Three years ago I herniated a disc in my lower back from a bad squat at the gym that was pushed over the edge by a long run. Following the run I was bedridden for two weeks with nine out of ten pain. The MRI was bad; it revealed a buldge out of the L5-S1 disc pinching the spinal cord, causing sciatica down both my legs. It took a year of physical therapy and a relapse four months in to regain my strength.

These days it saddens me whenever I learn that a friend is going through any form of back injury, from mild muscle strain to herniation. I relive the pain, which is often silent and crippling. In my circles, it’s particularly young men in their early 30s that I notice struggling. The triggers vary, from bad form in the gym to bad posture. Almost always, these injuries results either from neglect over time or hubris.

News of pain has occurred so often in recent months (3+ instances) that I’m starting to feel like the “back guy”, an old vet who can relate to the pain and lend both an ear and concrete advice. There are the things I now tell my friends.

It will be ok

You’ll be able to do most, if not all, the things you want to do in life. Play basketball, run, ski, climb, other adventure sports. It will take some time but you are likely not permanently hurt.

Start wearing well supported shoes immediately

The number one thing to do is buy shoes with good support and wear them whenever you step out. Every step matters and if your shoes lack support, the pain will just get worse just by walking. You’re asking the injured back to do work. The best shoes for back support are often the ugliest, embrace it. Brooks and New Balance are good for this, ditch the lifestyle shoes.

Stretch twice a day, every day

Your tender back needs to start mending in healthy ways. Depending on the level of pain, it may make sense to start seeing a physical therapist immediately. At the onset we minimize pain it by avoiding actions that flare it, like walking. This creates a fear loop. We’re scared of pain and back strength atrophies over time with less use.

What you want is to gradually guide the back into its functional use. Therapists will aim on slowly strengthening the back muscles and the abs, which serve as a counterpoint to support your trunk. Here is the routine I’ve shared countless times, that I used to do 2x per day:

Lower back:

• Cat cows (10 x 3 sets)
• Pelvic tilt (10 x 2 sets — hold each for 5 seconds)
• Prone press up (10 — hold each for 5 seconds)
• Knee to chest (15 each side — hold each for a few seconds)
• Clam shell (10 x 3 sets each side, better with light resistance band)
• Glute bridge (10 x 3 sets, hold at top for a sec)
• Piriformis stretch (hold for 30 seconds each side)
• Supine knees side to side (10 each side)

Abs:

• Dead bugs (10 x 3 sets)
• Bird dog (10 x 3 sets)
• Plank (1 min)

In addition to strength, mobility plays a crucial role in back function. You want to start doing things that stretch out the quads and the hamstrings. Yoga can be good, but some poses are bad for a tender back, including forward fold and its cousins.

Breath intentionally into the injury

As mentioned, fear causes us clench the back, which we think helps us but actually hurts us. Breathing into the back with long deep holds helped me release it back towards its natural state.

Surgery can be right, but is a risk

Surgery can be the right call if nothing else works, but carries an enormous amount of risk. I didn’t want anyone opening up all the fine muscles in my back with a scalpel if I could help it. I’ve heard of surgeons making mistakes, which can cause further and sometimes permanent damage. It’s best to get multiple professional opinions before pursuing surgery. Generally the tiers of back pain care are: physical therapy / strength with pain management, then local injections if needed, then surgery as a last resort.

Be proactive

I encourage everyone I meet not to back pain lightly. Often, it lingers in a dormant state until a fatal blow. It’s far better to never know back pain than to take risks around posture and lifting heavy things incorrectly.

Though I’d never want to relive it, injuring my back was a blessing in my life. It’s made me deeply aware of how my muscoloskeletal system works, which I now use every day to inform my decisions. It also happened young, giving me decades to recover and live my life. So many people experience all types of chronic pain on the daily. If these words can offer any guidance, that’s a win.