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Microsoft word - backpain
DISCLAIMER: Note that the contents here are not presented from a medical practitioner,
and that any and all health care planning should be made under the guidance of your
own medical and health practitioners. The content within only presents an overview
based upon research for educational purposes and does not replace medical advice
from a practicing physician. Further, the information in this manual is provided "as is"
and without warranties of any kind either express or implied. Under no circumstances,
including, but not limited to, negligence, shall the seller/distributor of this information
be liable for any special or consequential damages that result from the use of, or the
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TABLE OF CONTENTS: Introduction Facts vs Myths about Back Pain Types & Terms of Back Pain Methods of Back Pain Diagnosis Natural Supplement Treatments Physical Treatments Surgical Treatments Medications and Injections Exercises for Back Relief Coping with Chronic Pain Preventive and Healing Strategies & Tips Resources
Considering the fact that the majority or between 70 and 90 percent of the
population will experience some sort of back pain at one time or another, knowledge
about back pain relief is certainly welcome, appreciated and a popular topic. One of the
best ways to begin learning about back pain relief is by understanding the basics of back
pain: what causes it, how it’s diagnosed, what treatments are available, how to manage
the pain, etc. And this ebook will cover the bases for you. Note that the contents here are
not presented from a medical practitioner, and that any and all health care planning
should be made under the guidance of your own medical and health practitioners. The
content within only presents an overview of back pain relief research for educational
purposes and does not replace medical advice from a professional physician.
Let’s begin by learning some facts in order to separate truth from myth with
regards to back pain. First of all, under one percent of acute lower back pain is the result
of a serious infection or condition like cancer or a spinal injury. For those under 50, the
Back pain is the number one disability for those under age 45. And it runs second,
after the common cold, as the top reason for visiting a healthcare provider in the United
“There is nothing really wrong with you.” Myth! Chronic pain sufferers report
that doctors generally tell this to about 90 percent of them and it is incorrect. In reality,
the majority of low back pain cases or some 90 percent generally come from an unknown
cause, like an infection or a particular injury. And the duration of the pain runs generally
“People don’t die from chronic back pain.” Wrong! The pain combined with
depression and anxiety in long-term cases places sufferers at risk for suicide, which does
“Most back pain requires surgery.” Myth! On the contrary, under two percent of
patients with back pain need surgery. However, back pain is the third top reason for
“Only a small percentage of workers suffer back pain on the job.” Wrong! The
top occupational hazard in the USA is back pain.
“Lie down and rest for back pain.” Au contraire. Contrary to popular believe, bed
rest can hinder recovery. Health care providers recommend remaining active to decrease
“Men suffer back pain more than women.” Not! With regards to gender issues and
back pain, it is a myth that men suffer back pain more than women. In reality, the only
main difference is with secondary pain to disk disorders during middle age. However,
with regards to race, low back pain is reported more frequently among Caucasians than
other races including African Americans.
“If a patient’s pain description lacks a regular, consistent pattern, it’s probably
imagined or exaggerated.” Myth! No two people, no two cases are totally 100 percent
identical. Activities, events, pain and people themselves vary from day to day and there is
no 100 percent correct way to describe pain in words to fit a perfectly accurate diagnosis.
To learn more about specific types of back pain, it helps to identify the “type” of
pain present, similar to a doctor visit when asked, “Is it a stabbing pain or dull ache?”
These are helpful healthcare term associated with back pain
ACUTE – Most back pain sufferers fall into this category. With acute low back
pain, certain movement ranges for activities may be limited due to pain. But most people
recover within about four weeks on their own.
CHRONIC – Also referred to as recurrent low back pain or when acute pain
episodes recur for more than three months. This is most generally when medical
treatment is sought. Note one can suffer acute and chronic pain at the same time. As
secondary health problems be involved. In other words, chronic pain sufferers can be
ONSET - When the pain began. Acute onset means it occurred suddenly.
Insidious onset means it gradually developed over a period- could be days or longer.
DURATION / FREQUENCY – Some common questions asked with regards to
this area are how often does the worse pain occur and how long does it last.
RECURRENCE – When the back pain occurs from time to time with intervals of
PERSISTENCE – When the pain is always present.
LOCATION – A printed body diagram is usually used to that the patient can refer
to the place or location where pain is felt.
MOVEMENT – Where the back’s pain movement is located. Most generally it is
centrally located in the middle of the spine or an injury to either side of the spine. Pain
that reaches beyond, for example to legs, is known as peripheral. Other terms associated
with movement are twisting, lifting, bending, straightening, arching, vibrating, sneezing,
ASSOCIATED SYMPTOMS – When discussing back pain, other symptoms that
can come up include, but are not limited to, itching, burning, tingling, weakness or
numbness, bladder control loss or change in habit, nausea.
INTENSITY LEVEL – A verbal measurement used to quantify pain on a scale
rating from zero that signifies “no pain” to 10, referring to your “worst pain ever.” Other
criteria to help with understanding this pain indicator are does the scale vary; i.e. does the
pain intensify and if so with each occurrence? And within what range on the scale?
CAUSES OF BACK PAIN
Most references to back pain focus on lower back pain in the lumbar spinal
region. However, back pain causes in no particular order are:
A. Accidents or injuries leaving muscle pain
B. Osteoarthritis with deteriorating cartilage
C. Osteoporosis with bone loss / fracture
Muscle, ligament and tendon problems are generally at the root of the pain problems
along with some weakness in the lower back. Other body parts in the region can also be
When no specific cause is apparent, the term NSLBP (nonspecific low back pain) is
used. Any number of reasons for this pain can include degenerative disk disease,
psychological issues, systemic disease, facet syndrome (similar to pinched nerves
symptoms), herniated disk, spondylolisthesis or the forward displacement of one of the
lower lumbar vertebrae over the vertebra below it or on the sacrum. Other factors could
be spinal stenosis or constriction or spondyloarthropathy (disease affecting spinal joints).
Let’s take a look at each of these and what pain relief solutions are available.
DEGENERATIVE DISK DISEASE – The degeneration of vertebral disks is a natural
part of the aging process. What often happens though, is that when the narrowing of the
disk space combines with the nociceptors, sensory receptors that respond to pain, in the
outer annulus (in the disk space outside the nucleus) or dorsal root ganglion (spinal
nerves) that become heightened, the result can be pain, although not always. Sometimes
pain can be felt by some people, and other times not. For example a minor accident like
missing a step and landing a little harder than usual on your feet might cause back pain.
And certain activities can aggravate degenerative disks, like yard work or house cleaning
movements. But overall, pain associated with degenerative disk disease generally heals
within a few days at most. Preventative measures like strengthening muscle groups to
lessen future traumas are usually recommended along with an analgesic or medication
that helps relieve pain. Only in some cases are epidurals or injections, blocks or surgery
PSYCHOLOGICAL ISSUES - If acute back pain turns into chronic stages, factors of
depression, fear and anxiety could increase discomfort and pain. And the longer the
chronic pain persists, the more these factors tend to play a role, an increased role over
time. So treatment strategies may need to include learning coping skills and alternative
lifestyle enhancements to deal with the psychological factors present.
SYSTEMIC DISEASE – This disease is the cause for up to 10% of back pain and largely
among the elderly. Causes could be cancer-related or related to reduced bone mass or
simply the aging process. Increasing or decreasing activities as well as switching
positions all may have no affect on pain relief. Alternative therapies may be in need.
FACET SYNDROME - Similar to pinched nerves symptoms, this is believed to be
associated with pain in the back’s side joints and the main cause of up to 20 percent of
back pain cases, with buttocks and upper leg pain increasing with long-term standing, and
when switching sitting / standing / lying positions. An injection of local anesthetic into
the facet joint helps determine the diagnosis. However, since the anesthetic relieves the
pain at the same time and is used as a short-term solution, an x-ray doesn’t help with
imaging the pain results. Recommended treatment includes rigorous lumbar activities
and body mechanics exercises to learn proper or more beneficial posture and movement
HERNIATED DISK – Also known as a ruptured or protruding disk, a herniated disk
extends beyond its own area into a surrounding region. Compression of the nerve root
can cause pain. And pressure on the fibers in surrounding ligaments can cause pain.
Although an accident involving lifting could be the cause of a herniated disk, it’s not
necessarily so. For many, the cause is unknown; pain can occur suddenly or gradually
over time. Relief for the pain can come from walking instead of sitting or standing, and
surgery is rarely required right away, if at all in the event relief from pain happens within
a limited amount of time. During this time (up to several weeks) any of the following
might be effective to use, depending upon your healthcare provider: medication, physical
therapy or non-frequently, steroid spinal injections.
SPONDYLOLISTHESIS or the forward displacement or slippage of one of the lower
lumbar vertebrae (generally the fourth or fifth) over the vertebra below it or on the
sacrum. This state of health is diagnosed by x-ray. Pain is believed to occur where the
displacement is, at or below the displacement, or from spinal stenosis, discussed next.
Depending upon the patient, strengthening exercises or a back support may be all that’s
required. In others, surgery may be an option.
SPINAL STENOSIS – is the constriction or narrowing of the vertebral canal. Mainly
due to aging, as the gradual lessening of disk space and changes in ligaments advance
upon the nerve roots below the lumbar vertebra or L2, pain can result. It’s often
accompanied by numbness in the legs and is not aided any by walking. Different vertebra
and varied physical activities can affect the pain’s location, intensity, recurring and
duration. To help diagnose this condition, healthcare providers can use myelography, or
an x-ray of the spinal cord after injection of air or a radiopaque substance into the
subarachnoid space, with a post-CAT scan. And depending upon the patient, treatments
can vary and be minor with medication if the pain gradually disappears, to epidural
corticosteroid injections in the epidural, to blocks or surgery.
