<>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.
<>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
<>I apply a MythBusters approach to health care (without explosives): I have fun questioning everything. I don’t claim to have The Answer for low back pain. When I don’t know, I admit it. I read scientific journals, I explain the science behind key points (there are more than 460 footnotes here, drawn from a huge bibliography), and I always link to my sources.
<>Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT, associate professor of Physical Therapy at the University of Maryland School of Medicine. "Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes," she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice -- take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.
<>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.
<>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.
<>A neurologist, a doctor specializing in treatment of the nervous system. "Back pain is commonly associated with lower-extremity symptoms, such as numbness and tingling. These symptoms can also be caused by neurological conditions that are not spine-related, such as multiple sclerosis. Neurologists are great at sorting this out and offering solutions," says Dr. Kowalski.
<>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.
<>Mobilising your lower back is important to aid it’s recovery. The bird dog exercise is shown in the image below and is great for mobilising the lower back. To carry out this exercise get onto all fours, make sure your hands are directly under your shoulders, and knees directly under your hips. Your spine is in a neutral position and you need to keep your head in line with your spine. Take a deep breath in and as you breathe out extend one leg and the opposite arm to inline with your spine. You need to keep your spine in a neutral position at all times, so don’t let your lower back sag down. Hold for 5-10 seconds and as you breathe out lower both your leg and arm to the ground. Repeat this exercise eight to twelve times alternating sides.
<>Few people need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn't responded to other therapy.
<>A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. During the physical exam, you may be asked to lift your leg while lying on your back — shooting pain down the back of your leg while in this position is a common sign of sciatica. Your doctor will also check the strength and reflexes in your leg.
<>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
<>Start in a high plank position with shoulders directly over wrists and tops of feet resting on a stability ball. Your body should form a straight line from head to ankles. Without bending your knees, roll the ball toward your chest by raising your hips as high as you can toward the ceiling. Pause, then lower hips as you roll the ball back to the starting position. Perform 15 reps.
<>Stretching your lower back is going to be really helpful in alleviating your lower back pain. Kneel on all fours, with your knees directly under your hips and hands directly under your shoulders. Ensure your spine is in a neutral position. Keep your head in line with your spine, your shoulders back and avoid locking your elbows. Take a big deep breath in and as you breathe out slowly take your bottom backwards towards your heels. Hold the stretch for 20-30 seconds. As you breathe in bring your body up onto all fours again. Repeat six to eight times.
<>"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.
<>I accept Visa, Mastercard, and American Express. Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. Note that my small business does not handle your credit card info: it goes straight to the payment processor (Stripe). You can also pay with PayPal: for more information, click the PayPal button just below. CURRENCY ?
<>Chiropractors use posture exercises and hands-on spinal manipulation to relieve back pain, improve function, and help the body heal itself. They often work in conjunction with other doctors, and they can prescribe diet, exercise, and stretching programs. "A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor," Dr. Kowalski explains.
<>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.
<>“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.
<>It may be tempting to quit exercising when you're suffering from back pain, but it's essential to keep yourself moving. Pilates is one great option. In a 2014 European Journal of Physical Rehabilitation Medicine study, researchers found an improvement in pain, disability, and psychological health in chronic low-back pain patients who took five hourlong Pilates classes a week for six months. Meanwhile, people who remained inactive experienced further worsening of their pain. Similarly, a Medicine and Science in Sport and Exercise study revealed that taking either Pilates or a general exercise class twice a week for six weeks both improved pain and quality of life.
<>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!
<>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
<>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.
<>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.
<>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.
<>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.
<>A common culprit in lower back pain due to sitting are tight or shortened hip flexors, which connect to your iliopsoas muscle, and often result in weak or compromised lower back and glute muscles. The following effective static stretches will help stretch out those muscles and deliver lower back relief. Regular practice of these stretches will also aid in bettering your posture long term.
<>Mobilising your lower back is important to aid it’s recovery. The bird dog exercise is shown in the image below and is great for mobilising the lower back. To carry out this exercise get onto all fours, make sure your hands are directly under your shoulders, and knees directly under your hips. Your spine is in a neutral position and you need to keep your head in line with your spine. Take a deep breath in and as you breathe out extend one leg and the opposite arm to inline with your spine. You need to keep your spine in a neutral position at all times, so don’t let your lower back sag down. Hold for 5-10 seconds and as you breathe out lower both your leg and arm to the ground. Repeat this exercise eight to twelve times alternating sides.
<>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.
<>Bleeding in the pelvis is rare without significant trauma and is usually seen in patients who are taking blood-thinning medications, such as warfarin (Coumadin). In these patients, a rapid-onset sciatica pain can be a sign of bleeding in the back of the pelvis and abdomen that is compressing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is infrequent but can be a complication of conditions such as diverticulosis, Crohn's disease, ulcerative colitis, pelvic inflammatory disease with infection of the Fallopian tubes or uterus, and even appendicitis. Pelvic infection is a serious complication of these conditions and is often associated with fever, lowering of blood pressure, and a life-threatening state.
