A New Book, ‘Watch Your Back’ by Spinal Surgeon Dr. Ken Hansraj, Tells How to Reduce Neck and Back Pain Without Medication or Surgery

Dr. Ken Hansraj is a New York-based spinal surgeon who seems to be trying very hard to teach people how to not need his services. Hansraj has been in practice for more than 20 years, dedicated to helping people in every country improve their spinal health. His new book, Watch Your Back: Nine Proven Strategies to Reduce Neck and Back Pain Without Surgery, brings his years of accumulated expert medical knowledge to the public in an easily understood digest format to help people deal with spinal health issues, or avoid in the first place.

Dr. Ken, as he is known to his patients, has also released Lift: Meditation to Boost Spine Health, which is available wherever songs are sold. His goal with each of his books is to Dr. Ken Hansraj is well known for his appearances on national media outlets, including CNN, HLN, CBS, FOX, NBC, ABC, and NPR. Cision® estimates his current media impressions at 12 billion.

We emailed some questions to Dr. Ken, which he has answered in considerable detail. By all means, read to the end, but here is a spoiler: stand up straight!

Grit Daily: Back pain is very common. Why?

Dr. Ken Hansraj: According to the Bill and Melinda Gates Foundation-sponsored global burden of disabilities study, back pain is the world’s most common problem. Low back pain is estimated to be present in 577.0 million people = 7.5% of the global population. Neck pain is the world’s 4th most common problem, present in 289 million people. 577 + 289 = 866 million people at any one time = 12% of the world.

(James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-858. 10.1016/S0140-6736(18)32279-7)

Improper posture is the primary cause of back pain. Proper posture is the correct spine alignment leading to the correct loading of muscles, position for the spine and supporting structures.

Remember your mother saying, “Stop slouching”? You would think it goes without saying, but too many of us don’t maintain good posture, which is critical for a healthy spine. Good posture is defined as ears aligned with the shoulders and the “angel wings,” or the shoulder blades, retracted. In proper alignment, spinal stress is diminished. It is the most efficient position to achieve the best posture possible.

Poor posture has health and wellness consequences. San Francisco State University researchers have found a link between poor posture and depression. Many experts believe stooping and slouching could be associated with weight gain, heartburn, migraines, anxiety and respiratory conditions.

Proper posture leads to a taller appearance, deeper breathing, improved well-being and increased energy with enhanced human performance.

Billions of people use smartphones and electronic devices worldwide, essentially in poor posture. People spend an average of two to four hours daily with their heads tilted over reading and texting on their smartphones and devices. Cumulatively this is 700 to 1,400 hours a year of excess stresses around the cervical spine. A high school student today may spend an extra 5,000 hours in poor posture in the four years of high school. People of all ages are “heads down.” Walking, driving, working, especially when spending time with friends and family.

An adult head weighs 10-12 pounds in the neutral position. As the head tilts forward, the forces seen by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees, and 60 pounds at 60 degrees.

Most new onset acute back pain is due to muscle injury called a strain of the ligaments called a sprain in the soft tissues supporting the lower spine or neck.

Chronic back or neck pain is often related to the spinal joints, discs, or supporting muscles in the back. Stresses to bones, muscles, ligaments, joints, nerves, or the spinal cord may be involved.

Pregnancy is a cause of back pain. As the fetus grows, a woman’s body weight increases, putting more pressure on the lower back and pelvis. During pregnancy, the body produces hormones like relaxin that relax the ligaments and joints to prepare for childbirth. This looseness can cause instability in the spine and pelvis, leading to back pain.

As the baby grows, a woman’s center of gravity shifts forward, which can cause her to lean back to compensate. This shift puts extra strain on the lower back muscles, causing pain. In some cases, the abdominal muscles may separate during pregnancy, weakening the core muscles and leading to back pain. Also, pregnancy can be a stressful time, and stress can cause muscle tension and exacerbate existing back pain.

Tall height does not necessarily cause back pain, but it can increase the risk of developing certain types of back pain. The most common cause of back pain in tall individuals is poor posture. When a person is tall, they may be more likely to slouch or hunch over to fit into smaller spaces or make eye contact with people shorter than them. This forward posture can strain the muscles and ligaments of the back, leading to pain and discomfort.

Smoking causes back pain; it can cause damage to the discs in the spine. The discs act as shock absorbers between the vertebrae, and when they become damaged, they can bulge or herniate, leading to back pain. Smoking has been shown to reduce the blood supply to the spine’s discs, weakening them and making them more susceptible to damage. Smoking leads to inflammation, weakens the immune system, and makes it hard for the body to fight infections and inflammation. Smoking is associated with poor posture, which can lead to back pain. Smoking reduces lung capacity, making it harder to breathe. Insufficient lung capacity can cause people to hunch forward or adopt other poor postures that can strain the back muscles and contribute to pain and discomfort. Studies say that smoking delays healing and recovery from back injuries. Smoking has been shown to reduce blood flow and oxygen to injured tissues, slowing down the healing process and making it harder for the body to recover from injuries.

