<>Clinical examination and diagnostic skills are essential in the workup of low back pain. Athletes with neurologic compromise, fever, chills, or incontinence of bowel or bladder function or those with mechanism of action that could result in fracture or other serious injuries must first be evaluated for emergent causes. Workup and diagnosis must be individualized on the basis of differential diagnosis.
<>A 2008 study published in the journal Spine found "strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy" for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found "moderate evidence that acupuncture is more effective than no treatment" in relief of back pain.
<>“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.
<>Can stomach problems cause lower back pain? The back is a sensitive part of the body, which has many nerves and organs nearby. This means that issues such as digestive conditions can occur at the same time as back pain. Back pain and bloating are common symptoms of injury, pregnancy, or gastrointestinal problems. Treatment depends on the cause. Learn more here. Read now
<>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?
<>The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication or have a medical condition.
<>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.
<>The McKenzie method45 uses clinical examination to separate patients with low back pain into subgroups (postural, dysfunction, and derangement) to determine appropriate treatment. The goal is symptom relief through individualized treatment by the patient at home. The McKenzie method is not exclusively extension exercises; it emphasizes patient education to decrease pain quickly, restore function, minimize the number of visits to the clinic, and prevent recurrences.45 Two systemic reviews have compared the McKenzie method with different conclusions.11,43 Clare et al11 concluded that McKenzie therapy resulted in decreased short-term (less than 3 months) pain and disability when compared with NSAIDs, educational booklet, back massage with back care advice, strength training with therapist supervision, and spinal mobilization. Machado et al43 concluded that the McKenzie method does not produce clinically worthwhile changes in pain and disability when compared with passive therapy and advice to stay active for acute LBP.
<>While it’s true that some lower back pain just cannot be fixed, it’s also true that many “incurable” cases do turn out to be surprisingly treatable. People who believed for years that their pain was invincible have found relief. Not always, and often not completely — but sometimes any relief is far better than nothing. How can extremely stubborn pain finally ease up? Simple: because many cases weren’t truly stubborn to begin with, despite all appearances. So many health professionals are poorly prepared to treat low back pain that patients can easily go for months or even years without once getting good care and advice. When they finally get it, it’s hardly surprising that some patients finally get some relief from their pain.
<>An essential nutrient available in certain foods (such as fortified milk and fish with small bones), vitamin D is produced naturally by the body during exposure to the sun's ultraviolet rays. But since it's difficult to obtain your recommended daily intake of D solely through dietary sources and sun exposure, many medical experts recommend increasing your vitamin D levels by taking a dietary supplement.
<>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.
<>Situated between the bones of the spine, intervertebral disks act as cushions and shock absorbers. If they become damaged and start to bulge out between the bones of your lower back (a condition known as a slipped or herniated disk), they can press on your sciatic nerve roots and cause sciatica. Herniated disks are the most common cause of sciatica, according to the American Academy of Orthopaedic Surgeons.
<>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.
<>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
<>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
<>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.
<>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.
<>Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that ask your doctor about controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can help prevent further back injury by learning - and doing - gentle stretching exercises and proper lifting techniques, and maintaining good posture.
<>Patient Education. Patient education involves a discussion of the often benign nature of acute back pain and reassurance that most patients need little intervention for significant improvement. Patients should be advised to stay as active as possible, within pain limits; to avoid twisting and bending, particularly when lifting; and to return to normal activities as soon as possible. The goal is to reduce worry about back pain and to teach ways to avoid worsening of pain or pain recurrence.
<>Sports that have higher rates of back pain include gymnastics, diving, weight lifting, golf, American football, and rowing.61 In gymnastics, the incidence of back injuries is 11%. In football linemen, it may be as high as 50%.18 Ninety percent of all injuries of professional golfers involve the neck or back.19 Injury rates for 15- and 16-year-old girls in gymnastics, dance, or gym training are higher than the general population, while cross-country skiing and aerobics are associated with a lower prevalence of low back pain.4 For boys, volleyball, gymnastics, weight lifting, downhill skiing, and snowboarding are associated with higher prevalence of low back pain, while cross-country skiing and aerobics show a lower prevalence.
<>It’s estimated that up to 80 percent of adults experience persistent symptoms of lower back pain at some point in their lives, and about 31 million Americans struggle with the condition at any given time. Given its extremely high prevalence rate — whether due to a weak psoas muscle, sciatic nerve pain or some other cause — it’s not surprising that lower back pain is considered the single leading cause of disability worldwide according to the American Chiropractic Association, with half of all American workers reporting having occasional back troubles each year. (1) Naturally, this leads to millions searching for lower back pain relief.
<>There is strong scientific support for the effectiveness of Alexander Technique lessons in the treatment of chronic back pain, according to a research review published in the International Journal of Clinical Practice in 2012. The review included one well-designed, well-conducted clinical trial demonstrating that Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. These results were broadly supported by a smaller, earlier clinical trial testing the use of Alexander Technique lessons in the treatment of chronic back pain.
<>There are no systemic reviews for ultrasound.10 One small nonrandomized trial48 for patients with acute sciatica found ultrasonography superior to sham ultrasonography or analgesics for relief of pain. All patients were prescribed bed rest. For patients with chronic back pain, the small trials were contradictory to whether ultrasonography was any better than sham ultrasonography.2,52
<>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.