SPONDYLOARTHROPATHY - This term refers to a variety of diseases affecting
spinal joints; arthritis variations- psoriatic arthritis and ankylosing spondylitis, the more
common of the two and in males more often than women; and sacroiliitis, accompanies
inflammatory bowels. Diagnosis consists of a physical exam, history and testing
including x-rays, CAT or MRI, as the disease progresses slowly long-term fusing
sacroiliac joints together and joints between vertebrae together. To relieve pain, there is
treatment with exercises and physical therapy to promote better enhanced posture and
mobility and some arthritic medications.
In order to diagnose back pain for relief treatments, generally health care
professional begin by ordering a medical history and physical examination. A look at
each of these in depth can shed some light into what to look for and how to find relief
from pain. Then we’ll look at specific diagnostic tests. And then where to go for the
No matter whether the patient has acute back pain, which is what most have and
recover from with around a 4-week period, or chronic, recurring pain episodes, a medical
history helps patient an doctor become familiar with one another in confidence to begin
or continue a treatment program together. The medical history delves into these areas of
the person seeking pain relief: family medical history and personal and work history with
regards to back pain episodes and related symptoms and issues, psychological and
psychosocial factors, referral source(s) for evaluation and treatment, education on the
subject and treatment options, assessment throughout their working together on pain
relief treatment and treatment outcomes. For example, if physical therapy needs to be
added to the regimen or enhanced, it would be discussed in the medical history and
The medical history incorporates past and present factors of fatigue, fever and
weight loss. And it notes any use of drugs or herbs, minerals and supplements. A history
of past and present infections, cancer or other conditions is also noted.
The history also includes details about the back pain, focusing on the many facets
of the pain: information about any initial injury or trauma, if available, onset, intensity,
duration, location, associated symptoms, etc.
The physical examination includes evaluating the person generally inn the
“hospital gown” with the body and especially the back in a variety of postures and
movement ranges to determine pain symptoms, tenderness and range of motion. So the
patient may need to sit, stand, touch toes, move arms, etc. and share any pain symptoms
or other information notated with each change along the way.
Neurological testing can also be a part of the routine. A neurologic screening may
consist of tests for reflexes, strength of muscles, cramping and a detailed look at sensory
issues via various range of motion and movement exercises. Included in this can be an
assessment of the legs, upper leg, hip and groin area and pulses for neurological and
Results may point to a secondary problem like kidney stones or a slight bone
fracture, for instance, in which cases, further assessment and treatment options would be
considered and discussed in both the medical history and physical examination.
Noteworthy is that patients seeking relief after an extended period can tend to
exaggerate or magnify their symptoms out of a variety of reasons; possibly psychological
factors associated with fear of the unknown, change, coping alternatives, insurance
coverage and treatment costs, previous visits with health care providers, etc. So
education and patience is advised to that all bases can be covered, i.e. so that effective
For back pain relief, any of several tests can be performed; x-rays or radiographs,
isotope bone scan (referred to as technetium and SPECT), magnetic resonance imaging
(MRI), computerized axial tomography (CAT) scan, myelogram, blood and nerve tests
Where To Go For Pain Relief
Where to go for a diagnosis about back pain can include your family doctor, the
emergency room, an orthopedic surgeon, a naturopathic specialist, a rheumatologist , an
occupational therapist, a physiotherapist, a chiropractor, an acupuncturist, a massage
therapist, an osteopath and a chronic pain heath care provider. And here is a brief
FAMILY DOCTOR – This is a popular beginning point for many seeking back pain
relief. Although family doctors generally do not have extensive orthopedic backgrounds
nor sufficient time to schedule complete histories and examinations during regular hectic
weekdays, they are often able to do preliminary testing and assessment. Their blood tests
and general knowledge of your health and basic back care can help them point you to
further resources and places for following up, especially if they deem the case an
emergency. And hopefully your family doctor will be at the center or helm of your pain
relief management so that all testing, treatments, office visits, etc. are coordinated and not
left to chance, and also so that patient care is optimized.
EMERGENCY ROOM – When a family or general doctor is not available, some
symptoms may warrant an emergency room visit. The following list of symptoms, though
not limited, is what most often sends people to the emergency room for back pain relief; a
major injury or trauma, history of osteoporosis, steroid medications or cancer, severe
pain, fever, aggressive or quick weight loss for no known reason. The degree of
suggested seriousness in the symptoms may determine how quickly a person is seen in
the emergency room, with the more serious cases seen quicker.
Emergency room procedures can involve history and examination assessments
and a series of blood, urine and other tests. Additionally the emergency room physician
may recommend a consult with a specialist while you are there. Or they may recommend
you to your family doctor or other treatment facility for follow up, depending upon their
ORTHOPEDIC SURGEON – Orthopedic medicine in a nutshell deals with the
prevention or correction of injuries or disorders of the skeletal system and associated
muscles, joints, tendons and ligaments. Surgeons in this field offer treatment for
fractures, strains, arthritis, dislocations and other related problems throughout the entire
body. And their treatments vary with surgery and non-surgical health care; structure
repair, joint replacement, arthroscopy or the examination and possible treatment of the
interior of a joint, like the knee, using a type of endoscope inserted into the joint through
a small incision. Likewise, they coordinate healing activities during healing and pain
relief stages. Note that some orthopedic surgeons specialize: in the area of back pain
relief, a specialist based in spinal practice may be advisable.
NATUROPATHIC SPECIALIST – Naturopathic medicine refers to natural substances or
remedies massage as treatments. Doctors in this field are educated in nutrition and herbal,
botanical, homeopathic and Chinese medicines (and acupuncture). They may also treat
with hands-on procedures and lifestyle consultations where preventative measures are a
focus. These specialists may refer you to your family doctor and may also coordinate
healthcare activities before, during and after your back pain episode for overall improved
wellness. Often for back pain relief, they may advise natural supplements like herbal
medicines or minerals along with dietary modifications. And physical therapy;
acupuncture or message, combined with stress management and relaxation therapy may
RHEUMATOLOGIST – A rheumatologist deals with an array of pathological conditions
like arthritis related to the tendons, muscles, joints, nerves or bones, when seeking aid for
discomfort and disability. Although some may perform arthroscopy, most do not do
surgery. For back pain relief, they may suggest medications, occupational or injection
therapy and other medical treatment to determine cause and pain relief.
OCCUPATIONAL THERAPIST – An occupational therapist emphasizes correct
ergonomics or design factors, posture and safety practices both at the workplace and in
the home environment. These therapists educate patients about daily life activities and
can help with adjusting to health devices for mobility and operation. Adjusting to using
crutches, a back brace, a cane and other lifestyle changes are benefits of occupational
PHYSIOTHERAPIST – Registered therapists practice physiotherapy and focus on
educating and instructing patients about their pain- both in book learning and physical
understanding, like with posture and movement modifications. Their shared knowledge
helps patients overcome fear and anxiety and better manage their treatment programs.
Doctors often refer patients to physiotherapists for extended learning, particularly if there
is difficulty in diagnosing the cause and / or treatment for pain. Additionally,
physiotherapists help with the development and managing of their healthcare programs,
activities and preventive care instruction. For example, they may teach about using heat
or ice along with a varied range of motion for pain relief.
CHIROPRACTOR – In a nutshell, chiropractors diagnose spine, joint and muscle
problems with their hands. And their treatment is hands-on as well. For back pain relief,
they use mobilizations and manipulations in manual spinal movements, some known as
“cracking” the back into place. Although there is no scientific evidence to support or
negate chiropractors treatment, most generally work with the relief of acute low back
pain. Besides in-office treatment, many provide exercise and preventative strategies for
ACUPUNCTURIST – Acupuncture, relating to Chinese medical practice, is the piercing
of specific areas of the body with fine needles. The reasons for acupuncture are threefold;
for therapeutic purposes, to relieve pain or for regional anesthesia. It is mainly used for
musculoskeletal pain and low back pain and other related relief.
MASSAGE THERAPIST – Massage therapy incorporates hands-on handling or
manipulation of body tissues, especially helpful for low back pain relief. The reasons for
massage vary; for relief from pain and muscle spasms associated with it, for relaxation,
for stretching, improved circulation and metabolism.
OSTEOPATH – Osteopaths use Osteopathic Manual Medicine (OMM) to practice
medicine based on the theory that conditions in the musculoskeletal system affect other
bodily parts. These conditions cause disorders that they believe can hopefully be
corrected by manipulative techniques combined with traditional medical,
pharmacological, surgical and other therapeutic strategies. Generally within 10 to 14
days, osteopathy relieves low back pain. But there is no evidence to suggest osteopathy as
CHRONIC PAIN SPECIALIST – A chronic pain specialist is for rare cases and works in
teams. He or she generally manages pain relief treatment with psychiatrists, social
workers and other medical and counseling healthcare providers.
The main relief treatment for chronic low back pain is conservative intervention.
In other words, jumping into surgery is not advised because many people suffer no back
pain yet have degenerative change or aging issues going on in the back region. And other
treatment options may offer relief instead. And according to studies, there is no evidence
that points to delayed surgery resulting in increased complications. In fact approximately
80 percent of the cases where surgery was indicated as a solution recovered regardless of
the surgery. So whether or not they had it made no difference. Really under 40 percent
are reported to have benefited from surgery. And on the contrary, those people with
surgical pasts reported the need for future surgeries, many because their pain actually
increased with surgery. So good medical history and physical examination preparation
and assessment can go a long way in determining treatment options.
Conservative treatment would include an overall physical and psychological pain-
handling program incorporated into the patient’s lifestyle. It would education and offer
training about symptom management; movement and posture strategies, physical therapy,
acupuncture, epidural analgesics, pain medication and other associated issues.
There are a number of different ways you can treat your back pain naturally:
vitamins, minerals, herbs, nutrition, and homeopathy medicine. Some will help heal your
back pain and others are dangerous, so it’s best to consult with a physician or nurse
practitioner before taking anything and never, ever exceed recommended dosages. The
FDA has no control over natural supplements, so it does not recommend them. Since
supplements are not FDA approved they must be accompanied by a two-part disclaimer
on the product label: that the statement has not been evaluated by FDA and that the
product is not intended to "diagnose, treat, cure or prevent any disease."
