Think of the coming negativity as yin wisdom. To ignore it will bring consequences that will not ignore you back. Know it, avoid it, and we can get back to being positive.

The following are overlapping factors, the more of which you check off and the longer they have been checked, the worse things are, the worse they are going to get, and the less chance they will ever be back to normal. And not for someone else but for YOU. You can get Hindu about life and say everything is one and nothing’s a mistake if you think that will help, but fatalism like that leads to pain and disability that YOU are going to feel individually, in your atman as it were. And while it’s great to be self-sacrificing to some degree, when you weaken yourself, you are less able to help others. Eventually you will become a burden on others, and they’ll wish you took better care of yourself. This is not theory, but rather direct experience I witnessed countless times in my physical therapy office, where you really want to tell the person they really messed up, there’s no fixing their problem, not for real, but saying so isn’t going to do that person any good, so you say something “positive.”

It’s very pop psych to think you change for the better at some later date when you are “ready.” That’s true, but while you are deciding, and contemplating your “stages of change” just know that YOU ARE BOILING. And like a frog, the longer you let your body seethe, the less power for which your body will be able to jump when you need it too, and the less completely it will recover should you manage to get out of the water. If you have read the causes of spine pain you will know that spine degeneration and pain are a continuum, a slippery slope as it were. While in theory you can always pull things back, the sad reality is that true rock bottom is oft past the point of no return. I’m hoping that by knowing the hows, the whys, and the urgency in hopping, you’ll save yourself much needless pain. So here’s how you boil, and why it happens.

So here’s how you boil, and why it happens.

1: Being Fat

We might as well get the (almost literal) elephant in the room out of the way first since this factor drives many of the others. I’ve been paying attention for a lot of years, both in the media and at my physical therapy office. When you hear of a long time overweight person who finally gets their act together and loses a lot of weight, to what do you attribute the reason? Did they magically, after decades, have a revelation and suddenly gain willpower? Almost never, unless you count that revelation being their cardiologist telling them their coronary arteries are 90% occluded and they’re going to die SHORTLY if they don’t lose weight IMMEDIATELY. What they got was scared, the apparent opposite of satori, which Alan Watts describes as the feeling of peace you have when you hear a bomb dropping upon you. And so they lost weight, which is great. Unfortunately, as much as the diet helped to clean up their blood, their arteries are still occluded. So while they bought themselves time, and certainly made their life better not having to lug around excess adipose with every step, they’re still going to die younger than had they lost the weight years ago, or better still not let themselves get fat in the first place. I’m hoping this section motivates you to lose fat as quickly and as early as you can. Losing fat now, is the only way in the future to be happy that you lost weight in the past.

This relates directly to neck pain, back pain and vertebral disc degeneration. Excess fat accelerates disc degeneration as the fat puts more weight on the discs every minute of every day. Remove the fat and some squish is removed, and it’s best if the weight is removed before, rather than after it’s caused permanent spine damage. More recent research suggests some of that damage to be via blood vessel occlusion in the spine, the same as happens in the heart, decreasing circulation and thereby oxygen and nutrient delivery to the discs. Diet and exercise lessen the rate of future occlusion, but research indicating reversal of occlusion is scant, likely spurious, and nobody to my knowledge is implanting stents into vertebral blood vessels. 

Increased systemic inflammation has been getting a lot of press lately as being causal of many things bad in the body. Having reviewed the research I’ve concluded they’re not wrong. However, what the press doesn’t want to come clean on with their reporting is that the lion share of systemic inflammation is from fat cell secreted inflammatory cytokines (remember this because we’ll revisit it) and those cytokines are the mediators of said inflammation. Those cytokines basically rot the body from within causing all body breakdown, concurrently and inconveniently increasing pain sensitivity. The cytokines even destroy from without, prematurely aging and wrinkling of the skin. Among the tissues affected are the bone, ligaments, cartilage, and discs of the spine, chemically accelerating spine arthritis. It turns out there are a billion fat cells per pound of fat. You think some turmeric is going to fix that? Unlikely.

If you aren’t sure if you’re fat (surprisingly a lot aren’t) here’s how to know.

If you want to fix being fat, here are my favorite ways.

