<>A very important muscle to strengthen is the transverse abdominis, which provides a great deal of support for the lower back. In many people this muscle is extremely weak and this can lead to lower back pain. A very gentle and safe way to strengthen this muscle is shown below. To carry out this exercise lie on your back, place a small cushion under your head, and bend your knees. Your feet should be hip distance apart and placed on the floor. Keep your upper body relaxed and your chin gently tucked in. Take a deep breath in, and as you breathe out focus on drawing your belly button in towards your spine. Hold this gentle contraction for 5 to 10 seconds. As you breathe out relax your tummy muscles. This is a slow, gentle tightening so aim to use less than 25% of your maximum strength. Repeat five times.
<>A very important muscle to strengthen is the transverse abdominis, which provides a great deal of support for the lower back. In many people this muscle is extremely weak and this can lead to lower back pain. A very gentle and safe way to strengthen this muscle is shown below. To carry out this exercise lie on your back, place a small cushion under your head, and bend your knees. Your feet should be hip distance apart and placed on the floor. Keep your upper body relaxed and your chin gently tucked in. Take a deep breath in, and as you breathe out focus on drawing your belly button in towards your spine. Hold this gentle contraction for 5 to 10 seconds. As you breathe out relax your tummy muscles. This is a slow, gentle tightening so aim to use less than 25% of your maximum strength. Repeat five times.
<>For short-term pain relief, over-the-counter pain relievers including acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs) are sometimes suggested. The most common NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). Potential side effects of NSAIDs include stomach and liver problems. Talk to your doctor if you don't find relief after taking the recommended dose.
<>Muscle relaxants: Muscle spasm is not universally accepted as a cause of back pain, and most relaxants have no effect on muscle spasm. Muscle relaxants may be more effective than a placebo (sugar pill) in treating back pain, but none has been shown to be superior to NSAIDs. No additional benefit is gained by using muscle relaxants in combination with NSAIDs over using NSAIDs alone. Muscle relaxants cause drowsiness in up to 30% of people taking them. Their use is not routinely recommended.
<>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.
<>An ancient mind-body practice, meditation has been found to increase pain tolerance and promote management of chronic pain in a number of small studies. In addition, a number of preliminary studies have focused specifically on the use of meditation in the management of low back pain. A 2008 study published in Pain, for example, found that an eight-week meditation program led to an improvement of pain acceptance and physical function in patients with chronic low back pain. The study included 37 older adults, with members meditating an average of 4.3 days a week for an average of 31.6 minutes a day.
<>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.
<>These powerful painkillers may not be all that: In a study published in JAMA, fast-acting opioids like morphine and oxycodone were no better than non-opioid medications (like Tylenol or an NSAID) in improving function in moderate to severe back pain. Talk to your doctor about the option that’s best for you. Don’t miss these 24 things pain doctors won’t tell you.
<>As part of your exercise routine, you may want to consider doing yoga regularly for lower back pain relief. One study of over 960 people with low back pain found that those who completed a 12-week yoga program experienced greater improvements in back function and reduced pain compared to controls who did not participate. (4) There’s even evidence that mindfulness meditation, often practiced in some form with yoga, can also help people deal with chronic back pain more effectively. (5)
<>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.
<>AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
<>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.
<>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.
<>It may seem strange to see a psychologist for back pain. But studies show that cognitive behavioral therapy is very effective in the short and long term at helping chronic back pain. For example, CBT may target how people with back pain think about physical activity -- and why they may be avoiding it -- to help change the way they respond to being active. People who do CBT have reported significant decreases in pain and disability.

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Medical Disclaimer: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any exercise program.

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