<>2010 — Like new: Rewritten. I’ve lost track and can’t be bothered to go back into the archives to figure it out for sure, but I think that this section was brand new (but never announced) late in 2009, and then this past week I gave it a substantial upgrade: it is now one of the best-referenced chapters in the book, and it says as much as probably needs to be said on the subject — or more! [Section: Core strengthening has failed to live up to the hopes and dreams of therapists and patients.]
<>Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area. If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.
<>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.
<>Another way to get lower back pain relief is to hook up with an expert in physical therapy, who will guide you in safe exercises that can strengthen and stretch the muscles. “This will prevent symptoms from worsening and further damage to the spine,” says Strassberg. She says that PTs address symptoms and target the underlying cause so that you can prevent future discomfort.
<>Get some exercise. You may be tempted to stay in bed when your back acts up, but exercise and activity can actually help you heal faster and reduce pain. A study of 240 men and women found that regular exercise reduced pain by 28 percent and disability by 36 percent. Low impact, moderate intensity exercise is the safest option. Avoid movements that trigger pain or require excessive jumping or squatting, which can exacerbate injuries. Take two to three minutes at the end of your workout to stretch your back thoroughly. Lie flat on your back and hug your knees to release any tension that developed during your workout.
<>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.
<>Data Sources: We searched PubMed for the key term acute low back pain; this term was also searched with the following key terms: medications, nonsteroidals, muscle relaxants, opioids, red flags, differential diagnosis, exercise, McKenzie, spine stabilization, traction, acupuncture, heat, ice, advice, cost, manipulation, chiropractic care, brace, bed rest, massage. In addition, we searched the Cochrane Database of Systematic Reviews, Clinical Evidence, Essential Evidence Plus, and the National Guideline Clearinghouse. Search dates: April 2011 and May 2, 2011.
<>A doctor may recommend a spinal injection to help reduce your back pain. There are different types of injections that doctors specializing in pain relief may use. For example, an injection of a corticosteroid can help relieve inflammation that is causing the pain. Depending on the kind of injection, your doctor may limit your number of doses per year to avoid possible side effects.
<>Injury to the bones and joints: Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.
<>Luckily for 95 percent of people with lower back pain, the ache goes away within a few months. But for a few, it becomes chronic. “If pain becomes sharp and keeps you from sleeping, starts radiating down the front or back of your leg, or wraps around your side, get to the doctor,” says Strassberg. Another clue you should get medical attention: It’s “directional,” meaning it hurts more when you sit or stand in certain positions, she says. Start by avoiding these 15 everyday habits that hurt your back.
<>Low back pain is one of the most common complaints on the planet. And you may wonder where to turn when you start experiencing some of those aches or twinges in the lower part of your back. Take heart. "In most cases, you won't need a specialist," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
<>Turns out that the committees that write these things do not necessarily know the science! One of the best reviews of back pain research ever published — Machado 2009, more on this one later — found something really interesting: “treatment recommendations from recent clinical guidelines do not align with the results of this meta-analysis.” In fact, quite a few disproven pain treatments are still cheerfully recommended in otherwise sensible professional guidelines. Eek. BACK TO TEXT
<>Achy back? You're not alone: back problems send more Americans to the doctor annually than nearly any other medical problem, according to a 2013 Mayo Clinic study. Whether you're recovering from misjudging a heavy load (we've all been there), dealing with a lingering injury, or have a chronic problem, you don't necessarily need to resort to popping tons of pain relievers. Talk to your doc about these 15 expert-approved natural back pain remedies, and find out if they are safe and appropriate for you.
<>If your purse or briefcase tips the scales at more than 10% of your weight, it’s too heavy. And you need to carry it right. Your best bet is a model with a long strap that lets you position it across your chest like a messenger bag. Our pick: the Ellington Leather Moroccan Shoulder Bag ($169.90). Can’t part with your shorter-strapped number? Switch shoulders every 20 minutes.
<>This final stretch is great at stretching out your spine and it feels good to do, too. Lie on your back and place a small cushion under your head. Keep your knees bent and together. Keep your upper body relaxed and your chin gently tucked in. Take a big deep breath in and as you breathe out roll your knees to one side, followed by your pelvis, keeping both shoulders on the floor. Take a big deep breathe in as you return to the starting position. Repeat six to eight times, alternating sides.
<>Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
<>Pain is a leading cause of insomnia—difficulty with falling asleep and/or staying asleep. Approximately two-thirds of people with chronic back pain suffer from some type of sleep disorder. Paradoxically, inadequate sleep can make your back pain worse. This vicious cycle makes it ineffective to treat just the pain. If you have sleep problems, you need to get the sleep problems addressed too.
<>Endorphins are hormones made naturally in your body. What most people don't know is that they can be just as strong as any manufactured pain medication. When endorphins are released in your body, they help block pain signals from registering with your brain. Endorphins also help alleviate anxiety, stress, and depression, which are all associated with chronic back pain and often make the pain worse.
<>Patient information articles published in both the Journal of North American Spine Society and the Journal of the American Medical Association found evidence that spinal manipulations were safe, effective, drugless forms of professional treatment for both acute (short-term or sudden) and chronic low back problems in adults. (2, 3) Egoscue, another type of postural therapy protocol that focuses on fixing musculoskeletal misalignments, may also be able to help reduce and prevent back pain.
<>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.
