So You Want To Learn More About Back Health
BLACK IRON RADIO EP. 352: So You Want To Learn More About Back Health
Back pain has a way of making you terrified of the exact movements that would actually fix it. And at some point, a lot of people develop a complicated relationship with their back because of this.
Morgan sits down with Whitney, doctor of physical therapy, and Jess G. to talk about why back pain is so pervasive, what is actually causing it in most cases, and why avoiding the movements you are scared of is often making things worse. They get into the nervous system's role in pain perception, what the green light yellow light red light system looks like in practice, when to actually be alarmed versus when discomfort is just part of getting stronger, and what to do when a provider tells you to never do something again.
Plus a breakdown of bulging discs, how to build a strong low back, exercises to do after six hours at a computer, and why the way you talk about your body matters more than you think.
This one is dense, and it is worth every minute.
Lower back pain is probably the single most common complaint we hear. From longtime CrossFitters to people who have not exercised in years, from desk workers to new moms, it cuts across every category. And yet the conversation around it is still dominated by fear, bad advice, and a lot of well-meaning but ultimately unhelpful cues like "just stretch more" or "never deadlift again."
In this episode of Black Iron Radio, Morgan sits down with Jess Gordon, coach and owner of a CrossFit gym, and Whitney, our doctor of physical therapy here at Black Iron, to talk through what actually causes back pain, when to worry and when not to, and what it really takes to build a resilient, healthy back.
What Is Actually Causing Your Back Pain
The most common culprit, by a wide margin, is inactivity. When you spend eight hours hunched over a desk, your core fatigues, your hips lock up, and your spine settles into a compromised position. So the back pain that people experience in the gym is rarely from the big, heavy lift they were so nervous about. It is almost always from something mundane after eight hours of sitting: loading a barbell without bracing, picking up a kettlebell without thinking, bending over to grab shoes at the end of a long day. The inactivity and poor positioning throughout the day is what sets the stage. The kettlebell just happens to be the thing that tips it over.
From there, the causes branch out significantly. Whitney broke down a list that surprised even us: tight hip flexors, shortened hamstrings from prolonged sitting, core weakness, pelvic floor weakness, poor rib cage mobility, restricted thoracic rotation, dehydration, poor nutrition, sleep deprivation, and chronic stress. Any one of those can contribute to back pain on its own. Most of the time it is several of them stacked on top of each other.
One worth highlighting is the pelvic floor. Whitney has worked with people for years whose back pain went unresolved because nobody looked below the spine. The real issue was the basket of muscles at the base of the pelvis, and once that was addressed, the back pain followed.
Another underappreciated one is the rib cage. Our ribs connect to joints along the thoracic spine, and if those joints are restricted, you cannot take a full breath. Inadequate breath means less oxygen, less circulation, less lymphatic movement, and over time, tissues that are not getting what they need to stay healthy.
And then there is lifestyle. As Whitney put it, stress stacking, poor hydration, inadequate nutrition, and poor sleep are all paths to tissues that are not nourished and resilient. You cannot separate how you live from how your back feels.
The Fear Factor
This one deserves its own section because it is that common and that misunderstood.
When you experience a significant back injury, your nervous system learns from it. That is actually protective and useful. The problem is that the brain can become overly calibrated to threat, and start setting off alarms for things that are not actually dangerous. Whitney describes it like a car alarm. The first time it goes off, there is a real threat. But eventually, the alarm starts triggering when someone walks by the car, when leaves rustle nearby. The stimulus threshold drops, and sensation that should be neutral or even healthy starts to register as pain.
This is not imaginary, and it is not weakness. It is a well-documented neurological process. And it is also why some people can have the same MRI findings as someone in serious pain and feel completely fine, while others with relatively minor structural findings can be debilitated. The image does not always match what someone is feeling
Working through this kind of nervous system response requires a layered approach. Education helps, because understanding why the alarm is going off changes how it feels. Graded exposure helps too, slowly and safely reintroducing the movements or loads that have become associated with pain, pairing them with breathing, with reassuring language, with coaches and providers who understand what is happening. It is not quick. But it works.
Green, Yellow, Red
Jess uses a traffic light framework with her athletes, and it is worth knowing.
Green means you are moving well and feeling good. Yellow means your body is giving you feedback. Maybe you feel blood rushing to an area, a little tightness, some fatigue. These are not injuries. These are signals, and they are worth paying attention to, but they are not reasons to stop.
Red means numbness, tingling, or true sharp pain. That is a different category entirely, and it is a signal to stop and get assessed.
