<>The Pelvic Tilt is another great exercise for mobilising your lower back muscles. As shown below, lie on your back and place a small cushion under your head. Bend your knees and keep your feet hip-width apart and placed on the floor. Keep your upper body relaxed and your chin gently tucked-in. Gently flatten your lower back into the floor and contract your stomach muscles. Now tilt your pelvis towards your heels until you feel a gentle arch in your lower back, feeling your back muscles contracting and return to the starting position. Place one hand on your stomach and the other under your lower back to feel the correct muscles working. Repeat eight to twelve times, tilting your pelvis back and forth in a slow rocking motion.
<>To understand various causes of low back pain, it is important to appreciate the normal design (anatomy) of the tissues of this area of the body. Important structures of the low back that can be related to symptoms in this region include the bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
<>When structural problems are exaggerated, you also get a plague of bogus explanations and solutions based on that. Spines do degenerate, but not for the reasons most people think they do: genetics is by far the biggest factor in degeneration,27 not your posture, your office chair or mattress, your core stability, or anything else that low back pain sufferers have taught to blame their pain on.
<>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.
<>Testimonials on health care websites reek of quackery, so publishing them has always made me a bit queasy. But my testimonials are mostly about the quality of the information I’m selling, and I hope that makes all the difference. So here’s some highlights from the kind words I’ve received over the years … plus some of the common criticisms I receive, at the end. These are all genuine testimonials, mostly received by email. In many cases I withold or change names and identifying details.
<>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.
<>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.
<>Tip: One good pre-activity stretch is a yoga move called the cat-cow: Start on your hands and knees with your back straight and your head and neck in line. On an inhale, drop your belly toward the ground and look up toward the ceiling (cow pose). On an exhale, tuck in your stomach, arch your back and lower your head to your chest (cat pose). Do it gently, and stop if you feel any pain.
<>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.
<>Dr. Jerome Groopman has written brilliantly about back pain, from personal experience. In How Doctors Think he puts back pain in the context of how medical thinking is influenced by marketing and money, giving us a somewhat chilling insiders’ view of the surgical treatment of back pain. In The Anatomy of Hope, he tells his own story of super severe back pain. It has a happy ending! Both books are also otherwise worthwhile. “Marketing, Money, and Medical Decisions,” a chapter in the book How doctors think, by Jerome Groopman. Groopman, writing from personal experience with chronic back pain and a spinal fusion surgery, discusses back pain as intelligently as any medical expert I’ve come across, but he does so in a way that will fascinate patients. In this chapter, his discussion of back pain is placed in the context of how medical thinking is influenced by marketing and money, giving us a somewhat chilling insiders’ view of the surgical treatment of back pain.
<>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.
<>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. 
<>Another way to cure back pain fast at home is to use muscle creams and patches. You may have seen these advertised as the sticky patches that extend across your back, and they are effective to a degree. Many different companies make these types of products, but the two most popular are Ben Gay and Icy Hot. The medication in the patch or cream works to “confuse” the nerve endings in your back muscles. By making them feel hot or cold, they are distracted from the pain of the muscle tissue. In addition, the heat from these patches goes a long way toward soothing the muscles that have been strained or sprained. Large patches are probably the most convenient back pain home remedy of this type, but the cream may work better if your muscles are strained higher up on the back, to the side, or over a large area. Here are some exercises that can help make back pain better.
<>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?
<>My original inspiration for this tutorial was Dr. John Sarno’s 1984 book Mind over back pain. (His more recent Healing back pain makes too many empty promises. See my review.) However, as much as I respect Dr. Sarno’s early work, there are at least three reasons why this tutorial is better than his books: (1) I make a much more airtight case against the conventional medical myths of back pain than Dr. Sarno does; (2) I also build a much better case for the real causes of back pain, heavily referencing more credible sources than Dr. Sarno does; (3) and I offer many more practical suggestions than Dr. Sarno does, instead of focusing exclusively on the psychological factors. Although I have less experience and education than Dr. Sarno, I do have a lot more hands-on experience (and the useful perspective of a journalist). BACK TO TEXT
<>Acute low back pain can be defined as six to 12 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs (sciatica). Acute low back pain is often nonspecific and therefore cannot be attributed to a definite cause. However, possible causes of acute low back pain (e.g., infection, tumor, osteoporosis, fracture, inflammatory arthritis) need to be considered based on the patient's history and physical examination. Table 1 presents the differential diagnosis of acute low back pain.5,6
<>It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.”
