A Pilot’s Guide to Self-Managing Back Pain – Sitting, Standing, Swimming

“It’s not the job of sports medicine professionals to look after your tissues and joints, whether you hydrate or whether you actively work toward improving and maintaining healthy positions and range of movement throughout the day. It’s up to you. Spend 10 minutes minimum per day. No days off. No excuses.”

– Dr. Kelly Starrett, READY TO RUN

In my attempts to nurse my back to full strength, I have spent a great deal of time researching how to manage my pain, while also looking at the best home remedies/exercises to help fix my injury and prevent similar ones from happening again in the future.

As a result I have decided to compile my research into this comprehensive guide regarding all the things I’ve found useful for managing my back pain day to day, including some important what-not-to-dos!

This post will explore my best tips with regards to sitting, standing and swimming. Follow on posts will explore other exercises, lifestyle tips, how to sleep and the use of drugs/other treatments.

It goes without saying I’m not a medical professional in any way, shape or form, so please, please, don’t take what I’m saying as gospel. I’m simply relaying what has helped me in managing my pain. 

Back pain is a complex issue that I believe requires a complex approach from a number of different angles. Trial and error is necessary in figuring out what works best for you and your condition. 

Hopefully this guide will help you as well in some way, shape or form. As always seek advice from a professional (added advice – seek more than one opinion) and do your own research.

I’ve left links to a number of articles throughout that I found useful/helped support my own findings. I should add I am in no way affiliated with any of the organisations mentioned or products that I recommend. 

SITTING IS BAD

I like to think of sitting like drinking – something to be done in strict moderation! Of course I realise that’s not possible for all who have normal 9 to 5s (or non normal random pilot like jobs as the case may be), but you get my drift. A little bit of sitting ain’t a bad thing, but too much most certainly is. I’m guessing for the vast majority of us, we could all do with finding ways to sit (drink?) less.

While at home I like to CREATE A LYING DESK by laying a yoga mat on the living room floor (or hotel room if on a layover), instead of slouching on the couch should I decide to Netflix binge or work on my laptop. This way I can keep myself mobile, taking a break to perform stretches or core exercises while watching TV!

IF YOU HAVE TO SIT for long periods of time at work, or during a long haul flight for example, STAND UP AS OFTEN AS POSSIBLE (at least 10 mins for every hour). It always surprises me that more people don’t get up to have a walk and stretch in flight. Even a couple of minutes can make a big difference. A little and often is best.

Should you find yourself wedged in a middle row seat or unable to move for some other reason during your commute, CONSIDER DOING SOME IN-THE-SEAT STRETCHING (granted not all will be suitable in an aeroplane seat 💺). See examples below.

HOW TO SIT PROPERLY

Correct posture while sitting is very important – not just for managing back pain, but preventing further problems in the long run. My basic rule of thumb is three fold.

1. SIT UP STRAIGHT – head and torso stacked – with your head facing forward (imagine your ears in line with your shoulders in line with your hips)

2. FEET FLAT ON THE FLOOR or foot rest with knees at the same height or slightly lower than the hips (avoid crossing legs or ankles).

3. BACK FULLY SUPPORTED against the chair including your lower back.

Most chairs are, sadly, poorly designed in this respect, which is why I always TRAVEL WITH A LUMBAR SUPPORT PILLOW. I use a Travel Pal Auto-Inflating Mini Lumbar Pillow. You can, of course, improvise with any pillow you find or by rolling up a towel or piece of clothing to place at the curve of your back.

See the picture below for a good idea of what correct sitting posture looks like. 

https://www.medicalnewstoday.com/articles/321863.php

https://www.nhs.uk/live-well/healthy-body/how-to-sit-correctly/


WALKING IS GOOD

Walk yes, run no. You want to avoid impact from below for obvious reasons (especially if you have a dodgy back like mine).

Going up and down steps or hills has, on occasion, caused my pain to flair up, however, LONG GENTLE WALKS ON FLAT TERRAIN HAS PROVEN TO BE VERY HELPFUL.

A few notes.

DON’T WEAR HEELS. You’d think this might just apply to the ladies, but you’d be wrong. Heels are the devil with regards to back health. Even a small incline (ie the kind of elevation most shoes provide) ain’t great in the long run.

Your best solution is to WALK BARE FOOT WHENEVER POSSIBLE, otherwise finding shoes that have little to no difference in sole thickness from heel to toe (aka WEAR FLATS). I can highly recommend VIVO BAREFOOT for gym/outdoor wear.

