//Dr. Paul’s Healthy Back Protocol

Dr. Paul’s Healthy Back Protocol


Few things in life are as painful and debilitating as back pain.

Unfortunately, I’ve experienced it more than once and I’m not alone. Alarmingly, more than 31 million Americans suffer from low back pain at any given time and 80% will experience a back problem during their lifetime. Thus, it should come as no surprise that back pain is the leading cause of disability, costing Americans $50 billion a year in medical expenses!

The most common causes of back pain are sports injuries, accidents, poor posture, arthritis, degenerative disc disease, obesity, distraction during physical movements, psychological stress, and certain diseases (i.e. kidney conditions, blood clots). Interestingly, a recent study found that risk of back pain (injury) was highest between 7:00 am and noon… so, start your day slowly! This is also a good excuse to purchase a snow-blower…

Given my own history of back pain, I am often asked how to prevent and treat it. I always start by explaining the myriad structures that comprise the ‘back’, including the bones, joints, discs, ligaments, muscles, and of course, nerves. For most back pain sufferers, it’s injury and inflammation to the nerves that trigger the excruciating back pain and discomfort, as well as pain, weakness, numbness and tingling down the arms and legs. It’s because of this radiating pain (called radiculopathy) that I’ve become sort of a back pain expert, having survived it several times.

I first developed back pain as a teenager and figured it was a normal consequence of playing contact (hockey) and rotational (tennis) sports. However, I continued to experience back pain and “slipped discs” on occasion that would leave me in a pile of agony on the ground and not able to move and straighten up for several days.

Then, in the summer of 2003 at the age of 40, I experienced low-back tightness and pain radiating down the back of my right leg, also known as ‘sciatica’. Unwilling to rest and rehab my back properly, I foolishly entered a tennis tournament. During the warm-up of my first round match, on a cool late August morning, I bent over to pick up a tennis ball and my back “went out” and I fell to my knees. My stubborn pride and ego forced me to continue playing the remainder of the tournament hobbling around for the next 4 matches (somehow, I won the tournament).

An MRI the next week showed 2 herniated (ruptured) discs, one bulging disc, moderate narrowing of my spinal column (stenosis), and a condition the neurosurgeon thought I was born with, ‘spondylolisthesis’. This occurs when one vertebrae slides over another and pinches the nerves. Needless to say, my back was a mess and so was I. Determined to avoid surgery, I began the grueling journey to heal my back.

Over the course of 7 months I tried every treatment option available; anti-inflammatories, muscle relaxers, pain meds, a series of 3 steroid spinal injections, acupuncture, chiropractic care, physical therapy, massage therapy, yoga, and qi gong. Of the three spine surgeons I visited, two recommended surgery, however, the third one suggested I needed to strengthen my “core”. My wife and I thought he was joking… I was fit and could exercise for hours. In fact, I had no problem hammering out hundreds of ‘ab crunches’ before my injury. But, soon I came to realize that he meant my “entire core”, not just my abs, including all of the supporting back, hip and gluteal muscles (both large and small). This exercise routine has become the basis of my PRISE Protocol, specifically the Resistance (R) and Stretching (S) routines (see MVP blogs).

With the help of a team of healthcare providers, I slowly climbed out of the dark abyss of debilitating back pain and started to regain my health. The first several months after my injury I couldn’t walk more than a couple of steps before the pain stopped me in my tracks. I took several weeks off from work.

Eventually, I interrupted the pain cycle with a combination of PT, chiro, massage, and increased my walking from less than 30 feet at a time, to a mile, then two, three and eventually up to an hour or more of running. I started practicing yoga regularly and earned two different yoga teaching certifications (2006, 2008). Four years after the injury (2007), I was able to earn the top men’s doubles ranking in the eastern region of the United States Tennis Association and a third place finish, with an older brother, in the United States Tennis Association National 50-and-over Grass Court Tennis Championships (2012). I even completed a single day 150 mile solo bike ride through the hilly Berkshire mountains from Saratoga Springs, NY to Simsbury CT in 2011.

I don’t say this with even a hint of bragging, but instead with the message of optimism and encouragement for those who have struggled with back pain… there is hope.

Please know that I fully realize in certain circumstances back surgery may be required. However, this should always be the last resort, as a number of well-conducted research studies conclude surgery is not any more effective than non-invasive therapies (such as those I recommend) in treating back pain, long-term.

I wish I could’ve ended this month’s newsletter here. However, last year I wasn’t as consistent with my ‘RISE’ exercise routine and my daily preventative back therapy as I should’ve been due to a hectic travel schedule. So, nearly 11 years to the day of my first back injury (2003) on a cold August morning in 2014, I succumbed to a similar injury, this time swinging a sledge hammer against an old basketball hoop pole in my driveway (what was I thinking? L). This time the MRI showed severe stenosis, bulging discs, and spondylolisthesis.

Although I experienced the same intense, agonizing pain for several months, the silver lining was that I was able to shorten the length of time on conventional pharmacological drug therapies and so far, have avoided the round of steroid spinal injections (and surgery). Since the injury, I have stayed true to the same treatment regimen I’ve been recommending to others for the past 11 years, and which I outline below. I’m already ‘back’ performing my RISE exercise program and my core is stronger than ever. I’m even back competing at a high level on tennis court, too.

I have accepted the fact that my chronic back conditions (spondylolisthesis, severe stenosis) will never go away and require daily attention, beginning immediately upon waking in the morning while I’m still lying in bed. That’s when I start my ‘back in action’ therapy routine (see below).

Prevention Protocol

1. Wake-up Stretch (perform while still lying in bed)
a. Lie on your belly and extend up on your elbows and hold for 30 seconds then release down. Perform 4 sets
b. Lie on your back, extend your left leg and bring your right knee to the outside of your rib cage and hold for 4 breaths. Pull your right knee to your left shoulder keeping both hips on the ground, hold for 4 breaths. Repeat on the left side
2. Body Visit
3. Nutritional Strategies
a. Anti-inflammatory Foods:
i. Ginger
ii. Cinnamon
iii. Cayenne
iv. Cumin
v. Omega 3’s – fish oil, flaxseed, nuts, olive oil
b. Drink 4-6 ounces of water right before going to bed and again immediately upon waking in the morning. This is when your intervertebral discs hydrate and regain shape
4. Walking! Aim for 5-10K steps/day
5. Stand! Get up from your chair every 20-30 minutes during the day and stretch/walk for 5 minutes
6. Stretch! Do Yoga, Pilates, Tai chi, Qi gong at least once a week
7. Core exercise routine every other day (10-20 minutes)

Rehabilitation Protocol (Treatment for an acute back injury/pain)

1. Follow the 7 steps above, as much as possible
2. Physical Therapy (as prescribed; 2-3X/week for 8 weeks is ideal)
3. Massage Therapy (1X/week for 1st month; 1-2X/month thereafter)
4. Chiropractic care and acupuncture (optional)

Ultimately, taking a holistic and preventative approach is the solution to a healthy back.


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