Back Pain Treatments — What Works and What Doesn’t
December 11, 2015
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By Dr. Mercola
Back pain is perhaps one of the most common health complaints across the globe. Worldwide, 1 in 10 people suffer from lower back pain, and it's the No. 1 cause of job disability.
Seventy-five to 80 percent of back pain cases do resolve within two to four weeks,1 with or without treatment. This is particularly true for mechanical low-back pain (LBP), which is the second most common symptom-related reason for doctor's visits in the U.S.
LBP is typically preceded by some form of injury or strain, such as lifting an object or twisting while holding something heavy, operating vibrating machinery; car collisions, or falls.
Prolonged sitting is also on this list, which may explain why simply standing up more is part of the solution in many cases. Medscape2 lists a number of tests used to diagnose LBP, as well as a number of ways to manage such pain. This includes:
- Controlling inflammation
- Restoring range of motion
- Improving muscle strength and endurance
- Coordination training and cardiovascular reconditioning
- Maintaining an exercise program
First Line of Treatment — Stay Active!
As you can see from the list above, the emphasis is on exercise. Indeed movement appears to be the most effective strategy to address most forms of back pain, not just LBP.
Most people automatically want to "baby" the pain and avoid moving about as much as possible, but this may actually be contraindicated in most cases. As reported in The Guardian:3
"Despite a host of treatment options including acupuncture, manual therapies, drugs, injections, and surgery, nothing is more likely to work than staying active. Just when you least feel like it, and it hurts the most, is when experts say you have to get moving ...
Lesley Colvin, a pain medicine specialist in Edinburgh, says the best evidence is for exercise. 'If I had back pain, I'd do exercise that strengthens the core, such as yoga, pilates, and stretching.' [Dr. Christopher] Williams advises: 'Avoid bed rest ...'"
3D Dynamic Movement
Your body needs regular activity to remain pain-free. For example, when you sit for long periods of time, you typically end up shortening your iliacus, psoas, and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis.
When these muscles are chronically short, it can cause severe pain when you stand up as they will effectively pull your lower back (lumbar) forward.
Imbalance among the anterior and posterior chains of muscles leads to many of the physical pains you experience. By rebalancing and strengthening these muscles, you can remedy many pains and discomforts, including low back pain.
Also, when there's insufficient movement in your hip and thoracic spine, you end up with excessive movement in your lower back. As noted in a recent Epoch Times article,4 "the solution is a combination of mobility exercises for the hips and thoracic spine and stability exercises for the lumbar spine."
The article goes on to demonstrate a number of exercises to improve hip mobility, such as:
In short, one of the bestthings you can do to prevent and manage back pain is to exercise regularly to keep your back and abdominal muscles strong and flexible.
- Fire hydrants
- Straight-leg extensions
- Lateral swings
- Bent knee, heel to ceiling
- Thoracic mobility exercise
Foundation Training — an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain — is an excellent alternative to band-aid options like painkillers and surgery, as it actually addresses the cause of the problem.
Another approach is creating and maintaining a balance between stability and mobility, as well as your body's ability to move efficiently and resiliently on all planes.
This is what Lisa Huck's 3-Dimesional Dynamic Movement Techniques do, as explained and demonstrated in the video below. Both of these strategies are far more effective than the typical conventional medical approach for back pain.
Unresolved Back Pain Is a Leading Cause of Drug Addiction
In the U.S., an estimated 8 in 10 people struggle with back pain, and it has become a primary cause of pain killer addiction and lethal drug overdoses in this country. In 2013, 16,000 Americans died from overdosing on prescription painkillers.5 If you have back pain and suffer depression or anxiety, you're at particularly high risk for opioid abuse and addiction, according to recent research.6 Prescription painkillers are in turn fueling heroin addiction.
According to CDC Director Dr. Thomas Frieden, opioid painkillers like Vicodin, OxyContin, and Percocet increase your susceptibility to heroin addiction, and the vast majority — 75 percent — of heroin users report starting out on prescription painkillers.
Steroids and NSAIDs Also Have Their Drawbacks
Steroid shots are also commonly prescribed, but recent research7 reveals they're no better for back pain than placebo. As reported by The New York Times:8
"... [R]esearchers combined data from 30 placebo-controlled studies of epidural steroid injections for radiculopathy (back pain that radiates to the legs) and eight studies of spinal stenosis (back or neck pain caused by narrowing of the spinal canal).Other recent research9 shows that prescription-strength naproxen (Naprosyn) provides the same pain relief as more dangerous narcotic painkillers. The study compared three different drug treatments for lower back pain:
The study showed that for radiculopathy, injections provided some short-term pain relief, but over time were no more likely to be helpful than placebos, and they did not reduce the need for later surgery. The pooled data showed similar results with injections for spinal stenosis — some moderate temporary pain relief, but no differences between treatment and placebo in pain intensity or functional ability lasting six weeks or longer after the shot."