High Heels: When a person wears high heels, the body’s center of gravity is shifted forward, which can cause the lower back to arch excessively. Arching the spine leads to compression of the nerve roots as they leave the spinal channel and pain. High heels can cause the calf muscles to shorten and tighten, contributing to back pain. When the calf muscles are tight, it can alter how a person walks and stands, leading to increased stress on the back muscles and joints.

Skinny jeans, halter tops, pencil skirts, shapewear, heavy necklaces, shoulder bags, and heavy briefcases all lead to altered biomechanics, loading of the spine and pain.

Breast Forces on the Spine: Women have complained about the pain caused by oversized breasts since the dawn of humanity. Large breasts have been associated with physical complaints of back and neck pain, yet many people question the truthfulness of women suffering from this discomfort.

Women must maintain good posture, wear a bra that fits, and understand the impact increasing the bust size can have on physical health; an increase by a mere letter size, for instance, using an average of 36 cup, can mean as much as ten extra pounds of weight on the spine.

Often women seeking plastic surgery do not consider how the added weight of implants will affect their spines. On the other hand, a breast reduction of a naturally fuller bust can often help to alleviate pressure off the spine.

Women need to maintain a healthy weight, strong core, good posture, and a well-fitted bra to avoid spine strain.

Backpack forces on the spine: Backpacks are commonly used by people of all ages, including students, athletes, and military personnel, to carry their loads. Studies have been conducted to investigate the effects of backpacks on load distribution, back pain, and gait.

Using both backpack straps evenly distribute the force, with a uniform magnification of 7.23. Carrying the load on one shoulder doubles the load on that shoulder, leading to improper posture and increased stress on the spine. For instance, tilting the spine 20 degrees forward from a neutral position (+0 deg.) can result in a force magnification of 11.6, which means that a military officer carrying a 100-pound backpack experiences a force of 720 pounds with a neutral spine. However, when the same officer leans forward 20 degrees, the force increases to 1,163 pounds.

Lifting forces on the spine: Physicians, physical therapists, and health advisors intuitively recommend that people carry objects close to their bodies. When the arm is close to the body, then the forces are approximately 0.5 times the weight lifted; when the arm is raised 45 degrees, then the forces are about 2 times the weight lifted; and when the arm is raised 90 degrees, then the forces are approximately 4 times the weight lifted.

A regular person lifts 20 to 50 pounds daily, 5,000 to 18,000 pounds a year. I have worked with express delivery workers who lift 1 million to 1.5 million pounds annually. Remember that these workers may lift the same items 2 or 3 times before final delivery. The spine always sees a magnified amount of spine forces by 1x or 2x. With improper lifting techniques, the spine force may be 4x the weight.

Grit Daily: It’s easy to see why a person with a physical job, such as a worker in a warehouse or a construction laborer, would suffer back pain, but why is it so common among white-collar workers who spend their days sitting, typing, and talking?

Dr. Ken Hansraj: A regular person lifts 20 to 50 pounds daily, 5,000 to 18,000 pounds a year. I have worked with express delivery workers who lift 1 million to 1.5 million pounds annually. Keep in mind that these workers may lift the same items 2 or 3 times before final delivery. The spine always sees a magnified amount of spine forces by 1x or 2x. With improper lifting techniques the spine force may be 4x the weight.

A sedentary lifestyle is not good for the back. “Sitting disease” is a term used to describe the adverse health effects that can result from prolonged periods of sitting. The representation is based on the growing body of research showing that sitting for long periods can increase the risk of various health problems, including obesity, diabetes, heart disease, and cancer.

The human body is designed for movement, and sitting for long periods can lead to adverse health effects, including reduced blood flow to the legs, weakening of the muscles in the legs and back, and increased pressure on the spine. Prolonged sitting can also lead to poor posture and an increased risk of injuries such as back pain and neck pain.

In a 2018 interview with the Carlyle Group’s David Rubenstein, Apple Chief Tim Cook said, “Sitting is the new cancer,” and he has also been quoted as saying, “Sitting is like smoking. It’s bad for your health.” These statements reflect the growing body of research showing that prolonged sitting can increase the risk of health problems such as obesity, diabetes, heart disease, and some forms of cancer. To promote movement and activity among Apple employees, the company has implemented standing desks and encourages employees to take breaks and walk throughout the day.

Grit Daily: Does good posture prevent back pain?

Dr. Ken Hansraj: Yes. Maintaining an upright position is the most efficient way to keep your spine healthy. This position alleviates stress on the spine, bones, ligaments, and muscles. Conversely, poor posture can cause strain on the back muscles and ligaments, leading to discomfort and pain in the long run.

Grit Daily: Does improved posture cure (for lack of a better word) back pain once it becomes a condition?

Dr. Ken Hansraj: For the most part, yes. As a spine specialist, I have observed that the spine is forgiving. Most patients I see get better with sound advice and gentle care, including embracing proper posture. On the other hand, some people with fixed spinal deformities, long-standing chronic pain syndromes and millions of pounds lifting histories may not respond as quickly with proper posture techniques.

