<>The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
<>Press-ups: While lying on your stomach, put your hands flat on the floor under your shoulders, like you are going to start a push-up. Press your shoulders up and let your hips and low back relax. Your hips should remain in contact with the floor as you press up. Hold the end position for 1-2 seconds and return fully to the starting position. Perform 10 repetitions. Bonus exercise: the Prone Press Up with Hips Off Center.
<>Start in a high plank position with shoulders directly over wrists and tops of feet resting on a stability ball. Your body should form a straight line from head to ankles. Without bending your knees, roll the ball toward your chest by raising your hips as high as you can toward the ceiling. Pause, then lower hips as you roll the ball back to the starting position. Perform 15 reps.
<>Cold can be applied to the low back with towels, gel packs, ice packs, and ice massage. Heat methods include water bottles and baths, soft packs, saunas, steam, wraps, and electric pads. There are few high-quality randomized controlled trials supporting superficial cold or heat therapy for the treatment of acute or subacute low back pain. A Cochrane review cited moderate evidence supporting superficial heat therapy as reducing pain and disability in patients with acute and subacute low back pain, with the addition of exercise further reducing pain and improved function.22 The effects of superficial heat seem strongest for the first week following injury.44
<>Are you a serial sitter? Unfortunately, nowadays most of us tend to be. When you lead an inactive lifestyle where you spend a lot of your time — professionally or personally — seated, your posture, and eventually your health take the brunt of the blow. We drive to work to sit at our desks only to return home and relax by sitting on our sofas. This excessive amount of sitting over a period of time can have detrimental effects on our well-being and, in particular, our posture and spine health, eventually leading to lower back issues.
<>Imaging is not warranted for most patients with acute low back pain. Without signs and symptoms indicating a serious underlying condition, imaging does not improve clinical outcomes in these patients.9–11 Even with a few weaker red flags, four to six weeks of treatment is appropriate before consideration of imaging studies.8–10 If a serious condition is suspected, magnetic resonance imaging (MRI) is usually most appropriate. Computed tomography is an alternative if MRI is contraindicated or unavailable.10 Clinical correlation of MRI or computed tomography findings is essential because the likelihood of false-positive results increases with age.12–14 Radiography may be helpful to screen for serious conditions, but usually has little diagnostic value because of its low sensitivity and specificity.10
<>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.
<>Application of Ice or Heat. Low-quality evidence shows that in the first five days of acute low back pain, the use of heat treatments may be more effective for reducing pain and disability than nonheat wraps, NSAIDs, or acetaminophen, but shows no difference between heat application and McKenzie therapy at seven days.32 A low-quality study found that heat therapy in conjunction with education or NSAIDs is more effective than education or NSAIDs alone at 14 days.33 Ice and heat therapy have similar analgesic effects.32
<>Sleep disturbances are common among people with chronic back pain, and not getting enough quality sleep may actually worsen inflammation and pain. For a better night's sleep, invest in a good mattress and experiment with different sleeping positions. Adding an extra pillow under your body can help maintain the natural curve in your spine. If you’re a back sleeper, try putting the pillow under both knees; for stomach sleepers, try under your pelvis. If you sleep on your side, sleeping with a pillow between the knees may help.
<>Meditation has been proven to reduce chronic pain in several scientific studies. Research from Duke University found that people suffering from chronic back pain saw significant reductions in pain and psychological distress after practicing a form of meditation that focuses on releasing anger. In another study, meditators experienced a 40% reduction in pain intensity.
<>Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try under the guidance of your physician and spine physical therapist. However, the same set of exercises doesn’t work for everyone, says Nava. The exercises have to be tailored to your specific symptoms and condition. Maintaining the exercise routine at home is also a big part of success.
<>Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.
<>Joint Replacement Surgery Bursitis Fibromyalgia Fibrous Dysplasia Growth Plate Injuries Marfan Syndrome Osteogenesis Imperfecta Osteonecrosis Osteopetrosis Osteoporosis Paget’s Disease of Bone Scoliosis Spinal Stenosis Tendinitis Sports Injuries Sports Injuries in Youth: A Guide for Parents Sprains and Strains Back Pain Shoulder Problems Knee Problems Hip Replacement Surgery
<>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.
<>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.
<>I was an alternative health professional myself for many years — a Registered Massage Therapist, trained in Canada (which has unusually good training standards). Of course, some of my colleagues in alternative medicine were diligent students of medical science. However, in my experience, most were certainly not — indeed, many lacked even the most basic knowledge of how medical science works or how to keep current about recent discoveries with clinical implications. BACK TO TEXT
<>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.