<>Joint Replacement Surgery Bursitis Fibromyalgia Fibrous Dysplasia Growth Plate Injuries Marfan Syndrome Osteogenesis Imperfecta Osteonecrosis Osteopetrosis Osteoporosis Paget’s Disease of Bone Scoliosis Spinal Stenosis Tendinitis Sports Injuries Sports Injuries in Youth: A Guide for Parents Sprains and Strains Back Pain Shoulder Problems Knee Problems Hip Replacement Surgery
<>Soft tissue therapies help treat the underlying causes of back pain, such as poor posture, muscular compensations, and weakness through manipulative, hands-on adjustments. These natural therapies can help “turn on” muscles that have been “turned off” due to past injuries and therefore eliminate added stress on painful parts of the back or legs. I recommend finding a practitioner who offers one of the following:
<>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.
<>“Stretching of the back and legs can help maintain or improve movement for everyday functions. For example, being limber will help you lift objects off the floor or put on shoes without increased stress to the back,” says Jiang. “Additionally, physical activity [like stretching] can help increase back resilience, so that one can perform more activities without increased pain.”
<>Laboratory tests such as complete blood count with differential, erythrocyte sedimentation rate, and C-reactive protein level may be beneficial if infection or bone marrow neoplasm is suspected. These tests may be most sensitive in cases of spinal infection because lack of fever and a normal complete blood count are common in patients with spinal infection.15 Because laboratory testing lacks specificity, MRI with and without contrast media and, in many cases, biopsy are essential for accurate diagnosis.15
<>Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
<>A great exercise for the lower tummy muscles is shown in the image below. It is extremely gentle and also very effective. Lie on your back with knees bent and feet flat on the floor. Breathe in and as you breathe out bring one knee in towards your chest and as you breathe in return the foot to the floor. Repeat this exercise six to eight times on each leg.
<>Aquatic therapy: Aquatic therapy and exercise can also improve flexibility and decrease pain for some people with chronic low back problems. It is especially beneficial for those patients who cannot tolerate land-based physical therapy.This is because the unique properties of water often make it a safe environment for exercising a sore back, providing gentle resistance, comfort, and relaxation. Fear of pain associated with movement is a major limiting factor for rehabilitation and exercises therapy. The support and warmth of the water enables a person to gradually introduce daily exercise into their treatment.
<>Pain in the lower back or low back pain is a common concern, affecting up to 80% of Americans at some point in their lifetime. Many will have more than one episode. Low back pain is not a specific disease, rather it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified.
<>Patient Education. Patient education involves a discussion of the often benign nature of acute back pain and reassurance that most patients need little intervention for significant improvement. Patients should be advised to stay as active as possible, within pain limits; to avoid twisting and bending, particularly when lifting; and to return to normal activities as soon as possible. The goal is to reduce worry about back pain and to teach ways to avoid worsening of pain or pain recurrence.
<>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.
<>According to Susi Hately, owner of Functional Synergy, Inc., in Alberta, Canada, and author of several international best-selling yoga books, yoga can be very therapeutic for people with back pain as well. A review of scientific studies published in 2013 in the Clinical Journal of Pain found strong evidence that yoga can help reduce chronic low back pain. Yoga may help improve back pain by loosening tight muscles, building strength and range of motion, and improving breathing, explains Hately. Yoga also focuses on relaxation, which may help to relax your muscles as well as reduce pain perception.
