<>To ensure a thorough examination, you will be asked to put on a gown. The doctor will watch for signs of nerve damage while you walk on your heels, toes, and soles of the feet. Reflexes are usually tested using a reflex hammer. This is done at the knee and behind the ankle. As you lie flat on your back, one leg at a time is elevated, both with and without the assistance of the doctor. This is done to test the nerves, muscle strength, and assess the presence of tension on the sciatic nerve. Sensation is usually tested using a pin, paper clip, broken tongue depressor, or other sharp object to assess any loss of sensation in your legs.
<>Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
<>If you have severe back pain, if your back pain has not improved after two weeks, or if you are experiencing any of the following symptoms, you should contact your doctor: numbness in your genital area; pins and needles or numbness/altered sensation down your legs; altered walking patterns, ie losing balance and falling over; unexplained weight loss or gain; or night pain.
<>Talking about your back pain with a therapist may bring some relief. In a UK study, back pain sufferers who had 90 minutes of group cognitive behavioral therapy a week for six weeks reported less pain during the treatment. (Cognitive behavioral therapy focuses on solving problems by changing thoughts and behavior.) A year later, 59% said their pain was totally cured, compared to just 31% in the group that did not go through therapy.
<>Magnetic resonance imaging (MRI) scans are a highly detailed test and are very expensive. The test does not use X-rays but very strong magnets to produce images. Their routine use is discouraged in acute back pain unless a condition is present that may require immediate surgery, such as with cauda equina syndrome or when red flags are present and suggest infection of the spinal canal, bone infection, tumor, or fracture.
<>Welcome to one of the Internet’s saner sources of information about chronic low back pain.[NIH] This is a book-length tutorial, a guide to a controversial subject for both patients and professionals. It is not a sales pitch for a miracle cure system. It’s heavily referenced, but the tone is often light, like this footnote about being “shot by the witch.”1 I will offer some surprising ideas — underestimated factors in low back pain — but I won’t claim that all back pain comes from a single cause or cure. It’s just a thorough tour of the topic, the myths and misconceptions, and the best (and worst) low back pain treatment ideas available.
<>Rosenzweig, S., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010, January). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68(1), 29–36. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022399909000944
<>Spinal Manipulation and Chiropractic Techniques. Low-quality evidence shows that spinal manipulation may be more effective than sham treatments in the short-term reduction of pain (less than six weeks), but no more effective in reducing disability.18,20,42,43 There is little evidence that manipulation is cost-effective for treating acute low back pain.25
<>A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. During the physical exam, you may be asked to lift your leg while lying on your back — shooting pain down the back of your leg while in this position is a common sign of sciatica. Your doctor will also check the strength and reflexes in your leg.
<>Massage: There's an upside to your discomfort: It's a legit excuse to get a weekly massage. One study found that people who did had less lower back pain and disability after 10 weeks, compared with the control group—and general relaxation rubdowns worked just as well as structural massage targeted at specific parts of the body. Osteopathic and chiropractic therapies—in which joints and muscles get stretched and repositioned—have been shown to work, too. In a study published in the Annals of Family Medicine
<>Narcotic pain medications. Narcotic medications, also called opioids or painkillers, alter one’s perception of pain by weakening signals sent to the brain. Narcotic medications are most often used for treating intense, short-term pain, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can easily become addictive.
<>2013 — New section: An overdue upgrade! This way pain and fear power each other is now explained much more clearly and thoroughly than before. It’s noteworthy that, with this update, Dr. Lorimer Moseley’s valuable perspective on back pain is now fairly well-represented in this book. [Section: Pain and fear, together at last: an even simpler vicious cycle.]
<>In the elderly, atherosclerosis can cause weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause a pulsating low back pain. Aneurysms of certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.
<>Some exercises can aggravate back pain and should be avoided when you have acute low back pain. Partial crunches can help strengthen your back and stomach muscles. Lie with knees bent and feet flat on the floor. Cross arms over your chest or put hands behind your neck. Tighten stomach muscles and raise your shoulders off the floor.  Breathe out as you raise your shoulders. Don't lead with your elbows or use arms to pull your neck off the floor. Hold for a second, then slowly lower back down. Repeat 8 to 12 times. Proper form prevents excessive stress on your low back. Your feet, tailbone, and lower back should remain in contact with the mat at all times.
<>Low back pain can certainly be sensitive to emotional state, just like an ulcer gets worse when you’re stressed. But both are real physical problems! All of this will be discussed in detail, and it’s important, but this is not a tutorial about treating back pain through psychoanalysis, stress relief, and positive thinking. Tools like yoga and meditation are great for those who enjoy them, but not required.
