<>Battié MC, Videman T, Kaprio J, et al. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009;9(1):47–59. PubMed #19111259. “The once commonly held view that disc degeneration is primarily a result of aging and wear and tear from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences. Although environmental factors also play a role, it is not primarily through routine physical loading exposures (eg, heavy vs. light physical demands) as once suspected.” BACK TO TEXT
<>A randomized single-blind controlled trial compared manual therapy and spinal stabilization rehabilitation to control (education booklet) for chronic back pain.26 Spinal stabilization rehabilitation was more effective than either manipulation or the education booklet in reducing pain, disability, medication intake, and improving the quality of life for chronic low back pain.26 A systemic review found segmental stabilizing exercises more effective in reducing the recurrence of pain in acute low back pain; however, exercises were no better than treatment by general practitioner in reducing short-term disability and pain.50 For chronic low back pain, segmental stabilizing exercises were more effective than treatment from general practitioners but no more effective than exercises using devices, massage, electrotherapy, or heat.50 In a trial of 30 hockey players, dynamic muscular stabilization techniques (an active approach to stabilization training) were more effective than a combination of ultrasound and short-wave diathermy and lumbar strengthening exercises.41
<>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.
<>”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!“
<>Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.24 Acupressure or pressure point massage technique was more effective than classic massage. A second systemic review found insufficient evidence to determine efficacy of massage for acute low back pain.10 Evidence was insufficient to determine effects of the number or duration of massage sessions.
<>When you first hurt your back, one of the best back pain remedies is to ice the area. Injury to a muscle means that blood will rush to the site, bringing healing chemicals to ease the pain. Unfortunately, this leads to swelling, and that swelling leads to pain. Applying cold compresses constricts the blood vessels, and this reduces the flow of that blood. The reduction in swelling means that you will have less pain, and this is a great way to relieve back pain naturally. Be sure to keep the cold on for 20 minutes and off for 40. Don’t use this method after the first 24 hours. These are 10 surprising reasons your back hurts.
<>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.
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<>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.
<>Bony encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body, commonly as a result of arthritis), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation). Treatment of these afflictions varies, depending on their severity, and ranges from rest and exercises to epidural cortisone injections and surgical decompression by removing the bone that is compressing the nervous tissue.
<>2010 — Updated: Added a very beefy footnote about some new research showing that muscle imbalance does not result in higher rates of injury. This almost should have been a new section, but I decided to just make it a ginormous footnote — footnotes are there for delving if you want to, that’s the idea! You can read a summary of the research in the bibliography (see Hides et al), but the relevance to back pain is spelled out in detail here. And it’s interesting. [Section: Diagnosis: Your low back is not fragile!]
<>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."
<>A 2007 Cochrane review of opioids for chronic low back pain found that tramadol was more effective than placebo for pain relief and improving function.16 The 2 most common side effects of tramadol were headaches and nausea. One trial comparing opioids to naproxen found that opioids were significantly better for relieving pain but not improving function. Despite the frequent use of opioids for long-term management of chronic LBP, there are few high-quality trials assessing efficacy. The benefits of opioids for chronic LBP remain questionable. There is no evidence that sustained-release opioid formulations are superior to immediate-release formulations for low back pain. Long-acting opioids did not differ in head-to-head trials.9 Opioids are banned by the World Anti-doping Association.70
<>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.
<>Acupuncture: Both the American Pain Society and the American College of Physicians released guidelines stating that acupuncture may help patients with chronic low-back pain when other treatments have failed. It can be used alone or as part of a comprehensive treatment plan that includes medications and other therapies. However, there is not enough evidence yet to recommend it for acute back pain.
<>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.
<>I like to kick off a topic with an example of a terrible website about it, just for the chuckle and a teachable moment. ThePain.net is one of the worst I’ve seen: a large, stale, ugly thing by Pekka Palin, MD. There are hours of terrible reading there! Dozens of blandly composed, shallow, rambling, and frequently irrational mini-articles on every imaginable pain subject, all 100% unreferenced, laid out in huge blocks of text without a subheading for many screens (a typographic travesty). There’s soooo much badness, but I really got a chuckle out of this perfectly pointless phrase: “The most common term used for general, temporary low back pain is lumbago.” Now “lumbago” means “back pain” (see the definition of lumbago on Wikipedia), so Dr. Obvious has helpfully explained that the cause of back pain is, er, back pain. The Internet, at your service!
<>Your core muscles—not just your abdominals, but the muscles that wrap around your midsection—support your spine and lower back. And your core, hips, glutes, and hamstrings together form one big stability machine, so weakness in any one of those muscles forces the others to take up the slack. If you have weak hip and gluteal muscles, for example, as they become fatigued during a run, your lower back is forced to work harder to keep you upright and stable, and you become vulnerable to injury.
<>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
<>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.
<>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.
<>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.
<>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!
<>A very important muscle to strengthen is the transverse abdominis, which provides a great deal of support for the lower back. In many people this muscle is extremely weak and this can lead to lower back pain. A very gentle and safe way to strengthen this muscle is shown below. To carry out this exercise lie on your back, place a small cushion under your head, and bend your knees. Your feet should be hip distance apart and placed on the floor. Keep your upper body relaxed and your chin gently tucked in. Take a deep breath in, and as you breathe out focus on drawing your belly button in towards your spine. Hold this gentle contraction for 5 to 10 seconds. As you breathe out relax your tummy muscles. This is a slow, gentle tightening so aim to use less than 25% of your maximum strength. Repeat five times.
