<>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.
<>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.
<>Conventional treatments such as NSAIDs, heat and ice, and stretching will be enough for most people—but not everyone. “If you’ve exhausted various conservative treatment options and have been in chronic pain for several months, you may be a candidate for minimally invasive spine surgery,” says Koser. There’s no reason to suffer—and you may not have to consider traditional open spine surgery at all. Minimally invasive procedures use an incision of less than one inch and require little downtime. “The muscles are spared during the procedure and are gently spaced apart, rather than being cut or torn away during traditional open spine surgery,” Koser says.
<>Preliminary research suggests that hypnotherapy may be of some use in the treatment of low back pain. For instance, a pilot study published in the International Journal of Clinical and Experimental Hypnosis found that a four-session hypnosis program (combined with a psychological education program) significantly reduced pain intensity and led to improvements in mood among patients with chronic low back pain.
<>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.
<>Low-level laser therapy (LLLT) is a noninvasive light source treatment that generates a single wavelength of light without generating heat, sound, or vibration. Also called photobiology or biostimulation, LLLT may accelerate connective tissue repair and serve as an anti-inflammatory agent. Wavelengths from 632 to 904 nm are used in the treatment of musculoskeletal disorders. A Cochrane review of 7 small studies with a total of 384 patients with nonspecific low back pain of varying durations found insufficient data to either support or refute the effectiveness of LLLT for the treatment of low back pain. Because of the varied length of treatment, LLLT dose, application techniques, and different populations, it was not possible to determine optimal administration of LLLT.71 No side effects were reported.
<>Exercise is good for low back pain -- but not all exercises are beneficial. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. Some exercises may aggravate pain. Standing toe touches, for example, put greater stress on the disks and ligaments in your spine. They can also overstretch lower back muscles and hamstrings.
<>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.
<>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.
<>Staying in bed for any prolonged period can make you stiff and increase pain. When you don’t move and bend, you lose muscle strength and flexibility. With bed rest, you lose about 1 percent of your muscle strength each day. And you can lose 20 to 30 percent in a week. It becomes more difficult to return to any activity. As you become weaker and stiffer your recovery takes longer.
<>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.
<>Another great exercise for mobilizing the lower back is the bridge, as shown in the image below. To carry out this exercise lie on your back with knees bent and your feet placed hip distance apart on the floor. Take a deep breath in and as you breathe out lift your hips off the floor until shoulders hips and knees are in a straight line. As you breathe in lower your hips to the floor. Repeat eight to twelve times.
<>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.
<>A physiatrist or interventional pain management doctor may help you avoid more invasive treatments. “These can include medications delivered to the spine such as epidural steroid injections to reduce inflammation, or radiofrequency nerve ablations to reduce transmission of neck or back pain,” explains Koser. The expert you meet with will go over all of the options available to you.
<>Herbal therapies: “When back spasms are so strong you can barely move from the bed,” Grossman says, she suggests the homeopathic medicine Bryonia; when you have soreness after overexertion, she uses Arnica.  Keep in mind, there’s little scientific evidence that herbals such as Bryonia and Arnica are effective treatments for back pain; though, a study published in Alternative Therapies in Health and Medicine in 2016 suggested they might help to reduce chronic low back pain from arthritis when combined with physical therapy.
<>While a PT can guide you through exercises to strengthen lower back muscles, you can take matters into your own hands by regularly stretching at home. For lower back pain relief, Strassberg says, a PT may recommend a few moves: hamstring stretch, piriformis stretch, and lower trunk rotation. Pelvic tilts and “clams” are other good targeted exercises. No luck? These are the surprising reasons your lower back pain treatment isn’t working.
<>I found the [Consumer Reports] articles on back pain very disappointing. I hope I can still trust Consumer Reports when shopping for a washing machine, but I have no confidence that I can trust them when looking for an effective medical treatment. They seem not to understand the difference between anecdotes and data, between a popularity contest and a controlled scientific study. These articles may do harm by encouraging readers to try treatments that don’t work and by suggesting that it is reasonable to prioritize testimonial evidence over scientific studies. On the other hand, these articles may do some good insofar as they may dissuade some patients from rushing to a doctor and demanding imaging studies or prescription drugs.