Toss your flip flops in the bin 🗑 – they are also the devil for your back!

HOW TO STAND PROPERLY

Posture while standing or walking is also very important.

My best tips from the top down!

1. Hold your head up high and LOOK STRAIGHT AHEAD.

2.. PUFF YOUR CHEST OUT by squeezing your shoulder blades together slightly.

3. LET YOUR ARMS RELAX NATURALLY either side. Your ears, shoulders, hips and ankles should be aligned (have a look at other people walking while staring down at their phones – their ears are not even close to being in line with their shoulders and hips).

4. SQUEEZE YOUR BUT AND TIGHTEN YOUR ABS SLIGHTLY. If you look at yourself side-on in the mirror, if you have a little pot belly like me, it should look like its gone or significantly reduced (all the more motivation). The same with your but – it shouldn’t stick out like a horse’s arse (so much).

5. Keep practicing and practicing UNtill it Is automatic. I found the below article on anterior pelvic tilt (a common condition caused by sitting too much) and tips to correct it enormously helpful. 

https://acatoday.org/content/posture-power-how-to-correct-your-body-alignment

https://www.swolept.com/posts/fixing-anterior-pelvic-tilt-posture-tricks-to-make-your-butt-and-gut-smaller#.XkT4lSWlaEd


SWIMMING IS AWESOME

Following my recent back injury last month SWIMMING has proved to be an awesome LOW IMPACT WAY TO MODIFY. Not only did it help enormously with my back pain, it meant I could keep exercising to a level I was happy with. It also proved to do wonders for my cardiovascular system.

After months of regular exercise my resting heartbeat had settled in the very respectable low fifties. Following a few weeks of replacing that with swimming, however, my resting heart rate dropped into the mid to high forties for the first time in a long, long while!

A few things to note.

Although I found swimming massively beneficial on the whole, when I went at it too hard it did occasionally aggravate my pain. As always LET PAIN BE YOUR GUIDE. IF IT HURTS, BACK OFF!

Depending on the nature of your condition, THE TYPE OF SWIMMING STROKE YOU USE CAN MATTER GREATLY.  FRONT AND BACK STROKE WORKED WELL for me but BUTTERFLY AND BREASTSTROKE DID NOT.

Should all types prove painful, consider doing some gentle movements instead. Simply DAMPING THE AFFECTS OF GRAVITY BY GETTING IN THE POOL CAN MAKE A BIG DIFFERENCE. I found the following article useful.

https://www.spine-health.com/blog/3-essential-tips-swimming-back-pain


Mission ImBACKible – How do you fix chronic back pain and what if you can’t?

My mother has suffered with chronic back pain and sciatica for many years now. Sadly she still does.  

Her story is very similar to countless others. A story of multiple misdiagnoses and scans which showed little, if nothing, out of the ordinary. 

Ultimately the frustration over many years led her down the path of trusting a surgeon to remove one of her discs and then fuse two vertebra together.

It didn’t work.

In fact, it made matters worse. 

Forgetting the fat cheque that private surgeon took home, or the many painful and frustrating nights that followed, the happy ending to the story is this. 

My mum can do more or less everything she wants. She can stand. She can sit (although not for too long). She can walk. Her overall range of motion is good. She can pick up and hold her grandson. She can play with and read to him while sat in her lap. And she can do all of this without too much pain.

BUT.

She still suffers from chronic back pain.

She manages her pain by doing a number of daily mobility exercises, walking often and sitting less. When she does sit she uses a pillow for support (to watch tv or have dinner) and stands regularly to stretch. On top of this she occasionally goes swimming or attends a pilates class. She also takes pain killers to help her sleep through at night. All of this means she can still have a decent quality of life.

The main point is this though:

SHE MANAGES HER PAIN. Her pain has not been cured, but SHE HAS MADE PEACE WITH IT. She doesn’t complain about it or let it detract from her day. She simply gets on with life. 

Her acceptance, despite many years of fighting this frustrating, heart-breaking battle, is truly inspirational.

It’s an important lesson I mean to take with me as I attempt to solve/manage my own issues with back pain. 


A WORD OF WARNING ⚠️ 

(I should say, for those who are considering back surgery as an option to help cure their own back pain, proceed with caution!! Surgery should be the absolute last call of action and even then, you better be damn sure you have an accurate diagnosis. 