That doesn’t mean, though, that all supplements are bad. Some medications turn
out to be unsafe, too, despite rigorous trials and testing. The bottom line is to research
every product you consider taking and make sure you get supplements from a reputable
source, like a health food store. Everybody’s chemistry is different and reacts differently,
so if you are considering taking a supplement equivalent to a pharmaceutical, you may
There are many natural supplements that can be found in supermarkets and drug
stores. You may have to check health food stores for more obscure supplements. Like any
kind of medication that you buy over the counter, you’ll have a choice between the store
brand and name brands. Store brands are perfectly safe to use and are less expensive
because you don’t have to pay for advertising. You can also buy supplements over the
internet, but you should be sure you buy from a reputable source so you know exactly
what you are getting. Do some research and ask around to find out which online suppliers
Listed below are some natural supplement treatments that have been publicized to
help alleviate back pain. When dosages are listed, you should know that if you are
particularly thin or heavy, you should consult an expert before taking the supplement.
And remember, natural supplements will not relieve pain immediately, but have to be
taken for weeks or sometimes even months before you see results.
VITAMIN E-400 IU daily; anti-inflammatory
ZINC-30 mg twice daily; anti-inflammatory
BORON: 1-3 mg daily with food; helps the body absorb calcium and magnesium
MAGNESIUM- 250 mg daily; strengthens bones and relaxes muscles
GLUCOSAMINE SULFATE: 500 mg. three times daily. Can rebuild cartilage in joints
and has been studied by the American College of Rheumatology as an effective treatment
NIACINAMIDE: 500 mg three times daily; anti-inflammatory and heals damaged
cartilage. Can cause liver damage and aggravate diabetes, low blood pressure, ulcers, and
glaucoma, so have a doctor monitor you if you take this supplement.
Herbal supplements can be found in capsule or powder form, or as teas. If you are
making your own herbal tea, use 1 tsp. of herb per cup of hot water. Cover mixture and
steep for 5-10 minutes, or 10-20 if you are using roots. You can safely drink 3-6 cups of
KAVA KAVA: Recognized by some doctors as a safe alternative to Xanax and Valium.
BLACK HAW: relieves muscle spasms and is similar to aspirin
VALERIAN ROOT: Widely researched and documented as a sleep aid, valerian has been
given a number 1 rating for safety by The American Herbal Products Association.
WILD YAM: Long used to treat menstrual cramps; generally taken as a tea.
JAMAICA DOGWOOD: Used to treat muscle inflammation and spasms; little research
has been done on it and excessive amounts can be toxic. Do not use with sedatives.
BOSWELLIN: 150 mg three times daily. Has been proven in clinical trials to help
CURCUMIN: 400-600 mg three times daily; sometimes mixed with ginger, curcumin
has not been studied in clinical trials, but herbalists use it as an anti-inflammatory.
MSM: Has not been researched, but herbalists use it as an anti-inflammatory.
ST. JOHN’S WORT: 300-500 mg capsule three times daily; interacts with a wide variety
of medications and should only be taken under the advisement of an herbal specialist.
WHITE WILLOW BARK: effects are similar to taking aspirin
DEVIL’S CLAW: 400 mg three times daily. Used to treat arthritis, research shows
devil’s claw may boost the effectiveness of conventional drugs.
Homeopathy is a practice of medicine that has been around for about 200 years. It
is based upon what is called the Law of Similars and works on the same principle as do
immunizations: give someone a small dose of what would make them sick to cure their
sickness. Treatments have been proven in clinical trials, and are prepared by a
homeopathic pharmacy under FDA guidelines. Researchers don’t completely understand
how homeopathic medicines work, but the evidence is clear that they do. Homeopathy
has been popular in Europe and India for a long time, and is gaining popularity in the
United States. Many practitioners are doctors or have some other kind of medical degree,
perhaps in nursing or psychology. The legal issues surrounding homeopathic practitioners
that do not have medical degrees is unclear, but most homeopathic remedies are sold over
the counter and do not need a prescription. Here are some natural homeopathic remedies
that are helpful in alleviating back pain:
ARNICA MONTANA: used in cases of trauma to the back
COLOCYNTHIS: used for weakness and muscle cramps in the lower back
GNAPHALIUM: used to treat sciatica, which is often associated with back pain
RHUS TOXICODENDRON: used for lower back stiffness and pain
Unless back pain is due to an infection, malformation of the back, or tumor, your
pain can probably be alleviated by some type of physical treatment. All physical
treatments are more effective when done in combination with other treatments. It is best
if you can get a referral from your doctor for physical treatment, and many insurance
companies require you to do so before they will pay for treatment. The effectiveness of
the various physical treatments varies, and it’s really up to you as to which you are most
comfortable with. The effectiveness of physical treatments is increased when they are
One of the most common physical treatments for back pain is chiropractic
therapy, which is the manipulation of the spine. The purpose is to realign the spine,
increase the range of motion in the muscles of the back, increase the flexibility of spinal
soft tissue, break down scar tissue, and reduce pressure that occurs from restricted and
misaligned spinal joints, all of which help to relieve pain. Chiropractic therapists, which
include not only chiropractors, but also osteopaths and some physical therapists, diagnose
and treat only problems with the muscles, nerves, and skeletal system and do not use
drugs or surgery. Going to a chiropractor is much like going to a regular doctor: you will
be asked for a case history involving your symptoms, have a physical exam, and possibly
Chiropractors undergo intense medical training. They must have two years of
undergraduate work, and when they enter chiropractic college, they study the same topics
doctors do, including anatomy, physiology, x-ray, psychology, and orthopedics. After
getting the basics down, chiropractors then study diagnosis and adjustment techniques
that most other doctors do not. Besides their coursework, chiropractors also have intern
and externships, where they observe and assist licensed chiropractors. All in all,
chiropractors spend about 900 hours studying and working in their field. After
graduation, chiropractors must either take a test to be licensed in the state in which they
want to practice or the National Board of Chiropractic Examination.
Osteopaths are medical doctors and can prescribe medications. They must have an
undergraduate degree and take the Medical College Admissions Test before being
admitted to osteopathic medical school. Like other doctors, osteopaths take four years of
coursework and spend time observing in medical settings. They do internships and
sometimes residencies, and must take exams in order to be licensed.
Studies have shown that chiropractic manipulation is effective in treating lower
back pain. However, it has not been shown to be any more effective than any other
method of treatment, but has been shown to be better than no treatment at all.
Chiropractic treatment is most effective when applied within two months of the onset of
lower back pain, but probably will not help people who have disc prolapsed, previous
back surgery, or back pain due to disease. If you decide to consult a chiropractor, make
sure you tell him about any serious back injuries you have had, and any sharp pain or
lower back pain with leg pain or numbness. These could be the signs of serious
conditions that could be worsened by spinal manipulations.
If you are interested in chiropractic treatment, meet with the chiropractor in
person to get a feel for the kind of treatment he offers, and look for someone who
diagnoses with a physical exam. While x-rays are occasionally taken, they should not be
the only diagnostic tool used. Ask about what kind of manipulations the doctor or
therapist generally does and look for someone who uses primarily slow, gentle motions
rather than sharp and sudden jolts. Avoid anyone who wants to crack your neck, as this
When you go for treatment, you will lie on your side or stomach while the
therapist does various manipulations. He may put one hand on your shoulder and one on
your hip and gently twist your body, or he may put pressure on the spinal joints. When
this is done, you may or may not hear a crack. Chiropractors may also use ultrasound,
therapeutic massage, stretching, and muscle stimulation to help relieve back pain. You
may have some soreness for a day or two after treatment.
Studies have shown that you should feel relief from pain in four to eight sessions.
While some chiropractors may suggest a longer course of treatment, there is no evidence
that it will be more effective. If you don’t feel better in four to eight sessions,
chiropractic treatment probably won’t help you.
There are few risks involved with gentle manipulations, but there are some
serious ones that can occur in certain situations. People with osteoarthritis should avoid
twisting manipulations as this can cause bone spurs to damage the spinal cord and nerves.
Although it is rare, there have been cases where forceful neck manipulations have
resulted in neurological damage and death. It’s best to avoid spinal manipulations if you
have osteoporosis or nerve damage. Check with your doctor if you’ve had spinal surgery,
or back pain along with fever, chills, sweats, or unintentional weight loss. Chiropractic
therapy won’t help you if you have back pain due to infection or tumor. And finally,
rapid neck manipulations can lead to strokes. You can avoid risks by giving your
therapist a thorough account of all injuries and illness you’ve had.
A good chiropractor is one who is willing to work with your other medial
professionals. She should also give you self-care information and exercises to do at
home. Avoid anyone who wants you to continue sessions to prevent future back pain;
studies do not show this to be effective.
Acupuncture is an ancient form of Chinese medicine that has been around for
more than 2500 years and is becoming an increasingly popular treatment for back pain.
According to the theory of acupuncture, energy—called chi or qi—flows through the
body along pathways called meridians. If the flow of chi is interrupted, pain or illness can
occur. When that happens, very thin needles can be inserted along the meridians to
No one is sure exactly why acupuncture works. Eastern philosophy holds that the
needles unblock interrupted chi. Western medicine has a few theories of its own. Some
believe acupuncture stimulates the nervous system and the 2000 energy centers in the
body, which in turn triggers the release of natural painkillers in the form of endorphins,
opioid peptides, and chemicals from the hypothalamus and pituitary gland. Others believe
that acupuncture needles help contracted muscles relax, stimulate nerves in the legs, and
decrease inflammation of the nerves in the lower back.