<>Is “much” information really “just plain wrong”? I will establish this in the sections ahead with a steady supply of clearly explained references to the medical literature that patients can understand and professionals can respect. This extra layer of information in easy-to-use footnotes is available for any reader who wants to dig deeper and check my facts. For example, here’s a good start: In 2010, the Journal of Bone & Joint Surgery reported that “the quality and content of health information on the internet is highly variable for common sports medicine topics,” such as knee pain and low back pain — a bit of an understatement, really. Expert reviewers examined about 75 top-ranked commercial websites and another 30 academic sites. They gave each a quality score on a scale of 100. The average score? Barely over 50! For more detail, see Starman et al. BACK TO TEXT
<>Acupuncture. Based in ancient Chinese medicine, acupuncture stimulates points on the body thought to correct the body’s “qi,” or life force. It is believed that proper qi decreases pain and discomfort in the body. During a session, thin needles are placed in the skin for about an hour. Acupuncture has been shown to provide significant pain relief for some people.3
<>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.
<>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.
<>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.
<>2010 — Upgraded: Section now includes discussion of that bizarre and already infamous paper in the New England Journal of Medicine (see Berman). I also make an important new point: exactly why acupuncture placebos are such a problem for low back pain patients in particular. [Section: The fascinating case of acupuncture, formerly a contender in low back pain therapy, but which has now miserably failed well-designed scientific tests.]
<>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.
<>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.
<>There are a number of medications that can relieve back pain. Over-the-counter pain relievers, muscle relaxants, topical pain relievers and narcotics are all extremely effective in increasing your comfort. In addition, cortisone injections can decrease inflammation around the nerve roots and low doses of antidepressants can relieve certain types of chronic back pain.
<>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.
<>There are a number of medications that can relieve back pain. Over-the-counter pain relievers, muscle relaxants, topical pain relievers and narcotics are all extremely effective in increasing your comfort. In addition, cortisone injections can decrease inflammation around the nerve roots and low doses of antidepressants can relieve certain types of chronic back 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.
<>The seated position anatomically means that we don’t engage our abs and glutes, which can result in them switching off and falling asleep. The fall out of this is that other muscles have to work harder to compensate and support the body.  The muscles in our lower backs become overworked while our hip flexor muscles mainly the psoas — that attaches to the femur and lumbar spine — become tight and tense. It’s this imbalance that triggers the pain, especially in our lower back.
<>Prolotherapy treatments work by naturally promoting a minor inflammatory response near damaged connective tissue, promoting regeneration and the growth of new, healthier tissue in the process. These treatments have been used to effectively reduce or heal chronic musculoskeletal conditions of the back, such as herniated/bulging discs, arthritis, osteoarthritis or other chronic joint pains, and tendonitis that affects the lower body and causes compensations in the spine. (7) For the most benefits, it seems that prolotherapy works best when combined with other back pain treatments, such as spinal manipulation, exercise and in some cases medications when needed.
<>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.
<>The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue from impact trauma. Vertebrae also have a strong bony "body" (vertebral body) in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joints of the buttocks.
<>Transcutaneous electrical nerve stimulator (TENS) machines are small, battery-powered devices that transmit low-voltage electrical currents through electrodes that are attached to your skin. Considered very safe, TENS machines, according to one theory, work by scrambling the message of pain to the brain — literally blocking it. Another theory suggests that the electrical impulses cause a release of endorphins that override the sensation of pain. Many back pain patients have had success with TENS machines, though their effectiveness has not been clearly proven in controlled studies. Ask your doctor or physical therapist if this therapy might be right for you.
<>Leg lifts are sometimes suggested as an exercise to "strengthen your core" or abdominal muscles. Exercising to restore strength to your lower back can be very helpful in relieving pain yet  lifting both legs together while lying on your back is very demanding on your core.  If weak, this exercise can make back pain worse. Instead, try lying on your back with one leg straight and the other leg bent at the knee. Keeping your lower back flat on floor. Slowly lift the straight  leg up about 6 inches and hold briefly. Lower leg slowly. Repeat 10 times, then switch legs.
<>Rest: The basic treatment for relieving acute back pain from strain or minor injury is a limited period of rest for 24 to 72 hours. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. Do not give aspirin to a child aged 18 years or younger because of the increased risk of Reye syndrome. After the inflammation subsides, applying heat can soothe cramped muscles and strained connective tissue.
<>Physical activity. Exercise helps build strong, flexible muscles that will be less prone to injury. It can also help the healing process for an aching back, prevent problems in the future, and improve function. Work with your doctor to develop an exercise program, or seek a referral to another health professional who can. A good program typically includes the three major forms of exercise: aerobic activity, strength training, and flexibility exercises.
<>This traditional treatment scores well in research for its pain-relieving properties—and you can add lower back pain relief to the list. In a review published in the journal Evidence-based Complementary and Alternative Medicine, researchers concluded that for chronic low back pain, acupuncture alone or in conjunction with other treatments could provide short-term improvements in pain and function compared to no treatment at all.
<>In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.
<>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.
<>Poor posture and crookedness is another popular scapegoat — it seems obvious that posture is relevant. Many professionals assume that back pain is some kind of postural problem that you can exercise your way clear of. Unfortunately, the evidence shows that no kind of exercise, not even the most hard-core core strengthening, has any significant effect on low back pain.
<>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.
<>Long periods of inactivity in bed are no longer recommended, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.
<>As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own understanding and perception of their particular situation. British researchers found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
<>Sleep disturbances are common among people with chronic back pain, and not getting enough quality sleep may actually worsen inflammation and pain. For a better night's sleep, invest in a good mattress and experiment with different sleeping positions. Adding an extra pillow under your body can help maintain the natural curve in your spine. If you’re a back sleeper, try putting the pillow under both knees; for stomach sleepers, try under your pelvis. If you sleep on your side, sleeping with a pillow between the knees may help.

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