It’s a miracle if back pain never plagues you—even before midlife looms. Which is why stars including Rita Ora, Professor Green and Paloma Faith along with humble civilians consult the “celebrity” osteopath Anisha Joshi.
In her book, Heal Your Back, she reels off risk factors including lack of exercise, aging (from 30), obesity, smoking and stress. She also notes that lower back pain is the primary cause of disability worldwide, most commonly afflicting those aged between 50 and 55.
She’s speaking to me on a Zoom call from her clinic in London and I’m listing my midlife back woes. “I can see you’ve got a mild scoliosis just from looking at you,” she says, referring to the condition that causes a sideways curvature of the spine, “from the way you move, and from your left shoulder being slightly raised and from your left scalene muscle being a little bit tight.”
I feel like the Hunchback of Notre-Dame, but Joshi, 38, is kindly reassuring: “It’s nothing to worry about—so many people have it. It might mean that if you do strength training, you might be over-contracting on one side.” She advises consulting an osteopath to work with a personal trainer, and I realize that this is why I’m always twanging my back as I freestyle it in the gym—a lightbulb moment.
Here, Joshi explains what else may be causing your back pain and what to do about it.
Something “Went” — Have I Slipped a Disc?
Joshi hears this often, as if an intervertebral disc can shoot from position like a bar of soap. The back isn’t that flimsy, she says. Each disc consists of an outer layer of collagen fibre, providing strength, and a gel-like center, for shock absorption. As we age discs lose some water content, reducing their shock-absorbency. She compares it to a deflated tire or a squished doughnut: “Imagine you’ve taken a bite out of a jam doughnut, and a bit of jam has come out.”
Heavy lifting, excessively loading the spine, and sudden, forceful movements—perhaps while picking something surprisingly heavy off the floor or attempting an over-ambitious deadlift—can lead to injuries such as disc herniation or prolapse, she says, and the outer layer might rupture. Continuing the doughnut analogy, “more jam will come out.” The disc hasn’t “slipped” but its innards may protrude—and if the disc protrusion is sudden, “it can cause excruciating pain.”
If it’s touching a nerve, there will be even more discomfort. “Most commonly this occurs at the bottom of your back and causes sciatic symptoms,” she says, but notes that disc protrusions or herniations make up just 4 percent of back pain cases.
So Why Is My Back Still Hurting Weeks After I Deadlifted?
“Deadlifts are very commonly associated with back pain,” Joshi says. They’re not bad—we just need to respect them. Meanwhile, what damage have we done? “It depends when the pain comes on. If it’s a few hours later, and a dull ache, it’s more likely to be a muscle strain.”
A muscle tear is rare. “Your body hasn’t adapted yet—you’ve probably gone too heavy or done too many reps. Or you’ve put your foot in a different position, so used a different muscle from normal,” she says. If there’s a muscle imbalance (thinking it’s easier to do this on the left than on the right is a clue), you’re more likely to hurt your back because other muscles will compensate.
If the pain is sharp, instant and excruciating, it’s more likely a “structural injury” such as a strained nerve. Joshi says, “It’s your body’s way of protecting you, sending a pain signal to tell you to stop.”
What if you’re aching for weeks? It could be to do with the joints between the bones of the spine that help to control movement. “Between the vertebrae there are facets, and if you bend awkwardly, you might irritate the facet joint. That can create localized inflammation, and lead nearby muscles—such as the piriformis [a muscle in the buttocks that’s involved with leg movement and hip rotation]—to contract to protect the area. As the sciatic nerve runs through the piriformis, when it contracts it can cause sciatic nerve symptoms down the back of your leg.”
How Can I Support My Lower Back?
Some disc degeneration is natural with age and you may be asymptomatic. “You can get very gradual release of the ‘jam’, and your body adapts.” But it does mean that if you sit for hours, you’ll soon feel it in your lower back. So if a few “tires” are deflated and we’re sore, what can we do? If possible, even the smallest amount of movement is important, “because that’s telling your brain, ‘I’m OK’, and what you tell your brain, your body will believe”—it can help to calm the pain signals. If you’re able, lie on your back, knees bent, and gently rock from side to side.
For strength training to “bulletproof” your lower back, Joshi loves glute bridges. (If there’s an imbalance in glute strength, during exercise “it can be difficult for them to support your lower back. So your body will recruit other muscles around the area to do the deadlift, or pick up the child, which can lead to the muscles over-contracting,” predisposing you to pain.)