The latter two provided no better pain relief than taking naproxen alone. While naproxen may be a slightly better alternative to narcotic painkillers, it still comes with a very long list of potential side effects,10 and the risks increase with frequency of use. Considering the side effects and long-term hazards of drugs and surgery, it's important to find safer, less invasive ways to address your back pain.
- 500 milligrams (mg) of naproxen (brand name: Naprosyn. Lower doses are also available over-the-counter, sold under the brand name Aleve)
- 500 mg of naproxen plus 5 mg of cyclobenzaprine (a muscle relaxant)
- 500 mg naproxen plus Percocet (which contains 5 mg oxycodone and 325 mg acetaminophen)
Fortunately, there are many options. I've mentioned some already, but there are many more. The key is to keep experimenting until you find a combination that works for you. It's worth noting thought that in MOST cases, part of the solution is to avoid inactivity.
Avoiding Sitting May Be Part of the Long-Term Solution for Back Pain
Indeed, avoiding seated inactivity may very well be part of the long-term solution for back pain, and I can vouch for the effectiveness of this strategy myself. I suffered from lower back pain for many years and tried a host of treatments, including chiropractic, massage, stretching, grounding, back-strengthening and posture-improving exercises, and using an inversion table.
Nothing got to the root of the problem — until I learned about the hazards of sitting, and began standing more. Simply increasing the amount of time I spend standing up — I'm now at the point where I sit for less than 30 minutes daily — completely, 100 percent, resolved my back pain.
This was an unsuspected but pleasant surprise, as resolving my back pain wasn't the primary reason why I avoided sitting. But, that turned out to be the key puzzle piece in my case. These days, I don't even experience back pain during long plane flights.
Paradoxically, standing initially caused pain and it was difficult for me to stand in an hour lecture without pretty severe back pain. But, once I reduced my 12 to 14 hours of daily sitting to under one hour, my back pain quickly vanished. Now I stand most of the day barefoot on a 2 foot by 4 foot cushioned grounding pad I designed and that we hope to offer sometime next year.
If you have a desk job, I highly recommend investing in a stand-up desk. I'm so convinced of the benefits of standing up rather than sitting down, I've provided all employees at my office with stand-up desks. These desks should be available in our store around Christmas. They'll also receive cushioned grounding pads once we have them available. Below is the video I shot for our 18th anniversary celebration of my home office stand up desk.
Why Medical Scans and Surgery Are Typically Unnecessary
As soon as it starts to hurt, most people tend to want an x-ray or other scan, but experts generally agree that imaging is not necessary for low-back pain. Exceptions include cases of known trauma to the spine, pain lasting for more than a month, and cases where there are warning signs of underlying disease causing the pain (such as cancer).
As noted in the featured article:11
"In rare cases, back pain can be due to dangerous pressure on the spinal cord ... cancer in the spine or infection. Warning symptoms or 'red flags' for this include significant trauma, long-term steroid use, and a history of cancer. If your back hurts and you can't stand up, pass urine, or feel your anus and genitals, you need to call an ambulance."Contrary to popular belief, disc degeneration does NOT cause back pain, so getting a scan and receiving a structural diagnosis of a bulging disc for example, is not going to be very helpful — at least not in terms of dictating a course of treatment. In many cases, such a diagnosis may simply lead to unnecessary surgery, which in many cases sends patients in a downward spiral of increasing pain and reduced mobility.
Even though it's well-recognized that disc degeneration is not a cause for back pain, spinal fusions are still popular. Some 600,000 spinal fusions are performed in the U.S. each year, with a high percentage of them being performed for non-specific low-back pain, at a cost of more than $600 billion. The results however are typically dismal.
According to the medical literature, spinal fusions for back pain have a success rate of about 20 to 25 percent. For 75 to 80 percent of these patients, the surgery simply results in lifelong pain and suffering.
Dr. David Hanscom, an orthopedic surgeon with a practice in Seattle, discusses these and many other facts in a recent interview, along with a novel system for treating back pain that addresses a wide spectrum of contributing factors, including sleep hygiene, nutrition, relaxation, physical therapy, and emotional processing.