The distinction between discomfort and pain matters enormously, and a lot of people have lost the ability to articulate the difference. Part of what good coaching does is help people find better language. "Blown up" and "thrown out" are phrases that frame the body as something fragile and broken. The way we talk about our bodies influences how we experience them. Not in a woo-woo way. In a very real, neurological way.
When to Actually See Someone
Whitney laid out a clear list of red flags that warrant a referral out, regardless of what else is going on:
Numbness or tingling, because nerves exit the spine and you want to make sure those pathways are functioning. Sudden weakness on one side of the body. Any changes in bowel or bladder function, including difficulty urinating, excessive frequency, or loss of control. Changes in sensation around the saddle area or sitz bones. Pain that does not change at all with position or movement, especially if it has kept you in bed for more than a day. Night pain that consistently wakes you up. And unexplained weight changes, which are included as a screening question for other conditions that can present as back pain.
That last one is worth mentioning not to scare anyone, but because persistent back pain that does not respond to treatment, paired with night pain, sensation changes, or unexplained weight fluctuation, can be an indicator that something beyond muscle and tissue is involved. If that sounds like you, please see a provider.
What About "Never Deadlift Again"
If a provider has told you to stop doing a specific movement forever, and they said that without watching you move, without testing your strength, and without asking about your goals, get a second opinion.
Whitney has been a physical therapist for nearly a decade. Her consistent experience is that movement is medicine. People can and do come back from disc bulges, herniations, and serious back injuries to move well, load heavy, and live active lives. The movement may look different. There may be a longer runway to get there. But "never again" is almost never the right answer.
That said, if your imaging shows something serious, your provider's caution may be warranted. The point is not to dismiss medical advice wholesale. The point is that you deserve a provider who watches you move, understands your goals, and gives you a real plan, not a blanket restriction handed to you in a 15-minute appointment.
When looking for a physical therapist or provider, Whitney recommends word of mouth from people who felt genuinely heard. Look for someone who is active themselves and lists it on their website. Read Google reviews specifically for language about whether people felt listened to and encouraged to keep moving. Private practices are often better positioned to spend real time with you, but not always. Interview them if you need to.
Discs, Briefly
A quick anatomy note that came up in the episode: our vertebrae are separated by discs, each of which has a tough outer ring and a gel-like center. When pressure pushes that gel to one side, it is a bulging disc. When the gel pushes through the outer ring entirely, it is a herniation. Both exist on a spectrum of severity, and neither is automatically a life sentence.
With a bulge, conservative management, stability work, and progressive loading tend to do well. With a herniation, the approach depends on severity, and some cases do require more significant intervention. But even then, the goal is to get people moving again. That is always the goal.
How to Actually Build a Stronger Back
Start with stability. Isometric exercises like planks recruit the muscles and bring blood flow to the area without asking the spine to move through a range it might not be ready for yet.
Then add anti-rotation work. Farmer carries are a great example, especially offset carries where one weight is overhead and one is at your side. Your whole system has to work to prevent unwanted rotation and lateral bend, which is exactly what the spine needs to handle in real life.
From there, add speed, power, and load progressively. A lateral med ball throw, a goblet squat, a front rack, a barbell. The progression matters more than any single exercise.
For mobility specifically, if you have spent the day at a desk and are heading to the gym, Whitney recommends cat cow into thread the needle to address rotation, a seated windshield wiper variation with trunk rotation to the opposite side, and a hip flexor flow where you lunge forward, stretch the front hip, then rock back into a hamstring stretch. She also works with clients on nerve glides, which addresses the fact that nerves move through little sheaths in the body and can get sticky or cramped, contributing to discomfort. Moving the nervous system directly can help alleviate pain that feels like it is coming from somewhere else.
And through all of it: breathe. Whitney almost always starts here, especially with people who are in pain. Breathing brings oxygen, supports circulation, and lowers the fight or flight response that pain tends to trigger. It is the most accessible tool on this list, and it is almost always the one people forget.
The Bottom Line
Lower back pain is common. It is also, in most cases, very addressable. The path forward is not avoiding your back. It is understanding it, loading it appropriately, and building the strength and mobility it needs to do its job.
If you have been told to never load your back again, get a second opinion. If you are scared to feel your back working, that fear deserves attention alongside the physical work. If you are living with chronic stiffness or soreness, look at the full picture: your sleep, your hydration, your stress, your breathing, your movement patterns.
You are going to use your back every single day for the rest of your life. It is worth treating it like something you can actually work with.
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