Lesson 04 · 9 min read

The Big Levers: Lifestyle and Back Health

We can talk all day about the specifics of spine biomechanics, but the truth is that much of our ability to prevent and recover from back pain depends on our overall health and lifestyle. Getting enough sleep? Staying active? Maintaining a healthy body weight? These habits are the foundation of your health, and they matter to your back as much as any program or treatment. If there are two things I'd like you to take away:

You can improve your quality of life with back pain, and
You cannot ignore your general health in the process.

Sleep

Sleep is so important that it's first on the list. Sleep is when all of our systems perform maintenance to prepare us for the next day. Here are some tips.

Routine

Go to bed and wake up at the same time. This sets your circadian rhythm (your internal clock). An hour's deviation here and there is no big deal; consistency is the goal.
Aim for about 7-9 hours per night. You know when you have to be up, so do the math and hit the mattress then.
Avoid building a monstrous bedtime routine. Reading, meditating, stretching, a 20-step skincare routine, and gratitude journaling all sound nice, but the inconvenience can become a barrier to actually sleeping. Keep it simple and repeatable.

Environment

Make your room cool and as dark as possible. Without covers you should be a little cold, and just warm enough with them.
If you struggle to fall asleep: no TV or phones in bed, and reduce bright-light exposure before bed. Turn the lights down, use soft lamps or dimmers, and switch your phone to night mode.

Position

Find a position comfortable for you and your back. Many people like side-lying with a pillow between the knees, or lying on their back with a pillow under the knees.

Stress and anxiety

Chronic stress disrupts the balance between repair (anabolism) and breakdown (catabolism), which shows up as weakened immunity, fatigue, and irritability. If you're consistently in fight-or-flight, consider:

"Sigh breathing." Inhale deeply to fill your belly and chest, then take a second quick inhale to top off your lungs. Pause briefly, then release and deflate like a balloon. After a few rounds, make your exhales longer than your inhales. This activates the parasympathetic nervous system and switches you out of panic mode. A few of these breaths can work wonders.
Adequate sleep and regular exercise increase your ability to tolerate stress.
Remain positive and interrupt negative thoughts. Getting worked up about traffic or something you saw online just isn't worth your peace.

Activity level

I'm biased toward resistance training for its strength, stability, and metabolic benefits, but the most important thing is to find exercise you enjoy, because that means you'll actually do it.

"Use it or lose it." Extended inactivity leads to decreased capability. Get moving however you can, and stay moving.
Something is better than nothing. A short walk or taking the stairs nudges you in the right direction and builds momentum.

Healthy bodyweight

No judgment here, just some uncomfortable truths. Carrying extra weight means your joints (including your spine) see greater forces with every movement, and your muscles have to work harder to move you. There's also evidence that people living with obesity have greater systemic inflammation [1], an environment that accelerates the breakdown of spinal tissue and sensitizes us to pain.

Bodyweight is a function of energy balance:

Weight maintenance: intake = expenditure
Weight gain: intake > expenditure
Weight loss: intake < expenditure

A good first step is getting a sense of how much you're actually eating (free tools like MyFitnessPal make this easy for a week or two). From there:

Eat a balanced diet of high-satiety foods. Those high in protein, fibre, and water leave you fuller.

Eat more (high satiety)	Eat less (low satiety)
Protein: fish, beef, beans, lentils, eggs. Fruit: apples, oranges, grapes, bananas. High-fibre carbs: potatoes, whole-grain bread and pasta, oats, popcorn	Bakery: croissants, cake, doughnuts. Fatty snacks: candy bars, nuts. Chips, crisps, ice cream

Drink a full glass of water right before each meal. It can increase fullness.
Identify your overeating triggers and change your environment to avoid them (don't stock the pantry with ultra-processed snacks).
Consider a shorter eating window (e.g. noon to 8pm). There's nothing magical about it. People just tend to eat less in a condensed window.

And one thing off my chest: carbs are not the enemy. Of the three macronutrients, carbs are tied for the lowest energy density: carbs and protein have 4 calories per gram, fat has 9. Potatoes were the single most filling food in the satiety research and they're low-calorie. The mistake people make is drowning their carbs in high-fat, high-sugar sauces and cheeses. Stop blaming the carbs.

Smoking

Smoking is bad for your health, even for your back. Smokers have a higher prevalence of back pain, chronic back pain, and disabling back pain [3]. Smoking also drives more aggressive disc degeneration and strongly predicts failed recovery from spinal surgery, because nicotine inhibits bone growth and raises infection risk. You get the point: don't smoke.

References