<>Opioids are commonly prescribed for patients with severe acute low back pain; however, there is little evidence of benefit. Three studies showed no difference in pain relief or time to return to work between oral opioids and NSAIDs or acetaminophen, and there is risk of harmful dose escalation over time with opioids, especially with purer formulations.16,21 Although epidural steroid injections are not beneficial for isolated acute low back pain, they may be helpful for radicular pain that does not respond to two to six weeks of noninvasive treatment. Transforaminal injections appear to have more favorable short- and long-term benefit than traditional interlaminar injections.22
<>Battié MC, Videman T, Kaprio J, et al. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009;9(1):47–59. PubMed #19111259. “The once commonly held view that disc degeneration is primarily a result of aging and wear and tear from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences. Although environmental factors also play a role, it is not primarily through routine physical loading exposures (eg, heavy vs. light physical demands) as once suspected.” BACK TO TEXT
<>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.
<>When structural problems are exaggerated, you also get a plague of bogus explanations and solutions based on that. Spines do degenerate, but not for the reasons most people think they do: genetics is by far the biggest factor in degeneration,27 not your posture, your office chair or mattress, your core stability, or anything else that low back pain sufferers have taught to blame their pain on.
<>Narcotic pain medications. Narcotic medications, also called opioids or painkillers, alter one’s perception of pain by weakening signals sent to the brain. Narcotic medications are most often used for treating intense, short-term pain, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can easily become addictive.
<>Is “much” information really “just plain wrong”? I will establish this in the sections ahead with a steady supply of clearly explained references to the medical literature that patients can understand and professionals can respect. This extra layer of information in easy-to-use footnotes is available for any reader who wants to dig deeper and check my facts. For example, here’s a good start: In 2010, the Journal of Bone & Joint Surgery reported that “the quality and content of health information on the internet is highly variable for common sports medicine topics,” such as knee pain and low back pain — a bit of an understatement, really. Expert reviewers examined about 75 top-ranked commercial websites and another 30 academic sites. They gave each a quality score on a scale of 100. The average score? Barely over 50! For more detail, see Starman et al. BACK TO TEXT
<>Learning to keep your cool is as good for your back as it is for your mental health. When you're anxious, your body sets off the "fight or flight" response, which involves tensing your muscles so you're ready to spring into action. One European study revealed that people prone to negative thoughts and anxiety are more likely to suffer from back pain. Get calm now with these stress-busting solutions.
<>Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These changes in the disc and the joints produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.
<>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.
<>A recent double-blind randomized placebo-controlled study of 546 patients with acute low back pain (less than 4 weeks) with radiculopathy compared LLLT and nimesulide to nimesulide alone to sham LLLT. Treatment with LLLT and nimesulide improved movement, with more significant reduction in pain intensity and disability and with improvement in quality of life, compared with patients treated only with drugs or placebo LLLT.38
<>Most people will experience lower back pain at some point in their life, it is very common. In the old days bed rest was prescribed if your back was “playing-up,” whereas today it is recommended to keep exercising. Of course the exercises you do have to be appropriate, we are not suggesting to go for a run or lift heavy weights, that wouldn’t be smart. However, there are some great exercises you can do which should help alleviate lower back pain. These exercises are extremely gentle, but of course, listen to your body and stop if you experience any pain.
<>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.]
<>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.
<>Dr. Stieber strongly believes that a personalized treatment approach delivers optimal relief and a superior patient experience. As such, your back pain treatment regimen will be tailored based on the severity, duration and underlying cause of your symptoms. For most of our NYC patients, the solution will involve a blend of approaches, including medication, physical therapy and, in rare cases, surgery.
<>The outlook for low back pain absolutely depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that are irritating the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.
<>Low back pain is one of the most common complaints on the planet. And you may wonder where to turn when you start experiencing some of those aches or twinges in the lower part of your back. Take heart. "In most cases, you won't need a specialist," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
<>The outlook for low back pain absolutely depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that are irritating the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.
<>“I went in not knowing what the problem was, I hurt and I figured I was out of place. I was seeing another chiropractor but they were only adjusting me and there was no improvement - I was worsening. I went to see Dr. Riley and in one visit he found that I was weak in my left glute and my body was overcompensating and causing me pain. It took four visits working on strengthening that side and I'm pain free.”
