<>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.
<>Aquatic therapy: Aquatic therapy and exercise can also improve flexibility and decrease pain for some people with chronic low back problems. It is especially beneficial for those patients who cannot tolerate land-based physical therapy.This is because the unique properties of water often make it a safe environment for exercising a sore back, providing gentle resistance, comfort, and relaxation. Fear of pain associated with movement is a major limiting factor for rehabilitation and exercises therapy. The support and warmth of the water enables a person to gradually introduce daily exercise into their treatment.
<>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.
<>The presence of any acute nerve dysfunction should also prompt an immediate visit. These would include the inability to walk or inability to raise or lower your foot at the ankle. Also included would be the inability to raise the big toe upward or walk on your heels or stand on your toes. These might indicate an acute nerve injury or compression. Under certain circumstances, this may be an acute neurosurgical emergency.
<>This extremely popular 2017 article on Vox.com the “new science” of low back pain was praised by many because it superficially seems to be very modern and science-y, and it correctly dismisses a number of myths, but I think it’s an exasperating failure. It creates a strong impression of being scientifically rigorous without actually being so. It brims with promising science news about alternative treatments that do not actually stand up to more cynical and experienced analysis. Adding to the façade of scientific credibility, many of the right caveats and disclaimers about the “new science” are technically there — warnings about small effect sizes, mixed evidence, and potential flaws — but these cautions are also belated and consistently understated. The tone is overwhelmingly sunny and naïve, as though we are on the verge of a revolution in back pain treatment thanks to … a bunch of stuff that has been around forever and has clearly not been saving the world from chronic low back pain.
<>Rosenzweig, S., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010, January). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68(1), 29–36. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022399909000944
<>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.
<>Your doctor will first ask you many questions regarding the onset of the pain. (Were you lifting a heavy object and felt an immediate pain? Did the pain come on gradually?) He or she will want to know what makes the pain better or worse. The doctor will ask you questions referring to the red flag symptoms. He or she will ask if you have had the pain before. Your doctor will ask about recent illnesses and associated symptoms such as coughs, fevers, urinary difficulties, or stomach illnesses. In females, the doctor will want to know about vaginal bleeding, cramping, or discharge. Pain from the pelvis, in these cases, is frequently felt in the back.
<>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
<>Music therapy is a low-cost natural therapy that may reduce some of the stress of chronic pain in conjunction with other treatments. Studies find that it may reduce the disability, anxiety, and depression associated with chronic pain. It is thought to help because it can shift attention away from the unpleasant sensations of pain, and it may cause the release of endorphins or changes in catecholamine levels.
<>Articles and information on this website may only be copied, reprinted, or redistributed with written permission (but please ask, we like to give written permission!) The purpose of this Blog is to encourage the free exchange of ideas. The entire contents of this website is based upon the opinions of Dave Asprey, unless otherwise noted. Individual articles are based upon the opinions of the respective authors, who may retain copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the personal research and experience of Dave Asprey and the community. We will attempt to keep all objectionable messages off this site; however, it is impossible to review all messages immediately. All messages expressed on The Bulletproof Forum or the Blog, including comments posted to Blog entries, represent the views of the author exclusively and we are not responsible for the content of any message.
<>This tutorial has been continuously, actively maintained and updated for 14 years now, staying consistent with professional guidelines and the best available science. The first edition was originally published in September 2004, after countless hours of research and writing while I spent a month taking care of a farm (and a beautiful pair of young puppies) in the Okanagan.
<>Imaging is not warranted for most patients with acute low back pain. Without signs and symptoms indicating a serious underlying condition, imaging does not improve clinical outcomes in these patients.9–11 Even with a few weaker red flags, four to six weeks of treatment is appropriate before consideration of imaging studies.8–10 If a serious condition is suspected, magnetic resonance imaging (MRI) is usually most appropriate. Computed tomography is an alternative if MRI is contraindicated or unavailable.10 Clinical correlation of MRI or computed tomography findings is essential because the likelihood of false-positive results increases with age.12–14 Radiography may be helpful to screen for serious conditions, but usually has little diagnostic value because of its low sensitivity and specificity.10
<>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.
<>To relieve pain all over instead of just in one problem area, Dr. Mark Liponis, the chief medical officer at Canyon Ranch in Tucson, Arizona, recommended an inversion table that provides massage. While it may be expensive for some, he said it could be worth it for managing a chronic pain issue. "Over time can help relieve chronic neck and back pain,” Liponis added.
<>2010 — Upgraded: Section now includes discussion of that bizarre and already infamous paper in the New England Journal of Medicine (see Berman). I also make an important new point: exactly why acupuncture placebos are such a problem for low back pain patients in particular. [Section: The fascinating case of acupuncture, formerly a contender in low back pain therapy, but which has now miserably failed well-designed scientific tests.]
<>2010 — Updated: Added a very beefy footnote about some new research showing that muscle imbalance does not result in higher rates of injury. This almost should have been a new section, but I decided to just make it a ginormous footnote — footnotes are there for delving if you want to, that’s the idea! You can read a summary of the research in the bibliography (see Hides et al), but the relevance to back pain is spelled out in detail here. And it’s interesting. [Section: Diagnosis: Your low back is not fragile!]
<>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.
<>2010 — Like new: Rewritten. I’ve lost track and can’t be bothered to go back into the archives to figure it out for sure, but I think that this section was brand new (but never announced) late in 2009, and then this past week I gave it a substantial upgrade: it is now one of the best-referenced chapters in the book, and it says as much as probably needs to be said on the subject — or more! [Section: Core strengthening has failed to live up to the hopes and dreams of therapists and patients.]
<>Paget's disease of the bone is a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget's disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.
<>Bed Rest. Bed rest should not be recommended for patients with nonspecific acute low back pain. Moderate-quality evidence suggests that bed rest is less effective at reducing pain and improving function at three to 12 weeks than advice to stay active.46 Prolonged bed rest can also cause adverse effects such as joint stiffness, muscle wasting, loss of bone mineral density, pressure ulcers, and venous thromboembolism.37
<>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
<>Stretching. Almost everyone can benefit from stretching muscles in the low back, buttocks, hips, and legs (especially the hamstring muscles). These muscles support the weight of the upper body. The more mobile these muscles are the more the back can move without injury. It is typically advised to start small—stretch for 20 to 30 seconds and stop a stretch if it causes pain.
<>Clearly, stretching works as an effective back pain treatment (and offers a more natural pain relief solution than other common pain interventions, like prescription painkillers or surgery). But why is stretching so effective? Which back pain stretches should you be doing to maximize results? And what are the best ways to incorporate back pain exercises into your daily routine to strengthen your core and keep pain at bay?
<>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.

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