<>This tutorial is great for people who like to understand their problems. Its dorky, quirky thoroughness is unlike anything the big medical sites offer, and the lack of a miracle cure secret is rare among independent sources. My goal is “just” to empower you with education (without boring you to tears). When you’re done, you’ll know more about your back than most doctors. (Not that this is saying much!16) I’ve spent years compiling this information from hard study, professional experience, and lots of your stories and feedback. I update the tutorial regularly.
<>Lose excess weight. As we gain weight, stress and pressure on the lower spine and back muscles increases. The heavy weight at the front of the body can cause an increased arch in the spine and may lead to injury and compression of the discs and nerves. Losing weight reduces the tendency to arch the back and relieves pressure on the lower spine and nerves.
<>Massage might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.24 Acupressure or pressure point massage technique was more effective than classic massage. A second systemic review found insufficient evidence to determine efficacy of massage for acute low back pain.10 Evidence was insufficient to determine effects of the number or duration of massage sessions.
<>“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.
<>Start in a high plank position with shoulders directly over wrists and tops of feet resting on a stability ball. Your body should form a straight line from head to ankles. Without bending your knees, roll the ball toward your chest by raising your hips as high as you can toward the ceiling. Pause, then lower hips as you roll the ball back to the starting position. Perform 15 reps.
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<>Over-the-counter pain medications. The most common over-the-counter (OTC) medications are aspirin (e.g. Bayer), ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and acetaminophen (e.g. Tylenol). Aspirin, ibuprofen, and naproxen are anti-inflammatory medicines, which alleviate low back pain caused by a swollen nerves or muscles. Acetaminophen works by interfering with pain signals sent to the brain.
<>When you first hurt your back, one of the best back pain remedies is to ice the area. Injury to a muscle means that blood will rush to the site, bringing healing chemicals to ease the pain. Unfortunately, this leads to swelling, and that swelling leads to pain. Applying cold compresses constricts the blood vessels, and this reduces the flow of that blood. The reduction in swelling means that you will have less pain, and this is a great way to relieve back pain naturally. Be sure to keep the cold on for 20 minutes and off for 40. Don’t use this method after the first 24 hours. These are 10 surprising reasons your back hurts.
<>Can inversion therapy help with back pain? Inversion therapy, where a person is held upside down for several minutes, is an alternative therapy for back pain. They may use gravity boots or an inversion table or chair to reduce the pressure on their spine. Evidence for the effectiveness of this technique is mixed. Learn more about the benefits and risks here. Read now
<>Physical activity. Exercise helps build strong, flexible muscles that will be less prone to injury. It can also help the healing process for an aching back, prevent problems in the future, and improve function. Work with your doctor to develop an exercise program, or seek a referral to another health professional who can. A good program typically includes the three major forms of exercise: aerobic activity, strength training, and flexibility exercises.
<>Cold can be applied to the low back with towels, gel packs, ice packs, and ice massage. Heat methods include water bottles and baths, soft packs, saunas, steam, wraps, and electric pads. There are few high-quality randomized controlled trials supporting superficial cold or heat therapy for the treatment of acute or subacute low back pain. A Cochrane review cited moderate evidence supporting superficial heat therapy as reducing pain and disability in patients with acute and subacute low back pain, with the addition of exercise further reducing pain and improved function.22 The effects of superficial heat seem strongest for the first week following injury.44
<>Massage: There's an upside to your discomfort: It's a legit excuse to get a weekly massage. One study found that people who did had less lower back pain and disability after 10 weeks, compared with the control group—and general relaxation rubdowns worked just as well as structural massage targeted at specific parts of the body. Osteopathic and chiropractic therapies—in which joints and muscles get stretched and repositioned—have been shown to work, too. In a study published in the Annals of Family Medicine
<>Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try under the guidance of your physician and spine physical therapist. However, the same set of exercises doesn’t work for everyone, says Nava. The exercises have to be tailored to your specific symptoms and condition. Maintaining the exercise routine at home is also a big part of success.
<>Degenerative bone and joint conditions: As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
<>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.
<>Press-ups: While lying on your stomach, put your hands flat on the floor under your shoulders, like you are going to start a push-up. Press your shoulders up and let your hips and low back relax. Your hips should remain in contact with the floor as you press up. Hold the end position for 1-2 seconds and return fully to the starting position. Perform 10 repetitions. Bonus exercise: the Prone Press Up with Hips Off Center.
<>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.
<>A pinched nerve causes pain, numbness, or tingling in the affected area due to pressure on a nerve. Caral tunnel and sciatica are two examples of conditions caused by a pinched nerve. A pinched nerve is diagnosed by taking a patient history and performing a physical examination. Electromyography may be performed. Treatment for a pinched nerve depends on the underlying cause.
<>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.
<>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.
