<>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 seated position anatomically means that we don’t engage our abs and glutes, which can result in them switching off and falling asleep. The fall out of this is that other muscles have to work harder to compensate and support the body.  The muscles in our lower backs become overworked while our hip flexor muscles mainly the psoas — that attaches to the femur and lumbar spine — become tight and tense. It’s this imbalance that triggers the pain, especially in our lower back.
<>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.
<>Over-the-counter pain medications. The most common over-the-counter (OTC) medications are aspirin (e.g. Bayer), ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and acetaminophen (e.g. Tylenol). Aspirin, ibuprofen, and naproxen are anti-inflammatory medicines, which alleviate low back pain caused by a swollen nerves or muscles. Acetaminophen works by interfering with pain signals sent to the brain.
<>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
<>Epidural steroid injections. This injection involves a steroid administered directly into the outer part of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy, is used to guide the needle to the correct area. The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.
<>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:
<>If your symptoms persist more than four to six weeks, you have suffered trauma. If your doctor suspects a serious cause behind the back pain, X-rays may be ordered. X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, including disk problems, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
<>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.
<>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.
<>There is no single best exercise for lower back pain, the key is to build up strength in your core and glutes, which often tend to be weak; consequently, the lower back works overtime to compensate. Strengthen your core and relieve your lower back. Below are a selection of the best core and ab workouts that don’t strain your back straight from the 8fit app.
<>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.
<>As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own understanding and perception of their particular situation. British researchers found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
<>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.
<>Steroids: Oral steroids can be of benefit in treating acute sciatica. Steroid injections into the epidural space have not been found to decrease duration of symptoms or improve function and are not currently recommended for the treatment of acute back pain without sciatica. Benefit in chronic pain with sciatica remains controversial. Injections into the posterior joint spaces, the facets, may be beneficial for people with pain associated with sciatica. Trigger point injections have not been proven helpful in acute back pain. Trigger point injections with a steroid and a local anesthetic may be helpful in chronic back pain. Their use remains controversial.
<>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.
<>Paget's disease can be diagnosed on plain X-rays. However, a bone biopsy is occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is helpful to determine the extent of the disease, which can involve more than one bone area. A blood test, alkaline phosphatase, is useful for diagnosis andmonitoring response to therapy. Treatment options include aspirin, other anti-inflammatory medicines, pain medications, and medications that slow therate of bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel), alendronate (Fosamax), risedronate (Actonel), and pamidronate (Aredia).
<>Writers go on and on about how grateful they are for the support they had while writing one measly book, but this website is a much bigger project. PainScience.com was originally created in my so-called “spare time” with a lot of assistance from family and friends. Thanks to my wife for countless indulgences large and small; to my parents for (possibly blind) faith in me, and much copyediting; and to friends and technical mentors Mike, Dirk, Aaron, and Erin for endless useful chats, repeatedly saving my ass, and actually building many of the nifty features of this website.
<>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.
<>Transcutaneous electric nerve stimulation (TENS): TENS provides pulses of electrical stimulation through surface electrodes. For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at one week for TENS but no difference at three months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica.
<>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.
<>Regular updates are a key feature of PainScience.com tutorials. As new science and information becomes available, I upgrade them, and the most recent version is always automatically available to customers. Unlike regular books, and even e-books (which can be obsolete by the time they are published, and can go years between editions) this document is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 134 major and minor updates since I started logging carefully in late 2009 (plus countless minor tweaks and touch-ups).
<>“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.
<>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.
<>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
<>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.
<>No, the lower back pain isn't in your head. But what is in your head could be making it worse. "Fear, anxiety, and catastrophizing can amplify pain," says Mackey. "People often get swept up in thoughts like This will never get better." Because brain circuits that process pain overlap dramatically with circuits involved with emotions, panic can translate into actual pain. Cognitive-behavioral therapy helps you recognize and reframe negative thoughts. Deep breathing can help, too, as can simply shining a light on dark thoughts. "Start by accepting that you have pain," Mackey says. "Then say to yourself, It will get better."
<>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.
<>Most people — and most health care professionals — believe that back pain is usually caused mainly by structural problems, either injury or degeneration of the spine. This idea is not supported by the scientific evidence.25 Indeed, just the opposite is more the case: “The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).”26
<>Adherence to exercise is one of the most important factors for long term pain relief. However, maintaining exercise can be difficult for a variety of reasons, including worsened pain with activity, economic constraints, and low motivation.1 In one study, the most common reason for lack of adherence to exercise was increased pain caused by activity.1 When this is the case, an exercise professional can incorporate pain reduction and management as primary parts of the exercise program.
<>It is also good to stretch out your hip as your hip flexor muscles are very often tight when you have lower back pain. When the hip flexors are tight it can alter your posture leading to what is referred to as ‘donald duck posture’ where your butt sticks out too far. This tightens up your lower back and can lead to lower back pain. To stretch the hip flexors, kneel with one knee on the floor and the other foot in front with the knee bent. Push the hips forward and keep your back upright. Hold the stretch for 20-30 seconds. Repeat two times on each side.
<>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.
<>You know that calcium is key for strong bones, but Japanese researchers have identified something else you need: vitamin K. It’s believed that the vitamin, found in broccoli, spinach, and other dark leafy greens, helps calcium deposit in the bones, making them denser. The stronger your bones, the stronger your whole body—and the lower your chances of an injury that could cause back pain.
<>THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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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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