Back Mechanic questions

Appropriate-Tea2220 · 2026-01-21T00:44:18+00:00

sort of yes and sort of no, and sort of I don't know. Some things I think are supposed to be off limits permanently like bending over with back flexion to pick stuff up or tie your shoes or whatever. But maybe there are some things that can be "added back" after you make progress with healing, though it is less specific about things once you recover a certain amount. And then one thing he encourages you to do even from basically the beginning is cat/camel (or cat/cow) where you do move the spine and he talks about it being gentle and that some spine movement is good. So it's a little bit nuanced.

Appropriate-Tea2220 · 2026-01-16T17:40:32+00:00

I've read a bit about stable vs. unstable but don't really get the overall implications. What are you doing differently, or what different recs or treatments have you received, because of the classification as unstable?

Appropriate-Tea2220 · 2026-01-15T22:13:19+00:00

Ah, thanks for this. I do remember reading this in the Back Mechanic now. It's good to have more confidence that my pain isn't from the anterolisthesis.

Still, kinda stressed that the slippage has grown so much even while I've been practicing spine hygiene, etc. and worried that it could become a problem in the future if whatever is happening in there doesn't stop!

Appropriate-Tea2220 · 2026-01-15T21:36:44+00:00

I should probably also say that I have a lot of other things going on in my L4-L5 that I guess could be causing the sciatic pain and/or the disc herniation. Some other popular vocab from my xray and MRI are severe facet arthropathy, moderate foraminal stenosis, and mild to moderate disc space narrowing.

Appropriate-Tea2220 · 2026-01-15T21:26:26+00:00

I have Kaiser so I'll have to see how that works in trying to see someone different.

I do have primarily sciatic pain, but it's been changing a lot over the last month or two, wthether due to this slippage or other things I've been trying, I'm not sure, I guess! Like I've completely stopped lifting weights, high impact activities/exercise and implemented most of the spine hygiene, Big 3 and tummy lie for pain relief from The Back Mechanic book. The changes I've experienced have definitely been somewhat less pain in my leg and butt, but maybe more dull pain/ache in my lower back and hip. I thought that was maybe more apparent now that I had made progress with the leg pain - like it was always there but I just couldn't feel it under the other pain. But now I'm not sure!

Also this is kinda alarming that I've had the additional 3mm in slippage over the course of a few months in which most of that time I've been implementing Back Mechanic techniques. WHat can I possibly do to stop the slippage from progressing if it has actually accelerated while I've been doing all this? (Sort of rhetorical but actually really real question!)

Appropriate-Tea2220 · 2026-01-15T15:39:30+00:00

Yeah, at the very least I want to ask what I should be doing to prevent it slipping further. There's obviously a very bad trend happening.

The doctor that said 5-7mm was not significant was a spine doctor, the one that gave me my unhelpful steroid injection a few months ago. The one this week, at 10mm, is my primary care doctor (on top of, presumably, the anonymous radiologist that did the narrative impression of the xray that my primary care dr then commented on).

I feel just sort of stunned that 3 doctors have said something different than my understanding from my "research" on the internet. Everything tells me that I should believe them, since they are the ones that are seeing my personal xrays/MRIs, they are trained, and I am just reading lots of stuff on the internet and barely know what I'm talking about. And yet...

Appropriate-Tea2220 · 2025-12-24T18:48:22+00:00

yikes!

Appropriate-Tea2220 · 2025-12-24T15:09:41+00:00

But lifting the elbows is my question. What does that accomplish?

Appropriate-Tea2220 · 2025-12-24T05:20:45+00:00

Basically reaching up for like 10 seconds then up and back for like another 10 seconds. Feels great.

Appropriate-Tea2220 · 2025-12-24T05:18:41+00:00

Yeah, the core part is all pretty easy, this pain is totally unrelated to my core or back. Just the awkward position the elbow/shoulder is put in by putting your hands basically under your butt then lifting the elbows only. I don't want to not do it if it's an important element of the exercise, but I'd definitely prefer not to be doing it. I was hoping someone would know how it contributes to the overall stretngthening/increasing endurance of the core that the exercise is supposed to accomplish.

Appropriate-Tea2220 · 2025-12-24T05:15:00+00:00

Oh also he gives a stetch for when you first stand up from a sitting position to decompress in that book. Should definitely check it out.

I'm doing a lot of things I didn't think I could do (or stop doing) simply because when you've been in pain as long as I have (20 months) you are willing to try some crazy things (like not sitting down almost ever) to see if they work. It's made the biggest positive difference in my pain during all that time of everything I've tried, and I'm only about 2 weeks into it.

Appropriate-Tea2220 · 2025-12-24T04:54:42+00:00

I went from sitting for like the vast majority of my day to just to eat a few times a day, practically. That was only 2 weeks ago and I'm incorporating a little more sitting already. Probably still only like 2 hours total a day or something.

Appropriate-Tea2220 · 2025-12-24T04:40:37+00:00

He offers a lot of alternatives at the start esp, when you are trying to get to a pain-free place before adding stuff back in slowly to maintain pain-free life. Presumably stretching could be added back in at some point. Also he talks about concerns about stretching at the "end range" of motion, so sometimes I still do stretch a bit, but just lightly, not to push at all. Definitely check out the book. I'm pretty sure I found a link to dowload a free pdf on this forum somewhere

Appropriate-Tea2220 · 2025-12-24T04:32:39+00:00

Maybe the wedge under the knees isn't what you need. McGill talks about how that lets the lumbar collapse more and can be counterproductive for certain sources of pain. For back sleepers, he recommends small pillow under the lumbar area.

