How to Fix Chronic Low Back Pain

We’re continuing the conversation this week with Greg Potter, PhD., but with a plot twist. We’ve had Greg on the podcast many times discussing all facets of sleep and circadian biology, but today the topic is low back pain.  Greg has had personal experience with this problem since the age of 12 and has devoted extensive time and effort to researching and trying various treatment methods to find relief for himself and his coaching clients. He’s quick to admit he’s not an expert in low back pain, but it’s clear he’s well-versed on the topic.

Greg thoroughly examines low back pain in this podcast, including causes, treatments, and scientifically-validated approaches for relieving chronic discomfort. He discusses time-tested treatments and cutting-edge options, including therapies, exercises, and supplements. He also recalls the book that started his healing journey and the best ways to give your back a break during daily movement and activities.

Here’s the outline of this episode with Greg Potter: 

[00:00:10] Health Optimisation Summit.

[00:00:44] Podcasts: How to Use Time-Restricted Eating to Reverse Disease and Optimize Health, with Satchin Panda, PhD; Kale vs Cow: The Case for Better Meat, with Diana Rodgers, RD.

[00:01:53] Stuart McGill on HumanOS podcast: How to Avoid or Improve Back Pain Podcast with Stuart McGill

[00:02:14] Greg on STEM-talk Podcast: Episode 136: Greg Potter Talks About Circadian Biology and the Importance of Sleep.

[00:02:31] Greg's history with back pain.

[00:03:07] Book: Low Back Disorders: Evidence-Based Prevention and Rehabilitation Third Edition, by Stuart McGill.

[00:07:05] Chronic back pain: prevalence and costs to society.

[00:09:42] Causes and types of lower back pain.

[00:18:53] Sports that increase risk of back pain.

[00:21:11] Physical Therapist Zac Cupples; Podcasts: Movement Analysis and Breathing Strategies for Pain Relief and Improved Performance and Airway Dentistry: What to Do When You Don’t Breathe Right At Night.

[00:22:18] Podcasts with Mike T. Nelson: 1, 2, 3, 4, 5 and Ben House: 1, 2.

[00:22:18] Prevalence of spinal stenosis without symptoms; Review: Deer, Timothy, et al. "A review of lumbar spinal stenosis with intermittent neurogenic claudication: disease and diagnosis." Pain medicine 20.Supplement_2 (2019): S32-S44.​

[00:23:29] Spinal degeneration with no symptoms, by age; Study: Brinjikji, Waleed, et al. "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." American journal of neuroradiology 36.4 (2015): 811-816.

[00:24:02] Nociplastic (nonspecific) pain.

[00:26:29] Psychological causes for pain.

[00:27:34] Lorimer Moseley on YouTube.

[00:28:51] Certified Strength and Conditioning Specialist, Zach Moore; Podcasts featuring Zach: Overcoming Adversity and Strength Coaching and Health Fundamentals: Movement and Exercise.

[00:33:36] Rates of low back pain in traditional cultures and early human species.

[00:37:13] 2015 study: Plomp, Kimberly A., et al. "The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans." BMC evolutionary biology 15.1 (2015): 1-10.

[00:38:53] Difficulties in assessing and treating back pain.

[00:43:51] Stuart McGill; Backfit Pro.

[00:44:47] Abel Romero; Podcast: How to Avoid Chronic Pain, Improve Mobility and Feel 100% Confident in Your Lifting.

[00:46:11] Spine hygiene (i.e., how to give your lower back a break); moving well and often.

[00:50:53] Building spine stability.

[00:51:56] Stuart McGill's Big 3 Exercises.

[00:54:14] Bracing your spine when lifting things.

[01:02:06] Bracing with breath: Valsalva maneuver.

[01:03:22] Treatments that intervene with pain at the brain level.

[01:05:58] Mindfulness Based Stress Reduction (MBSR) vs Cognitive Behavioral Therapy (CBT) for low back pain; Study: Cherkin, Daniel C., et al. "Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial." Jama 315.12 (2016): 1240-1249.