Peter Ullrich, an orthopaedic surgeon, has this to say,

“The number one determining factor whether or not a fusion surgery will deliver the desired reduction in pain is an accurate preoperative diagnosis, meaning a diagnosis that clearly identifies the underlying cause of the patient’s pain.

Identifying degeneration of other changes in the spine is not sufficient—the diagnosis needs to identify that those changes in the spine are actually causing the patient’s pain. Many people have a bulging disc, herniated disc, stenosis, and other issues with their spine, but no pain.

I can’t stress this point enough.”

If you’d like to know more please have a read of this article).


So what’s wrong with me?

A lot of things but let’s stick to the topic of my back for now. 

I injured my back early on while training for the London marathon in 2014. Instead of backing off though, I ran through it, repeatedly… Stupid, I know. 

Following that I attempted to run a half marathon in new shoes, a month out from the main event, during which something in the back of my right knee gave way… Stupid, I know.

I limped home and didn’t train again till I ran the actual thing. 

On race day I wore a compression top for my back and had both knees strapped. Despite feeling pain in both, I felt committed (having asked so many people to sponsor my brother and I), so I ran the London marathon anyway… Stupid, I know. 

(Side note: I should write a piece on how not to run a marathon). 

I finished in what was probably a record slow time for my age, but I finished! It was an unforgettable day and one that I cherish.

BUT.

It came at a price. 

The long term result is, I’ve suffered on and off with a variety of different issues related to the back and neck ever since. While it’s clearly been nothing serious, as multiple MRI scans have shown, my back has never truly healed either. 

More recently (a few weeks back to be exact), I managed to put my back out lifting weights, bringing on a fresh wave of lower back pain and sciatica that has, quite frankly, scared the shit out of me. 

What if it’s something serious? 

What if I never can never lift weights again? 

What if I have chronic back pain for life? 

What if, what if…. I, I, I… Me, me, me….

STOP!

Take a breath. 

Observe. 

Proceed.

After a long period of catastrophizing and feeling sorry for myself, its clear I’m in a dangerous position of falling down the rabbit hole again.

I need a plan.

So, here it is…

1) Start treatment with my PHYSIO. (I know a lot of people who swear physio off as inconsequential, but I think it has its place. I can’t say it’s ever been a cure to my problems but I have responded positively to it, feeling better after – if only for a day or two. Nonetheless I believe it’s better than not having it, so I plan to continue)

2) Start treatment with an OSTEOPATH. I’ve had success with Osteopathy before, so I’m going to start here before considering other forms of treatment. (Those that I want to have look at include Acupuncture &/or Acupressure, Active Release Technique (ART), Biopuncture and Dynamic Neuromuscular Stabilisation (DNS) should the physio and osteopath not prove affective).  

3) In the interim I’m going to get an MRI SCAN to help see exactly what is or isn’t going on in my lower back – hopefully ruling out some more nasty possibilities as a result. 

4) Following that I’m going to take MRI results to an ORTHOPAEDIC specialist for advice on the problem.

5) Research/test out the best WAYS TO MANAGE MY BACK PAIN AT HOME AND AT WORK including the BEST STRETCHING AND STRENGTH EXERCISES plus HOW TO SIT, STAND AND WALK properly. Also what not to do and what other things or tools (shoes etc.) one can use to help (A pilots guide to managing back pain – my next blog post will be a result of this particular research). 

6) Follow up with my results later this year, looking into HOW I CAN PREVENT SIMILAR INJURIES GOING FORWARD and to make sure I have a healthy back well into my old age. I also want to look at HOW TO IDENTIFY AND CORRECT IMBALANCES WITHIN THE BODY (One thing I want to look into is Functional Movement Screening (FMS)). 

7) Regardless of whether I find myself back to full back health or not, I want to look into the IMPLICATIONS OF PERMANENT CHRONIC BACK PAIN. How to manage that going forward? What are the best coping mechanisms people who are in this situation use? (Aside from what pain killers one might use I really want to explore the best PSYCHOLOGICAL TREATMENTS for coping with chronic pain including Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT)).

January Review

“How noble and good everyone could be if, every evening before falling asleep, they were to recall to mind the events of the whole day and consider exactly what has been good and bad. Then, without realizing it, you try to improve yourself at the start of each new day; of course, you achieve quite a lot in the course of time.”

Anne Frank 

STATS:

Meditated  – 31/31 days (currently 144 days in a row)

Exercise – 17/31 days (Injured back lifting weights)

Writing – 20/31 days – Published 1 post/week on blog (5 total)

Reading – 24/31 days – Finished 3 books (The 4 Hour Body – Timothy Ferris. Tools of Titans – Timothy Ferris. How To Self-Publish A Children’s Book – Eevi Jones).

