Cooking a simple meal involves a lot of movements that could strain the back. Lifting a pot filled with water to boil pasta. Standing at the counter chopping vegetables. Bending forward to put pans in the oven.
"When you're making soup, you're doing all kinds of gymnastics to get different batches of it in and out of the pot or blender," says Julie Bozo Cotte, 50, who has suffered from chronic back and neck pain for some 15 years. She loves cooking for friends, but says the condition has severely limited her home cooking.
Back pain is one of the most common reasons people seek medical care in the U.S. Around 40% of U.S. adults experience back pain each year and around 13% have chronic back pain, which endures beyond three months and can limit how much they move in their daily lives.
A new cookbook, The Healthy Back Kitchen — out this month from cooking media empire America's Test Kitchen — aims to help back-pain sufferers enjoy cooking, with mindful adaptations to their kitchen techniques.
The impact of back pain is both mental and physical, says Dr. Griffin Baum, a spine surgeon at Northwell Health in New York City who wrote the book. "Almost universally, my patients tell me: 'My back pain is keeping me inside. It's keeping me from standing, bending, lifting. And it's keeping me from socializing, from being with my loved ones and cooking a weekend meal or a family dinner,'" he says.
Conversations with his patients inspired Baum to develop the advice in The Healthy Back Kitchen, including tips for creating a more ergonomic kitchen setup, ways to minimize motions like bending and torquing, and prep shortcuts to reduce cooking time.
"One of the rules we set was that every recipe had to include a break or two or three," Baum says. "So people wouldn't spend more than 10 to 15 minutes standing at a time because that's always an aggravating factor."
Cotte, a photography director at America's Test Kitchen who was not involved with making this book, says cooking a full meal in one stretch leaves her exhausted. She recently made cauliflower soup using tips from the book, which recommended chopping vegetables ahead of time and crisping capers in the microwave.
She hopes that cooking this way could leave her with more energy to spend with her family in the evenings — while still having home-cooked food. "I'd like for [my nine-year-old son] to eat less frozen pizza," she says.
The book focuses on the mechanics of cooking, starting with the concept of mise-en-place – gathering the tools and ingredients and tools you need before you start cooking, with the help of a rolling cart to minimize walking around with heavy things. It recommends sitting to chop vegetables, and using kitchen shears in the place of knives for trimming beans and cutting broccoli for less back exertion.
"A lot of these tips that are preventative, and that mitigate the risk of increasing back pain are really good," says Dr. Shaina Lipa, a spine surgeon at the Brigham and Women's Hospital in Boston, who reviewed the book at NPR's request.
Still, others think the book's focus on traditional comfort food recipes like pot pies and beef stews misses an opportunity to educate patients on healthier eating. For patients with chronic back pain, "your nutrition may make a difference," says Dr. Linda Shiue, a primary care physician and founder of a teaching kitchen for patients at Kaiser Permanente San Francisco, who also reviewed the book at NPR's request.
For many, she says, back pain is related to weight issues or to arthritis in the spine. "It may help to avoid inflammatory foods like sugar and refined carbohydrates," and to eat less meat, Shiue says.
Baum says his focus is on helping people adapt so they can still enjoy cooking. "Curing your back pain isn't possible. So let's talk about what is possible. What are the things you can't [currently] do that you want to do?" Trussing a 12-lb turkey may be out of reach – but they could try roasting a small spatch-cocked chicken instead, on a lightweight baking sheet that can be loaded into the oven with less bending.
Being able to cook again, and to share food with loved ones, gives back pain sufferers agency, Baum says: "You're getting part of your life back. And that experience of happiness and joy and connection with people will actually improve back pain."
People with chronic back pain can prepare delicious, beautiful meals, he says – so long as they adapt how they do it. Below are a few of his tips, and a sample recipe.
Cooking is just one aspect of life that can feel seriously limited by chronic pain. And the approach starts with being compassionate towards yourself. "Everybody has pain [of some kind]. You are not alone," Baum says. Accept that your pain is real, and that it's not your fault.
Plan ahead by a few meals so you can make the most of a trip to go food shopping. Unpack your groceries carefully, maybe using a rolling cart to bring all the cold items to the refrigerator at once. Set aside time in the morning to prep ingredients for dinner, to make it easier on your future self.
"It's important to find a way to keep going on your best days and your worst days," Baum says. To people in pain, "a minute can feel like an hour; a day can feel like a year. A routine helps keep an even keel and a cadence to your days, he says.
A flexible routine also allows you to modify on days when your pain is worse, and gives you a path to getting back on track. "If it's a bad day, it's not going to last forever," he says, "It's very rare for an acute episode of back pain to last longer than six weeks."
Retrain yourself to load a hot oven with less bending. First, you'll stage your pan or casserole on a stool next to the oven. "You drop the oven door open, and use a long pair of tongs to pull out the rack," Baum explains, "Then you'll lift whatever you're putting in off the stool and onto the rack," loading the oven from the side. "And then you slide everything back into the oven and flip the door back up."
Unloading is just the reverse – sliding the rack out with tongs, and moving your hot dish onto a stool as an intermediate stop, before bringing it to the table to serve.
It's one of the most challenging parts of cooking with back pain, and one that people can be retrained to do more safely.
Look for pre-chopped vegetables in the produce aisle or salad bar at the grocery store. For prepping ingredients at home, Baum recommends pulling a stool up to the kitchen counter.
