<>”Tulsa Spine & Rehab is not your ordinary chiropractor experience. They provide a thorough diagnostic, clinical massage therapy, adjustment & physical therapy to start. I started with excruciating thorasic pain in the lumbar region. After the first day my pain was reduced by 50% then after the second to 75% then after the third I am good to go! Thanking the Lord my primary care physician referred me to them!“
<>Lumbar radiculopathy: Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain of a herniated disc that shoots from the low back and buttock down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels. The sciatica of lumbar radiculopathy typically affects only one side of the body, such as the left side or right side, and not both. Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogramspina bifida
<>Cold and heat therapies. It's best to use cold compresses or an ice pack, not heat, immediately following a back injury, since this can alleviate pain by numbing the area and prevent or reduce swelling. About 48 hours after the onset of back pain, though, applying heating pads or a hot-water bottle to your back may be helpful. The warmth soothes and relaxes aching muscles and increases blood flow, which helps the healing process. Keep in mind that heat therapy is only helpful for the first week.
<>Spinal manipulation: Osteopathic or chiropractic manipulation appears to be beneficial in people during the first month of symptoms. Studies on this topic have produced conflicting results. The use of manipulation for people with chronic back pain has been studied as well, also with conflicting results. The effectiveness of this treatment remains unknown. Manipulation has not been found to benefit people with nerve root problems.
<>One of the new back pain remedies is a muscle stimulation machine. In the past, you would need to visit a chiropractor or physical therapist to receive the benefit of one of these machines, but they now sell them over the counter. However, they are expensive. They make the muscles of the back “twitch,” and this helps to strengthen them. After several sessions with the stimulation machine, your muscles are better able to handle the stress and strain of everyday life again. When a back muscle is hurt, it loses some of its primary strength, and the stimulation machine can restore that to a point. The over-the-counter versions are limited, though, and you may need to see a professional if your back pain persists.
<>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.
<>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!
<>If your symptoms persist more than four to six weeks, you have suffered trauma. If your doctor suspects a serious cause behind the back pain, X-rays may be ordered. X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, including disk problems, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
<>“Sitting tightens our hips, weakens our lower back and core, and keeps us stuck in the same position for hours on end," said Lauren Ohayon, a yoga and Pilates instructor in Miami, Florida, who founded the “Restore Your Core” online program. She recommended getting an adjustable standing laptop desk to help you move more throughout the work day. They make it easy to go from sitting to standing in a variety of positions.
<>Low back pain is the fifth most common reason for all physician visits in the United States.17,29 Approximately one quarter of US adults report having low back pain lasting at least 1 whole day in the past 3 months,17 and 7.6% report at least 1 episode of severe acute low back pain within a 1-year period.8 The prevalence rates of low back pain in athletes range from 1% to 40%.5 Back injuries in the young athlete are a common phenomenon, occurring in 10% to 15% of participants.18 It is not clear if athletes experience low back pain more often than the general population. Comparisons of wrestlers,27 gymnasts,60 and adolescent athletes40 have found back pain more common versus age-matched controls. Other comparisons of athletes and nonathletes have found lower rates of low back pain in athletes than nonathletes.67
<>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.
<>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.
<>Adherence to exercise is one of the most important factors for long term pain relief. However, maintaining exercise can be difficult for a variety of reasons, including worsened pain with activity, economic constraints, and low motivation.1 In one study, the most common reason for lack of adherence to exercise was increased pain caused by activity.1 When this is the case, an exercise professional can incorporate pain reduction and management as primary parts of the exercise program.
<>In all other cases, you can safely read this tutorial first. For instance, even if you have severe pain or numbness and tingling down your leg, you can safely read this first. Or, even if you have an obviously severe muscle tear from trying to lift your car or something, you can safely start here — rest and read. Your back is not as fragile as you probably think, and understanding why is a great starting place for healing in nearly all cases of low back pain.
<>Even more tragic is that good information exists, and not just here in this book: many medical experts do “get it” (the doctors doing the actual research). But they have fought a long battle trying to spread the word to their own medical colleagues on the front lines of health care. A 2010 report in Archives of Internal Medicine showed just how grim it is:
<>Piriformis Muscle Stretch. Lie on the back with knees bent and both heels on the floor. Cross one leg over the other, resting the ankle on the bent knee, then gently pull the bottom knee toward the chest until a stretch is felt in the buttock. Or, lying on the floor, cross one leg over the other and pull it forward over the body at the knee, keeping the other leg flat.
<>CBT: If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo.
<>Today, the most common conventional treatments for lower back pain relief are medications, including NSAIDS like aspirin and Tylenol, along with more potent prescription painkillers, such analgesics. These drugs can potentially cause adverse side effects in some patients and commonly don’t solve the underlying causes of lower back pain (such as poor posture, obesity or exercise-related strains). Some medications for back pains have even been tied to complications, such as liver damage or intestinal bleeding, when taken for long periods of time or in high doses.
<>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.
