It’s the second set of the night.  The Les Paul strung over your shoulders pours out hard and soulful sounds through the Mesa Boogie Mark IV (78 pound, 85 tube watt) combo amp. As you reach for that perfect note, bent over in trance, you feel a twinge in your lower back, then a sharp stab deep in your spine, and the life is suddenly sucked out of that singing lead.  Coming down from the clouds, mind and body are re-connected, your body telling your mind to stop doing what it is doing.  And you think about loading the amp into the car after the gig.

The low back pain we feel is most often the result of lumbar flexion—bending over at our waists. With twelve pounds of guitar or bass on our backs, our paraspinal muscles scream as they work to pull us above our pelvic centers, our discs bulging dangerously, their internal fibers tearing away from each other as inflammatory fluids rush in to control the damage.  Nerves compressed by the mechanical and biochemical pressure fire off, causing pain and spasm. Sometimes, when the damage is severe, we feel shooting pains down our legs.  Often debilitating–painful, numbing, and weak— it is hard to imagine relief.

Given the tough mechanical realities of the rock and roll life, we need to brace ourselves.  We need protection from these overwhelming stresses; protection rooted in core strength.  The abdominal and paraspinal musculature wrap around our trunk, connecting to create an internal lumbar support. As these muscles strengthen, they relieve pressure on the spinal joints by lifting their vertebral articulations and distributing balanced forces between the soft tissue structures—ligaments, tendons, and discs. With a strong core, a drummer lifting his or her 75 pound hardware case, will absorb (please have someone give you a hand here drummers!) the amplified (some knowledge of Newtonian mechanics required here) forces sharply concentrated deep in the low back but the damaging effects will be greatly minimized.

So what do we do? Join the gym? Get a trainer?  “But I’m a musician”, you say. “Trainers are not really in the budget. Bass strings and pedals, yes. Club One, no”! Well the good news is that all one needs to protect and preserve ones low back is a floor, a wall, the great outdoors, and one or two pieces of very simple, inexpensive equipment. First, start walking…quickly.  Increasing blood circulation provides biochemical nutrition to all the structures of the body, the nutrition needed for ongoing repair. Flushed with blood, our soft tissue remains soft.  Not weakly soft, but supple, poised for strengthening. In our culture, where we worship taut, buffed bodies, and equate softness with weakness, we seek a rippled effect.  But in fact, a tight muscle is a weak muscle, and a stiffened joint is a joint ready to break down.

After lubricating the musculoskeletal system with a sanguine cardio surge, it is time to stretch. Flush with fluids, one can more effectively nudge the muscles that connect to the pelvis.  The strong muscles of our upper legs—the hamstrings, quadriceps, adductors, the tensor fascia lata, and gluteals—all attach to the bony pelvic core and when there is too much tension in that musculature, motion is restricted and joint damage  becomes more likely.  All muscles can be specifically stretched on the floor and against the doorways of your apartment.  And when they are soft and stretched, they can then be strengthened.

From behind the Iron Curtain of Eastern Europe in the 1970’s and 80’s, emerged a new approach to the treatment of back pain.  While Medicine under Western Capitalism produced sophisticated and expensive methods of high tech diagnostics like C-T Scans and MRI’s, as well as surgical techniques to finely slice and reconstruct the human body, in the East, with minimal stores of cash, researchers discovered that functional evaluation and treatment which combined strength training and balance could be more effective than imaging and treating specific tears in soft tissue structures that might have nothing to do with a patients pain or dysfunction. Out of these Eastern European schools came the gymballs, styrofoam rollers, and balance discs we now see scattered around gym floors.  So to complete the home care program, get a balance ball, now available at every Costco and SportsMart.  Cheap! For abdominal and back muscle strengthening, all you need is the ball and the floor.  Minimalist exercise. Lying on that ball, face up, trunk below your neutral line, lift to neutral.  Then lie face down on the ball and do the reverse, lifting your trunk against gravity. Engaging, contracting the abdominals, upper, lower, and transverse, and your paraspinal erector spinae musculature you will feel your core when the workout is done. You may feel yourself standing immediately more upright, with less low back pain.  It is the miraculous nature of our deep centers when strong, the balanced confluence of the nervous, musculoskeletal, endocrine, and cardiovascular systems. Having this single piece of equipment at home completes your full gym requirements. Perfect for the musicians budget.  Find a Chiropractor, a Physical Therapist, or a good trainer to run through the basics described above and you will have gone a long way toward protecting your low back.

