George was having trouble with his back and came to see me as a second opinion. He was really tired of being called “the invalid” by his teenage sons who wanted him to join them in a game of basketball.

He wasn't doing too well on his job, stocking shelves at a Walmart, either. He had come to see me, probably to apply for disability.

Five years earlier he had fell down a set of stairs into somebody's basement while delivering heating oil.  He had been pulling a hose across the snow when he slipped and fell. He was in trouble and went to see a doctor who treated him with some anti-inflammatory pills and sent him to physical therapy. When he didn't get better they did an MRI where they discovered something wrong with his back that they felt surgery would help. For six months after the surgery he did better, but then it was back to square one, pain in the back, aching pain. Pain that seemed to take away all his energy. Pain that radiated down his hips and down his legs. He was off work again for pain and he went to see the doctor. They gave him more anti-inflammatory pills and sent him back to physical therapy. Nothing seemed to help. Another MRI didn’t show anything that needed to be operated on.  But he was still not doing well. He started switching from job to job, but nothing was working. The doctor even put him on narcotic pills and ordered more physical therapy. They gave him steroid injections in his spine, called epidurals. But they were no help. Another year passed and then they sent him to see another spine surgeon who ordered another MRI, but found nothing that needed an operation. Finally, he was sent to me, for a second opinion, possibly to get disability.

George was in trouble. As he would stock the shelves, the pain in his back would stop him. he'd take time off work from time to time. At age 52 he just felt like life had passed him by, that he was going to have to stay disabled at home from now on. He just really wasn't planning, in middle age, to be laid up like this. We're going to come back to George, but let's talk about back pain and how it's related to all his symptoms.

Our goal in this article is to help back pain sufferers recover without drugs, injections, therapy, or surgery.

I specialize in Lifestyle medicine. Lifestyle medicine maximizes your health above the probability of disease. I have been practicing lifestyle medicine since 2005, as well as researching and teaching people how to overcome back pain and other lifestyle diseases.

Back pain responds best to simple lifestyle improvements.

Overview: In this article I will be addressing spine physiology, good hydration, Impact of Obesity, the food we eat and how it affects the spine, exercise and stretching, and the mind/body connection.

In the last 15 years, physician visits for back pain have increased by 40%.[1]

Back pain is the second most common cause of disability in US adults[2] and a common reason for lost work days.[3]^,[4] An estimated 149 million days of work per year are lost because of back pain.[5] The condition is also costly, with total costs estimated to be between $100 and $200 billion annually, two-thirds of which are due to decreased wages and productivity.[6]^,[7]

There are many risk factors for back pain. Risk factors include: driving,[8] vibration,[9] physical inactivity,[10] sedentary occupation and prolonged standing or sitting,[11] smoking,[12] previous full-term pregnancy,[13] increased body mass index,[14] tall stature,[15] frequent twisting or bending,[16] and depression, stress, fear, anxiety.[17]

When someone comes to the doctor reporting work related back pain, the sooner the patient can be returned to gainful employment the more likely they will remain productive. For the most part 95% of patients return to work within 3 months, otherwise they my not ever get back to work. Only 20% return to work after 1 year of being off work on disability, and only 2% will return to work after 2 years of disability. Don’t get stuck in disability!

Aside from the risk factors for back pain, there is usually in an instigating event that sets of the cascade to pain and disability. These may include, lumbar “strain” or “sprain” in 70% of cases, degenerative changes in 10%, herniated disk in 4%, osteoporosis fractures in 4%, spinal stenosis in 3%, spondylolisthesis in 2%, spondylolysis, discogenic low back pain or other instability in 2%, traumatic fracture in <1%, congenital disease in <1%, cancer in 0.7%, inflammatory arthritis in 0.3%, and infections in 0.01%.[18]

Many people get into trouble with their backs through poor lifting techniques,[19] and/or poor posture[20] or poor ergonomics.[21]^,[22]

I was also interested to discover that there is a relationship between the use of electronic devices in our modern age and back pain. To be exact, daily TV watching, more than 3 hours a day, increases the risk by 17%, daily use of a laptop computer increases the risk by 40%, use of a cell phone in the supine or laying position increases the risk by 23%, use of the cell phone in semi-supine or half laying half sitting position increases the risk by 49%, daily cell phone use for more than 3 hours increases the risk by 36%, and the use of a tablet increases the risk by 67%.[23] Are you aware of, or managing your device time?