<>Expert opinion guidelines on RTP time frames have been published for lumbar spine conditions.20 Lumbar strains should achieve full range of motion before RTP. Patients with spondylolysis and spondylolisthesis (grade 1) should rest 4 to 6 weeks and then demonstrate full range of motion and pain-free extension before RTP.22 Athletes with herniated lumbar disks should rest 6 to 12 weeks following surgical treatment, while those with spinal fusion should wait 1 year to return to activity.20 Many surgeons advise against return to contact sports following spinal fusion.20 Iwamoto et al32 reviewed conservative and surgical treatments in athletes with lumbar disc herniation and time to return to previous level of sports activity. Seventy-nine percent of conservatively treated athletes returned in an average of 4.7 months, while 85% of those treated with microdiscectomy returned in 5.2 to 5.8 months. Sixty-nine percent of percutaneous discectomies returned in 7 weeks to 12 months.32
<>Hyperlordosis (lordotic low back pain) is the second most common cause of adolescent low back pain.18,47 This condition is related to adolescent growth spurts when the axial skeleton grows faster than the surrounding soft tissue, resulting in muscular pain.55 Other causes of low back pain unique to children are vertebral endplate fractures and bacterial infection of the vertebral disk. Adolescents have weaker cartilage in the endplate of the outer annulus fibrosis, allowing avulsion and resulting in symptoms similar to a herniated vertebral disk.58 Additionally, the pediatric lumbar spine has blood vessels that traverse the vertebral bodies and supply the vertebral disk, increasing the chance of developing diskitis.51
<>Soft tissue therapies help treat the underlying causes of back pain, such as poor posture, muscular compensations, and weakness through manipulative, hands-on adjustments. These natural therapies can help “turn on” muscles that have been “turned off” due to past injuries and therefore eliminate added stress on painful parts of the back or legs. I recommend finding a practitioner who offers one of the following:
<>Most acute low back pain fades steadily — up to 90% of it, for uncomplicated cases.14 So does a lot of so-called “chronic” low back pain!15 But when you don’t recover, many of the therapeutic options — things like surgery for a herniated disc — cause anxiety that is unnecessary and harmful. The purpose of this tutorial is to review and expand the options.
<>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.
<>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.
<>Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
<>The diagnosis of low back pain involves a review of the history of the illness and underlying medical conditions as well as a physical examination. It is essential that a complete story of the back pain be reviewed including injury history, aggravating and alleviating conditions, associated symptoms (fever, numbness, tingling, incontinence, etc.), as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms (EMG) and nerve conduction velocities (NCV).
<>I bought two of your eBooks last week, and I’m enjoying going through them. Your presentation is excellent. It’s far too early too say, of course, but I think I’ve already begun to benefit from your approach. One of the things I like most about your approach is your respect for “science,” as opposed to “merchandising.” You've put so much into those two eBooks, it's going to take time to do them the justice they deserve.
<>After reviewing data regarding various treatments for lower back pain, the Agency for Health Care Research and Quality concluded that those suffering from back pain should first try conservative/natural treatments and then consider other options for lower back pain relief if pain persists. Oftentimes low back pain sufferers can find relief naturally by making changes to their lifestyles (including sleep, physical activity, stress and body weight) before choosing more intensive care options.
<>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.
<>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.
<>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.
<>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.
<>In the elderly, atherosclerosis can cause weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause a pulsating low back pain. Aneurysms of certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.
<>Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often first-line therapy for low back pain. Low-quality evidence suggests that they are effective for short-term symptom relief, compared with placebo.16 No patient characteristics at baseline can predict the success of NSAID therapy.17 Moderate evidence suggests that no one NSAID is superior, and switching to a different NSAID may be considered if the first is ineffective. Whether NSAIDs are more effective than acetaminophen is unknown, but the addition of an NSAID to acetaminophen therapy is no more beneficial than acetaminophen alone.16,18
<>Most people will experience lower back pain at some point in their life, it is very common. In the old days bed rest was prescribed if your back was “playing-up,” whereas today it is recommended to keep exercising. Of course the exercises you do have to be appropriate, we are not suggesting to go for a run or lift heavy weights, that wouldn’t be smart. However, there are some great exercises you can do which should help alleviate lower back pain. These exercises are extremely gentle, but of course, listen to your body and stop if you experience any pain.
<>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.
<>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.
<>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.
<>The good news regarding back pain is this: Most cases of lower back pain are believed to be due to “mechanical” problems of the musculoskeletal system rather than serious illness or chronic health problems. Abnormalities, weakness, and added stress placed on the bones, joints, ligaments and muscles can all contribute to back problems. It’s been found that the most common causes of low back pain (there are many!) include: (8)
<>Did you know that aside from coughs and respiratory infections, back pain is the most common reason for seeing a doctor in the United States? More than 85 percent of Americans will experience back pain at some point in their life, and back pain is the leading cause of disability worldwide. Yet surgery is rarely needed to treat back pain. So, what’s the answer? Why is it such a problem and, more importantly, how can you prevent it from becoming a problem for you? This article will help answer some of those questions as well as give you some of the best exercises to beat back pain.
<>Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include pain during sex, pain with pelvic examinations, cramping or pain during bowel movements or urination, and infertility.
<>This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
<>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.
<>Preliminary research suggests that hypnotherapy may be of some use in the treatment of low back pain. For instance, a pilot study published in the International Journal of Clinical and Experimental Hypnosis found that a four-session hypnosis program (combined with a psychological education program) significantly reduced pain intensity and led to improvements in mood among patients with chronic low back pain.

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