Prepping while seated lessens the amount of time you spend standing and is better for your back, provided the setup is ergonomic. "You want your shoulders to be relaxed, your arms to be at a 90-degree angle," Baum says. From this position, you can slice ingredients like mushrooms and small potatoes with a utility knife, or cut greens with kitchen shears.
Chopping onions and meat can require the leverage you get from standing – which aggravates back pain. Cushioning can help. "I can never cook in the kitchen with bare feet or slippers on," Cotte says. "I have to wear big, cushiony shoes and stand on a thick foam mat" which alleviates stress on her joints, including her back.
"It makes a huge difference," Baum says, "whether you're standing for 20 minutes or two hours." And many mats are impervious to spills and stains, so they can be easily wiped clean.
Chronic pain is often cyclical. Baum recommends taking advantage of good days to prep freezable ingredients like onion and garlic, "so if you want to make a soup or a stock, it's super easy to do."
On days when your pain is bad, rely on shortcuts, such as using your microwave for toasting nuts and "roasting" beets (in a medium bowl, with a little water, for four minutes). And feel free to take frequent breaks. "You can do 20 minutes of work in the morning, go rest all day until you're feeling better in the afternoon, and come back and finish it for dinner," Baum says.
Using pre-prepped ingredients and simpler recipes appeals to Cotte, who tends to "swing for the bleachers," choosing complicated cooking projects that take a lot of time and energy – and are limited to good days. "I'm trying to bring it down a notch, to have a more sustainable model that I can keep going with," she says.
"A lot of these recipes are designed around how to create a bite of food that will not only nourish you, but refill your soul and take you back to a memory of a different time," Baum says. Finding something luxurious that you enjoy each day – getting in the mindset of "treating yourself" – boosts levels of dopamine and serotonin and helps reduce pain.
Meaty Loaf Pan Lasagna
Why This Recipe Works
Nothing satisfies like a big square of cheesy, meaty, homemade lasagna. But this timeless classic usually feeds a crowd and takes some time to put together. Made in a loaf pan, this petite lasagna is better suited for a couple (with leftovers) and puts lasagna back in the rotation of anyone suffering from back pain because it is easier to assemble and requires far less standing time.
In addition, no-boil lasagna noodles make assembly go quickly; plus, the noodles fit perfectly into the loaf pan. And finally, instead of making a from-scratch sauce, jarred tomato sauce means far less time standing at the stove.
To start, brown meatloaf mix, add the sauce, and let it all simmer together briefly; then add a touch of cream for richness. Covering the lasagna with aluminum foil prevents it from drying out in the oven, but then removing the foil for the last few minutes of baking achieves the browned, cheesy top layer found on a full-size lasagna. If you cannot find meatloaf mix, substitute equal parts 80 percent lean ground beef and sweet Italian sausage, casings removed. Do not substitute fat-free ricotta here.
Serves 2 to 3
Ingredients
1 tablespoon extra-virgin olive oil
8 ounces meatloaf mix
1/4 teaspoon plus 1/8 teaspoon table salt, divided
1 (16‑ounce) jar tomato sauce
1 tablespoon heavy cream
4 ounces (1/2 cup) whole-milk or part-skim ricotta cheese
1 ounce grated Parmesan cheese (1/2 cup) plus 2 tablespoons, divided
3 tablespoons chopped fresh basil
1 large egg, lightly beaten
1/8 teaspoon pepper
4 no-boil lasagna noodles
4 ounces shredded whole-milk mozzarella cheese (1 cup), divided
Directions
1. Heat oil in large saucepan over medium heat until shimmering. Stir in meatloaf mix and 1/4 teaspoon salt and cook, breaking up meat with wooden spoon, until it is no longer pink, about 2 minutes.
2. Stir in tomato sauce. Bring to simmer and cook until flavors meld, about 2 minutes. Stir in cream. Season with salt and pepper to taste. Turn off heat.
— TAKE A 10‑MINUTE BREAK —
3. Preheat oven to 400 degrees. Combine ricotta, 1/2 cup Parmesan, basil, egg, remaining 1/8 teaspoon salt, and pepper in bowl.
4. Spread 1/2 cup meat sauce over bottom of 9 by 5‑inch loaf pan, avoiding large chunks of meat. Place 1 noodle in pan and spread one-third of ricotta mixture over top. Sprinkle evenly with 1/4 cup mozzarella and spoon 1/2 cup sauce evenly over top.
5. Repeat layering process of noodle, ricotta mixture, mozzarella, and sauce twice more. Place remaining noodle on top, cover with remaining 1 cup sauce, and sprinkle with remaining 1/4 cup mozzarella and remaining 2 tablespoons Parmesan.
6. Cover dish tightly with aluminum foil sprayed with vegetable oil spray. Bake, on middle rack, until sauce bubbles lightly around edges, about 30 minutes.
— TAKE A 30‑MINUTE BREAK —
7. Remove foil and continue to bake until lasagna is hot throughout and cheese is browned in spots, about 10 minutes.
— TAKE A 10‑MINUTE BREAK —
8. Let cool for 15 minutes before serving.
Prep Ahead
You can make the ricotta mixture up to 1 day ahead and refrigerate. The fully assembled lasagna can be refrigerated for up to 2 hours before baking; increase baking time by 10 minutes.
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