Mesocycle: Sleep
Block 1/4: FOUNDATION
Connection month is done — if you kept up with it, you already know how this works. New pillar, same shape: four weeks, one focus, building on itself.
This month is sleep, and here's the one thing most people get wrong about it: they focus on bedtime. Bedtime barely matters. Wake time is the actual anchor. Your body's internal clock resets itself based on when you get up and get light exposure, not when you turn the lights off. A consistent wake time, even on weekends, is worth more than almost any other single sleep intervention — more than a fancy mattress, more than melatonin, more than a sleep tracker telling you things you already knew.
This week's ask: wake up at the same time every day this week — weekdays and weekends both. Not bedtime. Wake time.
Oops, I did it again. I threw my back out last month. Doing something cool? Kind of. Something reckless? Maybe a little. Doesn't really matter — my back doesn't care about my intentions, only my mechanics and my volume.
Every time it happens, the same thing strikes me: you can be charging full speed ahead — through a project, a training block, a season of life where everything feels like momentum — and then something invisible reaches out and pulls the emergency brake. No warning sign in advance. No dramatic buildup. Just: you were upright and moving, and now you're laid out on the couch, staring at the ceiling.
I've come to think of these moments as a kind of feedback, not just an injury. It sounds a little hippie-dippy written out like that, but I believe it: the world constantly hands us information for free, and most of the time we're simply not tuned to receive it. The back doesn't send a memo first. It just forces the correction directly, because you weren't going to make it voluntarily.
This isn't new territory for me specifically. I had back surgery at 21 — a double lumbar discectomy at L4/L5 and L5/S1. A few years after the surgery, overtraining caught up with me for good: irreversible disc degeneration, bone spurring, early spinal stenosis. I still carry an annular tear today, and my discs encroach on the nerve roots at three levels that serve my legs.
The result is a permanent, low-grade parasthesia — my toes sometimes don't feel entirely like my own — with sporadic lightning strikes of sciatica down my buttocks, and, on the worst days, muscle spasms that take my breath away. During those episodes, I've genuinely wondered whether I'd feel normal again.
If you've experienced debilitating pain of any kind — back or otherwise — I believe you. It's disorienting in a way that's hard to explain to someone who hasn't been forced to stop.
The body is stranger and more forgiving than people expect, and what shows up on imaging often bears almost no relationship to what someone actually feels. If you scan 100 low backs, roughly half will show real pathology — disc bulges, degeneration, the works. But only about half of those people report symptoms. And of the half with clean scans, another half report pain anyway. Structure and suffering are far less connected than most people assume.
The important thing with musculoskeletal pain is to keep moving "as tolerated." I've come to think this isn't just physical therapy advice. It's closer to a rule for living.
Keep moving as tolerated. It's closer to a rule for living.
No matter what happens to you — an injury, a loss, a failure, a diagnosis — keep moving as tolerated. The alternative is some combination of apathy, quitting, or externalizing your outcome onto something other than yourself. Life will hand you every excuse you could possibly want to stop. Grief is a legitimate excuse. Pain is a legitimate excuse. Fear is a legitimate excuse. Take any of them, and you shift from being the subject of your own story to an object being acted upon by it. Something happens to you instead of something continuing through you.
A yoga teacher once told me that pain lives largely in the mind — which sounds like a platitude until you notice how easily it's blocked by chemistry: anesthesia, anyone? But the mind produces its own powerful chemistry too, and it can choose, to some degree, whether to attend to pain or look past it. Consider how well-documented distraction is as an actual antidote to pain: it's why we use Buzzy to distract pediatric patients from vaccine needles, why "walk it off" became a real, if crude, piece of folk medicine, and why doctors will sometimes keep a patient talking about something unrelated while performing an exam maneuver that would otherwise be provocative.
I've seen the opposite of "move as tolerated" up close, working inpatient medicine. Patients come in with an acute flare of cervical or low back pain, genuinely immobilized by it — and then they stay immobilized for days longer than the injury requires, in a concave hospital bed, because nobody got them walking again soon enough. That prolonged stillness doesn't protect the injury. It cements the immobility, turning a temporary limitation into something closer to permanent.
I think about that pattern constantly, in patients and in myself, and not just about backs. The version of "staying in the hospital bed" that plays out in an ordinary life looks like refusing to make the phone call, skipping the workout because yesterday's setback hasn't fully healed yet, letting a bad week become a bad month because moving felt like too much. The injury was real. The extended stillness is usually optional.
Extra! Extra! Read All About It! Emerging research suggests NSAIDs may delay tissue healing at the cellular level.
What!? Are you kidding me?
NSAIDs are genuinely excellent at managing musculoskeletal pain, but may delay healing? This just goes to show you that reduction of pain isn’t always a positive. Pain is an important teacher. It should, rightly, teach a kid not to touch a hot stove ever again.
Of course, if you need that ibuprofen to get out of bed and get to work, take it — function is an important imperative, and a body that can't move at all isn't healing either. On the other hand, relying on fist fulls of NSAIDs daily, or any pain management regime, may hinder your ability to find harmony in your body.
Did I move the wrong way this time? Not really. Did I overdo it on load and volume? Almost certainly — which is its own kind of feedback, if I'm willing to actually listen to it instead of just treating the flare-up and going right back to whatever pace I was at before. I took the NSAIDs, showed up for work, took care of people much worse off than I’ve ever been, and decided to write this when I got home. I refuse to let pain hinder me more than it needs to, which in this case, was taking a few weeks off from a training protocol in which I diverted from my plan in a hair-brained attempt to increase my load by 33%.
One important caveat, because this topic deserves it: "move as tolerated" applies to ordinary flare-ups, not certain warning signs that need urgent medical attention — new bowel or bladder changes, numbness in the groin or inner thighs, or rapidly worsening leg weakness are not "push through it" symptoms. Those need a doctor immediately, not a home routine.
Keep moving. What other option is there? Just maybe put up the antenna a little sooner next time.
Talk soon,
Dr. Stevens
DON’T FORGET this week's ask: wake up at the same time every day this week — weekdays and weekends both. Not bedtime. Wake time.
General health information only — not a diagnosis, not treatment, and not a substitute for care from your own physician. Talk to your doctor before changing your exercise, diet, or medication routine, especially if you have an existing condition.
