Stop fixing your desk. Start building your capacity: The real cure for back pain

By the time most of my back pain clients come to see me, they've already had the workplace assessment, they've shelled out on a new mattress, a standing desk, a foam roller... and still the back pain lingers.

I'm not going to tell you ergonomics are worthless. They're just a very small lever, and most people are hauling on that lever with everything they've got while completely ignoring the big one. When it comes to a lot of injury management and chronic, long term pain issues, there are often bigger and better, lower hanging fruit, than chasing intangible improvements in posture, workplace efficiency, glute activation and pelvic tilt.

The biggest one: capacity.

What capacity actually means

Capacity is how much any given tissue can handle before it starts complaining and/or breaking down. How strong the muscles, bones, and connective tissue around your spine, hips and trunk are. How far they'll comfortably stretch. And, more than anything, how much load and stress they'll tolerate before they protest.

Anyone who has started out a bit too aggressively on their couch to 5k and struggled to walk for 3 days after intuitively knows the relationship between what you're capable of tolerating, and the stress you acutely put through your body.

If you've had months off and gone back to a busy gym in January, excitedly smashing out squats and deadlifts only to find you're burnt out and in pain after your first session, you're even more aware of the concept of tolerance and capacity.

Too much, too soon, into tissues that just aren't ready.

Where most people struggle

The tricky bit with a lot of lower back pain is reliably quantifying exactly what it is that triggers it. You can count reps, measure distance on a Garmin, or take note of the weight you're putting on the bar, but you can't measure the slow loss of strength and fitness that creeps in when you commit to a busy work and family life at the expense of training and activity.

It's hard to quantify the absence of something, so we assign blame to the 8 hours of sitting, or the pain that's there when you wake up after 6 hours on the mattress

You intuitively look at another desk fit or an orthopaedic mattress because sitting and sleeping make you feel acutely aware of your back pain, but they're just symptoms of the loss of strength and capacity, not the cause itself.

Key point to note...

The caveat here: this isn't every case.

Pain that radiates down a leg, wakes you at night, follows a fall, or comes with numbness or weakness: these are things that need looking at properly before anyone talks to you about training. That's exactly why we assess before we programme. But for the recurring, stiff-in-the-morning, goes-once-or-twice-a-year back that most people in your office are living with, or have experienced at some point, rebuilding their capacity is the key.

How you actually raise the ceiling

You train the muscles of your spine, your hips and your core to be stronger, and you do it in the positions you've spent years avoiding.

That last part matters. Most people's instinct after a bad back is to protect it. Keep everything neutral, brace hard, never bend, never twist. Understandable, and useful for a week or two. Carry on for a year and you've built a back that can only tolerate one narrow slice of movement. Real life is bending, twisting, reaching, loading one side and picking things up off the floor at an angle.

The more we avoid certain movements, the more we become sensitised to them, and the narrower our bandwidth for movement becomes. Push this to it's extreme and further down the line our movement narrows and narrows, and we become more and more sensitised. Classic catch-22.

So we deliberately train those positions. Loaded bending. Controlled rotation. Flexion and extension under manageable weight. Carries where one side is working harder than the other. Nothing heroic and nothing sudden. Just a bit stronger, a bit more range, a bit more tolerance, week on week.

In a nutshell: stress inoculation.

You expose those structures to a controlled dose of the exact stress that would otherwise floor you, and over months they stop finding it threatening. The morning stiffness fades. The twinges get shorter and further apart. The spasm that used to write off a full week doesn't turn up, and if it does, it's a bad afternoon rather than a bad fortnight.

It's slower than buying a chair. It also works, and it keeps working, which the chair very rarely does.

More importantly, if done really well, as and when a spasm or a bad day does surface, you'll likely have 3 or 4 exercises up your sleeve that you know will free you up. What normally serves as your warmup in the gym on a good day becomes your restorative morning routine on a bad day that simply brings you back to baseline in 5 or 10 minutes. Win-win.

Start soon!

Most people come to practitioners like me after the third or fourth flare-up, once the pattern is impossible to ignore. That's fine. But the best results go to the people who start while it's still merely annoying. Maintaining a strong base when you've got the capacity is a hell of a lot easier than starting from a hole. But both can be done.

If you're ready to stop optimising your desk and start raising your capacity, Book a free phone consultation