<>Pain from spine structures, such as musculature, ligaments, facet joints, and disks, can refer to the thigh region, but rarely to areas below the knee. Pain related to the sacroiliac joint often refers to the thigh, but can also radiate below the knee. Irritation, impingement, or compression of the lumbar root often results in more leg pain than back pain. Pain from the L1-L3 nerve roots will radiate to the hip and/or thigh, whereas pain from the L4-S1 nerve roots will radiate below the knee.
<>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.
<>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.
<>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.
<>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).
<>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.
<>Neurologic examination of the lower extremities includes strength, sensation, and reflex testing (Table 3), even in the absence of significant sciatica. A straight leg raise test is positive for L4-S1 nerve root pain if it radiates below the knee. A reverse straight leg raise test (extending hip and flexing knee while in the prone position) is positive for L3 nerve root pain if it radiates into the anterior thigh. A central, paracentral, or lateral disk herniation may affect different nerve roots at the same level. Examination of the lumbosacral, pelvic, and abdominal regions may provide clues to underlying abnormalities relating to back pain (Table 15,6  and 25,6,8).
<>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.
<>That’s a huge topic, but here’s one simple example of an extremely common problem with back pain science: control groups that don’t control. Rather than comparing a treatment to a good, carefully selected placebo, most studies use a comparison to a treatment that is allegedly neutral, underwhelming, or placebo-ish. That makes the results hard to interpret: if each works about the same, it could mean that the treatments are equally effective … or equally ineffective! So much back pain science has this problem — or any one of a dozen other weak points — that you can effectively ignore at least 80% of all back pain research, because it’s so far from the last word on anything. Good science is essential to solving these problems, but really good studies are also difficult to design and rare. BACK TO TEXT
<>Opioid analgesics: These drugs are considered an option for pain control in acute back pain. The use of these medications is associated with serious side effects, including dependence, sedation, decreased reaction time, nausea, and clouded judgment. One of the most troublesome side effects is constipation. This occurs in a large percentage of people taking this type of medication for more than a few days. A few studies support their short-term use for temporary pain relief. Their use, however, does not speed recovery.
<>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.
<>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!
<>Try acupuncture. Research suggests that acupuncture can help reduce chronic low back pain. One recent review showed that actual acupuncture was more effective than simulated acupuncture or no treatment in reducing pain. It's not entirely known how acupuncture regulates pain; however, one theory suggests acupuncture helps trigger the release of pain reducing chemicals in the body (like endorphins and natural opioids). Back pain is one of the most common reasons patients first try acupuncture and many find sustained relief.
<>To relieve pain all over instead of just in one problem area, Dr. Mark Liponis, the chief medical officer at Canyon Ranch in Tucson, Arizona, recommended an inversion table that provides massage. While it may be expensive for some, he said it could be worth it for managing a chronic pain issue. "Over time can help relieve chronic neck and back pain,” Liponis added.
<>Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often first-line therapy for low back pain. Low-quality evidence suggests that they are effective for short-term symptom relief, compared with placebo.16 No patient characteristics at baseline can predict the success of NSAID therapy.17 Moderate evidence suggests that no one NSAID is superior, and switching to a different NSAID may be considered if the first is ineffective. Whether NSAIDs are more effective than acetaminophen is unknown, but the addition of an NSAID to acetaminophen therapy is no more beneficial than acetaminophen alone.16,18
<>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.
<>As with any sort of pain, it's crucial to figure out the source so you can properly treat it. Sharp or stabbing pain that extends beyond your low back or is accompanied by symptoms like abdominal pain, nausea, and vomiting, could be signs of various other conditions and definitely warrant a trip to the doctor. If you have a history of lower back injuries or disc problems, always see your doctor before trying any new exercise.
<>Press-ups: While lying on your stomach, put your hands flat on the floor under your shoulders, like you are going to start a push-up. Press your shoulders up and let your hips and low back relax. Your hips should remain in contact with the floor as you press up. Hold the end position for 1-2 seconds and return fully to the starting position. Perform 10 repetitions. Bonus exercise: the Prone Press Up with Hips Off Center.
<>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.
<>Rosenzweig, S., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010, January). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68(1), 29–36. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022399909000944

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