<>Start in a high plank position with shoulders directly over wrists and tops of feet resting on a stability ball. Your body should form a straight line from head to ankles. Without bending your knees, roll the ball toward your chest by raising your hips as high as you can toward the ceiling. Pause, then lower hips as you roll the ball back to the starting position. Perform 15 reps.
<>Cold can be applied to the low back with towels, gel packs, ice packs, and ice massage. Heat methods include water bottles and baths, soft packs, saunas, steam, wraps, and electric pads. There are few high-quality randomized controlled trials supporting superficial cold or heat therapy for the treatment of acute or subacute low back pain. A Cochrane review cited moderate evidence supporting superficial heat therapy as reducing pain and disability in patients with acute and subacute low back pain, with the addition of exercise further reducing pain and improved function.22 The effects of superficial heat seem strongest for the first week following injury.44
<>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.
<>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.
<>I accept Visa, Mastercard, and American Express. Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. Note that my small business does not handle your credit card info: it goes straight to the payment processor (Stripe). You can also pay with PayPal: for more information, click the PayPal button just below. CURRENCY ?
<>Stretch. Don't sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. "Because most of us spend a lot of time bending forward in our jobs, it's important to stand up and stretch backward throughout the day," Reicherter says. Don't forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.
<>Braces are not effective in preventing back pain.64 However, there is conflicting evidence to whether braces are effective supplements to other preventive interventions.64 Bracing, in combination with activity restriction, is effective in the treatment of spondylolysis in adolescents.33,42,46,53 A meta-analysis of 15 observational spondylolysis and grade 1 spondylolisthesis treatment studies did not find a significant improvement in rates of healing with bracing when compared with conservative treatment without bracing.37 Most experts recommend surgical consultation for spondylolisthesis with 50% slippage or more (grade 3 and higher).46
<>Dr. Richard Deyo, one of the great myth busters of low back pain research, believes that “low back pain is second to upper respiratory problems as a symptom-related reason for visits to a physician” — only the common cold causes more complaints. Hart et al puts low back pain in fifth place (lower because Hart oddly excludes chronic low back pain). Chronic low back pain is usually the kind that this book will examine. Andersson writes: “Although the literature is filled with information about the prevalence and incidence of back pain in general, there is less information about chronic back pain … .” Indeed, it is almost impossible to measure how much chronic low back pain there is: for every time that acute low back pain is the main reason for a visit to a physician, how many times does a patient mention low back pain as a secondary problem? Or sees an alternative health care professional about it instead? (Answer: pretty danged often.) So it’s actually possible that low back pain is the single most common reason that people seek help. BACK TO TEXT
<>Herniated discs develop as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in one-third of adults older than 20 years of age. Only 3% of these, however, produce symptoms of nerve impingement.
<>Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.
<>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.
<>Among the issues a little downward dog can ease—such as anxiety, stress—yoga may also bring lower back pain relief, particularly if the pain is long-lasting. A 2017 study found that attending weekly yoga for three months was just as effective as physical therapy for alleviating symptoms, and far better than back advice alone. Yoga-goers were also more likely to stop taking medication after a year. Learn more about how yoga eases lower back pain.
<>Well said, but perhaps a bit wordy. Here’s the simple version: patients believe back pain is caused by structural fragility, and careers are built on catering to that belief. I would also say that it is difficult to alter that belief in anyone, patient or professional. This preoccupation with fragility isn’t just reinforced by the practices of many therapists, it’s a major reason for them.
<>Conventional treatments such as NSAIDs, heat and ice, and stretching will be enough for most people—but not everyone. “If you’ve exhausted various conservative treatment options and have been in chronic pain for several months, you may be a candidate for minimally invasive spine surgery,” says Koser. There’s no reason to suffer—and you may not have to consider traditional open spine surgery at all. Minimally invasive procedures use an incision of less than one inch and require little downtime. “The muscles are spared during the procedure and are gently spaced apart, rather than being cut or torn away during traditional open spine surgery,” Koser says.
<>Chiropractic care involving spinal manipulation appears to reduce symptoms and improve function in patients with chronic low back pain, acute low back pain, and sub-acute low back pain, according to a research review published in the Journal of Manipulative Physiological Therapeutics. In their analysis of 887 documents (including 64 clinical trials), the review's authors concluded that combining chiropractic care with exercise is "likely to speed and improve outcomes" and protect against future episodes of back pain.

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