Grit Daily: Is there a connection between obesity, or simply carrying a bit too much weight, and back pain?

Dr. Ken Hansraj: Yes.

In the U.S., over two-thirds of adults (220 million-plus) are overweight or obese, and childhood obesity affects 13.7 million children. As of 2016, 1.9 billion adults were overweight or obese globally. It is known that obesity, or the fat content of the belly, is associated with inflammation, diabetes, hypertension, heart conditions, metabolic syndrome, and back pain. Adipose tissue is linked to an increased risk of and aggressiveness of cancer.

Our study sought to assess the forces that belly fat exerts on the spine with increased waist circumference. Using data from the Dallas Heart Study, Grundy et al. calculated belly fat mass according to waist circumference by ethnicity and sex. Using a finite element analysis, our study specifically placed the abdominal fat masses into position in the abdomen. Then, we calculated the levered forces seen by the spine.

In our measurements, the magnitude of forces generated by abdominal fat to the lumbar spine ranged between 5 to 170 pounds of force. By the standard set by the American Heart Association, abdominal obesity in women starts at a thirty-five-inch waist circumference.

Waist Circumference	Pounds of Force	Approximate equivalent
25 inches	4.9	20 sticks of butter
28 inches	14.83	Pressure cooker
30 inches	22.17	2 bowling balls
32 inches	29.5	20 dozen eggs
34 inches	36.83	4 gallons paint
36 inches	44.16	Twin mattress
40 inches	58.81	9-year-old child
45 inches	77.13	16 bricks
50 inches	95.44	Baby crib
55 inches	113.76	60’ Flat screen TV

For men, the magnitude of forces generated by abdominal fat to the lumbar spine ranged between 3 to 120 pounds of force in our measurements. According to the American Heart Association, abdominal obesity in men begins at a waist circumference of forty inches.

Waist Circumference	Pounds of Force	Approximate equivalent
25 inches	2.8	Steam iron
30 inches	11.7	Gallon of paint
34 inches	22.12	Sledgehammer
36 inches	27.56	2-year-old toddler
40 inches	38.46	Small outboard motor
45 inches	52.08	$1000 in quarters
50 inches	65.71	58 Hardcover books

You must imagine what it feels like to lift this much weight to put these numbers in perspective. The magnitude of these forces is significant. If you are a man with a thirty-eight-inch waist, the excess fat in your abdominal area is equivalent to having nearly thirty pounds of pressure on your spine. For a woman, a thirty-six-inch waist is close to having forty-eight pounds of pressure on her spine. Imagine walking around all day carrying dumbbells that weighed nearly fifty pounds. That would be equivalent to carrying a large bag of dry dog food, six gallons of water, two cinder blocks, or, as the chart shows, a twin mattress. Not only would it be exhausting, but carrying those weights would also cause significant wear and tear on your back.

A literature review shows that fat cells comport an essential variety of metabolic influences. Our waist circumference is related to our metabolic health risks. Abdominal fat is a critical player in health problems. The fat around the abdominal organs, called visceral fat, is more disease-causing than the fat under the skin, called subcutaneous fat, which a person can pinch by hand. This visceral fat is linked to metabolic disturbances, increased cardiovascular disease, and type 2 diabetes. The visceral fat leads to an apple-shaped abdomen, while the subcutaneous fat leads to a pear-shaped body.

Fat itself is considered an endocrine organ that is biologically active. Abdominal fat cells disrupt the balance of the body’s normal hormones. Fat cells play a role in inflammation, secrete tumor necrosis factors and interleukin-6, increasing heart disease risk. Furthermore, fat cells blunt the body’s sensitivity to insulin and propagate high blood pressure. Data suggests that adipose tissue has been linked to increased risk and aggressiveness of carcinoma.

Grit Daily: The recommendations you give in Watch Your Back are very sensible for preventing back injuries, and for general good health, but are there circumstances when back surgery is the best option?

Dr. Ken Hansraj: Surgery is typically considered a last resort after more conservative treatment options have been exhausted. Here are some everyday situations where back surgery may be recommended:

Herniated or bulging disc: If non-surgical treatments such as physical therapy, medication, and spinal injections have not relieved the symptoms of a herniated or bulging disc, surgery may be recommended to remove the damaged portion of the disc and alleviate pressure on the nerve roots.

Spinal stenosis: If conservative treatments have not relieved the symptoms of spinal stenosis, surgery may be recommended to relieve pressure on the spinal cord and nerve roots.

Scoliosis: In severe cases of scoliosis, surgery may be recommended to straighten the spine and reduce pain.

Spinal fracture: If a spinal fracture is causing severe pain or instability, surgery may be recommended to stabilize the spine and promote healing.

Grit Daily: Is there anything you want to comment on that I haven’t asked about?

Dr. Ken Hansraj: OMG, NO!