There are certain characteristics of back pain we refer to as, “Red Flags” due to their ominous character.  History of cancer, because pain could indicate recurrence. Unexplained weight loss, because it too could indicate cancer. Osteoporosis, if present would suggest compression fractures of the spine. Prolonged use of corticosteroids, because they cause osteoporosis and resultant fractures. Older age, and/or major trauma, because they could indicate undiagnosed fractures. Intravenous drug use and/or fever, because they could indicate an infection in the spine. Back pain at rest or at night, because cancer, autoimmune disease or infection can present this way. Bowel or bladder dysfunction, because it indicates advancing disease.

That said, indications that something like surgery may need to be done include: loss of bowel or bladder control; progressive motor loss (advancing weakness); or sometimes even otherwise uncontrollable pain. And surgery is not a panacea, indeed, after two years most patients are the same, whether or not they opted for surgery.[24] 

Why does back pain really happen? It has a lot to do with the anatomy in the back. If we look at the spine, there are vertebra with disks between the vertebra. The disc is very much alive and needs to have access to some blood flow for oxygen and nutrition. But there's an interesting thing about these discs, there is only blood flow to the outer edge of the disk. The middle of the disc doesn't have blood vessels running through it, and so it's very vulnerable to not having good blood supply. If you looked at the top of the disk, down from above, you would see that there are blood vessels all the way around the edge but none in the middle. This makes the disk very vulnerable to not getting enough nutrition.[25] You have to get nutrition in, and then you have to get waste products out.[26]

Think of it like a sink, you want to have a good flow of water into the sink, that would be like the blood flow to the disc. And, you want to have a good drain where the water could go out of the sink, anything that plugs the drain is going to cause the sink to back up and overflow and you will have troubles. We call it a problem of perfusion, blood flow to the disc, and elimination, blood flow out, any impediments to the blood flow in or out and your back is going to give you problems.[27]^,[28]

Now in your back you have unusual blood vessel anatomy. Everywhere else in your body, where ever two blood vessels come together, or branch, they come together at a “Y” --a gentle angle, so the blood can flow on to the branches. But the blood vessels coming off your aorta (the biggest blood vessel in your body) to your spine, come off at a right angle. This creates turbulence. Turbulence is a spot where more atherosclerotic plaque usually develops. So, the back is very vulnerable to having plaque build-up right where the blood vessels are coming off to feed your spine.[29] Anything that plugs the pipes, we're talking plaque here, will cause disc degeneration and back pain.[30] Plaque can develop anywhere in your blood vessels, and it's very likely to develop in your aorta.[31] Sometimes we take a chest x-ray and we find more calcium in the plaque in the aorta then in the vertebra themselves. When this happens, all that calcium can end up plugging the spinal blood vessels. We know if plague is in the aorta, it's probably in other blood vessels in the body as well, including the spinal blood vessels.

You can have plugged pipes (blood vessels) too, for example from inflammation. If you get inflammation building up around blood vessels it tends to squeeze the blood vessels closed.  As the inflammation squeezes a blood vessel, less and less blood comes to your spine, and your spine deteriorates.[32] If you work hard, under these conditions, your discs will wear, but they won't repair. The next time you work hard the damage will accumulate, and your back will keep getting worse and worse.

Let's get back to George our back pain patient in my office. George was hinting that he might like to be on disability, but I reminded him that he told me he'd like to be out there with his teenage boys playing basketball, and that he had said he was tired of being called the invalid. he admitted that was right. I asked him if he would be willing to try something to get him over his back pain and return to work and being able to play basketball with the kids. He said he would be willing to try anything. I said how about for a week, one week! He said he would be willing to try anything for a week.

