<>When you have back pain, the best thing to do is rest until the pain subsides, right? Not necessarily. Too much rest can worsen certain types of back pain and decrease muscle strength — and strengthening and stretching the muscles may actually reduce or eliminate many types of back pain. Instead, start with gentle stretches and experiment to see how you can get moving without pain. Try going out for a slow, easy walk, and pick up the pace when you can. Remember, it's best to discuss your current fitness routine and any changes to it with your doctor to avoid aggravating your condition.
<>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.
<>I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about me • more about PainScience.com
<>Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.
<>Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping its progression.
<>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.
<>”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!“
<>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.
<>The use of injections and procedures in and around the spine is limited as such treatments often provide only temporary relief. However, they can be important in helping diagnose structural causes in pain and assisting the physical rehabilitation when other methods have failed. The various injection procedures are costly and have potential side effects, which should be discussed in detail before proceeding. Often, a pain specialist or back specialist will also employ rehabilitation and counseling by non-physician personnel such as therapists, counselors, and patient educators.
<>Also referred to as "hypnosis," hypnotherapy is a mind-body technique that involves entering a trance-like state of deep relaxation and concentration. When undergoing hypnotherapy, patients are thought to be more open to suggestion. As such, hypnotherapy is often used to effect change in behaviors thought to contribute to health problems (including chronic pain).
<>Levator scapula stretch. Rest one arm against a wall or doorjamb with the elbow slightly above the shoulder, then turn the head to face the opposite direction. Bring the chin down toward the collarbone to feel a stretch in the back of the neck. It may be helpful to gently pull the head forward with the other hand to hold the stretch for the desired time.
<>2009 — New section: Today I found a way to say some simple things about the power of self-treatment that have been “on the tip of my tongue” for years now. It all evolved from writing about an important bit of research, showing that manual therapists cannot (reliably) diagnose trigger points. [Section: Limitations of trigger point therapy, and how to take advantage of them.]
<>Low back pain is one of the most common complaints on the planet. And you may wonder where to turn when you start experiencing some of those aches or twinges in the lower part of your back. Take heart. "In most cases, you won't need a specialist," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
<>Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that ask your doctor about controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can help prevent further back injury by learning - and doing - gentle stretching exercises and proper lifting techniques, and maintaining good posture.
<>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 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.
<>Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter will review many of the causes of back pain and proper evaluation and diagnosis. Please be sure to discuss your individual symptoms as well as the suggested treatments with your health-care professional to determine the appropriate diagnostic and treatment plan for your circumstances.
<>Degenerative bone and joint conditions: As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
<>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.
<>It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit.
<>Most back pain can be successfully treated without surgery. If conservative back pain treatment fails, or if you have difficulty standing or walking, you may be a candidate for surgery. Dr. Stieber is a leader in the use of minimally-invasive surgical techniques with advanced expertise in restoring mobility to the back and helping his New York patients return to activity and an improved quality of life.
<>After your initial visit for back pain, it is recommended that you follow your doctor's instructions as carefully as possible. This includes taking the medications and performing activities as directed. Back pain will, in all likelihood, improve within several days. Do not be discouraged if you don't achieve immediate improvement. Nearly everyone improves within a month of onset of the 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.
<>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.
<>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
<>The outlook for low back pain absolutely depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that are irritating the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.
<>Evidence from the small number of placebo-controlled trials does not support the use of transcutaneous electrical nerve stimulation in the routine management of chronic low back pain.36 Evidence from single lower quality trials is insufficient to accurately judge efficacy of transcutaneous electrical nerve stimulation versus other interventions for chronic low back pain or acute low back pain.10
<>Can inversion therapy help with back pain? Inversion therapy, where a person is held upside down for several minutes, is an alternative therapy for back pain. They may use gravity boots or an inversion table or chair to reduce the pressure on their spine. Evidence for the effectiveness of this technique is mixed. Learn more about the benefits and risks here. Read now
<>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.
<>For a 2006 report published in Rheumatology, investigators analyzed the available research on the use of balneotherapy in treatment of low back pain. Looking at five clinical trials, the report's authors found "encouraging evidence" suggesting that balneotherapy may be effective for treating patients with low back pain. Noting that supporting data are scarce, the authors call for larger-scale trials on balneotherapy and low back pain.

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Medical Disclaimer: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any exercise program.

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