<>A definitive diagnosis is the first step in obtaining lasting relief from your back pain. When you arrive at our NYC office for your appointment, Dr. Stieber will begin by examining your back and collecting detailed information about your symptoms. From there, he will ask you to sit, stand, walk and lift your legs, all while rating your pain on a scale of zero to ten. This portion of the examination is critical in identifying the severity and origin of the pain.
<>Paget's disease of the bone is a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget's disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.
<>Many researchers seem to believe that low back pain is a modern problem. For instance, Waddell writes, “Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic … .” In 2008, Martin et al found that, “The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7%… to 24.7% … 1997 to 2005,” which certainly shows that it is a growing problem and therefore likely to be worse now than in the past. A Spanish study (Jiménez-Sánchez et al) showed that “serious” musculoskeletal complaints (including a great deal of back pain, presumably) increased significantly from 1993 to 2001. Finally, Harkness et al did a nice job in 2005 of comparing rates of musculoskeletal pain (including low back pain) 40 years apart in the northwest of England, and found a large increase. In his books, Sarno also strongly portrays low back pain as a modern problem — though he doesn’t defend it . It’s hard to say if back pain actually is a modern problem, or whether it just tends to be described as such. Remember that human beings have a strong tendency to sensationalize and dramatize! Harkness pointed out in her study that the appearance of an increase “could be partly explained by the ‘worried well’. The ‘worried well’ are those patients who are concerned about their health, and attend their GP to seek reassurance about their well-being.” This is a great example of how hard it is to really be sure of anything! BACK TO TEXT
<>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.
<>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.
<>Several systemic reviews have found skeletal muscle relaxants effective for short-term symptomatic relief in acute and chronic low back pain.7,56,65,66 However, the incidence of drowsiness, dizziness, and other side effects is high.66 There is minimal evidence on the efficacy of the antispasticity drugs (dantrolene and baclofen) for low back pain.66
<>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.]
<>If you've ever groaned, "Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.
<>Transcutaneous electric nerve stimulation (TENS): TENS provides pulses of electrical stimulation through surface electrodes. For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at one week for TENS but no difference at three months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica.
<>Although it may not sound like a back pain remedy, rest is vital when you are trying to relieve back pain naturally. Your muscles are in a state of shock and injury. Further insult will only make the pain worse and can lead to further injury of the musculature of the back. You shouldn’t go on complete bed rest, though. Yes, take it easy, but it is easy to lock up your back by not moving enough. Don’t engage in strenuous activity, but gentle stretching and light walking should be okay. Take time to sit or lay down regularly until your back pain remedies start to improve your situation. Don’t miss these lower back pain relief treatments that really work.
<>Can stomach problems cause lower back pain? The back is a sensitive part of the body, which has many nerves and organs nearby. This means that issues such as digestive conditions can occur at the same time as back pain. Back pain and bloating are common symptoms of injury, pregnancy, or gastrointestinal problems. Treatment depends on the cause. Learn more here. Read now
<>The McKenzie method45 uses clinical examination to separate patients with low back pain into subgroups (postural, dysfunction, and derangement) to determine appropriate treatment. The goal is symptom relief through individualized treatment by the patient at home. The McKenzie method is not exclusively extension exercises; it emphasizes patient education to decrease pain quickly, restore function, minimize the number of visits to the clinic, and prevent recurrences.45 Two systemic reviews have compared the McKenzie method with different conclusions.11,43 Clare et al11 concluded that McKenzie therapy resulted in decreased short-term (less than 3 months) pain and disability when compared with NSAIDs, educational booklet, back massage with back care advice, strength training with therapist supervision, and spinal mobilization. Machado et al43 concluded that the McKenzie method does not produce clinically worthwhile changes in pain and disability when compared with passive therapy and advice to stay active for acute LBP.
<>Gentle stretches, walking, and periodically standing up at your desk can help stabilize your spine and prevent muscle imbalances. And despite how hard it is to imagine doing Downward-Facing Dog with a bad back, yoga can work in your favor, too. A 2013 review of studies found strong evidence it can help beat lower back pain. Any type works; one to consider is the restorative viniyoga style.
<>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.
<>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.
<>Do you want to prevent back pain? Try a few basic exercises to stretch and strengthen your back and supporting muscles. Repeat each exercise a few times, then increase the number of repetitions as the exercise gets easier. If you've ever hurt your back or have other health conditions, such as osteoporosis, consult your doctor before doing these exercises.
<>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.
<>Once in a great while some cranky reader (always a guy) writes to tell me, “I didn’t learn anything from your book.” I’m a little skeptical about that, and it’s always tempting to start quizzing! There’s a great deal of information here, including analyses of recent research. Sure, readers who have already done a lot of reading about back pain might already be familiar with a lot of it — but you will know that going in, of course, and you’ll find the nuggets of new information and perspective that any keen reader is always looking for. BACK TO TEXT
<>”Tulsa Spine & Rehab is not your ordinary chiropractor experience. They provide a thorough diagnostic, clinical massage therapy, adjustment & physical therapy to start. I started with excruciating thorasic pain in the lumbar region. After the first day my pain was reduced by 50% then after the second to 75% then after the third I am good to go! Thanking the Lord my primary care physician referred me to them!“
<>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.
