<>Expert opinion guidelines on RTP time frames have been published for lumbar spine conditions.20 Lumbar strains should achieve full range of motion before RTP. Patients with spondylolysis and spondylolisthesis (grade 1) should rest 4 to 6 weeks and then demonstrate full range of motion and pain-free extension before RTP.22 Athletes with herniated lumbar disks should rest 6 to 12 weeks following surgical treatment, while those with spinal fusion should wait 1 year to return to activity.20 Many surgeons advise against return to contact sports following spinal fusion.20 Iwamoto et al32 reviewed conservative and surgical treatments in athletes with lumbar disc herniation and time to return to previous level of sports activity. Seventy-nine percent of conservatively treated athletes returned in an average of 4.7 months, while 85% of those treated with microdiscectomy returned in 5.2 to 5.8 months. Sixty-nine percent of percutaneous discectomies returned in 7 weeks to 12 months.32
<>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.
<>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.
<>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.”
<>Roughly 8 out of 10 people suffer from back pain at some point during their lives. Women, in particular, are prone to posture and back problems—thanks to toting around outrageously heavy purses, going through pregnancy, or giving one-hip rides to kids. Whether you’re in the midst of fighting the ache or just want to prevent it, here are some expert-endorsed quick-and-easy ways to wage your war.
<>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.
<>In a 2011 research review published in the British Journal of Anaesthesia, investigators looked at the available research on the use of topically applied capsaicin in the treatment of several types of chronic pain. This included two clinical trials examining back pain, both of which found that capsaicin helped reduce low back pain without causing notable side effects.
<>It’s estimated that up to 80 percent of adults experience persistent symptoms of lower back pain at some point in their lives, and about 31 million Americans struggle with the condition at any given time. Given its extremely high prevalence rate — whether due to a weak psoas muscle, sciatic nerve pain or some other cause — it’s not surprising that lower back pain is considered the single leading cause of disability worldwide according to the American Chiropractic Association, with half of all American workers reporting having occasional back troubles each year. (1) Naturally, this leads to millions searching for lower back pain relief.
<>Heat/ice therapy. Heat from a warm bath, hot water bottle, electric heating pad, or chemical or adhesive heat wraps can relax tense muscles and improve blood flow. Increased blood flow brings nutrients and oxygen that muscles need to heal and stay healthy. If the low back is painful due to inflammation, ice or cold packs can be used to reduce swelling. It’s important to protect the skin while applying heat and ice to prevent tissue damage.
<>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.
<>An essential nutrient available in certain foods (such as fortified milk and fish with small bones), vitamin D is produced naturally by the body during exposure to the sun's ultraviolet rays. But since it's difficult to obtain your recommended daily intake of D solely through dietary sources and sun exposure, many medical experts recommend increasing your vitamin D levels by taking a dietary supplement.
<>Activity modification. One variant of resting is to stay active but avoid activities and positions that aggravate the pain. For example, if long periods of sitting in a car or at a desk make the pain worse, then set a timer to get up every 20 minutes and walk around or gently stretch. If standing makes the pain worse, avoid chores that require standing such as washing dishes at the sink. Avoiding, or minimizing, activities and positions that worsen the pain will help prevent or reduce painful back spasms and allow for a better healing environment.
<>People who used an ointment that contains this plant-based extract for 5 days reduced the intensity of lower back pain by 95%, according to a 2009 study conducted by Merck (which manufactures the ointment). In comparison, a placebo group had a 38% reduction in pain during that same time, according to the study in the British Journal of Sports Medicine. Look for comfrey root ointment in health food stores or online. Just don't use it for more than 10 days at a time—it can be toxic.
<>“Opioid medications generally shouldn’t be used as the first, the only or the long-term line of treatment for chronic back pain,” recommends Nava. Many of them are addictive and don’t address the underlying cause of your pain. Opioids should be prescribed only after a thorough exam by a specialist and if other drugs have failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.
<>MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
<>This movement is helpful to stretch tight abdominal muscles and the lower back. Start by lying on your stomach with your legs extended and with palms planted on either side of your head with your forearms and elbows flat on the ground. Slowly, push your body upwards, so your weight is resting on your forearms. Be sure to keep your hips on the ground. Once you reach a comfortable position that gently stretches your abdominal muscles and lower back, hold for 10 seconds. Slowly return to starting position and repeat five times. If you have more flexibility in your lower back, try straightening your arms.
<>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
<>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.”
<>Since you shouldn't try to diagnose your own back pain, make your first call to a professional who can assess your problem, such as a primary care physician or a chiropractor. "Both can serve as the entry point for back pain," says Dr. Matthew Kowalski, a chiropractor with the Osher Clinical Center for Integrative Medicine at Harvard-affiliated Brigham and Women's Hospital. "And 35% to 42% of people with their first episode of back pain will consult a chiropractor."
<>2011 — Updated: Added scientific cases studies, examples, pictures and video of true dislocation and abnormal anatomy to help drive home the point that even significant spinal joint dysfunction can be surprisingly harmless … never mind subtle joint problems. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation, and cracking of the spinal joints.]