2: Stenosis

Stenosis is the narrowing of spaces within your spine. Either central where the spinal cord transcends, or peripheral where individual nerves exit the spinal cord. Stenosis can be caused by disc narrowing as shorter discs mean closer bones and less space between them for nerves. Stenosis can also be caused by disc bulges and herniations taking up space either centrally or peripherally in the spine. Thirdly stenosis can be caused by increased bone growth as the body tries to stabilize unstable (degenerated) discs by the manufacture of new bone, aka bone spurs. Fortunately, with a bit of luck the spine can tolerate a fair amount of stenosis and still become pain free, with full apparent function, and this is something I have witnessed many times. If you learn SpineFitYoga well, the chances of full functional recovery, even with stenosis, are pretty good. That said, get unlucky and your stenosis can be of a kind, or to a degree, for which recovery is only partial. Sometimes bone spurs poke a nerve, sometimes they don’t. Fortunately, usually by this time we are talking people of advanced ages 60-70 years and older, but when it happens there’s no going back in time to fix things.

3: Knee and Hip Arthritis

Keeping with the theme of fat and arthritis. The physical weight, and fat derived inflammation not only affects the spine but also hips and knees. However, fat is not the only cause. Injuries from work, sports, and recreation hit many of us, often of no fault of our own. Sedentary (in)actions can be just as bad. Sitting in padmasana (lotus posture) as you meditate overstretches knee ligaments, decreasing knee stability and accelerating arthritis. Want to know why the Dalai Lama limps? Betcha that’s why. Likewise, about 30 percent of Yin Yoga postures crank both knees and/or hips ligaments in a ways and durations I would never want done to myself. The rest are doing the spine no favors such than most minutes doing Yin Yoga are minutes in the cooking pot (yes, I think yin yoga is demonic and “Restorative” Yoga is just as bad). 

So why are knee and hip integrity important for back pain? SpineFitYoga treats back pain by teaching you to move better, and move more, about your hips and knees while keeping the spine strong and stable in neutral. Greater use of the hips and knees requires they also be strong. Stronger hips and knees (moving actively) accompanied by strong spine stabilizing muscles (working isometrically) thereby protects the passive structures (discs, ligaments, and bone) of the spine. If you have back pain, and significant knee and hip arthritis, you have really cooked yourself with regards to restoring full function because there is nowhere for you to go to rest one part without worsening something else. SpineFitYoga is still very likely helpful, but you’re probably going to have to focus more on the M5 routine, and L1 intensity level of M5, with goals maybe being to manage pain and restore some function, as opposed to eliminating pain and achieving elite level fitness.

4: Advanced Osteoporosis

For mild to moderate osteopenia and osteoporosis SpineFitYoga is positively good for, and should reverse. The Level-3 exercises of M5 were inspired by research on explosive weight training and bone mass, as that’s the only exercise shown to build back lost bone mass, as opposed to milder exercise which only slows further decline.

Osteoporosis even when advanced should still respond favorably to the right exercise, and SpineFitYoga, strictly adhering to the user rules, is the best exercise. However, problems I have seen in relation to neck and upper back pain especially begin when bad postures have been held for years, such that the thoracic (middle) spine becomes chronically and eventually permanently rounded forward. At first I think this starts with lack of awareness and muscle weakness, over time leading to deformed ligaments, and eventually osteoporotic compression fractures, becoming a permanently rounded posture. Awareness is easy to give, P5 does that. Muscle strength is made as easy as possible with M5, and together P5 and M5 may be able to help overstretched ligaments return to normal length. However, by the time you start getting osteoporotic compression fractures, your “hunchback” spine is locked in. Where you begin to see this is in the older person (usually 6th and 7th decades onwards) who cannot lay on their back without a pillow. And if they can, their neck, instead of being neutral with eyes looking up at the ceiling, rather they have their neck in full extension with eyes resting on the wall behind them. In my experience this can be lessened over time, but there is a point where trying too hard to fix it does more harm than good.

5: Fibromyalgia

Fibromyalgia, a contentious diagnosis for which some (including the originator of the term) say isn’t even a thing in itself, but rather a collection of symptoms. What makes fibromyalgia more iffy is that many are given the diagnosis even when they don’t meet the criterion for those symptoms. Over my years as a clinical physical therapist I have had many patients diagnosed with fibromyalgia who I didn’t think had it, but others who clearly did. The former did as well with exercise and cured up as well as anyone else, the latter, almost always did not. 

The problem with the latter case is that central sensitized pain (closely associated with fibromyalgia) is so dialed up that anything but the easiest exercise knocks the person out for days. In theory they should be able to work up exercise intensity and duration slowly, improving function and reducing pain gradually. In practice, this improvement is so slow that they run out of insurance long before they are able to progress their exercise far enough to do legitimate good. 

Unfortunately, people often cook themselves here by doing what they are told. They hurt their spine, they try and make it better by stretching (cause that’s what everyone says) providing only the mildest short term relief but making things worse, again via the usual causes, in the long run. Finally they see a doctor who maybe gives them more stretches, some pills that don’t do much and sends you to physical therapy. But the therapist, who more than anyone should know better, rather than giving good exercises that make one strong, gives bridges (that do nothing), and yet more bad stretches, followed by various “modalities” that are of placebo benefit at best. Feeling better via placebo would be great, except that benefit serves only to disguise the fact that the person is still boiling. After enough cycles of all that, pain is central sensitized, and they have fibromyalgia, and now even good activities hurt. 