Studies by the National Institute of Health show that acupuncture is effective in
treating back pain, and 2500 years of success for the Chinese backs this up. Like all back
pain treatments, acupuncture seems to be most effective when used in conjunction with
other treatments. It is also very safe, with no known risks as long as you chose a
reputable practitioner. Needles are sterile, disposable, and FDA-approved. In the U.S.
they are used only one time, sealed before use, and disposed as hazardous waste after
In the United States there are over fifty acupuncture training schools, which
require approximately 3000 credit hours of study and offer the equivalent of a Master’s
Degree. Often an undergraduate degree is required for admittance to an acupuncturist
college. The first two years in acupuncture school are spent in classroom study, the third
year is spent as an apprentice to a licensed acupuncturist, and the fourth year is spent as
in intern working under supervision on patients. States have different requirements for
acupuncturists, but all must take a state examinations and/ or a national exam in order to
be licensed to practice. To find an acupuncturist, contact the American Academy of
During an acupuncture treatment session, the practitioner will insert anywhere
from one to twenty needles into various places in the body. Some needles may go in just
under the skin, while others may go deeper into muscle and fat. Needles will be left in
from fifteen to thirty minutes. The practitioner may turn needles one way or another after
inserting them into the body, or leave some in for only a few seconds before removing
them and inserting them elsewhere in the body. Don’t be surprised if the practitioner
treats your back pain by putting needles in your ankles, knees, or fingers. This is a
technique called percutaneous electrical nerve stimulation (PENS), where needles are
inserted into nerve centers and electrically stimulated. You can expect to feel relief for
chronic pain in about ten to fifteen treatments and sooner for acute or sudden pain.
Other things an acupuncturist may do: 1) Use moxibustion, an herb that is burned
onto the needle before insertion to stimulate the area being treated; 2) Cupping: burn
cotton in a glass cup, which is then placed on the skin to create a vacuum; and 3)
prescribe herbal supplements in addition to physical treatment.
You may be surprised to learn that acupuncture is rarely described as painful. In
fact, many people find it relaxing and even fall asleep during treatment. Some people feel
energized. One reason for this is the type of needles used. Acupuncture needles are very
different from hypodermic needles. Instead they are very thin and fine, like hair. They are
also solid, whereas hypodermic needles are not, as they are made to extract tissue. So
getting acupuncture needles inserted into your skin will feel nothing like getting a shot at
When you are considering acupuncture, it is important to make sure the
practitioner is someone you feel comfortable working with. Look for someone who is
interested in your whole health and takes time to ask and answer questions. Since some
medical doctors also practice acupuncture, you will want to make sure they are licensed
in acupuncture in addition to their other training. To check if a practitioner is licensed and
accredited, contact the American Association of Acupuncture and Oriental Medicine.
Physical therapy uses different techniques, such as ultrasound, electrical
stimulation, cryotherapy, massage, exercise, and heat in order to relieve muscle spasms,
increase flexibility, strengthen muscles, relieve pain, and accelerate the healing process.
A study in The New England Journal of Medicine found that the effectiveness of physical
therapy for low back pain was about the same as that of chiropractic treatment and better
Physical therapists must graduate from an accredited physical therapy program,
many of which offer master’s and doctoral degrees along with bachelor’s degrees. Most
schools require two to four years of pre-physical therapy coursework before admittance.
Like other physical treatment programs, physical therapists spend time in both the
classroom and medical settings before graduation. After graduation, they must take
exams to become licensed, and some states require continuing education to maintain that
After it is determined by a doctor or back specialist that you are a candidate for
physical therapy—some time between two to six weeks after the onset of low back pain
or sooner if the pain is severe or recurs frequently—you will meet with the therapist to
determine the best plan of treatment for you. You will be asked how your back pain
developed, how long you’ve had it, whether or not it’s recurring, what actions make the
pain better or worse, and any relevant medical history you have. The therapist will also
give you a physical exam of your spine movement, muscular flexibility, sitting and
standing posture, muscle strength, reflexes, respiration, motor function, and repetitive
movements. From there, he or she will determine which treatments will be best for you.
There is some trial and error involved, so if one treatment doesn’t work to alleviate pain,
the physical therapist may try something different.
There are basically two types of physical therapy, passive and active. Passive
therapy is done to you and includes heat, cryotherapy, electrical stimulation, ultrasound,
massage, and lontophoresis. In heat, or thermal, therapy, the therapist applies heating
pads, heat wraps, or warm gel packs to the affected area. This works to increase the flow
of oxygen to the muscle, allowing it to heal faster and relieve pain by softening muscles.
In cryotherapy, cold is applied rather than heat, and is considered more effective than
heat in reducing inflammation. Electrical stimulation sends mild electrical impulses to the
nerves and spinal cord, which releases endorphins and blocks pain signals from the brain.
Ultrasound heats the deep tissue and allows it to relax and stretch more easily. Massage
breaks up scar tissue and encourages the relaxation of muscle spasms. During
lontophoresis treatment, a painkiller and steroid are rubbed into the skin and a low level
electrical current is applied to speed up the absorption of the drugs. It works similarly to
transdermal patches used to quit smoking.
You participate in active therapy, and it includes stretching, strength building
exercises, and aerobic exercise. A good physical therapist will combine passive and
active treatments, as exercise is essential to treating back pain. The therapist will
determine which exercises are best for your particular condition and supervise you in
those exercises to ensure you are doing them correctly. You will likely be given stretches
to be done daily, fifteen to twenty minutes of strengthening exercises, and thirty to forty
minutes of low-impact aerobic exercise, such as swimming or walking, to be done three
You may feel some soreness or discomfort after active physical therapy, but it
should go away in about twelve to eighteen hours. If it doesn’t, let your therapist know.
You may need to change exercises or how you are exercising. Results vary depending
upon the type of treatment done and the severity of symptoms, but a physical therapist
should know in about two weeks if the treatment is working or not.
Massage therapy breaks down scar tissue and releases muscles from spasms. It is
becoming increasingly more recognized as a form of medical treatment; a study by the
American Massage Therapy Association found that 54% of healthcare providers
encourage massage therapy, along with other types of therapy for back pain. Studies have
shown that massage therapy is more effective than both chiropractic and acupuncture for
relieving pain due to muscle spasms. The benefits of massage therapy include improved
circulation, which helps alleviate muscle soreness; muscle relaxation, which helps
muscles move without pain; and increased endorphins, the body’s natural pain relievers.
If muscle spasms do not relax with massage therapy, that means inflammation is likely
present and cannot be treated with massage. So if you know your back pain is due to
inflammation, it won’t help to seek out massage therapy.
You should be aware that the kind of massage you receive in a spa is not the same
kind of massage used to treat back pain. Swedish massage is the most common type of
massage found in spas and similar places that offer massages, and while it feels good, it is
too superficial to reach deep tissue and muscles and have any lasting affect on back pain.
The kind of massage used to treat back pain is called Neuromuscular therapy
(NMT), or trigger point myotherapy. This type of massage works to relieve pain by
balancing the musculoskeletal and nervous systems. NMT incorporates special massage
therapy techniques, myofacial release, and stretching to relive both acute and chronic
There are many massage training schools throughout the United State. Along
with massage, neuromuscular therapists study neurological laws governing pain, the roles
of soft tissue in pain, and palpation, as well as anatomy, physiology, and the function of
the spine. In order to practice, massage therapists must be licensed and you should make
sure that when looking for a massage therapist, you choose one that has had training in
neuromuscular therapy. To find a massage therapist, get a referral from your doctor or
contact the American Massage Therapist Association.
A neuromuscular therapist will ask you for all of the information that other
therapists do and examine your spine to determine where exactly the pain is and what’s
causing it. She will determine where nerves are compressed and where they are trapped
within soft tissue. The therapist will work to relieve your back pain with her hands,
fingers, elbows, and pressure bars, which are used to reach deeper into spinal muscles
and tendons. She will use some kind of lubrication and start first on superficial tissue
before moving deeper. This should not hurt, but you will feel pressure, and you may be
sore afterwards due to the muscles releasing lactic acid. The therapist will also palpate
trigger points, elevated neurological areas deep within the muscles. This may hurt
initially, but the pain should go away quickly as the therapist continues to work. Back
pain should respond to massage within four treatments over six weeks. If not, massage is
Several types of water therapies exist and can be broken down into two very
different groups: water exercise therapy and hydrotherapy. Water exercise therapy should
be done only by a qualified physical therapist, while hydrotherapy may be done by a
therapist but can also be done at home to relieve backaches.
Water exercise therapy has many benefits. The buoyancy of water supports the
patient’s weight, allowing a greater range of motion when the person has too much pain
to exercise on land. This makes water exercise therapy ideal for everyone who seeks
relieve from back pain. Additionally, the water temperature should be warm enough to
relax muscles, which also helps relieve pain. A physical therapist will have you do in the
pool the same exercises you would do on land; they will just be easier to do. Some people
transition to land exercises when their back allows it, some continue treatment in the
water because they prefer it, and some incorporate both land and water exercises into the
Hydrotherapy for back pain relieves pain by loosening the muscles and ridding
the body of toxins that produce pain and inflammation. Studies have shown that people
who soak in a hot tub or warm bath have less stiffness, more flexibility, and tend to use
less pain medication. Hydrotherapy consists of douches, sauna or steam baths, wraps, and
hot baths with or without herbal additives. It has been used for centuries and is most
popular in Europe. Many spas now offer various hydrotherapy treatments. The only risks
involved are to people who are temperature sensitive and to those who have diabetes.
You must be careful, though, not to get overheated.
To douche your back, use a hose hooked up to your bathtub faucet. Direct the
stream of warm water over the painful area and toward the heart. The water should not
splash, but rather wash gently over the skin. Do this for ten to fifteen.