Stretches and Yoga Poses That Can Help Ease Back Pain
At the end of this article, I will summarize a wide variety of pain-relieving tools, including herbs and supplements, physical manipulation, and various mind-body techniques. But first, let's take a look at some more exercises that may be particularly useful for back pain. First, by strengthening your core muscles, you add internal support for your back. Four simple core- and back-strengthening exercises reviewed in The Guardian12 include:
Prevention13 and Health14 magazine also recently published articles detailing a variety of yoga-based stretches for back pain relief. Here's a summary of some of the recommended poses. For visual demonstrations, please see the original sources.
- Toe taps
- Lunges
- Squats
- Single-leg balance
Seated neck stretch. Sit on a chair or cross-legged on floor. Place your left hand on the right side of your head and gently pull it toward your left shoulder.
Avoid raising your shoulder. Once you feel the stretch, hold for a few seconds, then return to starting position and repeat on the other side.Hip-buttock stretch. Lying on your back, lift your feet off the floor and cross your right ankle over your left knee. Grasp the back of your left thigh near the knee, and gently pull legs toward your chest.
The stretch should be felt through your right hip and buttock. Hold for a few seconds, then switch legs and repeat.Seated spinal twist. Sit on the floor and cross your left leg on top of and across your right thigh. Extend and place your right arm on the outside of your left knee. Keep your left hand on the floor behind you and twist your entire torso, head, and shoulders gently toward the left.
The stretch should be felt along your spine. Hold for a few seconds before returning to center. Switch legs and repeat on the other side.Child's pose. For this yoga pose, start by sitting on your knees on the floor. Lean forward and extend your arms out front on the floor.
The stretch should be felt from your shoulders to your lower back. Take several deep breaths and release the tension in your back.Back relaxer. Lie on your back with your knees bent over your chest. Hold the back of your thighs and gently pull your knees toward your chest, until you feel a stretch in your lower back. Hold for a few seconds, then release. Bridge pose. Lie on the floor with your knees bent, feet on the floor, and arms parallel to your body. Raise your hips toward the ceiling, and hold for several seconds. Interlacing your fingers together can help stabilize the pose. Chest stretch. This pose can be done seated or standing. Bring your arms behind your back, and interlace your fingers.
Gently pull your shoulders back, stretching your chest. Lower your chin toward your chest, and roll your head gently from side to side.Malasana. Stand with feet hip-width apart, toes turned out. Squat down as far as you can, maintaining a straight-backed posture.
If you want, you can use a yoga block beneath your buttocks for support. Bring your hands together in prayer position, pressing your elbows into your inner thighs.
Stretches for Sciatic Nerve Pain
Sciatic nerve pain is another common problem. Sciatica results when your sciatic nerve gets pinched in your lower back, but the pain is typically felt as originating in your buttock, radiating down your thigh.
Stretching exercises can be helpful here as well. Your sciatic nerve runs through your piriformis, a muscle located deep in your glutes. If the piriformis gets too tight, it can impinge the sciatic nerve, causing pain, tingling, and numbness in your leg. Sometimes, stretching your piriformis may be enough to reduce the pain.
The following video illustrates a simple one-minute daily stretching routine15 that can help reduce sciatic pain stemming from an overly tight piriformis muscle in your buttocks.
Tapping Away Your Pain
As emphasized by Dr. David Hanscom in his book, "Back in Control: A spine surgeon's roadmap out of chronic pain," addressing your emotions is another important component. Depression and anxiety tend to reduce or slow down your body's innate capacity for self-healing, so when pain strikes, it may be a sign that you've let emotional difficulties and stress go unaddressed for too long.
Your brain, and consequently your thoughts and emotions, actually play a large role in your experience of pain. Your central nervous system "remembers" any pain that lasts more than a few minutes at the neuronal level. These memories can become so vivid that the pain persists even after the injury has healed, or re-occurs when it shouldn't, such as from a gentle touch.
Retraining your brain using mind-body techniques like the Emotional Freedom Techniques (EFT) can be very helpful in such instances. In the following video, EFT practitioner Julie Schiffman shows how you can use EFT to relieve your pain, be it acute or chronic.
Other Non-Drug Alternatives for Pain Relief
With all the health risks associated with opioid painkillers and surgery, I strongly urge you to exhaust other options before resorting to these interventions. Below I list some of the most effective non-drug alternatives for the treatment of pain that I know of. Also remember that preventing back pain is surely easier than treating it, and staying active tops the list for both prevention and treatment.
Beneficial Physical Activities Avoid sitting down One of the most common causes of pain is low back pain. Even I struggled with it for many years. The only thing that eliminated it entirely was radically reducing the number of hours I spend sitting each day. Exercise Exercise and physical activity will help strengthen the muscles of your spine. Make your exercise time count by including high-intensity sessions. You probably only need this once or twice a week at the most.