But this handles only the physical part of the problem. There are some other, more ethereal challenges. Like the show.  Hours of “let loose playing”, jamming, doing what we do for the reasons all players understand.  When we enter that “zone”, the space we all seek, where mind and body disconnect, and the self  disappears in a cloud of divine vibration, we feel no pain, transcending for the moment our burdensome bodies. But the body keeps working, mind detached or not.  And with that Telecaster hanging over your shoulder, that eight pounds of  hardwood country rock joy, you might jam out in ecstatic abandon, but the facet joints of your lumbosacral spine will still scream. And after the gig, you will feel your beaten body again.

So when on stage, lost in the music, maintain a thread of connection to your conscious mind. Cultivate a gentle, mindful, awareness of your mind-body totality.  Feel the music and your body simultaneously and visualize a space where it all comes together in some kind of harmonic balance.  And if you know that bending over is what will mess you up, then lean back.  Stand upright.  Do a few back bends.  The audience will dig your move.  The cool, bouncing lean back.  A new signature, perhaps. And for those longer shows, leave the Tele at home and bring the SG.  Hey, if it was good enough for Duane Allman…  And for the players stuck in the hot seat—keyboards and drums—stand up when you can.  After four or five songs, just get up and do ten back bends.  If the lead guitar guy can take five minutes and tell some quirky story about his life, you can stand and bend back.

Everything I have mentioned so far has been about prevention and maintenance.  But if you are lifting a large speaker cabinet and feel a sudden sharp low back pain accompanied by a searing leg burn…stop!  Get help and do not continue lifting. If you keep pushing, you may further damage structures already at serious risk.  Most often, the appropriate first aid is the application of ice, wrapped in a paper towel–ten minutes on and one hour off.  Then repeat. This, accompanied by some over the counter, non-steroidal anti-inflammatory drugs (NSAID’s such as ibuprofen*) will help to slow down the inflammatory process which is causing the irritating pain. If the pain does not quickly subside, see a health care practitioner who understands the diagnosis and treatment of these injuries.

Chiropractors specialize in the treatment of back problems.  Acupuncturists and Physical Therapists can also be very skilled in this realm, but in choosing any of the above practitioners, find ones who understand body mechanics and who complement their care with manual therapies such as spinal manipulation, stretching and exercise.  Although back pain is one of the most common complaints that presents in the Medical Office, the medical prescription is generally limited to pain killers, muscle relaxors, and anti-inflammatories.  After prescribing, a skilled MD should refer to a qualified manual therapist.

We play because we love to play, so we haul our equipment from home to car to studio or club and then back again, often enduring low back pain caused by the bend over, the grab, and the lift.  We overstress paraspinal muculature, lumbar discs, articular cartilage, and deep ligaments and tendons, all of which keep us stable and moving.  The damage results in microtears, generating inflammation, nerve irritation, and pain.  But we are not powerless to prevent and manage the natural wear and tear that comes with our chosen Rock and Roll lifestyles.  Exercise, stretching, ergonomic understanding, and mindful attention paid to posture and position will help preserve and protect our bodies so that we can enjoy the long musical lives we envisioned when we picked up our axes and were raised up by those first power chords.

*Please note that the material in this article should not be construed as Medical Advice, but merely represents general guidelines and principles for low back care.  Please consult your Physician before taking pharmaceuticals to be sure there are no contraindications such as allergies or internal sensitivities and if one experiences back pain accompanied by loss of bladder control, seek medical care immediately.

Dr. Ricky Fishman is a San Francisco Chiropractor and has been a performing electric bass player for over thirty years.  He runs the Musicians Chiropractic Project which specializes in the treatment of musicians injuries and offers special rates for uninsured players.

[email protected] www.rickyfishman.com