<>Endorphins are hormones made naturally in your body. What most people don't know is that they can be just as strong as any manufactured pain medication. When endorphins are released in your body, they help block pain signals from registering with your brain. Endorphins also help alleviate anxiety, stress, and depression, which are all associated with chronic back pain and often make the pain worse.
<>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.
<>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
<>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.
<>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.
<>Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered, and is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
<>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.
<>An accurate history and physical examination are essential for evaluating acute low back pain. Often, patients awaken with morning pain or develop pain after minor forward bending, twisting, or lifting. It is also important to note whether it is a first episode or a recurrent episode. Recurrent episodes usually are more painful with increased symptoms. Red flags are often used to distinguish a common, benign episode from a more significant problem that requires urgent workup and treatment (Table 2).5,6,8 A recent study shows that some red flags are more important than others, and that red flags overall are poor at ruling in more serious causes of low back pain.8 Patients with back pain in the primary care setting (80 percent) tend to have one or more red flags, but rarely have a serious condition.8  However, physicians should be aware of the signs and symptoms of cauda equina syndrome, major intra-abdominal pathology, infections, malignancy, and fractures (Tables 15,6  and 25,6,8). Cauda equina syndrome and infections require immediate referral. Family physicians should rely on a comprehensive clinical approach rather than solely on a checklist of red flags.
<>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.
<>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
<>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.
<>Save a bundle on a bundle! The boxed set is a 50% discounted bundle of all 8 book-length tutorials for sale on this website, about 8 different common injuries and pain problems. It’s ideal for professionals, keen patients, and anyone who wants more for less. Purchased individually, all the tutorials would cost $160, but the set price is only $79.50. More information and purchase options.
<>This stretch is designed to help lengthen the piriformis muscle over time. This muscle is often the source of sciatica, or radiating leg pain. Sitting with a straight back, cross your left leg over your right leg placing your foot next to your thigh and tuck your right leg in towards your buttocks. Place your right arm on your leg as pictured and slowly ease into a stretch. Be sure to keep your back straight and chest lifted. Hold for 20 seconds and alternative sides, three times.
<>“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.
<>Three systemic reviews3,6,13 analyzed spinal manipulation therapy (SMT) for low back pain, including (1) high-velocity, low-amplitude manipulation of the spinal joints slightly beyond their passive range of motion; (2) high-velocity, low-amplitude technique rotating the thigh and leg; (3) mobilization within passive range of motion; and (4) instrument-based manipulations. There is moderate evidence of short-term pain relief with acute low back pain treated with SMT.6 Chronic low back pain showed moderate improvement with SMT, which is as effective as NSAIDs and more effective than physical therapy in the long term.6 Patients with mixed acute and chronic low back pain had better pain outcomes in the short and long terms compared with McKenzie therapy, medical care, management by physical therapists, soft tissue treatment, and back school.6 SMT was more effective in reducing pain and improving daily activities when compared with sham therapy.3 Dagenais13 found SMT effective in pain reduction in the short-, intermediate-, and long-term management of acute low back pain. However, a Cochrane review in 2004 on SMT in acute and chronic low back pain concluded that there was no difference in pain reduction or ability to perform daily activities with SMT or standard treatments (medications, physical therapy, exercises, back school, or the care of a general practitioner).3
<>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.
<>Low-impact aerobics. Low-impact aerobic exercise increases the flow of blood and supports healing from an injury without jarring the spine. Low-impact aerobics can include using stationary bikes, elliptical or step machines, walking, and water therapy. People with low back pain who regularly do aerobic exercise report fewer recurring pain episodes and are more likely to stay active and functional when pain flares.
<>**Please get an accurate diagnosis of your back pain.  If you want to know WHAT is causing your back pain we are experts at explaining what is causing your pain based on a thorough movement examination.  Then we can explain what exercises will help and what will make it worse!  We can help guide you with how to get in and out of bed and how to move around without making your back pain worse.    If you want peace of mind of what is causing the pain and what you can do about it we would love to help!
<>A definitive diagnosis is the first step in obtaining lasting relief from your back pain. When you arrive at our NYC office for your appointment, Dr. Stieber will begin by examining your back and collecting detailed information about your symptoms. From there, he will ask you to sit, stand, walk and lift your legs, all while rating your pain on a scale of zero to ten. This portion of the examination is critical in identifying the severity and origin of the pain.
<>Aquatic therapy is essentially physical therapy in a pool. Instead of using weights for resistance, patients use the resistance of the water. Studies show it may help alleviate lower back pain. In one 2013 study, sedentary adults who underwent aquatic therapy five times a week for two months saw reductions in pain and increases in quality of life. One smaller study found that aquatic therapy also helped pregnant women who were experiencing aching lower backs.
<>Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered, and is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
<>Conventional treatments such as NSAIDs, heat and ice, and stretching will be enough for most people—but not everyone. “If you’ve exhausted various conservative treatment options and have been in chronic pain for several months, you may be a candidate for minimally invasive spine surgery,” says Koser. There’s no reason to suffer—and you may not have to consider traditional open spine surgery at all. Minimally invasive procedures use an incision of less than one inch and require little downtime. “The muscles are spared during the procedure and are gently spaced apart, rather than being cut or torn away during traditional open spine surgery,” Koser says.
<>Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
<>A physical therapist will teach you stretches to manage your back pain, as well as exercises to correct any imbalances that might have brought on pain in the first place. Depending on the causes and severity of your back pain, your PT may also employ other treatment techniques, such as ultrasound, electrical stimulation, and active release therapy.
<>2009 — New section: Today I found a way to say some simple things about the power of self-treatment that have been “on the tip of my tongue” for years now. It all evolved from writing about an important bit of research, showing that manual therapists cannot (reliably) diagnose trigger points. [Section: Limitations of trigger point therapy, and how to take advantage of them.]
<>Doctors used to prescribe bed rest for back pain. But now we know that lying still is one of the worst things you can do. It can make back pain worse and lead to other complications. Don't rest for more than a day or two. It's important to get up and slowly start moving again. Exercise has been found to be one of the most effective ways to relieve back pain quickly. Try swimming, walking, or yoga.

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