Why Low Back Pain Influencers Are Misleading You

During WWII, the U.S. military wanted to add armor to fighter planes to reduce losses. Officials mapped the bullet holes on planes that made it back safely, and created a schematic like the one below.

Initially, the military planned to fortify the areas on the plane that were heavily hit. However, this approach would have failed. A statistician realized they were looking only at the planes that had survived. The correct course of action would be to reinforce the areas on the hull with no bullet holes.

I was thinking about survivorship bias during my recent low back flare — something that has been a major pain for almost two months now. In July, my 9-year-old son and I thought it would be fun to flip our two-sided mattresses from the firm side to the soft side to see what happens. My back has yet to recover from those few comfy nights.

I’m always astonished when the social media algorithm seems to know what I’m thinking. All summer I’ve been fed a steady stream of fitness influencers showing how they fixed their bad backs with strengthening and stretching that rivals world class gymnasts. Even before social media, a common trope in the gym was that the best way to deal with low back pain caused by heavy deadlifts was … to perform heavy deadlifts. The explanation for why deadlifts might work relates to pain from reflexive bracing or spasming. If you demonstrate to your brain that your low back is actually resilient, you can in theory reduce subconscious protective processing.

Still, all this hype around curing low back pain with intense training just becomes an excuse for an overexerciser like me to continue tearing myself down. If a handful of exercises for your core, done at home, truly worked, the country’s $100 billion a year low back treatment industry would be defunct.

The under-30 low back influencer I’m watching on my phone may have had:

• A muscle or ligament strain that naturally healed
• An acute disc herniation that gradually shrank or resorbed
• A stress injury that healed with rest
• A temporary episode of muscle spasm or protective guarding
• A problem that improved after an injection or surgery

This individual’s rigorous training may have helped restore his general capacity, confidence, and tolerance after the original injury, but there is no way to know if it directly healed the tissue.

In any event, these successful outcomes are distinct from my own age-related struggles: long-standing disc degeneration with loss of disc height. As a result, I’ve had the same realization as the WWII statistician. The people who dramatically recovered and built a fitness brand tell their stories; the people who tried an intense routine and stayed worse do not.