The reason why you are cooked beyond repair here is because even though in theory a gradual return of function through SpineFitYoga is possible, it takes a great deal of self-starting motivation, and this motivation needs to be sustained for a long time. But motivation is sapped by the depression often accompanying fibromyalgia. One’s frog is basically roasted, and roasted as young as one’s 30s. You can bet most other frog boiling factors are well in play also. This is the group that above all should be able to prove me wrong, unfortunately I’ve yet to see it happen.

6: Sarcopenia (frailty) and Sarcopenic Obesity (a two time loser)

I’ve had many patients with both. Sarcopenia usually not unless the person is in their 80s, and sarcopenic obesity as young as one’s 60s. Both are huge problems for senior citizens, leading to falls, broken hips, lost independence, with the latter arguably more a result of bad choices and with frequency growing at an alarming rate. Sarcopenia is the naturalish decline in muscle mass with age, most certainly offset with proper exercise, and I’d argue no exercise is more proper for this than M5. A healthy diet including more high quality protein than is current RDA seems important as well. 

Why sarcopenia cooks you is that age and inactivity lead not only to smaller, weaker muscles, but eventually individual muscle cells starting to die off and become fibrotic. When older people tell me they want some stretch because they are feeling stiff, I’m like, “probably more you need to strengthen.” That stiffness they are feeling is more so fibrotic muscle than tight joints, though eventually one leads to the other. Why this cooks you is if and when the person tries to turn it around if too many muscle fibers are gone they won’t respond to exercise because they can’t. In theory you can always take the remaining fibers and make them stronger but with advanced sarcopenia it becomes too little too late. 

Sarcopenic obesity is in some ways more interesting in a perverse way, and relates to research that started me intermittent fasting years ago. It was research that found monkeys who ate 30% less food had 10.6% more muscle as they aged than those monkeys who lived in the now and ate as much as they wanted. I gathered the restricted monkeys would be thinner, perhaps healthier, but I didn’t think they would be stronger as it was contrary to EVERYTHING I had been taught with regards to bodybuilding and weightlifting.

This is a relatively new area of research, but a major driver is again those fat cell secreted inflammatory cytokines. Remember those cytokines that increase inflammation throughout your body, increasing pain sensitivity while at the same time degenerating your joints? It turns out they are degenerating your muscles too. It’s beyond a bad coincidence when fat makes your body weigh more, also destroys the muscles you need to move it, accelerating joint degeneration, while making your body more sensitive to the pain. And you don’t even have to be that fat. When you see an older lady who’s maybe only 30-50 lb overweight, not even outside the new-American norm, you know the one who needs to use both hands to help herself stand up from a chair, this is what you are seeing. What you’re not seeing is probably she’s incontinent. The woman with fibromyalgia?, this is what’s coming. And when you see an older gentleman with a big belly, thin legs and no butt, this is what you are seeing, that central fat is particularly good at secreting cytokines and probably the guy sleeps with a CPAP. 

Why you are cooked here is exactly the same as with regular sarcopenia, it just happens sooner. A large proportion of the muscle cells have died and therefore can’t be brought back with exercise, but on top of frailty they have other health problems in spades owing to being fat as well.

7: Cognitive Decline (aka senility)

This section is short because the causes have been described above. Research continues to point towards a mind-body link and is overwhelmingly suggestive that senility isn’t something that just happens. Like muscle loss, to a degree it is age related, but also like muscles, neurons are very much subject to the use it or lose it principle. And like vertebral discs, joint cartilage, and muscle, neurons in the brain are protected by both exercise and intermittent fasting too, and likewise are killed off by the same fat cell secreted inflammatory cytokines. And why you are cooked is for all the same reasons. Kill too many cells, be they cartilage, muscle, or now brain and you can’t come back to normal. While there is no point for which I would tell a person not to exercise, or not to try to improve their diet, there are points where doing so results in diminishing levels of good, and it’s always sad when you are on the wrong side of those points. I’m reminded of an answer given by anti-aging researcher Mark Mattson, when asked about fasting as a treatment for Parkinson’s and Alzheimers, said for prevention sure, but after the diagnosis he didn’t think it would help. As much as he lauded “Fasting to Bolster Brain Power,” in what’s my absolute favorite TED Talk, Dr. Mattson said once symptoms of cognitive decline show up, the neurological degeneration is “too profound” to reverse course.