In one week, our plan is to reverse five years of back pain that failed surgery, failed physical therapy, failed epidural steroids, failed narcotics and failed anti-inflammatories. Our goal is that in one week we're going to take this guy and put him back to normal, back to work.

I handed him a piece of paper and a pen, and I started writing too. I told him the first thing he needed to do when he got up in the morning was to drink two glasses of water, big glasses, like 12-ounce glasses, and then not to eat for about a half hour, but then, when he did eat his breakfast eat nothing but oatmeal for the next week. Now by nothing but oatmeal, I mean, he could put some things in his oatmeal, like soy milk, or nuts, or raisins, but no oil, no margarine, no sugar, just oatmeal. Then I had him take a vitamin C, 500 milligrams right after breakfast.

Then, immediately upon completing breakfast, I asked him to take a walk for 10 minutes, a 10-minute walk, come rain or shine, or snow, just put on the right clothes, just go out and do it.

Two hours after breakfast, or mid-morning, I had him drink two more glasses of water, large glasses.

At lunchtime I had a special plan for his lunch, vegetables only, and preferably raw, but the idea especially is not to have any oil or excess salt. So, for the week he was to eat salads. I warned him not to put vinegar and oil on the vegetables, just things like olives, sunflower seeds, not commercial dressings that have things in them that aren’t particularly helpful.

He was to have another vitamin C after lunch and another 10-minute walk.

Mid-afternoon he was to have two more glasses of water, large glasses.

At supper time which was to be at least three hours before going to bed he was to eat just fresh fruit, raw fruit, fruit like cantaloupe, and watermelon, and apples, and bananas, and strawberries, and just raw fruit and make sure it's three hours before bedtime. He was then to have another vitamin C. Then he was to take another outdoor walk for 10 minutes, immediately after eating. Then two glasses of water two hours after supper.

I told him, no coffee, tea, sodas, no tobacco, luckily, he didn't smoke, no alcohol, no eating between meals. I said if you do get hungry between meals, then drink ice water. And so, we had his plan. When he got through writing it all down, and he said, okay. I asked him if he thought he could do all that and he said he thought he could.  And I gave him a follow up appointment in one week.

What is the nature of the cure? Why did I tell him to do the things that I told him? What difference do these recommendations make for back pain?

For starters, I had him drinking water from the very moment he got up in the morning. Dry discs can be the source of pain.[33]^,[34]  Research shows that men, on average, need 3.7L of water a day and women, 2.7L.[35] These numbers would have to be modified on days when the temperatures rise, and also when a person’s activity level increases. Urine color is a good indicator of hydration status, as you approach good hydration, urine color tends to lighten compared to times when you knew you were dehydrated.[36]^,[37]

Disc dehydration can happen, not just from poor water intake, but also from mechanical pressure brought to bear on the disc from an increased body mass index, and also from carrying heavy objects.[38] This, and other reasons make obesity a risk factor of back pain especially of disc disease origin.[39]^,[40] It’s like squeezing the water out of a sponge, the sponge becomes dehydrated. So, with the back, obesity puts loads on the discs that squeezes them out, or dehydrates them.

A breakfast of oatmeal may not seem like a cure-all for back pain, but given its ability to keep the stools regular and lower blood thickening cholesterol, oatmeal has actually been found to be helpful for musculoskeletal complaints.[41] It also has to do with the displacement phenomena, if you're eating a lot of oatmeal, you're probably not eating a lot of other stuff. I had taken a history of his diet in the process of talking with him and he was on an average American diet that was fairly high in grease and low in fiber, so this was a good change for him.

