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Kettlebells Have Your Back: A Neurosurgeon’s Personal and Professional Perspective

Patrick RothMD
I am a 53-year-old neurosurgeon and girya aficionado.

Kettlebells are an ideal tool for treating back pain. They not only strengthen the back, but also enable improved posture, improved bending form, and patient confidence. If you are already an experienced kettlebell user, this is likely already evident, but if you are a patient with back pain, read on and open your mind to some extraordinary possibilities.

A personal history of back pain resulted in my professional transformation from a general interest in the brain and spine, to a holistic focus on the cause, treatment, and philosophy of back pain. I spent the first 20 years of my career cultivating techniques to pinpoint, and then surgically treat the often-elusive anatomical generator responsible for back pain. However, personal and professional experience led me to shift my focus towards enabling patients suffering with back pain to help themselves—independently—without their surgeon, therapist, chiropractor, medications, etc.

My journey began when I was a teenager. At the time, any of my athletic endeavors triggered back pain. I accepted this pain as a part of my life. In retrospect, it was a healthy reaction attributable to my innocent age. My acceptance of the pain allowed me to exercise my back—even while in pain. I used a Roman chair (hyperextension machine) that happened to be in my basement. After exercising, I would feel a measure of relief. However, most of my patients are not innocent teenagers and tend to regard their back pain with anxiety. They assume the pain is a result of an injury and something broken must be "fixed".

Later in life I experienced my first herniated disc. After obtaining an MRI, I discovered that I not only had a herniated disc, but also had a chronic stress fracture with a laxity between my L5 and S1 bones. This latter fracture is called a spondylolisthesis.

My reaction to the MRI was eerily similar to the reaction that I tended to criticize in my patients. I was afraid because I thought something was broken. I ultimately managed to overcome my fears and embrace back strengthening again—but this time, with kettlebells.

As in my teen years, I was successful again with exercise. I began to study the muscles of the back (particularly the multifidus and gluteus muscles) in more detail to understand their potential role in both the cause of—and solution to—back pain. I began to encourage my more ambitious and open-minded patients to embrace the idea of back strengthening with kettlebells as a solution to their back pain—even while they were in pain. Almost always, patients who made the effort were rewarded with less pain. These patients learned how their posture and form could change with kettlebell training. Exercise changed their bodies, and their changed bodies changed their minds.


Back pain can be successfully treated by harnessing the synergy between the brain and the body—or in this case the brain and back—and by harnessing the equally extraordinary capacity of the body (and back) to adapt and change when properly stressed.

Kettlebell training is an excellent medium for using the body’s self-healing and self-changing capabilities. I have used it successfully, at first personally, then professionally with my patients. The typical back pain sufferer usually stares back at me incredulously when I suggest such an aggressive treatment for back pain!

To imagine how kettlebells can help back pain sufferers, it is helpful in to envision the body (and back) as antifragile. The term, borrowed from Nassim Taleb’s book Antifragile, refers to entities which are not eroded or weakened by stress, but instead become stronger.

Our capacity to change as a result of stress is called phenotypic plasticity. Recent research has shown that much of what was once thought to be meaningless DNA in our genome is likely dedicated to individual cells’ capacity to adapt to environmental stressors. This adaptation occurs in the alteration and expression of proteins. When stress is applied to an organism—a cell, an organ, or the entire individual—the adaptation is cumulative and interdependent. The organism’s design changes to match the functional demand created by the stress. This biological matching of functional demand to structural design is called symmorphosis.
multifidus psoas

An example of symmorphosis in healthcare is the treatment of heart disease. The traditional approach to a minor heart event would focus on medication to protect against a future event. An alternative approach to the same heart event would be to make the coronary arteries bigger. How many of you would look to fundamentally change your heart by gradually training for and competing in marathons? How many of you would become a vegan in order to improve your vascular function? In other words, how many of you would use the body’s capacity to change itself (symmorphosis) as the primary treatment of a disease? Focusing on causing the cells, organs, and body to adapt to a stressor is quite different than the "quick fix" most of my patients crave or have come to expect.