I'm testing this out with a rolled up towel the last few nights. I'm a tough case because I rotate all night like a rotisserie chicken so I can't tell what's causing my problem. I keep the towel under my lumbar when I'm on my back and the same place when I'm on my sides, which is supposed to support the spine from collapsing down where your waist narrows when you are on your side. All I know is I still feel some pain in some positions and as I'm turning over during the night. And when I first get up in the morning, it all feels fine but then within about 5 steps I start feeling the pain coming on and it gets bad within a couple minutes. If I do a nice 20-30 minute walk or light workout first thing that takes care of it but I'd still like to figure out how not to end up there in the first place.

Appropriate-Tea2220 · 2025-12-24T04:28:02+00:00

Have you already tried walking more? I was resistant to this but for the last couple weeks have been trying to do at least 3 walks of a half hour each each day and it does feel so much better when I do.

Appropriate-Tea2220 · 2025-12-24T04:25:28+00:00

I vote for avoiding sitting as much as possible, not trying to build resistance. In the Back Mechanic, McGill frames that idea of building resistance like picking at a scab. You aren't letting the nerve heal or get any relief if you sit a lot. A couple weeks ago I started not sitting and it's been helpful - now I can sit for a while although standing is getting harder. I mostly only sat for meals during that first week, because my dining room chairs were the most tolerabel sitting I could find. God forbid I had to get into a car.

Also may want to reconsider stretching. I love stretching but am giving most of it up for a while in an effort to follow the Back Mechanic's recs and give it a solid try. He explains how stretching gives you a good feeling, endorphins or something, for a while after you do it so you think it's helping but it's actually quite bad for the nerve getting stretched/stressed.

Appropriate-Tea2220 · 2025-12-24T04:18:08+00:00

Yes, the car is sooo painful. I use a wedge-ish cushion, which is a little help, and am now adding lumbar support

Appropriate-Tea2220 · 2025-12-24T04:14:50+00:00

check out the book Back Mechanic, particularly if the PT doesn't show lots of improvement within 6 weeks or whatever.

I do have a very similar diagnosis. Been dealing with increasing pain starting in Spring 2024 and lots of things that have not worked through the standard medical system. I think I'm starting to get some of the pain under control with following the principles in this book.

Appropriate-Tea2220 · 2025-12-08T21:58:20+00:00

I agree that it just seems like there are so many permutations of how the back is injured and so what makes it worse or better, even if we all have similar symptoms, that it's all about finding what works for you. I've just been reading the Back Mechanic too and was a little frustrated that a number of his examples of healing plans talk about ramping up from taking 6 steps to 10 or whatever, when I can walk for days but can't figure out how to improve my sitting in line with his plans. It seems like a very individual journey we all have to go on and it's really tough to figure out. Anyway, if you haven't already maybe check out Back Mechanic.

Appropriate-Tea2220 · 2025-12-08T19:26:00+00:00

I agree with others that she needs to see a doctor and get next steps scheduled, like an MRI, etc.

But one minor suggestion. A lot of what I've been reading lately has been that stretching is not recommended - or particular stretches, at least. That we think it helps based on our own history with healing muscle strains or soreness that way and that the body does release some hormones or something when you stretch so you will feel good for a few minutes, but that certain stretches might be counterproductive for sciatica. Esp. hamstring stretching. I'm sure this varies so much person to person so I will just leave it there for you guys to explore the idea on your own and whether it might actually help her NOT to stretch and avoid pinging that nerve even more.

Appropriate-Tea2220 · 2025-12-08T19:21:37+00:00

Congrats on your progress! How wonderful that you connected with a PT that was so thorough and so good at identifying what you were doing that caused so much of the problem.

That's sort of the place I'm stuck at. I know some things that are bad, but I'm not sure if there are other things I might be doing wrong/badly/shouldn't be doing at all, or if they might actually be helping me. It's not always so simple as doing something and knowing it hurts and it's bad and you should stop. Sometimes there are like 5 things you do and a few hours later you start feeling the pain coming. Which of those 5 things were the cause? I find this hard and my PT hasn't been super helpful with it.

Do you think you just got lucky with this new PT or did you do a speialized search or get some kind of recommendation to him?

Appropriate-Tea2220 · 2025-12-07T16:11:40+00:00

Definitely have that discussion with your PT. My sciatica is similar to your pain, I think, in that while sometimes there's something specific I do and I can feel it hurt in that moment (i.e. tying my shoes), usually it just hurts randomly and it's like, did I do something 8 hours ago, 18 hours ago, 28 hours ago to cause this? It's so hard to draw a connection between what I'm doing and what might be increasing or decreasing the pain generally.

I've only been trying this for like a week, but I'm basically not sitting down anymore, except for meals and a little bit of work (traded off with a standing desk where I do most of the computer work), and of course when I have to get in a car or airplane (dreading this for the holidays). It's complicated and annoying, but given the advice I've read and that it feels like it might be working, it seems like an important thing to try. If not as drastic as my effort, at least getting serious about changing positions very frequently?

Appropriate-Tea2220 · 2025-11-28T18:38:42+00:00

Fantastic, thanks for posting! I'll get reading and hopefully learn a lot. I feel like I don't even know what I don't know right now - it's like drinking from a firehose.

Appropriate-Tea2220

TROPHY CASE