Oatmeal is a whole plant food, it has not been submitted to any refining processes that would reduce its fiber and nutritional qualities. When foods are eaten that have been processed or refined, making them deficient in fiber and nutrients, the result is increased blood sugars, increased blood cholesterol, triglycerides,[42] and glycated hemoglobin (red blood cells coated with sugar) and glycation end products (other necessary body cellular components coated with sugar). These changes to the blood cells make them more likely to aggregate into clumps or chains we call “rouleaux”.[43] Refined foods that cause this health destroying clumping of red blood cells include sugars or refined starches, fats or refined oils such as cooking oils, margarines, butters, and animal shortenings. Clumped blood, or blood cells in chains, does not circulate well to the back and back pain can result.[44]^,[45] These rouleaux or clumps or clots need to be broken down, or back pain and disability will result.[46]^,[47]

The importance of fiber in the relief of back pain should not be overlooked. Fiber deficient foods cause constipation, and constipation can precipitate back pain.[48]^,[49] Incidentally, constipation, in and of itself, can be the source of pain which can radiate to the back, or be felt in the spine.[50]

Speaking of the gut, your intestines are filled with a lot of bacteria, a diet deficient in fiber tends to favor bacteria responsible for increasing back pain.[51] Whereas a diet abundant in fiber nurtures bacteria that fight back pain.

A good recipe for healthy oatmeal for back pain:

·      2 cups water

·      ½ cup whole rolled oats

·      ¼ cup oat bran

·      2 Tbsp. ground flax seed

·      ¼ tsp sea salt

Bring to a boil, let simmer for 45 minutes, eat with your favorite fresh fruit, nuts and seeds.

Oats and oat bran are not the only sources of fiber. Most unrefined, unprocessed foods, such as fresh fruits and vegetables, nuts and seeds, beans and grains, are high in nutrition and fiber. Fresh fruits and vegetables have the advantage of having antibiotic, antiallergic, tumor-protective, anti-inflammatory and immune system stimulating properties.[52] These are the types of foods you will want to be eating if you want to improve your back health and avoid pain.

Good whole plant foods also increase blood concentrations of antioxidants. This is a defense against back disability. For example, total plant-based vegetarians have significantly higher intakes of antioxidants than omnivores.[53] Compared with omnivores, total plant-based vegetarians have significantly higher blood concentrations of: vitamin A, vitamin C, and vitamin E.

As we mentioned earlier, refined oils (margarines, butters, cooking oils, animal shortenings, etc.) are not going to promote back health, because they cause clumping of the red blood cells. They also cause a decrease in the oxygen carrying capacity of the blood. When we eat a high fat meal, within six hours the oxygen in the brain falls below seventy percent, what's more it does not return to normal for three whole days![54] This happens to all the tissues of the body including the back. Low oxygen levels in the back result in pain, poor recovery from exercise or injury, and chronic disability.

When choosing oils it is well to take into consideration their composition. If oils must be used, the best choice is oils high in omega-3 fatty acids because, in moderation, they can reduce intervertebral disc degeneration.[55]

Fermented foods are foods in which deterioration has cause inflammation in the actual food, which can be transferred to you and your back.  Foods that are a product of fermentation are full of toxic waste products of putrefaction such as aflatoxins[56] and ethyl carbamate[57], which can cause inflammation and cancer. Aflatoxins, formed in the process of aging or fermenting,[58] are a source of inflammation.[59] Dietary sources of aflatoxins include: cheese,[60] wine, vinegar, and any food created by rotting or fermentation. For the best results, in fighting back pain, fresh foods, free from any taint of rot or spoilage (fermentation) will give the best result.

“The salads are prepared with oil and vinegar, fermentation takes place in the stomach, and the food does not digest, but decays or putrefies. As a consequence, the blood is not nourished, but becomes filled with impurities, and liver and kidney difficulty appear. Heart disturbances, inflammation, and many evils are the result of such kind of treatment, and not only are the bodies affected, but the morals, the religious life, are affected.”[61] 

I mentioned sugar as a refined food to be avoided earlier. There is a significant association between sugar and back pain symptoms. Sugar consumption increases the risk of back pain by 84%.[62]

Strict meal times are important. I have had patients who still had pain after starting this program which did not resolve till they realized that the part of the program they were not being conscientious about was their meal schedule regularity. Once they adhered to a consistent daily schedule, seven days a week, the pain resolved. Not everyone is used to such a consistent schedule. Some are used to eating whenever they can, others eat between meals. Some get hungry when they should not, especially when making changes in their schedule. To combat hunger at inappropriate times I recommend drinking cold water,[63] and taking a walk.