“Body-weight lunges are great because they’re one-sided. Not only do you engage your legs and glute muscles, you use your core to stabilize you,” she says. Planks too: start on your knees, if necessary, rather than a full plank. Do alternate shoulder taps to work on stability.
Why Is My Back Pain Worse When I’m Stressed?
“Pain is multi-faceted,” Joshi says. As contributors go, “Stress is a big one.” Continuing stress increases cortisol levels and therefore low-level chronic inflammation, she says. “Inflammation is swelling and it can press on nerves, which will send pain signals to the brain.” Also, when we’re tense our breathing often turns shallow, meaning we “under-use” our diaphragm (so other muscles, including those in the back, compensate to help us breathe). “Where your diaphragm attaches to your lumbar vertebrae, it can cause lower back pain.”
How about when you’re tense, then sneeze and hurt your back? “A muscle isn’t ready to contract and contracts suddenly and causes a strain.” Deep, slow breathing stimulates the vagus nerve, promoting relaxation by slowing your heart rate. It also creates better movement through the ribs. “This will help increase mobility through your mid-back and diaphragm,” and greater mobility leads to a decrease in pain. “I often recommend my patients do box breathing—breathe in [through the nose] for four, hold for four, out [through the mouth] for four, and hold out for four.”
I Sit Up Straight, So Why Do I Ache?
People think posture is the cause of their back pain. “I sit really badly,” they tell her. It’s more that they’ve sat at their desk for eight hours. “You can sit up straight like a royal princess for the whole day and still you’d feel your back.” You need to move—change position regularly, she says. A workable motto is “the best posture is your next posture.” A simple exercise to strengthen your shoulders and bring them back? “Interlace your fingers behind your back and pull your shoulders down, and breathe through it.”
Is a Weak Core Causing My Back Pain?
“Core isn’t everything when it comes to back pain. All the muscles around your lower back are important,” Joshi says. If you’re about to pick up a barbell/toddler, bend your knees and lower your body to the level of what it is you are about to lift. “You’re contracting, bracing—that’s tightening all the muscles that attach to your pelvis so your pelvis can lift heavy objects. And your back muscles are getting stronger in that moment.” It’s good to focus on engaging your core, but “your whole body braces to lift that weight—quads, hamstrings, glutes, abs, arms—it should all be strong.” Although if your core does need work, try the bird-dog, planks, glute bridges and dead bugs.
What’s Causing My Sciatica?
Sciatica is the inflammation of the sciatic nerve. “Nerve pain is usually caused by compression of the nerve where it comes out of the spine,” Joshi says. “You can have a disc prolapse that pinches on the sciatic nerve and then causes sciatica, or your piriformis muscle can go into spasm, which will then press on the sciatic nerve and cause sciatica.” She notes: “Excessive movement might increase risk.” Could this be why a 74-year-old relative got sciatica after doing 100 sun salutations? “It’s a shock to your body,” Joshi says. “A hundred sun salutations sounds like an easy, gentle thing, but even if it’s slow and controlled, you have to build up gradually—an extra five every day. Even if she does yoga all the time, she should have trained.”
What Are the Signs It Could Be Something More Serious?
See a doctor “if you have severe back pain that is unrelenting and not responding to painkillers,” Joshi says. Sometimes “red flag” symptoms occur in conjunction with back pain—”night sweats, a change in your appetite or sudden weight loss without changing your diet.” Any numbness and tingling in the pelvic area and any loss of bladder or bowel control should also be investigated. But, she says, “I’ve seen a ‘red flag’ cause of back pain only twice in my career of 15 years.”
Is Rest the Best Route to Recovery?
If back pain is from overuse—you’ve done a triathlon, say, or moved house—“allow those muscles to rest.” But otherwise “rest isn’t rehab.” Movement, physical therapy, stretching and strengthening is her rule—even though, she says, “If you’re fearful, you don’t want to move.”
It may be far more appealing to just lie down but “lean into the pain a little bit—that’s what you need to be doing.” To what extent? “I always say, lean into pain 10 percent.”
So if you wake and your neck’s stiff, slightly, slowly, gently twist a few millimeters to one side, then back. How to know when to rest or move? Imagine your body is a car, Joshi says (she loves a metaphor). “Be mindful of the warning lights on your dashboard. These little twinges you get when doing a certain exercise—the oil lamp might flicker and disappear the next day. If it stays on for a day, potentially you could be overdoing it.”
Anna Maxted is a London-based journalist and novelist
