<>Pain in the lower back or low back pain is a common concern, affecting up to 80% of Americans at some point in their lifetime. Many will have more than one episode. Low back pain is not a specific disease, rather it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified.
<>To improve your workstation, position your computer monitor at eye level, at least 20 inches away from your face. Invest in a comfortable chair with armrests and good lower back support. Keep your head and neck in line with your torso, your shoulders relaxed. While you work, keep elbows close to your body, and your forearms and wrists parallel to the floor.
<>Long periods of inactivity in bed are no longer recommended, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.
<>Injury to the bones and joints: Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.
<>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!]
<>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.
<>2011 — Major update: Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
<>If you've ever groaned, "Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.
<>Another way to get lower back pain relief is to hook up with an expert in physical therapy, who will guide you in safe exercises that can strengthen and stretch the muscles. “This will prevent symptoms from worsening and further damage to the spine,” says Strassberg. She says that PTs address symptoms and target the underlying cause so that you can prevent future discomfort.
<>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.
<>Keep moving. "Our spines are like the rest of our body -- they're meant to move," says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you're feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you -- and your back -- more mobile. Just don't overdo it. There's no need to run a marathon when your back is sore.
<>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.
<>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.
<>In some cases, it’s difficult to pinpoint the cause of chronic back pain. “If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist,” recommends Nava. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse, warns Nava.
<>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.]
<>Low back pain is the fifth most common reason for all physician visits in the United States.17,29 Approximately one quarter of US adults report having low back pain lasting at least 1 whole day in the past 3 months,17 and 7.6% report at least 1 episode of severe acute low back pain within a 1-year period.8 The prevalence rates of low back pain in athletes range from 1% to 40%.5 Back injuries in the young athlete are a common phenomenon, occurring in 10% to 15% of participants.18 It is not clear if athletes experience low back pain more often than the general population. Comparisons of wrestlers,27 gymnasts,60 and adolescent athletes40 have found back pain more common versus age-matched controls. Other comparisons of athletes and nonathletes have found lower rates of low back pain in athletes than nonathletes.67
<>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.
<>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.
<>Kneeling Lunge Stretch. Starting on both knees, move one leg forward so the foot is flat on the ground, keeping weight evenly distributed through both hips (rather than on one side or the other). Place both hands on the top of the thigh, and gently lean the body forward to feel a stretch in the front of the other leg. This stretch affects the hip flexor muscles, which attach to the pelvis and can impact posture if too tight.
<>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.
<>Despite the high prevalence of low back pain and the significant burden to the athletes, there are few clearly superior treatment modalities. Superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies. Nonsteroidal anti-inflammatory medications and skeletal muscle relaxants have benefit in the initial management of low back pain; however, both have considerable side effects that must be considered. Athletes can return to play once they have recovered full range of motion and have the strength to prevent further injury.
<>While a PT can guide you through exercises to strengthen lower back muscles, you can take matters into your own hands by regularly stretching at home. For lower back pain relief, Strassberg says, a PT may recommend a few moves: hamstring stretch, piriformis stretch, and lower trunk rotation. Pelvic tilts and “clams” are other good targeted exercises. No luck? These are the surprising reasons your lower back pain treatment isn’t working.
<>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.
<>COX-2 inhibitors, such as celecoxib (Celebrex), are more selective members of NSAIDs. Although increased cost can be a negative factor, the incidence of costly and potentially fatal bleeding in the gastrointestinal tract is clearly less with COX-2 inhibitors than with traditional NSAIDs. Long-term safety (possible increased risk for heart attack or stroke) is currently being evaluated for COX-2 inhibitors and NSAIDs.
<>Kneeling Lunge Stretch. Starting on both knees, move one leg forward so the foot is flat on the ground, keeping weight evenly distributed through both hips (rather than on one side or the other). Place both hands on the top of the thigh, and gently lean the body forward to feel a stretch in the front of the other leg. This stretch affects the hip flexor muscles, which attach to the pelvis and can impact posture if too tight.
<>The available science includes a 2011 study published in Arthritis Care & Research, which found that a 10-week tai chi program reduced pain and improved functioning in people with long-term low back pain symptoms. The study involved 160 adults with chronic low back pain, half of whom participated in 40-minute-long tai chi sessions 18 times over the 10-week period.
<>Home care is recommended for the initial treatment of low back pain. Bed rest remains of unproven value, and most experts recommend no more than two days of bed rest or decreased activity. Some people with sciatica may benefit from two to fours days of rest. Application of local ice and heat provide relief for some people and should be tried. Acetaminophen and ibuprofen are useful for controlling pain.
<>I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about me • more about PainScience.com
<>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.
<>Low back pain is the fifth most common reason for all physician visits in the United States.17,29 Approximately one quarter of US adults report having low back pain lasting at least 1 whole day in the past 3 months,17 and 7.6% report at least 1 episode of severe acute low back pain within a 1-year period.8 The prevalence rates of low back pain in athletes range from 1% to 40%.5 Back injuries in the young athlete are a common phenomenon, occurring in 10% to 15% of participants.18 It is not clear if athletes experience low back pain more often than the general population. Comparisons of wrestlers,27 gymnasts,60 and adolescent athletes40 have found back pain more common versus age-matched controls. Other comparisons of athletes and nonathletes have found lower rates of low back pain in athletes than nonathletes.67
<>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.
<>There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
<>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.
<>"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.
<>Too Much of an Activity: For the active person, chronic back pain can come from repetitive pounding on the spine as in running, jumping or other high impact activities. Think of the “wear and tear” that happens on cars or appliances—the same holds true for our bodies. It can also be from repetitive twisting and turn as in swinging a golf club or a tennis racket. There are endless things that cause wear and tear on the back.
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<>Most back pain can be successfully treated without surgery. If conservative back pain treatment fails, or if you have difficulty standing or walking, you may be a candidate for surgery. Dr. Stieber is a leader in the use of minimally-invasive surgical techniques with advanced expertise in restoring mobility to the back and helping his New York patients return to activity and an improved quality of life.
<>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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