Back Pain

The fast majority of back pain resolves spontaneously and future flare-ups can be greatly reduced through a focused strength training and stretching program.


Acute Phase:

Injured muscles and tissues create pain to tell us that something is wrong. This is a time to be gentle, not worsen the acute injury, and focus on decreasing the inflammation around the inflamed muscle, connective tissue, and nerves.

  • Nutrition- optimize nutrition to decrease inflammation: eliminate complex/refined sugars and carbs. I like a Mediterranean type diet and also enjoy quality red meat/steak. The vegan/carnivore elimination diets all get the majority of their benefit from eliminating complex and refined sugars/carbohydrates (processed food). Dietary extremes don’t make sense to me for numerous reasons and I think the Mediterranean diet is a great starting point

  • NSAIDS- I’m not a huge fan of the effect of NSAIDS on the gut microbiome and overall gut health BUT sometimes you have to go to work. NSAIDS can definitely help get you through an acute exacerbation so that you can move. Alternate with tylenol if pain especially severe

  • Stretching- Gentle stretching during an acute flare up can be very helpful. Just don’t over do it. 

    • Cat-Cow Stretch

    • Pelvic Tilts

    • CastleFlexx- for me personally, and so many of my patients, the hamstrings are tight and this exacerbates back pain. Using the CastleFlexx I will do some very gentle rotational stretching

    • Knee to Chest Stretch

    • Child’s Pose Stretch

    • Note: I personally don’t recommend superman’s and prone press ups (Cobra Pose)- these hyperextension exercises kill my back and if you have facet mediated pain can make you worse. 

  • Movement- The body is meant to move. In the 80s they would admit people to the hospital for back pain and keep them on bed rest. This pretty much made everyone worse.

    • Start your day with core bracing (flatten you abs and obliques while maintaining good posture. Then do 5 hip hinge and 5 air squats. Go into → 

    • McGill Big Three

      • Modified Curl up

      • Bird Dog

      • Side Plank- Start on your knees if painful

    • Traction- I do like hanging in a little traction (I use the straps for a hanging knee raise or just do a simple dead hang on a pullup bar) 


That’s it for my acute flare-ups. Don’t overdo it during the acute stage.


Training Phase- these is when the acute flare up has settled and the goal here is to prevent future injuries

Make a Training Plan

  1. Nutrition

  2. Strength

  3. Stretching

  4. Cardio


Keep it simple and plan out your week every Sunday. If you don’t write down a weekly training plan then it probably won’t happen


Nutrition- See the recommendations above. 


Strength- I have a more comprehensive training plan pdf if you are interested. Basically want to train every muscle group 1-2x/week starting out


Core Exercises

  • McGill Big Three

    • Modified Curl up

    • Bird Dog

    • Side Plank- Start on your knees if painful

  • Hanging Knee Raises

  • Planks

  • Reverse Hypers

  • Morning Hip hinge and air squats


Additional Exercises that I rotate in and out

  • Roman Chair back extension- keep the pad low and keep your back in neutral lordosis

  • Rotational work- I use a medicine ball and do a lot of rotational training for golf and climbing. I love the landmine attachment and this is a rabbit hole for rotational strength training. It can definitely aggravate back pain so start slow

  • Single arm Farmer Carry

  • TRX- do a bunch of TRX core work and pushups. 

  • Trap bar and DB deadlifts- great way to start adding weight through your spine after the acute phase. 

  • Parallel Bar- I have some low parallel bars that I do L sits on. 



Joseph Miller