You'll also want to include exercises that really challenge your body intensely along with those that promote muscle strength, balance, and flexibility.Yoga Yoga, which is particularly useful for promoting flexibility and core muscles, has been proven beneficial if you suffer with back pain. As reported in Prevention Magazine:16
"A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64 percent and disability by 77 percent. Although yoga's effects on sciatica are less clear, gentle forms may be beneficial."
The Yoga Journal has an online page17 demonstrating specific poses that may be helpful.Pilates A recent Spanish study18,19 found that older women with back pain can reduce their pain, improve balance, and reduce risk of falling by adding Pilates to their physiotherapy routine.
All of the 100 women in the study received 40 minutes of nerve stimulation and 20 minutes of massage and stretching twice a week. Half of them also did one hour of Pilates twice a week.
At the end of the six-week long study, those taking Pilates reported greater improvements.Helpful Therapies Chiropractic Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for back pain.
Qualified chiropractic, osteopathic, and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training, which lasts between four to six years.
These health experts have comprehensive training in musculoskeletal management.Acupuncture Research has discovered a "clear and robust" effect of acupuncture in the treatment of: back, neck, and shoulder pain, osteoarthritis, and headaches.
Research20 published in the Journal of Traditional Chinese Medicine found that 17 out of 30 patients with sciatica experienced complete relief with acupuncture. You may need about a dozen treatment sessions to see improvement.Physical therapy and massage therapy Both have been shown to be effective for painful conditions such as torn cartilage and arthritis.
Trigger point therapy, where the therapist applies firm pressure to points on your piriformis, lower back muscles, and glutes, can help release the pressure and impingement on the sciatic nerve.K-Laser Class 4 Laser Therapy Infrared laser therapy treatment helps reduce pain, reduce inflammation, and enhance tissue healing — both in hard and soft tissues, including muscles, ligaments, or even bones.
These benefits are the result of enhanced microcirculation, as the treatment stimulates red blood cell flow in the treatment area. Venous and lymphatic return is also enhanced, as is oxygenation of those tissues.
The infrared wavelengths used in the K-Laser allow for targeting specific areas of your body.
The K-Laser is unique in that it is the only Class 4 therapy laser that utilizes the appropriate infrared wavelengths that allow for deep penetration into the body to reach areas such as your spine and hip.
For more information about this groundbreaking technology, and how it can help heal chronic pain, please listen to my previous interview with Dr. Phil Harrington.Mind-body techniques Methods such as yoga, Foundation Training, massage, meditation, hot and cold packs, and other mind-body techniques can also result in astonishing pain relief without any drugs. Grounding Grounding yourself to the earth, also known as Earthing, decreases inflammation in your body, which can help quiet down back pain and other types of pain.
Your immune system functions optimally when your body has an adequate supply of electrons, which are easily and naturally obtained by barefoot/bare skin contact with the earth.
Research indicates the earth's electrons are the ultimate antioxidants, acting as powerful anti-inflammatories. Whenever possible, take a moment to venture outside and plant your bare feet on the wet grass or sand.
Walking barefoot is also an excellent way to strengthen your feet and arches.Nutritional Considerations Eat real food Avoiding processed grains and refined sugars (particularly fructose) will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced.
That is why stopping sugar and sweets is so important to controlling your pain.High-quality, animal-based omega-3 fat Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they manipulate prostaglandins.) My personal favorite is krill oil. Vitamins D and K2 Optimizing your vitamin D level by getting regular, appropriate sun exposure and taking a vitamin D3 supplement can help reduce pain via a variety of different mechanisms.
Vitamin D in combination with K2 is also important to help prevent the softening of the bones that can often lead to lower back pain.Pain-Relieving Herbs and Supplements Medical cannabis Medical cannabis has a long history as a natural analgesic.21
At present, 23 U.S. states22 have legalized cannabis for medical purposes. Its medicinal qualities are due to high amounts (about 10-20 percent) of cannabidiol (CBD), medicinal terpenes, and flavanoids.
As discussed in this previous interview with Dr. Allan Frankel, varieties of cannabis exist that are very low in tetrahydrocannabinol (THC) — the psychoactive component of marijuana that makes you feel "stoned" — and high in medicinal CBD.
Just be sure to seek out a knowledgeable cannabis physician, as many have no idea of the proper dosing.
If you are seriously considering medical cannabis for pain, it is imperative that you view my interview with Dr. