Three Big Takeaways:
 

1. It is well known that at least one popular operation - spinal fusion – is one of the most overprescribed operations in the country. It is expensive, it is often unnecessary, and it often doesn't work. The best surgeons all say that surgery should be a last resort. There are other medical steps, like cortisone and other shots, but relief is temporary. The basic problem with traditional medicine and back pain is that they are not a very good fit. Western medicine is not heavily focused on behavioral problems and behavioral change; it simply did not grow up that way. (pg. 7)
    

2. Now we turn to the important business of maintaining your neutral spine in a range of situations. Basically, that means stabilizing the neutral spine by clenching or tightening your core slightly. Over time, we want you to be able to carry yourself with a slightly tightened core all the time. When you turn on the core muscles in the right way, it takes pressure off the discs and joints in your back and allows you to lock in your neutral spine so that you can move, exercise, and go about your day without irritating your back. (pg. 90)
    

3. Trigger points are tight, painful bands of muscle tissue that have predictable and recognizable patterns of pain. They are muscle spasms, which is what you get when a muscle or muscle segments eases up, under pressure, and won't let go. It's like those cramps you sometimes get in your leg, except it doesn't go away and the pain can be horrendous. One thing that helps is that trigger point or muscle pain in general is recognizably different from nerve pain and other pain, so that you know what you are dealing with. Most of the time, nerve pain is burning, sharp, electric, and you can pinpoint exactly where it is. Trigger point pain, on the other hand, is a key, diffuse, and dull. And often arises far from the source, which is a trigger point in a muscle. (pg. 167)
   
    

Other Key Ideas:​

Chiropractic treatment has its place in back care and offers many benefits when done properly. Skilled chiropractors use manual therapy to restore normal joint movement and muscle function through chiropractic adjustments and other techniques such as stretching and joint mobilization. This therapy can be invaluable, especially in the short-term. But even today many chiropractors do not teach their patients how to make the necessary behavioral changes to permanently relieve back pain. (pg. 17)

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Bulging and actually ruptured discs are mostly a young person's problem, meaning people in their 30s. Older people have horrendous problems, too; after all, some 35% of people from ages 45 to 65 have serious back pain. But usually not bulging discs. Which also means that more younger people are going to get sent to the surgeon, if the problem is grim enough. Older people have disc problems, too, but nowhere near as often. (pg. 31)

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It is the muscles of your core that do the most to make your spine work correctly. Think of the core as all of the muscles between your shoulders and hips all around your body. The core is the area over which you have the most control and for which you bear the most responsibility. Okay, posture, too, but tending your core is your most serious responsibility. Meaning, you need to exercise six days a week, for the rest of your life. (pg. 35)

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Pain is often caused by general shrinking. The cause of this unpleasantness is compression, especially compression of your spine. Time and gravity have had their way with you and pressed the vertebrae down. You lose height mostly because you lose disc height. The vertebrae press down and you get shorter. By the way, being a good kid and working out and having good posture, and so on, will not save you from shrinking; it's just part of aging. (pg. 42)

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Let's address the business of sitting for hours at your computer. The main fix is just to get up every 20 or 30 minutes and move around. That alone will do wonders. Do that religiously, and you can continue to use your computer. Folks tell me that they cannot get up that often. They will lose their train of thought. Well, yes, they can. And they have to, because continuing to do what you do is not working for you. In my experience, your concentration will get better, not worse, once you get slightly used to it. (pg. 66)

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Relatively minor behaviors (sitting at your computer, picking up heavy stuff) have no impact at all, the first time. But time and pressure always win. Over time the pressure on your back from hunching over your computer raises hell with your back. time and pressure, tears you down. (pg. 73)

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You have to be really serious about maintaining a neutral spine all the time. Maintaining a neutral spine is at the heart of your cure, and will be at the heart of your life after your cure. This is the time to learn how to achieve a neutral spine and how to maintain it all the time, even when doing various movements. (pg. 81)

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When chiropractors pop your back, what they are really doing, in most cases, is restoring range of motion to a joint and/or releasing a muscle spasm. That pop you here is the release of gases that build up in the joint. Restoring range of motion and releasing a spasm is a blessed relief, but it has nothing to do with curing the condition that caused the spasm in the first place. Given that chiropractors are paid very little for these sessions, it is advantageous for them to do a bunch of adjustments and give their patients blessed relief and stay in business to help their patients another day. Assuming the chiropractor knows how to address serious back pain, he or she is not really compensated to try. (pg. 88)

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Developing a serious exercise habit is one of the easiest of all those things you ought to be doing but are not. Getting a don't eat garbage habit is hard and most people fail at it. But exercise is comparatively easy. Doing something is so much easier than promising not to do something. Sounds silly but you can just plain make up your mind and do it. (pg. 144)

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When you let your glutes go to sleep, things get bad. They forget all those critical functions, and the muscles that take up the slack are not up to the job. When those big powerful muscles aren't doing their job, the spine takes over. It bears the brunt of the forces that the glutes are supposed to be handling and it gets overwhelmed and damaged. Instead of using those big muscles to do things like pick up your grandchild, you first use the tiny muscles around your spine to do them, and those muscles can't handle it. They become strained and eventually fail. (pg. 149)

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Back pain is almost always a blend of muscle pain, joint pain, nerve pain, and other pain. This can be a little confusing. All pain is transmitted by nerves. When we speak of muscle pain or nerve pain, we are referring to the primary source of pain – that is, the pain generating tissue. Sometimes an aggravated nerve is this source of pain so it is referred to as nerve pain. However, often it is muscle pain. Even though the pain is transmitted to your brain via nerves, the tissue that's causing the pain is muscle tissue, so we refer to it as muscle pain. (pg. 166)

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One reason it is called trigger point pain is that it is usually triggered by an actual event, just the way it feels. You rolled over funny in bed or you picked up a box of books with your back. More often than not, the trigger point has been building for a long time. Vulnerable muscles have been under repetitious pressure for a long time, and they are ready to go at the drop of a hat. (pg. 169)

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Once you have a general idea of where the trigger point is, mash away at it, if you would like, with your bare hands (or with a tennis ball), and see if that manual manipulation is enough to release the rascal. What you do is hold down hard on the place that hurts the most and you should feel an easing of the pain. That is the trigger point letting go. Nice work. If the pain does not ease up after 30 seconds or so, either you are not directly on the trigger point or this may not be a trigger point you are dealing with. (pg. 172)

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Sleeping can be a huge challenge. Let's start with mattress selection. If you have back pain as soon as you get up in the morning, chances are your mattress is playing a role. Try experimenting with different mattresses to see if the pattern changes. Go to sleep in a hotel or a guest bedroom. Is your back pain any different when you wake up? If it is different in any way, then it is very likely that your mattress is playing some role in your back pain. The following is a rule of thumb: those who are skinny tend to do best on firm mattresses while those who are less so tend to do better on a softer mattress. Regarding sleeping position, the best for most people is on your back,  Although most people cannot sleep like this. Most other positions have their benefits and negatives based on each individual person. (pg. 201)