Alcohol free days – 20/31 days – 1 x alcohol free week (1st – 7th)

10k + Steps – 21/31 days

WHAT WENT WELL?

Meditated every single morning. 

Got plenty of reading and writing done – resulted in reading a total of three books plus publishing a post on the new blog every week (5 total)! 

Diet has been consistent, keeping to largely protein rich/low carb meals during my fasting window of 12-8pm. 

Completed alcohol free week (1st – 7th). 

Body weight = 75.2kg and body fat = 17.1% as of Jan 31st. Although my body fat loss has plateaued in recent weeks I’m mindful of the fact I’ve not been lifting weights or doing HIT because of my back (see below). (Also I’ve been having a few more cheat days as Mum and Dad have been in town to celebrate a belated Christmas and Chinese New Year!) At any rate I’ve not gained weight which is a plus. 

Injury setback through weight training. Despite this I managed to modify my exercise regime – replacing planned weight and hit workouts with lots of swimming (FYI swimming is awesome!). It has also given me a few ideas for upcoming blog posts. 

In terms of admin got plenty done – filling my UK tax return and paying my HK ones. Also organised new mortgage for UK property. 

WHAT DIDN’T GO WELL?

Work – haven’t performed as well as I would have liked although, in my defence, I’ve not done much flying this month. At any rate, still plenty of room for improvement. Lack of motivation still an issue too. How might I resolve this and find my former enthusiasm for flying? Honestly I think I’m suffering a little burn out following nearly ten years of long haul flying. A longer break this year is planned for exactly this reason. As a way of resting, resetting and coming back stronger. 

Injury set back. Managed to hurt my back during weights training. This stopped me from working the second half of the month due to lower back pain associated with sciatica. The warning signs were there – a small twinge but definitely felt something before stupidly going ahead with weights training when I should have backed off. MISSING ONE WORKOUT TO PREVENT INJURY IS ALWAYS WORTH IT! Listen to your body!

At home I’ve not prioritised writing a will which I keep putting off – mainly because I’m lazy which is no excuse. Get it done!  

WHAT DID I LEARN?

Mentally it’s been a tough month with this back injury. I have felt angry and frustrated, failing to see the bigger picture – ie. it will pass and NOTHING IS PERMANENT. I think finding the time to BE MORE PLAYFUL and HAVE MORE LAUGHS with friends and family should be a priority for February. Mercifully I have some leave this month and plans to go to skiing in Japan (back permitting) with the family. I must make the most of it regardless of how much skiing I can actually manage. 

TALK TO YOUR WIFE more (insert expletive) head. She’s your partner and wants to help you (just like the rest of your family!). Communication clearly still a weakness for me. My idea of talking every night before bed is a good one but I must MAKE A POINT OF REALLY ENGAGING. Asking more questions and listening intently. Just as importantly TELL HER WHAT’S REALLY ON YOUR MIND

Two things I can think of implementing straight away: 

MEDITATE MORE OFTEN, not just in the morning. Meditation really helps but I think I’m simply going through the motions a bit with my morning practice. My plan is to experiment more with different times during the day when I have a quiet moment and to meditate in the evening just before I go to sleep! 

When talking to my wife in the evening come prepared with THE SINGLE GREATEST CONCERN you have had during the day and TELL IT TO HER. Don’t keep it to yourself.

There is always an opportunity with any set back and it’s important to look for it. Following my injury I told myself NO EXCUSES, that THERE IS ALWAYS A WAY TO MODIFY even if you have to scale way back! Adopting swimming has been a great way to do this given the circumstances and is something I’m particularly proud of implementing. It turns out SWIMMING IS AWESOME and I believe is what’s responsible for a marked improvement in my cardiovascular system. My resting heart rate dropped from the mid to low fifties into the mid to high forties for the first time in a long time! Not to mention it’s been brilliant for my back pain. 

Another silver lining regarding my back injury is I’ve had more time to read and write. TAKING NOTES OF THE BOOKS I READ is something relatively new I’ve been doing but has proven a GREAY WAY TO CONSOLIDATE MY LEARNING. One thing I’ve noticed is that I’m spending more time on writing blog posts then continuing with my children’s book. I must revisit notes from how to self publish a children’s book and WRITE A TIMELINE TO FOLLOW. Approaching an editor will be a close second objective.