<>Stretching your lower back is going to be really helpful in alleviating your lower back pain. Kneel on all fours, with your knees directly under your hips and hands directly under your shoulders. Ensure your spine is in a neutral position. Keep your head in line with your spine, your shoulders back and avoid locking your elbows. Take a big deep breath in and as you breathe out slowly take your bottom backwards towards your heels. Hold the stretch for 20-30 seconds. As you breathe in bring your body up onto all fours again. Repeat six to eight times.
<>Start on your hands and knees, and tighten your stomach muscles. Lift and extend one leg behind you. Keep hips level. Hold for 5 seconds, and then switch to the other leg. Repeat 8 to 12 times for each leg, and try to lengthen the time you hold each lift. Try lifting and extending your opposite arm for each repetition. This exercise is a great way to learn how to stabilize the low back during movement of the arms and legs. While doing this exercise don't let the lower back muscles sag. Only raise the limbs to heights where the low back position can be maintained.
<>Nearly everyone suffers from some type of back pain at some point in their lives. But no matter when it appears or what may have caused it, back pain can be a real, well … pain to deal with. The good news? There are several simple things you can do to ease pain and keep your back in good condition. The following tips can help you get on the way toward feeling better.
<>If you have severe back pain, if your back pain has not improved after two weeks, or if you are experiencing any of the following symptoms, you should contact your doctor: numbness in your genital area; pins and needles or numbness/altered sensation down your legs; altered walking patterns, ie losing balance and falling over; unexplained weight loss or gain; or night pain.
<>Are you a serial sitter? Unfortunately, nowadays most of us tend to be. When you lead an inactive lifestyle where you spend a lot of your time — professionally or personally — seated, your posture, and eventually your health take the brunt of the blow. We drive to work to sit at our desks only to return home and relax by sitting on our sofas. This excessive amount of sitting over a period of time can have detrimental effects on our well-being and, in particular, our posture and spine health, eventually leading to lower back issues.
<>A large Cochrane review of 65 trials (11 237 patients) of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors in the treatment of acute and chronic low back pain showed that NSAIDs had statistically better effects compared with placebo.51 The benefits included global improvement and less additional analgesia requirement. NSAIDs were associated with higher rate of side effects. There was no strong evidence that any one NSAID or COX-2-selective NSAID is clinically superior to the others. NSAIDs were not superior to acetaminophen, but NSAIDs had more side effects. NSAIDs were not more effective that physiotherapy or spinal manipulation for acute low back pain. COX-2-selective NSAIDs had fewer side effects than nonselective NSAIDs.51
<>According to Susi Hately, owner of Functional Synergy, Inc., in Alberta, Canada, and author of several international best-selling yoga books, yoga can be very therapeutic for people with back pain as well. A review of scientific studies published in 2013 in the Clinical Journal of Pain found strong evidence that yoga can help reduce chronic low back pain. Yoga may help improve back pain by loosening tight muscles, building strength and range of motion, and improving breathing, explains Hately. Yoga also focuses on relaxation, which may help to relax your muscles as well as reduce pain perception.
<>Degenerative bone and joint conditions: As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
<>Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.
<>AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
<>It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit.
<>Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk.
<>Even as you practice patience, a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can help ease the pain you're pushing through. The research behind medicine guidelines for lower back pain finds that these may give slightly better relief than acetaminophen (Tylenol). Over long periods, NSAIDs can cause gastrointestinal problems, so don't take them for more than 10 days without consulting your doctor.
<>In some cases, it’s difficult to pinpoint the cause of chronic back pain. “If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist,” recommends Nava. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse, warns Nava.
<>Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy, which causes pain.
<>Lie on your back with knees bent and just your heels on the floor. Push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until shoulders, hips, and knees are in a straight line. Hold about 6 seconds, and then slowly lower hips to the floor and rest for 10 seconds. Repeat 8 to 12 times. Avoid arching your lower back as your hips move upward. Avoid overarching by tightening your abdominal muscles prior and throughout the lift.
<>I was an alternative health professional myself for many years — a Registered Massage Therapist, trained in Canada (which has unusually good training standards). Of course, some of my colleagues in alternative medicine were diligent students of medical science. However, in my experience, most were certainly not — indeed, many lacked even the most basic knowledge of how medical science works or how to keep current about recent discoveries with clinical implications. BACK TO TEXT
<>Tip: One good pre-activity stretch is a yoga move called the cat-cow: Start on your hands and knees with your back straight and your head and neck in line. On an inhale, drop your belly toward the ground and look up toward the ceiling (cow pose). On an exhale, tuck in your stomach, arch your back and lower your head to your chest (cat pose). Do it gently, and stop if you feel any pain.
