This tutorial has been continuously, actively maintained and updated for 9 years now, staying consistent with professional guidelines and the best available science. The first edition was originally published in September of 2004, after countless hours of research and writing while I spent a month taking care of a farm (and a beautiful pair of young puppies) in the Okanagan.
A major feature of my tutorials is that I actively update them as new science and information becomes available. Unlike regular books, and even ebooks — which can be obsolete by the time they are published, and can go years between editions — this tutorial is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 64 major and minor updates worth logging since I started logging carefully in late 2009, and countless more minor tweaks and touch-ups.
Minor update (Apr 4 '13, section #2) — Interesting, useful new reference to Barzouhi. See section #2, Diagnosis: Your low back is not fragile!
Minor update (Mar 29 '13, section #3.8) — Upgraded risk and safety information about Voltaren Gel. See section #3.8, Pain medications (and even alcohol) can be useful.
New section (Mar 26 '13, section #2.18) — No notes. Just a new section. See section #2.18, Could it be a bacteria from your mouth? A delightfully weird possibility.
New section (Feb 2 '13, section #4.4) — No notes. Just a new section. See section #4.4, As if massage wasn’t good enough already!
Major update (Jan 26 '13, section #4) — All major professional treatment options now summarized. See section #4, Getting professional help: A consumer’s guide to buying therapy and medical care for low back pain.
New section (Jan 26 '13, section #3.1) — New standard section I’m introducing to most of the tutorials to “manage expectations.” Too many readers assume there’s going to be a specific miracle treatment plan. See section #3.1, So what’s the plan?
Major update (Jan 26 '13, section #3) — All major self-treatment options now summarized. See section #3, Self-treatment options: How to save yourself from low back pain, or at least avoid getting hurt or ripped off trying.
Edited (Jan 19 '13, section #3.2) — Nothing in particular has changed, but it’s definitely a better chapter now. See section #3.2, The confidence cure.
Science update (Nov 10 '12, section #4.13) — New reference strongly supporting a key, controversial point. See section #4.13, The fascinating case of acupuncture, formerly a contender in low back pain therapy, but which has now miserably failed well-designed scientific tests.
Minor update (Nov 2 '12, section #2.22) — Added an intriguing quote about evolution and the lack of back pain in hunter gatherers. See section #2.22, Are you crooked? The alignment theories: short legs, pelvic tilts, and spinal curves.
Science update (Oct 28 '12, section #2.25) — Put “foot fear” in context with some reassuring high heels science. See section #2.25, Is it all in your feet? Foot-o-centric low back pain theories.
Science update (Oct 26 '12, section #1.1) — Added evidence that the stakes are high with chronic pain: it may even shorten lives. See section #1.1, A tragic low back pain myth.
Minor update (Oct 24 '12, section #3.24) — Added a new suggestion for safe, pleasant self-tractioning. See section #3.24, Traction: low back pain on the rack!
New section (Oct 24 '12, section #2.30) — No notes. Just a new section. See section #2.30, Back pain and sneezing.
Product upgrade (Jul 30 '12) — PDF versions of all SaveYourself.ca tutorials are now available. They are ideal for printing and offline reading on e-readers. The online version will always be the “real” version (guaranteed current) and the best way to read the books, but fresh PDF copies will always be available to customers. Announcement on my blog: Finally! PDF versions of my books, and the “technologically interesting” story of how they were made.
Science update (Jul 4 '12, section #2.3) — Interesting evidence that massage therapists cannot reliably find the side of pain by feel. See section #2.3, Structural problems in the low back are hard to diagnose accurately.
Minor update (Jun 7 '12, section #3.4) — Added a fine example of taking yoga very, very seriously as an option. See first footnote in section. See section #3.4, Stress relief and the tyranny of meditation and yoga.
Update (Apr 27 '12, section #3.6) — Editing, and several new paragraphs about safety issues. See section #3.6, Yoga and meditation are still an option, of course.
Minor update (Apr 27 '12, section #3.4) — Some simple revision for clarity and quality, and a bit more content. See section #3.4, Stress relief and the tyranny of meditation and yoga.
Science (Apr 4 '12, section #4.14) — More science, and a few substantial new footnotes fielding common concerns and questions. See section #4.14, Core strengthening has failed to live up to the hopes and dreams of therapists and patients.
Science update (Mar 21 '12, section #2.22) — Clarified information about pelvic tilt, and beefed it up with some more science. See section #2.22, Are you crooked? The alignment theories: short legs, pelvic tilts, and spinal curves.
Minor update (Mar 7 '12, section #3.8) — Important new, skeptical footnote about the dangers of the powerful narcotic drugs. See section #3.8, Pain medications (and even alcohol) can be useful.
