<>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.
<>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
<>Physician specialties that evaluate and treat low back pain range from generalists to subspecialists.These specialties include emergency medicine physicians, general medicine, family medicine, internal medicine, gynecology, spine surgeons (orthopaedics and neurosurgery), rheumatology, pain management, and physiatry. Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.
<>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!
<>Application of Ice or Heat. Low-quality evidence shows that in the first five days of acute low back pain, the use of heat treatments may be more effective for reducing pain and disability than nonheat wraps, NSAIDs, or acetaminophen, but shows no difference between heat application and McKenzie therapy at seven days.32 A low-quality study found that heat therapy in conjunction with education or NSAIDs is more effective than education or NSAIDs alone at 14 days.33 Ice and heat therapy have similar analgesic effects.32
<>The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low 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.
<>If your back pain hasn't resolved itself within four to six weeks, you'll want to make an appointment with your doctor. Your doc will examine your back and ask you to sit, stand, bend, walk, and lift your legs to see how your pain is affecting your mobility. You'll likely be asked to rate your pain on a scale of one to 10, and you may be sent for imaging tests like an x-ray or MRI. You might be asked to try one of these therapies:
<>One of the new back pain remedies is a muscle stimulation machine. In the past, you would need to visit a chiropractor or physical therapist to receive the benefit of one of these machines, but they now sell them over the counter. However, they are expensive. They make the muscles of the back “twitch,” and this helps to strengthen them. After several sessions with the stimulation machine, your muscles are better able to handle the stress and strain of everyday life again. When a back muscle is hurt, it loses some of its primary strength, and the stimulation machine can restore that to a point. The over-the-counter versions are limited, though, and you may need to see a professional if your back pain persists.
<>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.
<>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
<>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
<>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.
<>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.
<>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.
<>Another muscle which can be tight when you have lower back pain is the piriformis, a muscle in your butt. The stretch below is really effective in stretching this muscle, and very easy to do. To carry out the exercise, lie on your back and cross the right ankle over the left knee. Grip the thigh of your left leg and take a deep breath in. As you breathe out pull the knee in towards you. Hold the stretch for 20-30 seconds. Repeat two times for each side.
<>"Having excess weight pulling on your back all day (except when you're lying down) is just bad news for your back," says Lauri Grossman, DT, a licensed chiropractor in private practice in New York City. "Often times, when people who wrestle with back pain for a lifetime lose a few pounds, they find that the pain that they've taken a million medications for and a million vitamins for just goes away." If you're having trouble shedding extra pounds, consider consulting with a registered dietitian or personal trainer.
<>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
<>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.
<>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.
<>Chronic back pain is straining both physically and emotionally. To manage the frustration, irritability, depression and other psychological aspects of dealing with chronic pain, you may get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi and other cognitive and relaxation strategies to keep your mind from focusing on pain.
<>A 2008 Cochrane review of randomized controlled trials for subacute and chronic low back pain included 18 trials of 1179 participants.59 Studies that compared intradiscal injections, prolotherapy, ozone, sacroiliac joint injections, or epidural steroids for radicular pain were excluded unless injection therapy with another pharmaceutical agent was part of one of the treatment arms. Corticosteroids, local anesthetics, indomethacin, sodium hyaluronate, and B12 were used. Of 18 trials, 10 were rated for high methodological quality. Statistical pooling was not possible because of clinical heterogeneity in the trials yielding no strong evidence for or against the use of injection therapy.59
<>Some people may need prescription-strength NSAIDs or opioid medications to help with pain. It is important to talk to your doctor or pharmacist if you are taking any other medications -- including over-the-counter medicines -- to avoid overdosing on certain active ingredients. Your doctor may also prescribe muscle relaxants to help ease painful muscle spasms.

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These back pain movements really did help me with my chronic back pain.
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