbow zooms in on that sweet spot and you get that weird, sweet ache and you’re just kind of begging for more. That is symptomatic of a reasonably good hypothesis for what’s causing back pain. That muscle gets herky. Muscle is very metabolically active stuff, very neurologically rich stuff, and very high performance material. It really does a lot and it probably has a tendency to painfully malfunction.

Now that is a controversial hypothesis. I’m going to hasten to say that. There are lots of people who are not so sure. I’m going to bring up two separate angles here, more butt covering. One way of looking at it is the muscle itself is kind of sick. It actually gets kinda polluted and stinky. The massage is essentially mechanically squishing tissue fluids around and helping clean it out. That’s really over-simplifying but basically, that’s it. Another way to go, and more and more over the years I’m favoring this way of looking at it, is that it’s just the muscle and the overlying skin and all the soft tissues are really richly innervated. It’s a lot of sensation. It’s a really brainy experience. It’s not so much the issue is in the tissue but they you can produce a lot of sensation by interacting with that tissue and forcing the brain to reconsider how it’s feeling about the back.

Very important to understand that all pain is in the brain. It’s a completely brain-generated experience. Even if there something oogy going on in the muscle, even if the muscle is “sick,” it’s still up to the brain to decide whether or not that’s a problem. That’s where we get the black magicky, totally weird array of things that don’t work and the sort of strange surprises in low-back pain science. Ultimately, it’s all up to the brain and there are all these other x factors that get involved that the brain takes under consideration and advisement when it’s deciding how much pain you’re going to be in.

The reason that massage might work kind of well might have nothing to do with the tissue itself actually be sick. It could just be that massage is a really good way of talking to your brain about your tissues. Ultimately, it doesn’t really matter to the patient. What matters to the patient is that you have that deeply satisfying sensory experience. You walk away going, “Phew, I needed that.” People who have that experience tend to do quite well.

**Armi Legge:** Instead of it necessarily being a problem with the spine or the connective tissue, you’re saying the most likely cause of back pain in your experience and based on a good amount of experience is it’s probably more muscular based rather than other aspects of our physiology. Now before our skeptical listeners turn this off and run away screaming, are there any more scientific terms in the research that are used to describe muscle sickness or that ooey pain?

**Paul Ingraham:** Yeah, I didn’t really ever actually call them by their name, did I? I came up with all that colorful imagery but I didn’t say “trigger points.” “Myofascial trigger points” is the official label. Myofascial trigger points date back a few decades now. That name and the basic story of how they work were invented by a couple of doctors who weren’t very important. They weren’t branding a treatment system. They didn’t particularly profit from this. They were simply interested in the widely observed phenomenon that people tend to have sore spots in their muscles and that, sometimes, those seem to blossom into full-blown, major, chronic regional pain problems.

You look at a lot of people who’ve got some area of their body that has really driven them nuts over the years. Time and time again, there are these spots and muscles or other soft tissue that seem to be hypersensitive. This phenomenon has been labeled a ton of things. A ton of things. We’re talking literally dozens of different labels over the decades, but those two doctors, Janet Travell and David Simons kind of standardized the field and did more work than anyone else. They said, “Can we all stop calling it all those other things? It’s trigger points. We’re going to call them trigger points from now on.”

Today, there are plenty of really smart and skeptical people who have questioned a lot about what Travell and Simons did and appropriately so. We probably are in a position to understand trigger points a lot better than we did 30 years ago.

Particularly, they may just not be what they seem. We have been thinking of them thanks to Janet Travell and David Simons. For many, many years, we’ve been thinking of them as a sick spot in muscle. They may not be that but there is definitely a phenomenon of tenderness in muscle that seems to be strongly associated with chronic pain. So let’s call them trigger points. Hopefully over the next 20 years, we’re really going to nail that down and figure out what does that exactly.

**Armi Legge:** We have these kinda mysterious pain problems in certain areas of our bodies called trigger points that at least can cause back pain and massage needs to help. Does that mean people need to see a message therapist? Or what can our listeners do at home maybe to help work on their low-back pain?

**Paul Ingraham:** One of the reasons I’m willing to put my reputation behind recommending massage for low-back pain is it can be done relatively cheaply and safely. What healthcare consumers need to worry about more than anything else when choosing treatments is how much it’s going to cost them and how much danger it’s going to put them in. A theory that’s kind of weak is a lot more acceptable to run with if it’s not going to put the patient in danger or cost them that much. Massage therapy can cost a lot if you go to a professional. Anyone with serious chronic or low-back pain is probably going to want to give some professional massage a try even though it costs.

But good news. You can do a lot yourself. It is possible to self-massage quite effectively. I’m a popularizer. I like to see these things tried by as many people as possible. Even though I think professional massage can be awesome, I don’t want it to be only available to the rich and there’s definitely really great potential with incredibly simple tools like lying down on a tennis ball at home. You can give yourself a pretty good massage. A lot of my writing is devoted to helping people figure out the best possible way to do that while spending as little as possible and putting themselves at little risk as possible.

If you get great, promising results from your own cheap experimentation, then that gives you a lot better reason to justify maybe spending some money on some professional assistance.

**Armi Legge:** That is definitely a good segue to the last part of our show and that is where can people learn more about your books?

**Paul Ingraham:** Oh, yes. That’s a great thing to finish with. We publish a large website called, “ca” for Canada. And on that website, I have hundreds of free articles and eight very detailed ebooks. The idea of those ebooks is to explain everything possible about a specific pain problem to patients who are really desperate for good information. Time and time again out there on the internets, there are a ton of pages, but they’re all kind of shallow. Nothing really goes into good, satisfying depth and that’s my business concept. Get into it. Get right into. Fully satisfy the craving for information. My advanced tutorials, my ebooks are really long and detailed on very specific topics. So if you’ve got one of those pain problems, you’re going to have a hard time finding another source of information that’s more thorough or with a stronger, science-based approach.

**Armi Legge:** Speaking of science-based, it’s a good point to remind our listeners that they can find links to studies that support everything you’ve said in the show notes as well as links to your site back on, and if they’re listening to this on their iPhone, they will see links to these studies and your books pop up in real time. Paul, thank you so much for taking the time to talk to us today.

**Paul Ingraham:** Thank you, it was fun.

**Armi Legge:** Thank you for listening to episode two of Impruvism Radio. Please join us again next week, when we hear from exercise physiologist, chef, and elite athlete nutrition consultant Allen Lim on how to prepare healthy meals while traveling.

You’re probably bursting with anticipation for the next show. To burn off some of your excitement, why you don’t you leave a nice comment and review on iTunes for this podcast? If you enjoyed this episode and you want more like it, leaving a ranking on iTunes is the best way to support the podcast and keep these episodes coming. Just click on the iTunes link in the show notes for this episode at the URL Open the podcast in iTunes. Scroll down to where it says “customer ratings” and leave your thoughts.



1. Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD001929. Abstract: | Full Text: NA

2. Furlan AD, Imamura M, Dryden T, et al. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1669-84. doi: 10.1097/BRS.0b013e3181ad7bd6. Abstract: | Full Text:

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