<>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.
<>Free second tutorial! When you buy this tutorial, you will also get Save Yourself from Trigger Points and Myofascial Pain Syndrome! — a $1995 value. The low back pain tutorial makes the case that trigger points are a major factor in low back pain. However, trigger point therapy is not an easy skill to master — and it’s an enormous subject. PainScience.com publishes a separate tutorial about trigger point therapy. It’s offered as a free, essential companion to the low back pain tutorial. As a pair, they give you everything you need to know about helping most cases of low back pain.
<>Turns out that the committees that write these things do not necessarily know the science! One of the best reviews of back pain research ever published — Machado 2009, more on this one later — found something really interesting: “treatment recommendations from recent clinical guidelines do not align with the results of this meta-analysis.” In fact, quite a few disproven pain treatments are still cheerfully recommended in otherwise sensible professional guidelines. Eek. BACK TO TEXT
<>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).
<>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.
<>Veritas Health publishes original and accessible health related content written by more than 100 physician authors and peer-reviewed by a 16 member Medical Advisory Board. The Veritas Health platform comprising of Spine-health.com, Arthritis-health.com, Sports-health.com, and Pain-health.com, provides comprehensive information on back pain, arthritis, sports injuries, and chronic pain conditions. For more information visit Veritashealth.com.
<>Use capsaicin cream. Capsaicin is a substance found in chili peppers. When used medicinally it helps reduces the amount of substance P, a neurotransmitter that leads to pain impulses in the brain. One study showed that after 3 weeks of capsaicin use, patients had a significant reduction in pain. To use: apply topically, at least twice per day, for maximum relief. The warm sensation also allows you to stretch and move without pain.
<>Even more tragic is that good information exists, and not just here in this book: many medical experts do “get it” (the doctors doing the actual research). But they have fought a long battle trying to spread the word to their own medical colleagues on the front lines of health care. A 2010 report in Archives of Internal Medicine showed just how grim it is:
<>Physical therapists often recommend aquatic therapy — including exercises done in warm, therapeutic pools — for back pain. The buoyancy of the water helps alleviate strain on the joints to encourage strengthening and gentle stretching of the muscles. Even floating in warm water can help relax muscles and release tension as well as increase circulation, according to the Arthritis Foundation. With home whirlpool baths, try aiming the jets directly at your sore spots for a soothing underwater massage.
<>Get some exercise. You may be tempted to stay in bed when your back acts up, but exercise and activity can actually help you heal faster and reduce pain. A study of 240 men and women found that regular exercise reduced pain by 28 percent and disability by 36 percent. Low impact, moderate intensity exercise is the safest option. Avoid movements that trigger pain or require excessive jumping or squatting, which can exacerbate injuries. Take two to three minutes at the end of your workout to stretch your back thoroughly. Lie flat on your back and hug your knees to release any tension that developed during your workout.
<>Model Zach Job is a New-York based artist and producer who is also an up-and-coming drag queen known as "Glow Job." Zach has aspirations to join a circus and thus has some training in gymnastics, silks/wall running, parkour, boxing, dance, and acro-yoga. He also swings kettlebells at New York's Mark Fisher Fitness, climbs rocks at Brooklyn Boulders, bicycles 10-20 miles every day, and plays competitive dodgeball.
<>Well said, but perhaps a bit wordy. Here’s the simple version: patients believe back pain is caused by structural fragility, and careers are built on catering to that belief. I would also say that it is difficult to alter that belief in anyone, patient or professional. This preoccupation with fragility isn’t just reinforced by the practices of many therapists, it’s a major reason for them.
<>Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
<>There are numerous reasons why you may be saddled with lower back pain, says Melanie Strassberg, PT, DPT, clinical director of Professional Physical Therapy in New Rochelle, New York: Muscle strains and spasms, a herniated disc, degenerative disc disease, spinal stenosis, and osteoarthritis are just a handful. Given the wide range of causes, your doctor will need to uncover the source during a medical examination before you can find the best lower back pain relief. These are 10 other common reasons your back is hurting.
<>After reviewing data regarding various treatments for lower back pain, the Agency for Health Care Research and Quality concluded that those suffering from back pain should first try conservative/natural treatments and then consider other options for lower back pain relief if pain persists. Oftentimes low back pain sufferers can find relief naturally by making changes to their lifestyles (including sleep, physical activity, stress and body weight) before choosing more intensive care options.
<>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.
<>Exercise methods: The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help you become more aware of your movements and may help relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is also good for stress reduction and can help with the psychological aspects of pain. Core exercises strengthen the muscles that support the back and help reduce pain. These non-medical and conservative therapies empower patients. This empowerment with a self-help plan may reduce feelings of helplessness and pain separate from any effect on body tissues and structures. More research is needed to see how these exercise techniques affect back pain.
<>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

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