<>Use capsaicin cream. Capsaicin is a substance found in chili peppers. When used medicinally it helps reduces the amount of substance P, a neurotransmitter that leads to pain impulses in the brain. One study showed that after 3 weeks of capsaicin use, patients had a significant reduction in pain. To use: apply topically, at least twice per day, for maximum relief. The warm sensation also allows you to stretch and move without pain.
<>That’s a huge topic, but here’s one simple example of an extremely common problem with back pain science: control groups that don’t control. Rather than comparing a treatment to a good, carefully selected placebo, most studies use a comparison to a treatment that is allegedly neutral, underwhelming, or placebo-ish. That makes the results hard to interpret: if each works about the same, it could mean that the treatments are equally effective … or equally ineffective! So much back pain science has this problem — or any one of a dozen other weak points — that you can effectively ignore at least 80% of all back pain research, because it’s so far from the last word on anything. Good science is essential to solving these problems, but really good studies are also difficult to design and rare. BACK TO TEXT
<>Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping its progression.
<>Start facedown on a stability ball with feet resting on floor and core engaged so body forms a straight line. Keeping your back naturally arched, place hands behind ears and lower your upper body as far as you comfortably can. Squeeze glutes and engage back to and raise your torso until it’s in line with your lower body. Pause, then slowly lower your torso back to the starting position. Repeat for 12 to 15 reps.
<>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.
<>Low back pain can cause a wide variety of symptoms and signs depending on the precise cause of the pain as reviewed above. Symptoms that can be associated with low back pain include numbness and/or tingling of the lower extremities, incontinence of urine or stool, inability to walk without worsening pain, lower extremity weakness, atrophy (decreased in size) of the lower extremity muscles, rash, fever, chills, weight loss, abdominal pains, burning on urination, dizziness, joint pain, and fatigue.
<>To avoid unwanted weight gain, consuming inflammatory ingredients or complications due to nutrient deficiencies, reduce or eliminate the following foods: added sugar, sweetened beverages or snacks, refined vegetable oils, refined grain products, too much alcohol and tobacco products (smoking impairs blood flow and adds to nutrient deprivation to spinal tissues).
<>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.
<>Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk.
<>I apply a MythBusters approach to health care (without explosives): I have fun questioning everything. I don’t claim to have The Answer for low back pain. When I don’t know, I admit it. I read scientific journals, I explain the science behind key points (there are more than 460 footnotes here, drawn from a huge bibliography), and I always link to my sources.
<>Chronic back pain is straining both physically and emotionally. To manage the frustration, irritability, depression and other psychological aspects of dealing with chronic pain, you may get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi and other cognitive and relaxation strategies to keep your mind from focusing on pain.
<>When we stand, the lower back is functioning to support the weight of the upper body. When we bend, extend, or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements.
<>2017 — Major upgrade: The section has been re-written and expanded significantly, with a key change in position. After reviewing the same scientific papers previously cited more carefully, I decided that they were much less promising than I originally thought. The section has flip-flopped from optimism to pessimism about nerve blocks without a single change in what’s actually cited, just a change in the level of diligence in interpreting the science. [Section: Diagnostic numbing of facet joints.]
<>Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
<>Chiropractic care involving spinal manipulation appears to reduce symptoms and improve function in patients with chronic low back pain, acute low back pain, and sub-acute low back pain, according to a research review published in the Journal of Manipulative Physiological Therapeutics. In their analysis of 887 documents (including 64 clinical trials), the review's authors concluded that combining chiropractic care with exercise is "likely to speed and improve outcomes" and protect against future episodes of back pain.
<>Braces are not effective in preventing back pain.64 However, there is conflicting evidence to whether braces are effective supplements to other preventive interventions.64 Bracing, in combination with activity restriction, is effective in the treatment of spondylolysis in adolescents.33,42,46,53 A meta-analysis of 15 observational spondylolysis and grade 1 spondylolisthesis treatment studies did not find a significant improvement in rates of healing with bracing when compared with conservative treatment without bracing.37 Most experts recommend surgical consultation for spondylolisthesis with 50% slippage or more (grade 3 and higher).46
<>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.
<>Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might relieve acute back pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects. If OTC pain relievers don't relieve your pain, your doctor might suggest prescription NSAIDs.
<>Jackson, M., & Tummon Simmons, L. (2018, April 1). Challenging case in clinical practice: Improvement in chronic osteoarthritis pain with use of arnica oil massage, therapeutic ultrasound, and acupuncture — A case report [Abstract]. Alternative and Complementary Therapies, 24(2), 60–62. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/act.2018.29152.mja?journalCode=act
<>Since I first started treating low back pain in 2000, there’s been an explosion of free online information about it — countless poor quality articles. Back in the day, we actually had to go to a doctor or buy a book to get shoddy back pain information — now it’s just a Google search away.234 Even many better articles still have serious “attitude” problems.5 But it’s worse than that: even professional back pain guidelines are often misleading.6 For instance, despite overwhelming scientific evidence to the contrary, it’s extremely common to incorrectly portray back pain as a “mechanical” problem, as if the spine is a fragile structure which breaks down and causes pain.7 This is based on decades old misconceptions about how backs work, and how pain works, which the medical world is only gradually learning to leave behind.