In the diet that I recommended for the patient in our story, fruits and vegetables played a major role, and I encouraged him to get as many of them in the raw state as I could. Studies of people with back pain show that eating more fruits and vegetables improves back pain outcomes.[64]

I also pushed him to eat only raw/fresh fruit for his third meal. This is because fresh fruit digests quickly and he would have better sleep if his digestion was all finished by the time he went to bed. Better sleep is associated with better back health.[65]^,[66] Ending the last meal at least 3 hours before retiring for the night helps ensure complete digestion before sleeping and improves sleep and back pain.

What kind of diet was I giving him? Isn’t this the original diet? “Then God said, "I give you every seed-bearing plant on the face of the whole earth and every tree that has fruit with seed in it. They will be yours for food.” “and you will eat the plants of the field.”[67]

Notice that I told the patient in our story not to use coffee, tea, sodas, alcohol, or tobacco, and not to eat between meals. Coffee is especially detrimental to spine health.[68] Coffee mimics the flight/fight reflexes in which blood is decreased to certain body tissues, like the back, and increased in others in the interest of survival when confronted with a threat or stress. Coffee greatly increases the incidence of chronic back pain.[69]

Nicotine is also a chemical which alters a person’s body’s blood,[70] it too makes the body mimic the physiological fight/flight response to stress or trauma. Additionally, Smoking decreases available oxygen for the spinal tissues and increases oxidative stress, and inflammation. People who smoke have a much higher incidence of back pain.[71]^,[72]

Now that said, stress and trauma cause the same decrease in blood flow to important structures in the spine which result in pain.[73],[74] For example, high anxiety people have 2 and ½ times higher incidence of back pain.[75] People who are lonely also have higher risks of back pain[76] and neck pain.[77] Poor job satisfaction can be a serious problem leading to increasing risks for back pain.[78] Because stress is such a driver of back pain, stress relief has a very positive effect at helping with back pain.[79]

Even the Bible makes a connection between stress and pain. “I stayed by myself and was filled with anger. Why do I keep on suffering? Why are my wounds incurable? Why won't they heal?”[80] “Sorely have they afflicted me from my youth, yet they have not prevailed against me. The plowers plowed upon my back; they made long their furrows.” [81]

Forgiveness also plays a role in back pain. “Look upon mine affliction and my pain; and forgive all my sins.”[82] “And the inhabitant shall not say, I am sick: the people that dwell therein shall be forgiven their iniquity.”[83] Back pain patients who have learned by experience value of forgiveness have less pain, anger and psychological distress. It has been found that the anger resulting from a lack of forgiveness has the greatest impact. Patients who have the hardest time forgiving others are at the highest risk of back pain and psychological distress.[84]

Jesus had the ultimate stress management, “Come unto me, all ye that labour and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls. For my yoke is easy, and my burden is light.”[85]

You may be wondering why I would have George take vitamin C as a tablet, and honestly, today my first choice would be to encourage him in eating some specific high vitamin C food, such as kiwi, pineapple, red cabbage, red bell peppers, etc. The reason I emphasize vitamin C for back pain is that most of your connective tissues are dependent upon vitamin C for repair. You may be aware that a deficiency of vitamin C results in a condition called scurvy, where a person’s connective tissues deteriorate. That would certainly cause back pain. Vitamin C also helps thin the blood, and it a strong antioxidant. Vitamin C has been discussed in the literature as of benefit for back pain.[86]

Intervertebral discs are highly dependent on cyclic loading for good nutrition, they have to be pumped. Since, as stated earlier, blood vessels do not traverse directly though any disc, the disc is dependent on the diffusion of nutrients from surrounding tissues, which do have local blood supply, for its nutrition.[87]^,[88] This is one of the reasons exercise, such as walking, is so important.[89] Indeed, one of the advantages of walking, outdoors in the fresh air, over, say running, is the increased blood and tissue oxygen levels and any given moment in time.[90] And, do not get me wrong, the benefits of walking are not limited to mechanical advantages, walking is also a great stress reliever.[91] Especially if you can experience nature as you exercise.[92] Walking is very good at reducing pain.[93] The best walking is energetic walking, holding the head high, and swinging the arms in time with your walking, while taking big steps.

While you are out there walking don’t forget the benefit of sun to back pain. The sun stimulates antioxidants such as melatonin,[94] and it plays a role in vitamin D production. People with higher melatonin[95] and Vitamin D levels have less back pain.[96] The major determinant of melatonin and vitamin D levels is sun exposure.[97]^,[98]

Now, while walking is the best overall exercise, there additional stretches and exercises which have value in treating back pain. Over all, personal fitness reduces back pain.[99] Stretching is particularly helpful, because it improves one’s range of motion, makes connective tissues more flexible, and reduces stiffness which can lead to injury.[100] Stretching exercises can be a preventative measure as well as a treatment.[101]^,[102]

Let’s start with flexion exercises or stretching. Flexion exercises can be very good for the spine, easing back pain.[103],[104] An easy example would be bending over and trying to touch your toes. Now, you may say, that’s easy, I know how to do that. And while it is easy and you may know how to do that, do you know how long to do it for? The answer is two minutes. That’s write, two minutes. Two minutes of stretching on each of these stretches ensures that the muscles assume a new length and do not rebound and get tighter. Forward flexion exercises strengthen abdominal and buttock muscles reducing the load on the spine. They also stretch the back and hip muscles and widen the spaces between vertebrae, thereby reducing pressure on the nerves. These are slow, easy stretches. Sudden twisting or vigorous forward flexion, such as aerobic dancing and rowing could raise pressure in the discs and may actually do more harm than good.

The opposite of flexion, or forward bending, exercises are called extension exercises or stretches. These exercises open up the spinal canal and develop the muscles that support the spine. Extension exercises may minimize pain that radiates from your back to other parts of your body.[105] An example would be laying on your stomach on a bed, while keeping your pelvis flat on the bed, use your arms to do, as it were, a push-up, arching or extending your back. Again, hold each of these stretches for 2 minutes.

The next exercise or stretch, in this routine designed to fight back pain, would be a twisting stretch. My favorite variety of this exercise is to sit in a chair with my lets tucked under the seat between the chair legs, and ten grab the back of the chair with my hands and twist my shoulders as far in one direction as is reasonable. For me, when I have had back pain, this stretch has made the most difference. Again, I hold it for two minutes. After two minutes, twist in the opposite direction for two minutes.

The next back pain stretch is what is sometimes referred to as the piriformis stretch.[106] While lying flat on one’s back, flex the right hip up into sitting position, or 90 deg. Grab the knee with the right hand and the ankle with the left hand. Bring the right knee toward the right shoulder and the ankle toward the left shoulder as far as is reasonable. Again, hold it there for 2 minutes. Then perform the stretch on the opposite leg for two minutes.

The next exercise I refer to as the windshield wiper exercise. The exercise is done standing with your back to a wall. Slightly bend you knees (meaning, don't lock the knees in a straight position). Lift both shoulders at same time and roll them back to touch the wall. Put your hips against the wall, then your back, and then the back of your head. You are now in the correct anatomical position. The bending will be done while staying in this position in contact with the wall. That way there is no twisting of the spine. Slowly bend to one side, reaching the hand down toward the knee, stretch to tolerance (will feel some stretching, but you don't want any pain). This exercise you will not do for 2 minutes, just hold the stretch for 10 seconds (or 4 deep breaths). Then come back up to the neutral position (standing up straight). On this side-bending exercise, the individual will need to bend the knee on the side he/she is bending towards. Next, slowly bend to the opposite side. Again, hold for 10 seconds or 4 deep breaths. Return to standing up straight. This is one repetition. Do a total of 6 repetitions and do the exercise once a day.