<>Try an over-the-counter pain reliever. Anti-inflammatory drugs such as aspirin, ibuprofen (Advil, Motrin, Nuprin), and naproxen sodium (Aleve, Anaprox, Naprosyn) can help reduce back pain. Acetaminophen (Actamin, Panadol, Tylenol) is another over-the-counter option for pain management. Be sure to check with your doctor or pharmacist about any interactions over-the-counter pain relievers may have with other medications you are taking. People with a history of certain medical conditions (such as ulcers, kidney disease, and liver disease) should avoid some medicines.
<>It’s estimated that up to 80 percent of adults experience persistent symptoms of lower back pain at some point in their lives, and about 31 million Americans struggle with the condition at any given time. Given its extremely high prevalence rate — whether due to a weak psoas muscle, sciatic nerve pain or some other cause — it’s not surprising that lower back pain is considered the single leading cause of disability worldwide according to the American Chiropractic Association, with half of all American workers reporting having occasional back troubles each year. (1) Naturally, this leads to millions searching for lower back pain relief.
<>Because back pain can be so debilitating, a lot of people turn to more serious interventions, like surgery or painkillers — but turns out, all you really need is a good stretch. “Most back pain can be resolved by doing regular exercises to keep muscles that support your spine strong and flexible,” says Fei Jiang, PT, DPT, OCS, at Providence Saint John’s Health Center’s Performance Therapy in Santa Monica, California. In fact, a recent study on back pain found that participants who followed a 12-week stretching regimen reported better back functioning, less pain, and a reduced need for pain medication.[1]
<>“Opioid medications generally shouldn’t be used as the first, the only or the long-term line of treatment for chronic back pain,” recommends Nava. Many of them are addictive and don’t address the underlying cause of your pain. Opioids should be prescribed only after a thorough exam by a specialist and if other drugs have failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.
<>Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. "They help you maintain the proper posture and alignment of your spine," Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.
<>Cauda equina syndrome is a medical emergency whereby the spinal cord is directly compressed. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence or the inability to begin urination.
<>Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter will review many of the causes of back pain and proper evaluation and diagnosis. Please be sure to discuss your individual symptoms as well as the suggested treatments with your health-care professional to determine the appropriate diagnostic and treatment plan for your circumstances.
<>Perhaps you bent the wrong way while lifting something heavy. Or you're dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say they've had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.
<>For instance, there’s good evidence that educational tutorials are actually effective medicine for pain.?Dear BF, Gandy M, Karin E, et al. The Pain Course: A Randomised Controlled Trial Examining an Internet-Delivered Pain Management Program when Provided with Different Levels of Clinician Support. Pain. 2015 May. PubMed #26039902. Researchers tested a series of web-based pain management tutorials on a group of adults with chronic pain. They all experienced reductions in disability, anxiety, and average pain levels at the end of the eight week experiment as well as three months down the line. “While face-to-face pain management programs are important, many adults with chronic pain can benefit from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit.” Good information is good medicine!
<>Low-impact aerobics. Low-impact aerobic exercise increases the flow of blood and supports healing from an injury without jarring the spine. Low-impact aerobics can include using stationary bikes, elliptical or step machines, walking, and water therapy. People with low back pain who regularly do aerobic exercise report fewer recurring pain episodes and are more likely to stay active and functional when pain flares.
<>Most acute low back pain fades steadily — up to 90% of it, for uncomplicated cases.14 So does a lot of so-called “chronic” low back pain!15 But when you don’t recover, many of the therapeutic options — things like surgery for a herniated disc — cause anxiety that is unnecessary and harmful. The purpose of this tutorial is to review and expand the options.
<>This stretch is designed to help lengthen the piriformis muscle over time. This muscle is often the source of sciatica, or radiating leg pain. Sitting with a straight back, cross your left leg over your right leg placing your foot next to your thigh and tuck your right leg in towards your buttocks. Place your right arm on your leg as pictured and slowly ease into a stretch. Be sure to keep your back straight and chest lifted. Hold for 20 seconds and alternative sides, three times.
<>Having strong core muscles (we’re talking abs here) can help protect your back from injury. Do this core-strengthening pelvic tilt 2 to 3 times per week: Lie on your back with knees bent, feet flat on the floor, and lower back flattened. Pull in your belly button toward your spine, contracting your abs; your pelvis should lift slightly off the floor.