<>Too much tension and tightness can cause back pain. "Our goal in increasing flexibility is to put an equal load throughout the body from the feet all the way up to the head,” Davis says. “One good exercise is to sit on the edge of the bed with one leg extended and the other one on the floor. Give your hamstrings a stretch by leaning forward while keeping your back in a neutral position.”
<>Clinical examination and diagnostic skills are essential in the workup of low back pain. Athletes with neurologic compromise, fever, chills, or incontinence of bowel or bladder function or those with mechanism of action that could result in fracture or other serious injuries must first be evaluated for emergent causes. Workup and diagnosis must be individualized on the basis of differential diagnosis.
<>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
<>2016 — Science update: There is now a good scientific concensus on the subject of spinal fusion, thanks to papers like Mannion 2013 and Hedlund 2016. Putting a spotlight on this called for some serious revision and editing. The whole section is greatly improved. [Section: The back surgery placebo problem, and how it limits our knowledge of the effectiveness of back surgeries.]
<>Piriformis Muscle Stretch. Lie on the back with knees bent and both heels on the floor. Cross one leg over the other, resting the ankle on the bent knee, then gently pull the bottom knee toward the chest until a stretch is felt in the buttock. Or, lying on the floor, cross one leg over the other and pull it forward over the body at the knee, keeping the other leg flat.
<>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.
<>There is no single best exercise for lower back pain, the key is to build up strength in your core and glutes, which often tend to be weak; consequently, the lower back works overtime to compensate. Strengthen your core and relieve your lower back. Below are a selection of the best core and ab workouts that don’t strain your back straight from the 8fit app.
<>Well, at least there’s that! But most of what CR published was horrifyingly naive and misleading. I scanned this issue in a grocery store lineup and was rolling my eyes within seconds. And then fuming: it seems like the flood of misinformation about back pain is infinite! I’ve been actively debunking back pain myths for about 15 years now, and the need for it has barely changed in all that time. So-called information like this, reaching a massive audience, seriously exacerbates the problem.
<>The McKenzie method45 uses clinical examination to separate patients with low back pain into subgroups (postural, dysfunction, and derangement) to determine appropriate treatment. The goal is symptom relief through individualized treatment by the patient at home. The McKenzie method is not exclusively extension exercises; it emphasizes patient education to decrease pain quickly, restore function, minimize the number of visits to the clinic, and prevent recurrences.45 Two systemic reviews have compared the McKenzie method with different conclusions.11,43 Clare et al11 concluded that McKenzie therapy resulted in decreased short-term (less than 3 months) pain and disability when compared with NSAIDs, educational booklet, back massage with back care advice, strength training with therapist supervision, and spinal mobilization. Machado et al43 concluded that the McKenzie method does not produce clinically worthwhile changes in pain and disability when compared with passive therapy and advice to stay active for acute LBP.
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<>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.
<>Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.
<>I bought two of your eBooks last week, and I’m enjoying going through them. Your presentation is excellent. It’s far too early too say, of course, but I think I’ve already begun to benefit from your approach. One of the things I like most about your approach is your respect for “science,” as opposed to “merchandising.” You've put so much into those two eBooks, it's going to take time to do them the justice they deserve.
<>Sports that have higher rates of back pain include gymnastics, diving, weight lifting, golf, American football, and rowing.61 In gymnastics, the incidence of back injuries is 11%. In football linemen, it may be as high as 50%.18 Ninety percent of all injuries of professional golfers involve the neck or back.19 Injury rates for 15- and 16-year-old girls in gymnastics, dance, or gym training are higher than the general population, while cross-country skiing and aerobics are associated with a lower prevalence of low back pain.4 For boys, volleyball, gymnastics, weight lifting, downhill skiing, and snowboarding are associated with higher prevalence of low back pain, while cross-country skiing and aerobics show a lower prevalence.
<>Today, the most common conventional treatments for lower back pain relief are medications, including NSAIDS like aspirin and Tylenol, along with more potent prescription painkillers, such analgesics. These drugs can potentially cause adverse side effects in some patients and commonly don’t solve the underlying causes of lower back pain (such as poor posture, obesity or exercise-related strains). Some medications for back pains have even been tied to complications, such as liver damage or intestinal bleeding, when taken for long periods of time or in high doses.
<>A pinched nerve causes pain, numbness, or tingling in the affected area due to pressure on a nerve. Caral tunnel and sciatica are two examples of conditions caused by a pinched nerve. A pinched nerve is diagnosed by taking a patient history and performing a physical examination. Electromyography may be performed. Treatment for a pinched nerve depends on the underlying cause.
<>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
<>Grandma was right! Slouching is bad for you. And poor posture can make back pain worse, especially if you sit for long periods. Don't slump over your keyboard. Sit upright, with your shoulders relaxed and your body supported against the back of your chair. Try putting a pillow or a rolled towel between your lower back and your seat. Keep your feet flat on the floor.

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