<>Sitting at a desk for eight (or more) hours a day can really do a number on your back. Make sure to sit with your back against your chair (get a lumbar pillow if you chair doesn’t allow this) and both feet flat on the floor. Another option: Try using a stability ball as your desk chair like many Health staffers do—good posture is a must just to stay on the thing. Start off slow (20 minutes at a time), and if it feels good, stick with it.
<>Stretch. Don't sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. "Because most of us spend a lot of time bending forward in our jobs, it's important to stand up and stretch backward throughout the day," Reicherter says. Don't forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.
<>Most of us spend a good part of our day sitting down, which may be more harmful than you realize. You can minimize the impact by maintaining good posture. Correct posture in a chair means having all the bones in your spine lined up neatly, like a stack of perfectly aligned blocks. You should keep your feet flat on the floor and your computer keyboard within easy reach so you’re not leaning forward or slumping. This is part of proper office ergonomics.
<>MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
<>Acupuncture: Acupuncture may provide even more relief than painkillers, according to one 2013 review. In 11 studies of more than 1,100 people, this Chinese medicine staple improved symptoms of lower back pain better than simulated treatments and, yes, in some cases, NSAIDs. The needles appear to change the way your nerves react and may reduce inflammation around joints (which is only one of the therapy's benefits), says DeStefano.
<>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.
<>To diagnose back pain -- unless you are totally immobilized from a back injury -- your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort. Sometimes blood and urine tests are performed to make sure that the back pain is not caused by an infection or other more widespread medical problem.
<>Sometimes, however, the conditions that cause acute back pain can lead to more chronic and serious problems. Clues to a different and more serious cause include: persistent pain, pain and numbness that radiate down both the legs, bothersome pain at night plus fever, weight loss and swelling of the joints. If you experience any of these, it's important you consult a doctor who can examine you carefully, X-ray your back and perform some lab tests. Possible causes of pain in these cases could include ankylosing spondylitis or an infection or tumor of the spine.
<>Lower back pain may be debilitating at times, but there is some good news. “Most mild or acute lower back pain will dissipate with time and conservative treatment,” Koser says. One proven option is chiropractic care—the doctor can evaluate your spine and joints, and then offer treatments such as chiropractic manipulations of the spine, electric stimulation to decrease inflammation, and manual therapies to quell muscle tension, explains Koser.
<>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.
<>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.
<>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.
<>Special thanks to some professionals and experts who have been particularly inspiring and/or directly supportive: Dr. Rob Tarzwell, Dr. Steven Novella, Dr. David Gorski, Sam Homola, DC, Dr. Harriet Hall, Dr. Stephen Barrett, Dr. Greg Lehman, Dr. Jason Silvernail, Todd Hargrove, Nick Ng, Alice Sanvito, Dr. Chris Moyer, Dr. Brian James, Bodhi Haraldsson, Diane Jacobs, Adam Meakins, Sol Orwell, Laura Allen, Dr. Ravensara Travillian, Dr. Neil O’Connell, Tony Ingram, Dr. Jim Eubanks … oh dear, there’s so many more still …
<>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.
<>The Agency for Healthcare Research and Quality has identified 11 red flags that doctors look for when evaluating a person with back pain. The focus of these red flags is to detect fractures (broken bones), infections, or tumors of the spine. Presence of any of the following red flags associated with low back pain should prompt a visit to your doctor as soon as possible for complete evaluation.
<>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.
<>Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure (impingement) by bone or other tissues, or from disease, anywhere along their paths -- from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See descriptions of these conditions below.
<>You don’t need to take my word for anything — you can just take the word of the many low back pain medical experts that I quote,12 and the hard evidence that their opinions are based on. At the same time, I am realistic about the limits of the science, much of which is pretty junky.13 My own credentials are somewhat beside the point. My decade of professional experience as a Registered Massage Therapist does help me understand and write about low back pain, but what really matters is that I refer to and explain recent scientific evidence, but without blindly trusting it.
<>You don’t need to take my word for anything — you can just take the word of the many low back pain medical experts that I quote,12 and the hard evidence that their opinions are based on. At the same time, I am realistic about the limits of the science, much of which is pretty junky.13 My own credentials are somewhat beside the point. My decade of professional experience as a Registered Massage Therapist does help me understand and write about low back pain, but what really matters is that I refer to and explain recent scientific evidence, but without blindly trusting it.
<>Use this movement to stretch the paraspinal muscles and strengthen the abdominal muscles. Lie on your back with your legs extended straight out. Bend the right knee up and cross it over the left side of your body. Hold in a position that allows you to feel a gentle stretch through the back and buttocks muscles for 20 seconds. Tighten your core muscles and rotate back to center. Repeat three times on each side.
<>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.
<>Medication: If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or NSAIDs -- such as ketoprofen, ibuprofen (Advil, Motrin), and naproxen (Aleve) -- can be helpful. For severe pain, your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe a short-term combination of opioid (narcotic) and acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, some of these medications have a direct effect on the brain and often cause drowsiness.
<>A 2008 study published in the journal Spine found "strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy" for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found "moderate evidence that acupuncture is more effective than no treatment" in relief of back pain.

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