Similarly, in cases of back pain, the back can be changed by the appropriate use of kettlebells. Fundamentally altering the fabric of the back with kettlebells will result in decreased back pain, despite the many possible causes for that pain. The pain may be the result of a herniated disc or spondylolisthesis (which was the case with my situation). Back pain can also be the result of postural changes, muscle imbalances, disused muscles, muscle spasms, or scar tissue in muscles of the back. Kettlebell training is an excellent way of treating all of these etiologies for back pain because the back muscles can change. Back strengthening in this setting can also result in less pain by diminishing the motion between the spinal bones. Thus, the back can be held stiff while bending or getting up from a chair, preventing the sensation of pain.

Back pain always has a psychological component. Kettlebells utilize the psychological principles of embodied cognition. This concept suggests that our minds are inexorably bound to our bodies. For example, we all know that we smile because we are happy, but often forget that we are also happy because we smile. Likewise, learning to move our bodies with increased back strength, improved posture, and form will alter our perceptions of back pain. This is a biologic "bait and switch" of sorts. The patient’s improved mental state is also described by a psychological principle called self-efficacy—the patient’s belief that he or she is able to achieve the goal.


My belief in symmorphosis as an approach to back pain, and using kettlebells to treat the pain while strengthening the back, motivated me to write a book on the subject—The End of Back Pain. Obviously, no treatment is perfect and no treatment is universal for all back pain sufferers. However, we healthcare providers are currently doing a poor job of treating back pain. More and more money is being spent on disappointing results.

Earlier, I alluded to my patients’ incredulity when I suggest back strengthening as a treatment for back pain. This conceptual transition is often a difficult task for the patient. When I send patients to physical therapy, therapists often suggest that my measures are draconian. The therapists provide the more "sensible" advice: "let pain be your guide" in what exercises to perform. This resonates with most patients, as they have been indoctrinated with this idea for years. However, I believe that it is wrong. Therapists attempt to protect themselves from legal liability by advising their patients to be guided by the "sensible" warning sign of pain, but in doing so, they limit the patients’ potential gains. This "sensible" advice may in fact be detrimental advice!

As difficult as it is for me, as a physician, to convince my patients of the efficacy of kettlebells to diminish back pain, I’d imagine it’s even harder for kettlebell instructors to encourage their clients to strengthen their backs when they have back pain. If the client subsequently becomes a patient of a therapist or doctor, one can only imagine the ensuing conversation… "He did WHAT to you?"

The scientific rationale provided in my book, and my own experience of empirical success treating back pain with back strengthening, supports the use of kettlebells as an effectual treatment option for back pain sufferers. Ultimately, it is my hope that the onus and responsibility for treating back pain will be shifted from the healthcare providers to the back pain sufferers themselves. Kettlebell instructors are indispensible in this paradigm, as proper form, technique, variety, and safety are essential to success. The key to treating the patient with back pain is to find the "sweet spot". An approach that is too aggressive could potentially result in a set-back, while too little effort might not yield results. Proper supervision by kettlebell instructors maximizes the potential for healing.

One of my favorite quotes is by Michelangelo, "The greater danger for most of us lies not in setting our aim too high and falling short: but in setting our aim too low, and achieving our mark". This is a perfect conceptual guideline for exercising with kettlebells as a treatment for back pain.

Patrick RothMDDr. Patrick Roth is a neurosurgeon practicing in New Jersey. He is the Chairman of the Department of Neurosurgery at Hackensack University Medical Center and the Director of the Hackensack Neurosurgical Residency Program. He has authored numerous publications related to the spine. He has been a perennial recipient of Castle and Connolly "Top Doctors" as well as New York Magazine’s "Best Doctors" and New Jersey Magazine’s "Top Doctors" His interests include medical decision-making, minimally invasive spinal surgery, and rehabilitation of back pain. He has had a life-long interest in exercise and diet. He lives in northern New Jersey with his wife and two children.