<>Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT, associate professor of Physical Therapy at the University of Maryland School of Medicine. "Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes," she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice -- take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.
<>Roughly 8 out of 10 people suffer from back pain at some point during their lives. Women, in particular, are prone to posture and back problems—thanks to toting around outrageously heavy purses, going through pregnancy, or giving one-hip rides to kids. Whether you’re in the midst of fighting the ache or just want to prevent it, here are some expert-endorsed quick-and-easy ways to wage your war.
<>This myth of “mechanical” failure of the low back has many unfortunate consequences, such as unnecessary fusion surgeries — a common and routinely ineffective procedure — and low back pain that lasts for years instead of months or weeks. The seriousness of chronic low back pain is often emphasized in terms of the hair-raising economic costs of work absenteeism, but it may well be far worse than that — a recent Swedish study shows that it probably even shortens people lives.8 The stakes are high. “Tragedy” is not hyperbole.
<>The treatment of lumbar strain consists of resting the back (to avoid reinjury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Initial treatment at home might include heat application, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and avoiding reinjury and heavy lifting. Prescription medications that are sometimes used for acute low back pain include anti-inflammatory medications, such as sulindac (Clinoril), naproxen (Naprosyn), and ketorolac (Toradol) by injection or by mouth, muscle relaxants, such as carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and metaxalone (Skelaxin), as well as analgesics, such as tramadol (Ultram).
<>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.
<>Levator scapula stretch. Rest one arm against a wall or doorjamb with the elbow slightly above the shoulder, then turn the head to face the opposite direction. Bring the chin down toward the collarbone to feel a stretch in the back of the neck. It may be helpful to gently pull the head forward with the other hand to hold the stretch for the desired time.
<>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.
<>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
<>Avoiding injury to the low back is a method of preventing low back pain. Additionally, conditioning exercise programs designed to strengthen the lumbar area and adjacent tissues can help to minimize risk of injury to the low back. Specific programs to relieve and prevent back pain can be designed with the help of physical therapists and other treating health-care professionals.
<>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.
<>I apply a MythBusters approach to health care (without explosives): I have fun questioning everything. I don’t claim to have The Answer for low back pain. When I don’t know, I admit it. I read scientific journals, I explain the science behind key points (there are more than 460 footnotes here, drawn from a huge bibliography), and I always link to my sources.
<>But how do you kow if you’re the exception? Can you recognize the early warning sign of cancer, infection, autoimmune disease, or spinal cord injury? These things often cause other distinctive signs and symptoms, and so they are usually diagnosed promptly. If you are aware of these red flags, you can get checked out when the time is right — but please avoid excessive worry before that.
<>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.
<>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.
<>An accurate history and physical examination are essential for evaluating acute low back pain. Often, patients awaken with morning pain or develop pain after minor forward bending, twisting, or lifting. It is also important to note whether it is a first episode or a recurrent episode. Recurrent episodes usually are more painful with increased symptoms. Red flags are often used to distinguish a common, benign episode from a more significant problem that requires urgent workup and treatment (Table 2).5,6,8 A recent study shows that some red flags are more important than others, and that red flags overall are poor at ruling in more serious causes of low back pain.8 Patients with back pain in the primary care setting (80 percent) tend to have one or more red flags, but rarely have a serious condition.8  However, physicians should be aware of the signs and symptoms of cauda equina syndrome, major intra-abdominal pathology, infections, malignancy, and fractures (Tables 15,6  and 25,6,8). Cauda equina syndrome and infections require immediate referral. Family physicians should rely on a comprehensive clinical approach rather than solely on a checklist of red flags.
<>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:
<>Muscle relaxants: Muscle spasm is not universally accepted as a cause of back pain, and most relaxants have no effect on muscle spasm. Muscle relaxants may be more effective than a placebo (sugar pill) in treating back pain, but none has been shown to be superior to NSAIDs. No additional benefit is gained by using muscle relaxants in combination with NSAIDs over using NSAIDs alone. Muscle relaxants cause drowsiness in up to 30% of people taking them. Their use is not routinely recommended.
<>COX-2 inhibitors, such as celecoxib (Celebrex), are more selective members of NSAIDs. Although increased cost can be a negative factor, the incidence of costly and potentially fatal bleeding in the gastrointestinal tract is clearly less with COX-2 inhibitors than with traditional NSAIDs. Long-term safety (possible increased risk for heart attack or stroke) is currently being evaluated for COX-2 inhibitors and NSAIDs.
<>“For most people, it means their back hurts,” says Richard A. Deyo, MD, MPH,the Kaiser-Permanente Endowed Professor of Evidence-Based Medicine in the department of family medicine at Oregon Health & Science University in Portland. “But it’s often impossible to know the precise anatomical cause of back pain because the back has so many sources of pain.”
<>Hyperlordosis (lordotic low back pain) is the second most common cause of adolescent low back pain.18,47 This condition is related to adolescent growth spurts when the axial skeleton grows faster than the surrounding soft tissue, resulting in muscular pain.55 Other causes of low back pain unique to children are vertebral endplate fractures and bacterial infection of the vertebral disk. Adolescents have weaker cartilage in the endplate of the outer annulus fibrosis, allowing avulsion and resulting in symptoms similar to a herniated vertebral disk.58 Additionally, the pediatric lumbar spine has blood vessels that traverse the vertebral bodies and supply the vertebral disk, increasing the chance of developing diskitis.51
<>No, the lower back pain isn't in your head. But what is in your head could be making it worse. "Fear, anxiety, and catastrophizing can amplify pain," says Mackey. "People often get swept up in thoughts like This will never get better." Because brain circuits that process pain overlap dramatically with circuits involved with emotions, panic can translate into actual pain. Cognitive-behavioral therapy helps you recognize and reframe negative thoughts. Deep breathing can help, too, as can simply shining a light on dark thoughts. "Start by accepting that you have pain," Mackey says. "Then say to yourself, It will get better."
<>Back pain is a health concern for most people in the United States at some point in their lives and one of the most common reasons people miss work or visit the doctor. More than 80 percent of Americans will experience low back pain, and this health problem costs the United States over $100 billion each year, most of which is a result of lost wages. 

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