Saunas and steam baths help relieve mild back pain because they stimulate the
flow of blood, which relieves the pain of pulled muscles. You should not use a sauna if
pregnant and never stay in longer than fifteen to twenty minutes. To keep from getting
over heated, wipe your face frequently with a cold cloth. Drink plenty of water to keep
Warm baths are excellent for relieving mild backaches. Fill the tub with about 6
inches of tepid water and get in. Gradually add hot water until the water level in the tub
reaches your naval. The final temperature should be no hotter than 104 degrees. Anything
higher can induce a mock fever. Soak for fifteen to thirty minutes, and when you get out,
wrap up warmly and go to bed. For even more benefit, you can add ½ cup of Epsom salts
to the water to help draw toxins from the body. Essential oils can also be added to the
bath. Some good ones for alleviating back pain are lavender, marjoram, rosemary, clary
sage, black pepper, ginger, and birch. First mix two or three drops of the essential oil with
two tablespoons of a carrier oil, such as sweet almond, peanut, olive, grape seed, or
walnut oil, and then pour the mixture under running water. The mixture can also be
massaged directly into the skin. To get a similar effect, tie ½ cup of herbs in cheesecloth
and hang under the faucet so the water runs through the bag. Some good herbs for
alleviating back pain are birch, German chamomile, white fir, wintergreen, and lavender.
Using herbs and essential oils for healing is called aromatherapy; it promotes self-healing
by indirectly stimulating the immune system.
Sometimes a physical therapist may do a heat wrap for your back pain, or you can
also do one yourself at home. Moisten a cloth with warm water, wring it out, and wrap it
snugly around the painful area of your back. Then wrap up in a dry cloth and next a
blanket. Relax for 45-60 minutes. Herbs or hot mud may be added to the water for added
The good news about surgical treatments for back pain is twofold: 1) Less than 1
percent of those who suffer from back pain ever need it. 2) Medical advances have made
back surgery easier to tolerate and recover from, with more optimistic prospects for
recovery than ever before. At present, many experts agree that more back surgery than
was medically necessary was performed in the past, with too many of the recipients not
benefiting from it. Some even became worse as a result. Today the standard for back
surgery is that an individual has a clearly defined medical condition with a specific
solution that will provide clear benefits.
Below we will look at the three most common types of back surgery: disc
surgery, spine stabilization
and creating additional space in the spine.
There are general standards that must be met before one can be a candidate for
disc surgery, a procedure that is usually done when a disc is herniated (protrudes from its
normal spot) and causing severe discomfort.
A) An MIR or CT scan reveals that a disc is pressing against the root of a nerve.
B) Persistent pain is experienced despite the use of more conservative measures,
such as weight loss, exercise, and ergonomic measures.
C) Severe pain is radiating down the leg or into the buttock, despite conservative
interventions of physical therapy or medications.
D) Neurological warning signs are observed, such as the loss of reflexes or
bodily control. These may be indicators of a surgical emergency.
Once the need for disc surgery has been established there are a number of
1 Discectomy: This is the most frequently performed back operation. In
general, an incision is made over the disc and a part, or all of it, is removed in
2 Microdiscectomy: The procedure is much the same as for a discectomy. The
difference is that a smaller incision is made because magnification is used to
3 Laser Decompression: A needle is inserted into the disc and a portion of it is
destroyed with a laser. This relieves pressure on the nerve. The advantage of
the procedure is that it is less invasive than traditional surgeries and can be
4 Percutaneous Removal: A small tube called an endoscope is inserted into the
back and used to remove portions of the disc. This allows the surgeon to
pinpoint the problem and leave the surrounding area intact. This, too, can be
5 Chemonucleolysis: This is an alternative to taking out part or all of a disc. A
preparation from papaya plants, called chymopapain, is injected and has the
effect of decreasing the size of a disc, with the intention of relieving nerve
In this form of back surgery two vertebrae are joined together in a process called
spinal fusion. It is accomplished by putting bone grafts either between or alongside the
vertebrae. Hollow metal cages filled with bone graft can also be inserted between the
vertebrae. The bones may be attached to the vertebrae with metal plates or screws that
Once the grafts are in place the bones begin growing together, which serves to
fuse the vertebrae. This serves to bring normal stability and strength to structures that
have been fractured or damaged by disease.
Creating Additional Space
The purpose of this form of surgery is quite simple: by opening up more room for
the vertebrae pressure is taken off the affected nerve(s). Most often this is done for
patients with spinal stenosis. In this condition the spinal canal has become too narrow,
with the result being a lack of suitable space for the spinal cord and nerves that causes
pain in the back and weakness of the legs.
In order to provide more space a laminectomy is performed. This involves
removing portions of the laminae, the bones on the back of the vertebrae.
An Improved Process
With greater specialization in back surgery and the ongoing development of
techniques, success rates have improved and there has been a reduction in post-surgery
difficulties. Recovery times, especially given the growth in outpatient procedures and
rehabilitation strategies, have been significantly reduced. Surgeries that once were
regarded as things we needed months to fully recover from are now seen more as
temporary interruptions, with some only requiring a few hours.
An important point to remember when considering back surgery is that it is only
helpful when a specific change in the anatomy of an individual’s back is called for to
correct a condition that has been clearly identified. It is not done on an exploratory basis
or because no cause has yet been found. In addition, even when the problem has been
identified, surgery is generally regarded as a last resort and recommended only after more
conservative approaches, such as medication and physical therapy, have been attempted
Among the common pain relief medications prescribed by physicians are muscle
relaxants, antidepressants, NSAIDs (nonsteroidal inflammatory drugs) and COX –2
inhibitors. Some popular muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol
(Soma), methocarbamol (Robaxin) and gabapentin, in seizure medications. The NSAIDs
help with stiffness and in reducing inflammation. Opiates like Duragesic or OxyContin
may be prescribed but are not a popular choice with a low risk of possible addiction.
With all medications, other treatment strategies should be combined into the relief
program. So physical therapy, movement and posture techniques and other treatment
options should be carefully assessed to see which combination best helps relief over time.
Doctors may also prescribe injections, such as Sacroiliac joint blocks, Thoracic
Facet Joint injections, Epidural steroid injections, selective nerve root block, and Facet
Muscle relaxants act on the brain, not on the muscle. They help relieve pain so
that patients are able to exercise and have other physical treatments that would otherwise
be too painful. Muscle relaxants are sedatives, so doctors may prescribe them to be taken
at night to avoid daytime drowsiness. They should not be taken when driving or operating
heavy machinery. Muscle relaxants have been shown to be effective alone or in
conjunction with anti-inflammatory medications within a week of the onset of severe
muscle spasm in the lower back. Side effects include drowsiness, dizziness, addiction
after one week of use, dry mouth and urinary retention. Some common muscle relaxants
are carisoprodol (Soma), cyclobenzaprine (Flexeril), diazepam (Valium), metaxalone
Low doses of tricyclic antidepressants have been used to relieve chronic back
pain. They work by increasing the level of certain chemicals in the brain that change the
way the brain perceives pain. They are not used for sudden and acute pain, and usually
take two to three weeks to go into effect. Side effects include constipation, dry mouth,
blurred vision, drowsiness, fatigue, low blood pressure, weight gain, increased appetite,
sweating, and urinary retention. Since side effects vary from medication to medication, it
is worth trying another antidepressant if one does not work well. Some common
antidepressants used to treat back pain are amitriptyline (Amitril, Elavil, Endep), doxepin
hydrochloride (Sinequan), imipramine hydrochloride (Janimine, Tofranil), nortriptyline
NSAIDS and COX-2 inhibitors are effective in relieving pain and reducing
inflammation. They are generally the first line of treatment in acute low back pain.
NSAIDS are usually taken for one to three weeks but can be taken for four weeks or
longer. People under the age of twenty should not take NSAIDS because they can cause
Reye’s syndrome, a central nervous system disorder. Other people who should not take
NSAIDS include those taking blood thinners, corticosteroids, lithium, and oral
antidiabetic medication. Before taking NSAIDS you should let your doctor know if you
are pregnant, trying to get pregnant, breastfeeding, or have a peptic ulcer, history of
gastrointestinal bleeding, nasal polyps, kidney or liver disease, allergic reactions to
aspirin or related drugs, anemia, or a blood-clotting defect. Short-term side effects can
include stomach irritation, which can be minimized by taking them with food and a full
glass of water. Taking NSAIDS long term can cause ulcers. In rare cases, naproxen,
ibuprofin and rofecoxib have caused meningitis. A common nonprescription NSAID is
aspirin (Anacin, Bayer, Bufferin). A common prescription NSAID is naproxin
(Naprosyn). Some common COX-2 inhibitors are celecoxib (Celebrex), rofecoxib
COX-2 inhibitors are less likely to cause stomach problems, but they may
increase the risk of heart attack. If you have a history of heart trouble, talk to your doctor
to see if COX-2 inhibitors are best to treat your back pain.
Spinal injections have been used to as an alternative to surgery in treating back
pain since the early 1900s. Studies have shown injections to be effective in up to 50% of
patients. They are typically given after medication and physical treatments have been
utilized, but before surgery. Injections tend to be more effective than oral pain medication
because they deliver medicine right to the source of the pain.
Sacroiliac (SI) joint blocks are injections used to treat low back pain. The
sacroiliac joints are located next to the spine and connect the sacrum to the pelvis. Painful
joints cause pain in the lower back, buttocks, abdomen, groin, and legs. SI joint blocks
work in three ways: 1) they are used to determine if the SI joint is the source of back pain
(if the injection makes the pain better, that’s where the pain is coming from), 2) the
numbing medication used in the block gives temporary relief so the patient can have
chiropractic or other physical treatments immediately after the block is administered, and
3) a time-release steroid gives extended pain relief by reducing inflammation.
During an SI block, the patient lies on his stomach and live x-ray, known as
fluoroscopic guidance, is used to allow the doctor to see the joints. The skin is sterilized
and numbed. The doctor then inserts a very small needle into the joint and injects it with
lidocaine (a numbing agent) and a steroid (an anti-inflammatory). After treatment the legs
sometimes feel numb or weak for a few hours. Side effects are rare and include allergic
reaction, infection, excessive bleeding, nerve damage, and chemical meningitis.
Thoracic Facet joints are small joints about the size of a thumbnail and are located
in pairs along the back of the spine. If they become irritated, middle back pain occurs.
Thoracic facet joint injections have the same purpose as SI joint injections, are performed
in exactly the same manner, and have the same side effects. The only difference is they
treat middle back pain instead of lower back pain.