Science update (Dec 16 '11, section #4.14) — More evidence of the exercise effects are limited and non-specific. See the paragraph starting “Does spinal function improve…” See section #4.14, Core strengthening has failed to live up to the hopes and dreams of therapists and patients.
New section (Dec 10 '11, section #3.3) — No notes. Just a new section. See section #3.3, What is the difference between a ‘confidence cure’ and a mere placebo?
Updated (Dec 1 '11, section #4.5) — Added scientific cases studies, examples, pictures and video of true dislocation and abnormal anatomy to help drive home the point that even significant spinal joint dysfunction can be surprisingly harmless … never mind subtle joint problems. See section #4.5, Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.
Minor update (Nov 25 '11, section #2.4) — Minor, but fun — a great quote about models of slipped discs, and a good new image to help it along. See section #2.4, Those scary spine models.
Rewritten (Nov 23 '11, section #4.7) — Improved and expanded. In particular, intramuscular stimulation (IMS) was “demoted.” I am disillusioned with it and no longer want to promote it without strong caveats. See section #4.7, “Medical” treatment option for trigger points: dry needling (IMS), stretch and spray, and trigger point injections.
Major science update (Nov 3 '11, section #3.6) — Detailed reporting on some new yoga science. Significant re-writing of the section ensued. Sometimes new science does not back up my preconceptions: I’ve changed my tune here somewhat. See section #3.6, Yoga and meditation are still an option, of course.
Minor update (Nov 1 '11, section #2) — Added a couple great points/quotes from doctors about overuse of MRI, as reported by Gina Kolata for the New York Times. See section #2, Diagnosis: Your low back is not fragile!
New science (Aug 26 '11, section #2.27) — I tumbled at random across a fantastic scientific paper about the prevalence of nerve pinches (hint: it’s low). Great stuff! A most welcome addition. See section #2.27, Could you have a “pinched” nerve? The nerve pinch myth.
New section (Aug 26 '11, section #2.15) — A key concept covered in the trigger points tutorial long ago, but so relevant to low back pain that I decided it needed to be here as well. See section #2.15, Could it be a vicious cycle of pain-spasm-pain?
New section (Aug 26 '11, section #2.14) — This section is a summary of an important concept that’s been available in a free article since late 2008, but it really needed to be emphasized here. See section #2.14, From the frying pan of injury pain to the fire of trigger point pain.
Minor update (Aug 12 '11, section #3.19) — A few new paragraphs summarizing an important new study of massage for low back pain with disappointing results. See section #3.19, The evidence for massage.
Minor update (Jul 29 '11, section #1) — Added a reference about the poor overall quality of online information about common injuries. See Starman et al. See section #1, Introduction.
New section (Jul 13 '11, section #2.10) — More information about an important characteristic of muscle-dominated back pain. See section #2.10, “Out of nowhere”: seemingly random episodes of low back pain.
Major update (Jul 12 '11, section #2.9) — Totally renovated section: re-written, reformatted, expanded, upgraded. A few new checklist items were added, most were expanded, and all were clarified. A separate and handier “quick” checklist was added to the existing “slow” checklist. See section #2.9, A trigger point checklist: does this sound like you?
Major update (Jun 19 '11) — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really be cleaned up in general, paving the way for efficient conversion to other formats (Kindle, Apple’s iBookstore, etc). Best of all, it is now significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
Minor Update (May 11 '11, section #4.9) — Added evidence that spinal fusion surgeries are not just ineffective but often harmful (Nguyen). See section #4.9, The back surgery placebo problem, and how it limits our knowledge of the effectiveness of back surgeries.
Minor update (May 11 '11, section #3.8) — Added a fascinating science item about the effect of anti-inflammatory gels on back pain (Huang). See section #3.8, Pain medications (and even alcohol) can be useful.
Minor Update (May 11 '11, section #2.23) — Long overdue, I finally added some science to this section, showing that the connection between low back pain and obesity is weaker than it seems (Wright). See section #2.23, Do you really need to lose some weight?
Minor Update (May 5 '11, section #2.24) — Added some interesting references about sensation (Luomajoki) and the relationship between back pain and a disrupted “body schema” (Bray). See section #2.24, Is it core weakness?
Upgraded (Feb 17 '11, section #4.5) — New artwork from SaveYourself.ca artist Gary Lyons, plus some important new references. See section #4.5, Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.
Minor Update (Feb 17 '11, section #2) — Added a fun and informative quote from the TV show House. See section #2, Diagnosis: Your low back is not fragile!
Updated (Jan 12 '11, section #2.2) — Added some new evidence about back pain and aging, and a nice new graph. See section #2.2, Maybe you’re just getting older? Actually, no ….