NECK EXERCISES FOR NECK PAIN

For neck pain, stretches can also be helpful. Do each one for 2 minutes. The First is to turn the head as far to one side as is practical and see if you can put your chin on or over your shoulder. Hold it there for 2 minutes and then turn to the other side for 2 minutes. Next, flex the neck, with your chin to your chest, for 2 minutes and the extend the neck, chin toward the roof, for 2 minutes. If at any time you feel faint, stop the exercise and return the neck to a its usual position. Next is to try to put your ear on your shoulder, first one direction and then the other for 2 minutes each. Next are exercises where your resist the push of your hand. Place your hand on your forehead and press against it for 2 minutes. Then repeat with your hand behind your head, pressing for 2 minutes. Then, on each of left and right sides of your head, repeat this exercise of pressing against your hand for 2 minutes each side.

Aerobic exercises can also be helpful.[107] It would be good to get at least 30 minutes of aerobic exercise three times a week. Aerobic exercises include brisk walking, jogging, and swimming. Aerobic exercise gets your heart pumping faster. If you cannot do 30 minutes at a time, try three 10-minute sessions per day and work up.

Let's talk about George again, the gentlemen that came to me for a second opinion on his back pain. I waited a week and looked at my list of patients, and he was on the list. I was thinking and wondering if he was going to show up. He did, and he was looking pretty stoic. I asked him to come in and he walked down the hall. I was bursting with curiosity, I said, “Well, did you do it? What happened? He says, “Well, Dr. Clark, within three days I could tell a dramatic difference, my back pain was totally gone, I was feeling so much better, that deep aching pain that always took all my energy way was gone, I could do things with the kids again”, he said, “but, I had a problem, I was always drinking iced water between meals, because I was always hungry between meals, and I was always going to the bathroom.” He said, “I was wide awake though, when I was on break at Walmart, everybody else was nodding off and going to sleep and eating their junk food, and here I was, wide awake!” We talked a little more, and I said, “Well, I guess there's not much more to do for you, you're basically fixed, and you did it yourself, and you'll have to expand on your diet, the more you can eat of a vegetarian diet, that's low in fat and low in refined products the better off you'll be. So, he left. About three months later I was going to Walmart and I walked over to the vegetable section, and there he was, he was pushing a cart in the vegetable section, I said, “How are you doing” and he said, “Oh hi Dr. Clark, praise the Lord I'm doing well, my back's great, I'm finding a new house and I’m moving to a new area of town where I can walk out in the country.”

In summary

·      Hydration is very important because your discs are supposed to be about seventy to eighty percent water and if you don't drink your water they become zero percent water and turn into hard pancakes, like hard rubber, and then they're painful because that hard rubber has nerves in it.

·      Nutrition is especially important, because nutrition is part of keeping the blood vessels open, and keeping the blood going to the discs, and keeping the best antioxidants reaching the discs.

·      Exercise is valuable because it keeps pumping the discs so that you get the food to the center of the discs and the waste products away from the disc, it's also important for getting the oxygen to the disc cells.

·      It is best to exercise outdoors where you have more oxygen and less stress. Stress management is very important, because there's a lot of psychological connections between why people have low back or neck pain.

“Today thousands are sick and dying who might get well if they would; but imagination keeps them sick. Self-made invalids, they think that to work would make them worse, when work is just what they need to make them well. Without labor, they can never improve. When the body is inactive, the blood flows sluggishly, and the muscles decrease in size and strength. Rising above their aches and pains, forgetting that they have aching backs, sides, and heads, they should engage in useful employment. Physical exercise, and a free use of air and sunlight, --blessings which heaven has abundantly bestowed on all, --would give life and strength to many an emaciated invalid.”[108]