Epidural steroidal injections are similar to SI and thoracic facet join injections,
except the cortosteroid is injected into the spinal canal surrounding the spinal cord. They
are used to treat chronic and not acute low back pain. This procedure has the same side
effects of other injections. Relief generally lasts anywhere from one week to one year.
Selective nerve root blocks (SNRB) are used primarily as a diagnostic tool and
secondarily as treatment for pain. Back pain can occur when nerve roots become
compressed and inflamed. While MRIs can be used to show which nerves are causing the
pain, they don’t always work successfully. In cases when this happens, an SNRB
injection can be performed in order to isolate the source of the pain. SNRBs are also used
to treat disc that rupture outside of the spinal canal, or far lateral herniated discs. The
procedure is the same for other types of injections. As with other injections, SNRBs
should not be performed more than three times per year. SNRBs are considered more
difficult to perform than other types of injections and should be done only by a physician
Facet rhizotomy may be recommended if three facet blocks have been performed but
more pain relief is needed. Facet rhizotomy injections disable the sensory nerves that lead
to the facet joint, thereby providing pain relief. The procedure for facet rhizotomy
injections is different from that of other injections. A needle with a probe is inserted just
outside the joint, is heated with radio waves, and applied to the sensory nerve. This
disables the nerve and keeps it from sending pain signals to the brain.
EXERCISES FOR BACK RELIEF
Many people believe that rest is best for a painful back, but actually, what your
back really needs when it’s hurt is exercise. Regular exercise relieves back pain by
strengthening and stretching the muscles that support the spine and helps to prevent
future injury. This is a use it or lose it situation: the more you rest, the weaker your back
gets, even if it is hurt. Studies have actually shown that you can heal your back pain
faster and get back to your regular activities with just two days of rest. So let’s look at
some of the best exercises for relieving back pain.
A good, regular yoga practice will go far in relieving the stress and tension that
sometimes cause mild back pain, and in fact, studies have shown that yoga is the number
one most effective exercise for relieving back pain. However, not all yoga poses relieve
back pain, and some can in fact aggravate existing pain, so it is important to know which
poses will be most helpful in relieving back pain. It is best to do these exercises under the
supervision of a certified yoga instructor, and if you encounter any problems with these
poses, you should consult an expert. Even just one or two sessions with a yoga instructor
can help, as an instructor will help you with your form and posture during poses. Here
are some of the best yoga poses for relieving back pain. Each pose should be held from
five to ten seconds, depending upon your level of comfort, and should be done on a mat
CORPSE: Lie flat on your back in a relaxed position, arms resting at your sides,
palms down, and legs lying naturally, with knees turned out slightly. If it hurts your back
to have your knees turned outward, do this pose with knees bent, feet flat on the floor.
Breathe in and out for a few seconds while allowing any tension to leave the body.
CAT STRETCH: Start out on your hands and knees with a flat back. Your hands
should be directly under your shoulders with fingers spread. Knees should be directly
under the hips. Head is held loosely so that you are looking at the floor between your
hands. Inhale, and as you exhale, arch your back toward the ceiling, tuck your chin in to
your chest so that you are looking at your navel, and tuck your tailbone underneath. Hold,
then release back into your original position.
WIND-RELEASING POSE: Lie flat on your back as in Corpse pose. As you
inhale, bend your knee, place your hands right below the knee, and draw your leg towards
your chest. Your left leg should remain flat on the floor. Exhale and bring your forehead
up to touch your knee. Inhale, and then as you exhale, return to your original position.
SAGE TWIST: Warning for this pose—it involves twisting your back, so you
should take particular care not to twist too far or you risk aggravating any existing back
pain. This should be a gentle stretch; twist just as far as is comfortable. Sit on the floor
with both legs out in front of you. Bend your right knee, lift your right leg over your left,
and place your right foot on the floor next to your left knee. Sitting with spine straight,
place your left elbow on the right side of your right knee. Bend your left arm so that your
left fingertips are touching your right hip, while at the same time, twisting to look over
your right shoulder. This is where you need to be careful not to twist too far. Hold for a
few seconds, release, and repeat on the opposite side.
PALM TREE: Stand with feet facing forward, arms at your sides, weight
distributed evenly on both feet. Raise both arms over your head, interlock your fingers,
and turn your hands so that your palms are facing upward. Next, place your palms on
your head and turn your head so that you are looking slightly upward. Stretch your arms
upwards, and at the same time, come up onto your toes if you can do so without pain.
Stretch your entire body upward and hold, if you can. Some people have difficulty
balancing during this pose, so just do the stretching parts if you need to.
FISH POSE: Lie on your back with knees bent and arms at your side. Arch your
back as far as you comfortably can and raise it off the ground by pushing the floor with
your elbows. If you can, tilt your head backwards and rest the crown of your head on the
floor. Breathe deeply from the diaphragm and hold pose for one minute if you can.
LOCUST: Lie face down with arms at the side, palms down, and elbows slightly
bent with fingers pointing towards the feet. Raise your legs and thighs as high off the
ground as possible without causing your back any pain. Hold for one second and repeat
up to twelve times. This can be a vigorous exercise so you must take care to strain
BENDING FORWARD POSTURE: Stand up straight with feet together and
arms hanging loosely along your sides. Breathe in deeply and raise your arms straight
above your head. While breathing out, bend forward and touch your toes if you can. If
you can’t reach your toes, grab hold of your ankles or calves. To complete the pose, you
should touch your head to your knees, but this may be too difficult for many who suffer
from lower back pain. Your movements during this pose should be smooth, not jerky.
Pilates is another great exercise for relieving back pain because it focuses on
strengthening your core muscles, which include the back. Pilates exercises are very
smooth and controlled movements, so there is little danger of getting injured while
exercising. It’s also a great way work on your strength and flexibility, both of which help
to alleviate back pain. However, as with yoga, you should avoid any extreme twisting or
bending movements. Also as with yoga, Pilates exercises should be done on a mat or
other soft, supportive surface. One of the best benefits of Pilates is that it helps improve
posture, a common cause of lower back pain. Use common sense when doing Pilates; if
exercises that arch your back hurt, don’t do those. Or if exercises that round your back
The following Pilates exercises benefit the spine and are appropriate for
beginners. Do each exercise slowly and smoothly, and repeat ten times if you can. The
key to pilates is quality of exercise, not quantity; it is more important to do fewer
exercises slowly and correctly than to do all ten repetitions quickly.
THE HUNDRED: Start by lying on your back with your legs either stretched out
or bent at the knees, whichever is most comfortable. Raise your head and, if you can,
your legs off the floor a few inches. If this puts too much stress on your lower back, just
raise your head and keep your feet on the floor with your knees bent. Try to keep your
neck relaxed. Now extend your arms, and raise and lower them about two inches. While
doing this, inhale for a count of five and exhale for a count of five.
SPINE STRETCH FORWARD: Sit with legs extended in front of you and
slightly more than hip width apart and feet flexed. Inhale and pretend that you are
hovering over an imaginary beach ball by leaning your upper body forward, arms
extended, while rounding your back and pulling in your abdomen. Exhale as you sit back
The ROLLUP: Begin by lying on your back, legs extended, and arms stretched
above your head with your shoulders on the floor. Alternately, you may want to do this
exercise with your feet on the floor, knees bent. Inhale and lift your arms toward the
ceiling. Exhale and roll your torso forward, as if you are doing a full body sit-up. You
should ideally roll into a sitting position, but if you can’t, just bring your torso as far off
the mat as you comfortably can before returning to your starting position.
The SAW: Sit with your legs slightly wider than hip width, feet flexed. Your arms
should be extended straight out to the side. Sit up very straight as if you are trying to
touch the ceiling with the top of your head. Exhale; turn your body to the left, keeping
your arms in line with your shoulders, and bend over as if your hand is going to saw off
your little toe. Inhale, return slowly to your original position, and repeat on the other side.
SPINE TWIST: Sit with your legs slightly more than hip width apart and your
arms extended out to the sides. Inhale, tighten your abs, and sit up very straight as if you
are trying to touch your head to the ceiling. Now exhale and turn to the right as far as you
comfortably can. This exercise is to increase your back mobility only, so do not stretch
your back muscles. Inhale and return to your starting position. Repeat on the left side.
BALLERINA ARMS: Sit with legs crossed and spine straight, as if you were
sitting against an imaginary wall. Bend the elbows at a 90-degree angle and pull the arms
back so that the shoulder blades are touching. Next take your arms down so that the
shoulder blades slide down the spine. Next raise the arms over the head as a ballerina
would. Return arms to starting position.
Tai chi is an ancient form of martial arts that is soft and slow, making it great for
people who have back pain. The Taoist Tai Chi Society's Medical Advisers have
documented that tai chi helps improve posture, reduce spinal degeneration, maintain
flexibility of joints, improve balance, and increase strength and stability in the lower
back. Everyone can benefit from tai chi; if you can’t do the exercises standing up, you
can still do many of them while sitting in a chair.
Unlike yoga, tai chi requires extensive movement, but is less jarring to the joints
than aerobic exercise. It’s almost impossible to describe how to do a tai chi movement
correctly—you really need to see someone else doing it to understand. There are
numerous videos you can check out if you’re interested, and some video stores offer free
exercise video rentals. Libraries may have videos, too. The best way to learn tai chi,
though, is from an instructor, and classes tend to be relatively inexpensive. Take a class
or two just to learn the movements and you’ll be able to practice at home on your own.
Stretching is very important in relieving back pain for several reasons: 1) it
improves your flexibility, which in turn allows your back to move through its natural
range of motion painlessly, 2) it sends necessary nutrients to the tissue along the spine
that keep your muscles from getting stiff and weak, and 3) it helps to prevent further
injury to the back. Some of the above yoga and pilates exercises involve stretching, and
listed below are a few more stretches that will benefit the back. There are a couple of
things you should remember about stretching. First, you should not feel pain when you
stretch. If you do, you have gone too far so ease up a little. Stretch only as far as you
comfortably can, hold it for about ten seconds, and then slowly release the stretch. And
second, don’t bounce. Move smoothly and slowly. If you jerk or bounce your body,
HAMSTRING STRETCH: It might seem strange to stretch your leg to relieve
back pain, but actually, the upper leg is important to the support of your lower back.