Minor update (Jan 7 '11, section #4.18) — Just added a link, but a really great link! The CBC show Marketplace did an amazing job last year reporting on spinal decompression machines. Well worth a look — the show and their show page is probably now the single best source of information on this topic. See section #4.18, Spinal decompression therapy: worth the money and risks?
Minor update (Jan 7 '11, section #2.24) — Some editorial cleanup on core strengthening, and I a link to a good summary of recent research. See section #2.24, Is it core weakness?
Like new (Dec 29 '10, section #3.21) — Re-written and significantly expanded. See section #3.21, Act normal! Rest minimally and strategically, while maintaining as much normal activity as you can.
New section (Dec 29 '10, section #2.16) — No notes. Just a new section. See section #2.16, Could low back pain be an overuse injury?
Major Update (Oct 1 '10, section #2.21) — Rewriting and expansion of the Special Supplement on spinal manipulative therapy. The update was inspired by new science on the (significant) risks of spinal manipulative therapy, and by Sam Homola’s excellent article at ScienceBasedMedicine.org, Chiropractic Vertebral Subluxations. See section #2.21, Is there such a thing as a “subluxation”? Can your back be “out”?
Updated (Sep 21 '10, section #2.3) — Added a much more detailed description of the Hancock et al study, and in fact turned it into the main substance of this section. See section #2.3, Structural problems in the low back are hard to diagnose accurately.
Updated (Sep 15 '10, section #2) — Added a very beefy footnote about some new research showing that muscle imbalance does not result in higher rates of injury. This almost should have been a new section, but I decided to just make it a ginormous footnote — footnotes are there for delving if you want to, that’s the idea! You can read a summary of the research in the bibliography (see Hides et al), but the relevance to back pain is spelled out in detail here. And it’s interesting. See section #2, Diagnosis: Your low back is not fragile!
Upgraded (Aug 25 '10, section #4.13) — Section now includes discussion of that bizarre and already infamous paper in the New England Journal of Medicine (see Berman). I also make an important new point: exactly why acupuncture placebos are such a problem for low back pain patients in particular. See section #4.13, The fascinating case of acupuncture, formerly a contender in low back pain therapy, but which has now miserably failed well-designed scientific tests.
Like new (Aug 7 '10, section #4.14) — Rewritten. I’ve lost track and can’t be bothered to go back into the archives to figure it out for sure, but I think that this section was brand new (but never announced) late in 2009, and then this past week I gave it a substantial upgrade: it is now one of the best-referenced chapters in the book, and it says as much as probably needs to be said on the subject — or more! See section #4.14, Core strengthening has failed to live up to the hopes and dreams of therapists and patients.
New cover (Aug 6 '10) — At last! This e-book finally has a “cover.”
Minor update (Jun 7 '10, section #3.8) — Updated with a summary of a bizarre experiment with muscle relaxants that had quite surprising results. See section #3.8, Pain medications (and even alcohol) can be useful.
Minor update (Jun 5 '10, section #4.19) — Added a scientific thumbs down for transcutaneous electric nerve stimulation (TENS). See section #4.19, A few more snack-sized reality checks: brief comments on other treatments to avoid.
New section (Jun 5 '10, section #3.9) — A surprising scientific thumbs up for comfrey ointment was worth a whole new small section. See section #3.9, Comfrey makes backs comfy, study claims.
Minor update (Feb 13 '10, section #1.1) — Added clear evidence that family doctors don’t do a good job caring for patients with low back pain, and that a myth-busting ebook like this is still important. See section #1.1, A tragic low back pain myth.
New section (Jan 23 '10, section #3.32) — No notes. Just a new section. See section #3.32, Less than a cure, but better than nothing: short term symptom relief options for low back pain.
New section (Jan 23 '10, section #3.19) — An important update: a major new section that goes a long way to substantiating one of the most important points of this tutorial. See section #3.19, The evidence for massage.
Major upgrade (Jan 23 '10, section #3.8) — Rewritten and significantly expanded information about medications. See section #3.8, Pain medications (and even alcohol) can be useful.
New section (Jan 22 '10, section #3.24) — Having debunked expensive spinal traction using expensive decompression machines, here are some ideas for cheaper and safer methods of tractioning. See section #3.24, Traction: low back pain on the rack!
New section (Jan 21 '10, section #4.18) — No notes. Just a new section. See section #4.18, Spinal decompression therapy: worth the money and risks?
New section (Nov 25 '09, section #3.12) — Today I found a way to say some simple things about the power of self-treatment that have been “on the tip of my tongue” for years now. It all evolved from writing about an important bit of research, showing that manual therapists cannot (reliably) diagnose trigger points. See section #3.12, Limitations of trigger point therapy, and how to take advantage of them.