<>When you're working to strengthen the core, you'll want to focus on exercises that don't exacerbate lower back issues. "It's important to find out which movements (flexion, extension, rotation) cause pain or discomfort and to avoid those movements, while continuing to work into ranges that are not provoking," Dircksen says. Crockford suggests focusing on exercises that keep the core stable and avoiding twisting movements to avoid exacerbating pain.
<>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.
<>Lose excess weight. As we gain weight, stress and pressure on the lower spine and back muscles increases. The heavy weight at the front of the body can cause an increased arch in the spine and may lead to injury and compression of the discs and nerves. Losing weight reduces the tendency to arch the back and relieves pressure on the lower spine and nerves.
<>One of the most common reasons people develop low back pain is posture. Postural problems, including spinal abnormalities, along with muscular compensations or inactivity put added pressure on the back. Although people of all ages experience low back pain — including both athletes and those who are sedentary — middle-aged to older adults (especially when they’re overweight) are most likely to develop severe symptoms and therefore can benefit from lower back pain relief treatments like chiropractic care, soft tissue therapy and regular exercise.
<>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.
<>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.
<>Practice yoga. Holding downward dog for five to ten seconds can help stretch your back muscles. This motion reduces pressure that can build up in the lower spine and cause pain. Remember to also tilt the pelvis under to avoid any further lower back strain. Pigeon pose is another great posture for backaches. Hip muscles can quickly become tight and shift strain to the back. Stretching out hip flexors and extensors can alleviate back pressure and pain.
<>A Cochrane review of 10 antidepressant and placebo trials showed no difference in pain relief or depression severity.62 The qualitative analyses found conflicting evidence on the effect of antidepressants on pain intensity in chronic low back pain and no clear evidence that antidepressants reduce depression in chronic low-back-pain patients. Two pooled analyses showed no difference in pain relief between different types of antidepressants and placebo. Another systemic review found different results: Antidepressants were more effective than placebo,9 but the effects were not consistent with all antidepressants. Tricyclic antidepressants were moderately more effective than placebo, but paroxetine and trazodone were not.9 Antidepressants were associated with significantly higher risk for adverse events compared with placebo, with drowsiness, dry mouth, dizziness, and constipation the most commonly reported.54 Duloxetine has recently been approved by the Food and Drug Administration for treatment of chronic low back pain and osteoarthritis,63 and evidence suggests effectiveness in chronic low back pain.58,57
<>Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depression, blood clots in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can.
<>Expert opinion guidelines on RTP time frames have been published for lumbar spine conditions.20 Lumbar strains should achieve full range of motion before RTP. Patients with spondylolysis and spondylolisthesis (grade 1) should rest 4 to 6 weeks and then demonstrate full range of motion and pain-free extension before RTP.22 Athletes with herniated lumbar disks should rest 6 to 12 weeks following surgical treatment, while those with spinal fusion should wait 1 year to return to activity.20 Many surgeons advise against return to contact sports following spinal fusion.20 Iwamoto et al32 reviewed conservative and surgical treatments in athletes with lumbar disc herniation and time to return to previous level of sports activity. Seventy-nine percent of conservatively treated athletes returned in an average of 4.7 months, while 85% of those treated with microdiscectomy returned in 5.2 to 5.8 months. Sixty-nine percent of percutaneous discectomies returned in 7 weeks to 12 months.32
<>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.
<>Not Enough Activity: Sedentary people experience the same kind of pain for the opposite reasons. Muscles that go unused become stiff and inflexible. Sitting all day causes tight hip-flexors, poor posture and weak abdominals. When your muscles are limited to the same basic body position day in and day out they do not learn to move safely and freely through different ranges of motions and are injured more easily at sudden movements. In addition, the body is one long kinetic chain. Tight hamstrings or hip flexors turn into tight hips and glutes, which pull on the back and create pain.
<>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.
<>Purchase full access to this tutorial for USD$1995. Continue reading this page immediately after purchase. A second tutorial about muscle pain is included free. See a complete table of contents below. Most content on PainScience.com is free.?Almost everything on this website is free: about 80% of the site by wordcount (well over a million words), or 95% of the bigger pages (>1000 words). This page is only one of 8 big ones that have a price tag. There are also hundreds of free articles, including several about low back pain. But this page goes into extreme detail, and selling access to it keeps the lights on and allows me to publish everything else (without ads).
<>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.
<>Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
<>When you're working to strengthen the core, you'll want to focus on exercises that don't exacerbate lower back issues. "It's important to find out which movements (flexion, extension, rotation) cause pain or discomfort and to avoid those movements, while continuing to work into ranges that are not provoking," Dircksen says. Crockford suggests focusing on exercises that keep the core stable and avoiding twisting movements to avoid exacerbating pain.
<>Research shows that certain forms of magnesium can be effective for pain relief and muscle relaxation, as well as nerve pain. Many people in our society are magnesium deficient, so it may be a good idea to supplement. Magnesium glycinate is known to be a highly bioavailable form. Magnesium citrate can be used by those who tend toward constipation, as it has an additional effect of loosening the bowels.

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