<>Endorphins are hormones made naturally in your body. What most people don't know is that they can be just as strong as any manufactured pain medication. When endorphins are released in your body, they help block pain signals from registering with your brain. Endorphins also help alleviate anxiety, stress, and depression, which are all associated with chronic back pain and often make the pain worse.
<>The available science includes a 2011 study published in Arthritis Care & Research, which found that a 10-week tai chi program reduced pain and improved functioning in people with long-term low back pain symptoms. The study involved 160 adults with chronic low back pain, half of whom participated in 40-minute-long tai chi sessions 18 times over the 10-week period.
<>The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
<>"Having excess weight pulling on your back all day (except when you're lying down) is just bad news for your back," says Lauri Grossman, DT, a licensed chiropractor in private practice in New York City. "Often times, when people who wrestle with back pain for a lifetime lose a few pounds, they find that the pain that they've taken a million medications for and a million vitamins for just goes away." If you're having trouble shedding extra pounds, consider consulting with a registered dietitian or personal trainer.
<>Plain X-rays are generally not considered useful in the evaluation of acute back pain, particularly in the first 30 days. In the absence of red flags, their use is discouraged. Their use is indicated if there is significant trauma, mild trauma in those older than 50 years of age, people with osteoporosis, and those with prolonged steroid use. Do not expect an X-ray to be taken.
<>Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
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<>Most people will experience lower back pain at some point in their life, it is very common. In the old days bed rest was prescribed if your back was “playing-up,” whereas today it is recommended to keep exercising. Of course the exercises you do have to be appropriate, we are not suggesting to go for a run or lift heavy weights, that wouldn’t be smart. However, there are some great exercises you can do which should help alleviate lower back pain. These exercises are extremely gentle, but of course, listen to your body and stop if you experience any pain.
<>“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.
<>Lumbar strain (acute, chronic): A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as "chronic." Lumbar strain most often occurs in people in their 40s, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back. The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, X-ray testing is only helpful to exclude bone abnormalities.
<>Over-the-counter pain medications. The most common over-the-counter (OTC) medications are aspirin (e.g. Bayer), ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and acetaminophen (e.g. Tylenol). Aspirin, ibuprofen, and naproxen are anti-inflammatory medicines, which alleviate low back pain caused by a swollen nerves or muscles. Acetaminophen works by interfering with pain signals sent to the brain.
<>2010 — Like new: Rewritten. I’ve lost track and can’t be bothered to go back into the archives to figure it out for sure, but I think that this section was brand new (but never announced) late in 2009, and then this past week I gave it a substantial upgrade: it is now one of the best-referenced chapters in the book, and it says as much as probably needs to be said on the subject — or more! [Section: Core strengthening has failed to live up to the hopes and dreams of therapists and patients.]
<>Use capsaicin cream. Capsaicin is a substance found in chili peppers. When used medicinally it helps reduces the amount of substance P, a neurotransmitter that leads to pain impulses in the brain. One study showed that after 3 weeks of capsaicin use, patients had a significant reduction in pain. To use: apply topically, at least twice per day, for maximum relief. The warm sensation also allows you to stretch and move without pain.
<>Other back pain remedies that work fast at home is over-the-counter pain medications. Tylenol, or acetaminophen, is really not recommended for muscular strains and sprains. If you’ve hurt your back, the best back pain remedy is a non-steroidal anti-inflammatory medication, or NSAID. These are popularly known as Advil (ibuprofen) and Aleve (naproxen). Once again, these medications help to stem the tide of the blood flow to the area to reduce pain. By keeping inflammation low, your pain is decreased, and you are better able to move. Be careful to follow the bottle’s instructions, though, because these medications can cause stomach ulcers.
<>Lose excess weight. As we gain weight, stress and pressure on the lower spine and back muscles increases. The heavy weight at the front of the body can cause an increased arch in the spine and may lead to injury and compression of the discs and nerves. Losing weight reduces the tendency to arch the back and relieves pressure on the lower spine and nerves.
<>2011 — Updated: Added scientific cases studies, examples, pictures and video of true dislocation and abnormal anatomy to help drive home the point that even significant spinal joint dysfunction can be surprisingly harmless … never mind subtle joint problems. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation, and cracking of the spinal joints.]
<>Nachemson says, “Rarely are diagnoses scientifically valid … .” And Deyo: “There are wide variations in care, a fact that suggests there is professional uncertainty about the optimal approach.” Many other researchers have made this point, but Sarno states it most eloquently: “There is probably no other medical condition which is treated in so many different ways and by such a variety of practitioners as back pain. Though the conclusion may be uncomfortable, the medical community must bear the responsibility for this, for it has been distressingly narrow in its approach to the problem. It has been trapped by a diagnostic bias of ancient vintage and, most uncharacteristically, has uncritically accepted an unproven concept, that structural abnormalities are the cause of back pain” (p111). BACK TO TEXT
<>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.
<>30. Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy [published ahead of print November 19, 2010]. Spine (Phila Pa 1976). http://journals.lww.com/spinejournal/Abstract/publishahead/Management_Patterns_in_Acute_Low_Back_Pain__The.99251.aspx (subscription required). Accessed May 2, 2011.
<>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.
<>Clearly, stretching works as an effective back pain treatment (and offers a more natural pain relief solution than other common pain interventions, like prescription painkillers or surgery). But why is stretching so effective? Which back pain stretches should you be doing to maximize results? And what are the best ways to incorporate back pain exercises into your daily routine to strengthen your core and keep pain at bay?

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