Increase the flexibility of your upper leg and you’ll be helping your lower back. Some
hamstring stretches put a lot of strain on the lower back so try this one: Lie on your back
and bring your right knee towards your chest. Put a towel around your right foot, hold the
two ends in each hand, and try to straighten the foot as far as you can. Repeat with the
left leg. When you an easily accomplish this, try some harder hamstring stretches: 1) Sit
in a chair and place legs straight out in front of you resting on another chair. Try and
touch toes. 2) Lie on the floor with the buttocks against the wall. Place the foot up against
the wall and then try to push the knee straight one leg at a time, and 3) Bend over at the
waist, with legs straight, and try to touch your toes. Hold this stretch.
LOWER BACK STRETCH: Lie face down on the floor with hands on each side
of your head, elbows on the ground, and feet shoulder width apart. Slowly lift your body
off the floor so that only your forearms and toes are supporting you. Contract your
buttocks and extend your right arm straight out in front of you. Hold this position for ten
seconds, and then switch arms. Do the same with your legs; return your forearms to the
floor and extend first your right and then your left legs straight out behind you. Work up
to extending your right arm and left leg at the same time, holding for ten seconds, and
MIDDLE BACK STRETCH: Stand with feet shoulder width apart, arms
extended out to your sides parallel to the floor, and knees slightly bent. Slowly twist to
the right side until you feel the stretch in your back. Do not twist quickly or so far that
you feel any pain in your back. Hold for ten seconds and then twist to the left side.
UPPER BACK STRETCH: Stand in the same position as with the middle back
stretch. Interlock your fingers and extend your arms as far out in front of you as you can,
palms turned away from your body. Keep your upper back relaxed and you will feel this
One way to get a good stretch is with an exercise ball. Many people like these
because you can stretch your back without straining it and other muscles. And like with
pilates, exercise ball stretching helps strengthen your core muscles, including your back.
If you are new to the exercise ball, chose one that is soft and not 100% inflated. These are
just a little bit easier to work on than hard balls. As with other stretches, do these exercise
ball stretches slowly and smoothly, hold for about ten seconds (longer if you can), and
BACK ARCH: Sit on the ball as if it is a chair. Walk your feet forward so that the
ball rolls under your back until your rear end is on the ground. Place your hands behind
your head and slowly push yourself back up so that you roll backwards over the ball.
BACK FLOOR PRESS: Lie on the floor with the ball under your knees and legs
over it. Arms should be resting at your sides. Pull your belly button towards your spine
and hold. Remember to keep the rest of your muscles relaxed. As you get more
comfortable with this exercise, you can do it while lifting your arms a few inches off the
BALL SQUATS: Stand with ball between your back and a wall, with feet hip
width apart. Keeping your back straight, bend knees until they at ninety degrees and
thighs are parallel to the floor. The exercise ball will roll up your back. Hold and return to
Strengthening exercises are great for relieving back pain, as well as preventing
future injury. Many of the above exercises will strengthen the back muscles, and here are
a few more to incorporate into your exercise routine.
FRONT LYING CHEST LIFT: Lie on your stomach on the floor, interlace your
fingers, and place your palms against the back of your head. If that causes pain, simply
place your palms on the floor on either side of your head. Now raise your chest up of the
floor just a few inches and hold for five seconds. Work up to three sets of eight
DOUBLE KNEES TO CHEST: Lie on your back, arms to your side and legs
extended. Bring both knees in to your chest, grasping your legs behind the knees. Hold
PELVIC TILT: Lie on your back, feet flat on the floor with knees bent. Press
down with your feet and push your pelvis upward. Hold and repeat.
STOMACH LEG LIFTS: Lie on your stomach, palms on the floor supporting
your chin. Press your pelvis to the floor and lift both legs off the ground a few inches.
CURL UPS: Lie on your back, hands behind your head, knees bent and feet flat
on the floor. Curl up, lifting your face toward the ceiling, until your shoulders are a few
inches above the ground. Hold and repeat.
OBLIQUE CURL UPS: Start out the same was as curl ups, but roll your knees to
the right side and then curl up. Repeat on left side.
If you go to a physical therapist for back pain, chances are you will have to do
some kind of aerobic exercise as part of your treatment. Even if you don’t seek therapy
for your back, it’s still a good idea to incorporate aerobic exercise into your back pain
treatment plan. For those who suffer from back pain, the best aerobic exercises are low
impact. These include swimming, walking, water aerobics, and bicycling. Running and
aerobic dance should be avoided as these jar the body and are too hard on already-injured
muscles and joints. There are even videos featuring non impact aerobics, which can be
great for those suffering from debilitating back pain. Not only does aerobic exercise
benefit your body, but it also benefits your mind: aerobic exercise has been shown to
improve moods, decrease depression, and increase the tolerance for pain.
If you haven’t exercised regularly in the past, you should start out slowly. Just
walk two or three blocks or swim one lap, and gradually increase your pace and distance.
Any exercise at all is much better than none. You should eventually work up to a regular
schedule of twenty to forty minutes of exercise three to five times per week. An added
bonus is the release of endorphins that occurs with thirty minutes or more of aerobic
exercise. Posture is very important in easing the strain on your back. If you chose to
walk, stand up straight without slouching. Keep your back arched slightly and abdominal
muscles pulled in. If you bicycle, adjust the peddles and handle bars so that you an sit up
COPING WITH CHRONIC PAIN
There is not a single definition of pain that is appropriate for everybody because it
is a highly subjective experience. What, to another person, is excruciating may be
nothing more that a slight discomfort for you. Not only do views of pain vary among
individuals, your own perception of it can change over time. Even when you do have a
clear perception of what pain means to you, there is not an objective way to measure it
you can use to convey your impressions to somebody else. It is not unusual for patients
in a doctor’s office, who have come in because pain is severely impairing their day-to-
day lives, to have great difficulty describing it clearly.
One thing we do know, however, is the difference between when we are hurting
and when we are not. In the case of acute pain, you may cry out from it and experience
terrible suffering for a time, but it ends eventually, and usually the sufferer returns to
their normal activities and way of life. Chronic pain is different. A sufferer of chronic
pain not only hurts, but they keep on hurting. Indeed, the psychological impact of
chronic pain can be worse than the physical sensation itself, especially when the daily
grind of it wears you down and turns the world grim. Acute pain usually does not change
one’s personality. Chronic pain, if not addressed properly, can alter it drastically.
Chronic pain may have a physical basis, a psychological basis, or some mix of the
two. Maybe it comes from an injury. Maybe it comes from stress. Maybe the two
factors are interconnected. People who cannot pinpoint a clear physical connection often
say, or are told, that it is “all in their heads.” But that is not how it feels. Chronic back
pain caused by stress can hurt just as badly as chronic pain that resulted from falling off
It has been estimated that over 34 million Americans suffer from chronic pain, be
it from arthritis, migraine headaches or their backs (with lower back pain being the most
common). 15 million people experience chronic pain at work on a daily basis. So if you
are a sufferer of chronic pain you are not alone – though it can certainly feel that way.
To begin with, you must make sure clear lines of communication have been
established with you physician(s) and any other health care providers being seen for
chronic back pain. Do not just assume it is your cross to bear and suffer in silence.
Though it is true that the majority of back pain in general is not symptomatic of serious
illness, do not assume you are therefore free from all risk. There have been cases of
people whose backs’ hurt persistently and they just mistook it for a fact of life and went
on the best they could, only to discover that “bad back” was really a sign of something
much worse, like cancer or otherwise damaged internal organs.
In order to facilitate communication to a health care professional it is a good idea
to spell out some specific things to yourself first as a means of organizing your thoughts
and presentation. For example, asking yourself and answering the following questions
can go a long way toward clarifying what you are experiencing:
5 How bad, on a scale of 1 – 10 is my pain?
7 What words can be used to describe it (tearing, burning, throbbing, etc.)?
8 What could have caused my pain? Is there an injury, psychologically stressful
event, or activity I can link to its onset?
9 Are there any other health problems I am having?
10 In addition to pain medication, what other medicines am I taking?
11 What kinds of things have I done to try alleviating the pain? Have any helped,
12 Both emotionally and physically, how has pain affected my daily life, be it at
The questions do not have to end with the examples above, of course, and asking
a few may help you zero in on more specific inquiries – just as the information provided
will help your physician to get a clearer picture of what is happening with you. Once the
chronic pain is described, a variety of approaches, alone or in combination, are available
A wide range of drugs are available for the treatment of chronic pain. Most
commonly used are aspirin, acetaminophen, and the anti-inflammatory drugs like
ibuprofen. Then there are the more powerful narcotic analgesics, such as morphine and
codeine. People respond to these differently and there is no one medication that is right
for everybody. Only a physician who knows your medical history and what other
medications you might be taking is truly qualified to make the best recommendation for
you. And, after beginning to take one, it is important to keep your physician updated on
their effectiveness, not only if they are working or not, but also about any side effects you
Do not fall into the trap of thinking that a lack of effectiveness or the experience
of side effects are things that must be tolerated without question. Many different drugs
are available and improvements in pharmacology bring us more and better alternatives as
time goes one. Regular contact with a physician is necessary to make sure the course of
medication one is on is indeed the best available.
Psychological approaches are best for chronic pain where a specific physical
cause has not been identified or, when it has, is used in conjunction with a sensible course
of medical treatment. The strategies used generally fall into four categories, with plenty
of room for overlap and the use of more than one technique at a time. These categories
are: relaxation, imagery, hypnosis,
Though it is best to seek the
advice of experts to ascertain what, or what combination, is best for you, below are
examples of some things you can do on your own in the effort to cope with chronic back
: Separate your experience of pain from the pain itself. If the pain is
throbbing, for example, focus on the throb and not the hurt. Another variation
is to separate the painful body part (your back) from the rest of your body.