<>I was an alternative health professional myself for many years — a Registered Massage Therapist, trained in Canada (which has unusually good training standards). Of course, some of my colleagues in alternative medicine were diligent students of medical science. However, in my experience, most were certainly not — indeed, many lacked even the most basic knowledge of how medical science works or how to keep current about recent discoveries with clinical implications. BACK TO TEXT
<>Regular updates are a key feature of PainScience.com tutorials. As new science and information becomes available, I upgrade them, and the most recent version is always automatically available to customers. Unlike regular books, and even e-books (which can be obsolete by the time they are published, and can go years between editions) this document is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 134 major and minor updates since I started logging carefully in late 2009 (plus countless minor tweaks and touch-ups).
<>Heat/ice therapy. Heat from a warm bath, hot water bottle, electric heating pad, or chemical or adhesive heat wraps can relax tense muscles and improve blood flow. Increased blood flow brings nutrients and oxygen that muscles need to heal and stay healthy. If the low back is painful due to inflammation, ice or cold packs can be used to reduce swelling. It’s important to protect the skin while applying heat and ice to prevent tissue damage.
<>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.
<>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.
<>Numerous powerlifters over the years have come back following ‘career-ending injuries’ to set all-time personal records. Donnie Thompson is the only man to total 3,000 lbs (1,265 lb squat, 950 lb bench, 785 lb deadlift). Many people don’t know this, but several years back Donnie suffered a horrendous back injury and herniated three discs. He could barely walk, but he got out of bed and rehabbed himself every day. Within three months he was back to heavy squatting and setting personal records. Got that? Setting personal records three months following an injury that herniated 3 discs!
<>Practice yoga. Holding downward dog for five to ten seconds can help stretch your back muscles. This motion reduces pressure that can build up in the lower spine and cause pain. Remember to also tilt the pelvis under to avoid any further lower back strain. Pigeon pose is another great posture for backaches. Hip muscles can quickly become tight and shift strain to the back. Stretching out hip flexors and extensors can alleviate back pressure and pain.
<>Data Sources: We searched PubMed for the key term acute low back pain; this term was also searched with the following key terms: medications, nonsteroidals, muscle relaxants, opioids, red flags, differential diagnosis, exercise, McKenzie, spine stabilization, traction, acupuncture, heat, ice, advice, cost, manipulation, chiropractic care, brace, bed rest, massage. In addition, we searched the Cochrane Database of Systematic Reviews, Clinical Evidence, Essential Evidence Plus, and the National Guideline Clearinghouse. Search dates: April 2011 and May 2, 2011.
<>If you have severe back pain, if your back pain has not improved after two weeks, or if you are experiencing any of the following symptoms, you should contact your doctor: numbness in your genital area; pins and needles or numbness/altered sensation down your legs; altered walking patterns, ie losing balance and falling over; unexplained weight loss or gain; or night pain.
<>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.
<>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.
<>Low-level laser therapy (LLLT) is a noninvasive light source treatment that generates a single wavelength of light without generating heat, sound, or vibration. Also called photobiology or biostimulation, LLLT may accelerate connective tissue repair and serve as an anti-inflammatory agent. Wavelengths from 632 to 904 nm are used in the treatment of musculoskeletal disorders. A Cochrane review of 7 small studies with a total of 384 patients with nonspecific low back pain of varying durations found insufficient data to either support or refute the effectiveness of LLLT for the treatment of low back pain. Because of the varied length of treatment, LLLT dose, application techniques, and different populations, it was not possible to determine optimal administration of LLLT.71 No side effects were reported.
<>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:
<>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)
<>Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.
<>Plain X-rays are generally not considered useful in the evaluation of acute back pain, particularly in the first 30 days. In the absence of red flags, their use is discouraged. Their use is indicated if there is significant trauma, mild trauma in those older than 50 years of age, people with osteoporosis, and those with prolonged steroid use. Do not expect an X-ray to be taken.
<>When you have chronic pain, it’s important to accept your limitations and adapt. “Listen to your body and learn to pace yourself,” suggests Nava. Take a break when mowing the lawn, or make several trips when carrying groceries. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, it could also prevent the underlying condition from advancing. 
<>A pinched nerve causes pain, numbness, or tingling in the affected area due to pressure on a nerve. Caral tunnel and sciatica are two examples of conditions caused by a pinched nerve. A pinched nerve is diagnosed by taking a patient history and performing a physical examination. Electromyography may be performed. Treatment for a pinched nerve depends on the underlying cause.
<>In addition to chiropractic care and naturopathic solutions including acupuncture, we also provide physical therapy and soft tissue work, including clinical massage and myofascial release—even personal strength training. That's because we’re a comprehensive care team in one place dedicated to freeing you of your pain, restoring your flexiblity, stability, mobility, and lower back health. 
<>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
<>Injections. If other measures don't relieve your pain, and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — or numbing medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

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