[01:06:17] Effects from MBSR are not sustained long term; Meta-analysis: Anheyer, Dennis, et al. "Mindfulness-based stress reduction for treating low back pain: a systematic review and meta-analysis." Annals of Internal Medicine 166.11 (2017): 799-807.

[01:07:18] The Mindfulness App.

[01:07:36] Russ Harris; Acceptance and Commitment Therapy (ACT).

[01:08:06] Pain Reprocessing Therapy; Study: Ashar, Yoni K., et al. "Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial." JAMA psychiatry 79.1 (2022): 13-23.

[01:10:48] Relationship between low back pain and sleep problems.

[01:11:38] Insomnia comes before back pain; Study: Agmon, Maayan, and Galit Armon. "Increased insomnia symptoms predict the onset of back pain among employed adults." PLoS One 9.8 (2014): e103591.

[01:12:02] Treating insomnia can help with pain; Transdiagnostic sleep and circadian approach, Allison Harvey and Daniel Buysse.

[01:12:29] Cognitive Behavioral Therapy for Insomnia (CBTI); Podcast with Ashley Mason: How to Use Cognitive Behavioral Therapy for Insomnia.

[01:13:18] Mattresses, pillows, and sleep positions for sleep quality and musculoskeletal support.

[01:19:04] Nutritional considerations for pain.

[01:20:24] Intramuscular vitamin B12 for back pain; Study: Rooijakkers, Johanna M. "Intramuscular Vitamin B12 Injections for Treating Chronic Low Back Pain." (2014).

[01:20:57] Effects of weight loss interventions on low back pain; Systematic review: Chen, Lu Hsi, et al. "The effectiveness of weight loss programs for low back pain: a systematic review." BMC Musculoskeletal Disorders 23.1 (2022): 1-14.

[01:22:27] Impact of supplements on different kinds of back pain.

[01:22:42] UC-II collagen, hydrolyzed collagen, ginger.

[01:25:10] Palmitoylethanolamide (PEA) - Levagen.

[01:26:06] Meta-analyses on effects of PEA for pain reduction: Einaudi, Via Luigi, and Giustino Varrassi. "Palmitoylethanolamide, a special food for medical purposes, in the treatment of chronic pain: a pooled data meta-analysis." Pain Physician 19 (2016): 11-24 and Artukoglu, Bekir Berker, et al. "Efficacy of palmitoylethanolamide for pain: a meta-analysis." Pain Physician 20.5 (2017): 353-362.

[01:26:49] Protein, creatine monohydrate, vitamin D3, glucosamine sulfate.

[01:27:34] Glucosamine may not be effective; Study: Wilkens, Philip, et al. "Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial." Jama 304.1 (2010): 45-52. 

[01:27:47] Glucosamine + chondroitin + msm, low efficacy for pain reduction; systematic review: Stuber, Kent, Sandy Sajko, and Kevyn Kristmanson. "Efficacy of glucosamine, chondroitin, and methylsulfonylmethane for spinal degenerative joint disease and degenerative disc disease: a systematic review." The Journal of the Canadian Chiropractic Association 55.1 (2011): 47.

[01:28:21] Glucosamine is associated with fewer cardiovascular events and less mortality; Study: Ma, Hao, et al. "Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank." bmj 365 (2019).

[01:28:35] Glucosamine is associated with reduced all-cause mortality: King, Dana E., and Jun Xiang. "Glucosamine/chondroitin and mortality in a US NHANES cohort." The Journal of the American Board of Family Medicine 33.6 (2020): 842-847.

[01:28:59] Malcolm Kendrick; Book: The Clot Thickens: The enduring mystery of heart disease; Podcasts with Dr. Kendrick: 1, 2, 3.

[01:31:23] Work with Greg: gregpotterphd.com. @gregpotterphd on social media.

[01:32:28] Simon Marshall; Podcast describing SEEDS approach: Nudge Tactics for Performance and Health.

[01:33:00] Kanban board; Trello.