<>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.
<>According to Susi Hately, owner of Functional Synergy, Inc., in Alberta, Canada, and author of several international best-selling yoga books, yoga can be very therapeutic for people with back pain as well. A review of scientific studies published in 2013 in the Clinical Journal of Pain found strong evidence that yoga can help reduce chronic low back pain. Yoga may help improve back pain by loosening tight muscles, building strength and range of motion, and improving breathing, explains Hately. Yoga also focuses on relaxation, which may help to relax your muscles as well as reduce pain perception.
<>Perhaps you bent the wrong way while lifting something heavy. Or you're dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say they've had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.
<>Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk.
<>Spinal manipulation: Osteopathic or chiropractic manipulation appears to be beneficial in people during the first month of symptoms. Studies on this topic have produced conflicting results. The use of manipulation for people with chronic back pain has been studied as well, also with conflicting results. The effectiveness of this treatment remains unknown. Manipulation has not been found to benefit people with nerve root problems.
<>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.
<>Luckily for 95 percent of people with lower back pain, the ache goes away within a few months. But for a few, it becomes chronic. “If pain becomes sharp and keeps you from sleeping, starts radiating down the front or back of your leg, or wraps around your side, get to the doctor,” says Strassberg. Another clue you should get medical attention: It’s “directional,” meaning it hurts more when you sit or stand in certain positions, she says. Start by avoiding these 15 everyday habits that hurt your back.
<>Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might relieve acute back pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects. If OTC pain relievers don't relieve your pain, your doctor might suggest prescription NSAIDs.
<>30. Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy [published ahead of print November 19, 2010]. Spine (Phila Pa 1976). http://journals.lww.com/spinejournal/Abstract/publishahead/Management_Patterns_in_Acute_Low_Back_Pain__The.99251.aspx (subscription required). Accessed May 2, 2011.
<>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.
<>This traditional treatment scores well in research for its pain-relieving properties—and you can add lower back pain relief to the list. In a review published in the journal Evidence-based Complementary and Alternative Medicine, researchers concluded that for chronic low back pain, acupuncture alone or in conjunction with other treatments could provide short-term improvements in pain and function compared to no treatment at all.
<>Herbal therapies: “When back spasms are so strong you can barely move from the bed,” Grossman says, she suggests the homeopathic medicine Bryonia; when you have soreness after overexertion, she uses Arnica.  Keep in mind, there’s little scientific evidence that herbals such as Bryonia and Arnica are effective treatments for back pain; though, a study published in Alternative Therapies in Health and Medicine in 2016 suggested they might help to reduce chronic low back pain from arthritis when combined with physical therapy.
<>A diagnosis of sciatica is usually made during a history and physical examination. Your doctor will ask you about your pain. During the physical exam, you may be asked to lift your leg while lying on your back — shooting pain down the back of your leg while in this position is a common sign of sciatica. Your doctor will also check the strength and reflexes in your leg.
<>In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.
<>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.
<>2013 — New section: An overdue upgrade! This way pain and fear power each other is now explained much more clearly and thoroughly than before. It’s noteworthy that, with this update, Dr. Lorimer Moseley’s valuable perspective on back pain is now fairly well-represented in this book. [Section: Pain and fear, together at last: an even simpler vicious cycle.]
<>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.
<>Because back pain can be so debilitating, a lot of people turn to more serious interventions, like surgery or painkillers — but turns out, all you really need is a good stretch. “Most back pain can be resolved by doing regular exercises to keep muscles that support your spine strong and flexible,” says Fei Jiang, PT, DPT, OCS, at Providence Saint John’s Health Center’s Performance Therapy in Santa Monica, California. In fact, a recent study on back pain found that participants who followed a 12-week stretching regimen reported better back functioning, less pain, and a reduced need for pain medication.[1]
<>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.
<>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
<>Moderate-quality evidence shows that non-benzodiazepine muscle relaxants (e.g., cyclobenzaprine [Flexeril], tizanidine [Zanaflex], metaxalone [Skelaxin]) are beneficial in the treatment of acute low back pain. Most pain reduction from these medications occurs in the first seven to 14 days, but the benefit may continue for up to four weeks.19,20 However, nonbenzodiazepine muscle relaxants do not affect disability status.19,20 Very low-quality evidence shows that a short course (up to five days) of oral diazepam (Valium) may also be beneficial for pain relief.19 Because all muscle relaxants have adverse effects, such as drowsiness, dizziness, and nausea, they should be used cautiously. Diazepam and carisoprodol (Soma) use should be brief to decrease the risk of abuse and dependence. There is also moderate-quality evidence that muscle relaxants combined with NSAIDs may have additive benefit for reducing pain.19
<>For a 2006 report published in Rheumatology, investigators analyzed the available research on the use of balneotherapy in treatment of low back pain. Looking at five clinical trials, the report's authors found "encouraging evidence" suggesting that balneotherapy may be effective for treating patients with low back pain. Noting that supporting data are scarce, the authors call for larger-scale trials on balneotherapy and low back pain.

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