: Imagine an injection of a powerful medicine that numbs the area of
: Imagine yourself at a time in the past or future where you are free
of pain. A pain-free location, like a favorite vacation spot, may also work.
: Visualize the pain moving from your back to another area of the
body where it is easier to handle. An alternative is to imagine it leaving your
body and taking up residence somewhere else, like the ground.
Be are that psychological approaches are particularly helpful when stress is
suspected as the culprit in your experience of chronic back pain. Our daily lives are
constantly subject to stress, be it from work, relationships, or simply new and different
experiences. People react to stress in different ways. Some individuals feel tired, others
get upset stomachs, and many of us show our tension in the form of back pain. Instead of
a psychological technique that focuses on pain management, then, a more sensible
approach could be the identification and treatment of the factors that cause you to
A Physical Approach
Most chronic back pain is the result of activities that have an adverse effect, such
as lifting heavy objects improperly or simply sitting in a chair for long periods with bad
posture. Changing our habits, therefore, can have a significant impact. Below are some
of the most commonly advised physical measures to take. As always, see a physician or
other qualified professional for assistance in deciding what is best for you.
17 Weight loss: approximately 67 percent of Americans are overweight. These
extra pounds put pressure on the back and strain both back and abdominal
muscles, which can weaken these muscles and compound the problem.
18 Improve Posture: Bad posture means your body is out of balance. When it
comes to your back this means that only a small number of muscles and joints
are doing most of the work. Proper posture will spread out the task and
relieve the intense pressure on small areas of the back.
19 Exercise: A good exercise program, designed by a professional, will
strengthen muscles in your back, keep them limber, and increase endurance.
Though our instincts may tell us to rest until the pain passes, the proper
exercise can be an effective means of pain relief or reduction.
20 Movement: Simple measures, like using your leg strength, instead of back
muscles, to lift heavy objects can make a big difference. Whether at work,
home, or engaged in leisure activities, be aware of how you can alter you
movements to avoid unnecessary stress on your back.
PREVENTIVE AND HEALING STRATEGIES & TIPS
What you can do to prevent back pain and injuries and, if you do sustain them,
what can be done to promote the healing process? Though the focus here is on what can
be done on an individual basis, it must always be remembered that there is no
replacement for consultation with a qualified physician. 80 percent of the adult
population suffers from back pain at some point in their lives, so, whether it’s you of
somebody you care for, it is useful to have some techniques at hand for treating it.
The good news about back pain is that is usually goes away on its own over time.
The vast majority of it comes from simply straining muscles and joints at levels they are
not designed to withstand, which leads into the first recommendation:
. In most cases a few days worth of reducing the normal load you put
on your back in enough. A strained back muscle may cramp or “freeze,” which causes
acute discomfort. Given time to mend, however, the muscle will began to relax and the
body’s natural healing processes will commence.
In response to an injury a body part may
become inflamed, which you will know by the signs of swelling, pain, warmth, and
redness. To achieve a measure of pain relief and assist the healing process you can buy
over-the-counter anti-inflammatory medications like ibuprofen. Acetominophen is
another alternative. Though not an anti-inflammatory drug, it does treat pain effectively
Ice and Heat.
During the first 48 hours after a back injury ice slows
down the swelling process and acts to reduce the pain. After 48 hours,
however, it loses these abilities. This is when your switch to heat, as in
the form of a heating pad. This increases the blood flow to recovering
Be it done by a friend or family member with a nice touch or a
professional, a massage can relax strained muscles and, just as
importantly, a strained psyche that is causing back muscles to tense up.
When we are hurt instinct tells us to lay low and keep
movement to a minimum. Indeed, the traditional approach to treating
back pain used to tell us exactly that. More recent studies, however, have
shown that careful movement does a better job of promoting recovery than
remaining still. Much can be accomplished with simple exercises –
provided you have consulted with a specialist who can dispense advice
and instructions on what is best for you.
Change Your Routine.
Though movement can help in the recovery from
a back injury, it is also important during this period to avoid things that
result in putting too much stress, be it physical or psychological, on your
healing back. Whether it is in improving your posture in a chair, not
lifting heavy objects, or avoiding things that cause you aggravation, adapt
your daily routine to the requirements of your recovering back.
Otherwise, there is a pronounced risk of re-injury, a longer than necessary
recovery period, or an injury that does not heal properly and is vulnerable
For persistent or long lasting pain, refer to the
chapter on chronic pain for additional strategies.
An encouraging thing about back pain is that so much of it can be avoided by
simple cautionary measures, usually, in fact, by making slight modifications to things we
When standing upright, your chest should be forward, your head up, shoulders
straight, and your weight even distributed between your feet with your hips tucked in. If
you have to remain standing for long periods, avoid remaining in the same position for
the entire time. Be sure to move around and change positions regularly. Another good
idea is to rest one foot on a stool, curb, etc. then switch to the other foot after a few
If your work requires you to perform tasks on a platform or desk make sure to
adjust it to a height that is comfortable for you. Spending day after day hunched over
while on your feet is almost a sure recipe for back problems.
In today’s work world many of us have jobs that involve spending most of our
time in a seated position. The rule of thumb here is to sit for as little as possible, and
even then for only short periods of time. Since this is not always possible, be sure to get
up and walk around frequently. Even a short stroll across a room will help.
When in a seated position for long periods, sit with a support positioned in the
curve of your back. Nothing fancy, even a firm pillow or a rolled up towel will do the
trick. At the same time, keep your hips and knees at right angles. If your chair is too
high for this, either replace the chair or get a stool to rest your feet on. Otherwise keep
both feet on the floor and do not cross your legs.
The chair you use should be firm and have a high back and arm rests. The
problems with soft chairs or couches in that the curve in your back is not supported and it
can come to be in a rounded position, which causes the kind of muscle and joint stress
When seated in a chair in front of a desk, make sure the different pieces of
furniture complement each other so that you can sit up straight as you work, with your
elbows and arms on your chair or desk and your shoulders relaxed. Hunching or leaning
Finally, when getting out of a chair after sitting for a period of time, be sure to
stand up by straightening your legs, not bending at the waist. Once in a standing position
stretch your back by doing a series of simple back bends.
Much of the same applies when driving in a seated position. Support the curve of
your back and be sure your seat is positioned close enough to the wheel so that your
knees can bend and your feet reach the pedals without having to stretch for them.
The simplest thing to do is avoid lifting heavy objects, or those whose size or
shape make them awkward to move. Since lifting cannot always be avoided, be sure not
to lift with your back. When grasping a object to be lifted have it close to your body with
your feet spread shoulder width apart and planted firmly on the ground. Use your leg
muscles to do the actual lifting, with the simplest means of doing this being to start with
your legs bent so that you merely need to straighten your knees.
Once you have lifted the object, keep it in front of you and move with small, slow
steps. Instead of twisting, change direction with your entire body coordinated together
for the move. When the object is set down, once again keep it close to your body and let
your legs do the work. Remember, the muscles in your legs are a lot bigger and stronger
Many a back injury can be prevented by following an exercise program that keeps
the muscles strong and flexible. When designing your own, do so with the aid of your
physician, physical therapist, or a qualified trainer.
Invest in a firm mattress and box spring that supports your body without sagging.
It is best to sleep in a position where the curve in your back can be supported. Lying on
one’s stomach on a soft mattress is exactly the wrong thing to do for your back.
The sleeping method recommended by many experts in on your back with three
sources of support for your body: one below your lower back that is fitted to the curve
there, one below your knees that supports them enough to take strain off the lower back,
and a pillow below your neck that, like the lower back support, conforms to the natural
Here are some other helpful healing strategies and tips for back pain relief. Try
one or more to see how they work in with your lifestyle.
Control your breathing slow and steady for a few minutes. Focus on rhythmic,
controlled breathing, holding inhaled breaths in for about three seconds, then exhale and
repeat to help redirect focus from back pain and allow the body to naturally respond on
its own. Repeat as needed throughout the say to help the body relax.
Choose a comfortable position that takes the strain off your back and is least painful
A. On your back with your knees up, rest your lower legs over the coach or a chair.
B. Lie in a fetal position on your side and place a pillow between your knees.
When possible for back relief, rest for a couple of days. Find a couple of your
most comfortable breathing positions above and alternatively use them throughout the
day. From time to time, every hour to couple hours or so, include these into your routine:
A. Get up and move around a little, walking and arching your back a little.
B. Add some light stretching activities like gently pulling knees, one at a time, to
C. Light water / pool activity or aquatherapy
D. Light stationary bike riding or sitting in a comfortable chair for brief periods.
Over The Counter HELP
Check with your local drug store pharmacist to see which pain medications are
available over-the-counter (OTC). Popular to use are aspirin for overall pain relief,
ibuprofin for a combination anti-inflammatory and pain relief response like in the Advil,
and acetaminophen products like Tylenol. When selecting the type of medication, keep in
mind that liquid gel types absorb fasted into your system. However, regardless of your
choice, do follow the directions on the labels, unless otherwise directed by your
physician, and follow the recommended dosage guidelines.
Check with your local pharmacist and health store to see which liniments and
ointments are available. Some popular items on the market are BENGAY, Tiger Balm
and Sportscreme; generally products with a form of rubbing alcohol listed in the
Ask about the availability of other back pain remedies including herbal
treatments. Some health food stores stock packaged herbal tablets, teas and other
products. Be aware, though, that most often these alternative products are not thoroughly
tested as OTC products are, nor can the contents be assured for safety, quality and
Here are some other back pain relief strategies for you.
1. Place an ice pack on the pain area up to three times a day for about 12 minutes per
session during the first two days of the onset of your pain.
2. Moist heat applied to the pain after one day can help sooth your body. A warm
washcloth or a heating pad for about 30 minutes should do the trick.
3. After the first day or two, interchange your ice and heat solutions. Heat is for
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