<>For short-term pain relief, over-the-counter pain relievers including acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs) are sometimes suggested. The most common NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). Potential side effects of NSAIDs include stomach and liver problems. Talk to your doctor if you don't find relief after taking the recommended dose.
<>Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. "They help you maintain the proper posture and alignment of your spine," Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.
<>Thirty-five randomized controlled trials did not allow firm conclusions for the effectiveness of acupuncture for acute low back pain.25 For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment in the short term only. Acupuncture is not more effective than other conventional or alternative treatments.25
<>Return-to-play (RTP) guidelines are difficult to standardize for low back pain because of a lack of supporting evidence. A commonly encountered question is, can athletes play through pain? There is no simple answer to this question. For example, an athlete with suspected spondylolysis is generally advised that he or she should not play through pain, while athletes with chronic low back pain from muscular or ligamentous strain may continue to practice, exercise, and compete. However, there is little evidence to support either of these approaches. These athletes should always be monitored for their safety.
<>Ongoing pain can wreak havoc on your life, affecting your cherished relationships, finances, and your ability to get stuff done at work and at home. It can also interrupt your sleep and affect your mood. Because many other problems commonly occur along with chronic lower back pain, anything you can do for yourself that is a natural anti-depressant will help.
<>I have had life-altering low back pain for more than 8 years. I’ve had the fusions at L5-S1. Prior to my first surgery I spent 18 months seeking relief through physical therapy, intense massage therapy, myofascial “release” therapy, a visit to Dr. Sarno himself, injections, dry needling of trigger points and massage from a physiatrist, chiropractic work and more. For years between surgeries I tried core strengthening, acupuncture, PT, more massage, two rhizotomies, and visits to the Mayo clinic and Johns Hopkins’ pain management in-patient programs. So I’ve been through a lot. And your book is the first thing I’ve read that dispassionately and entertainingly dissects all of the options and offers some realistic, pragmatic suggestions. It’s a gift to all back pain sufferers.
<>Whether it was brought on by arthritis, a structural or nerve problem, bending the wrong way, or lifting something a little too heavy, low back pain is frustrating as all get-out. But if you're struggling, know this: You're definitely not alone. Most people experience back pain at some point in their lives, and it's one of the most common reasons people book doctor's appointments and call out of work. It's also one of the leading causes of disability worldwide.
<>It may sound funny to massage your own back, but it is easy to have someone massage your back for you. In fact, having a loved one or friend use Ben Gay to massage the cream into your back is a great way to naturally help your back pain. Don’t massage directly over the spine, as this can cause harm to that delicate collection of anatomical structures. Long, smooth strokes over the entirety of the back are the best. These are called gliding movements, and they help to relax the muscles under the skin. Work the muscles up and down the back to either side of the spine, allowing the hands to glide over the problem area and work the cream into the muscle to provide maximum, natural healing. Next, find out the 15 everyday habits that are causing back pain and damaging your spine. 
<>Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.
<>Mobilising your lower back is important to aid it’s recovery. The bird dog exercise is shown in the image below and is great for mobilising the lower back. To carry out this exercise get onto all fours, make sure your hands are directly under your shoulders, and knees directly under your hips. Your spine is in a neutral position and you need to keep your head in line with your spine. Take a deep breath in and as you breathe out extend one leg and the opposite arm to inline with your spine. You need to keep your spine in a neutral position at all times, so don’t let your lower back sag down. Hold for 5-10 seconds and as you breathe out lower both your leg and arm to the ground. Repeat this exercise eight to twelve times alternating sides.
<>This tutorial is great for people who like to understand their problems. Its dorky, quirky thoroughness is unlike anything the big medical sites offer, and the lack of a miracle cure secret is rare among independent sources. My goal is “just” to empower you with education (without boring you to tears). When you’re done, you’ll know more about your back than most doctors. (Not that this is saying much!16) I’ve spent years compiling this information from hard study, professional experience, and lots of your stories and feedback. I update the tutorial regularly.
<>Keep moving. "Our spines are like the rest of our body -- they're meant to move," says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you're feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you -- and your back -- more mobile. Just don't overdo it. There's no need to run a marathon when your back is sore.
<>Research suggests that topical medications may be just as effective as oral ones. Many of them worked significantly better than placebo. These medications can come in the form of gels, creams, patches, and more. One study also saw decrease in pain when people applied lavender essential oil or ointments prepared with cayenne peppers with acupressure.

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Medical Disclaimer: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any exercise program.

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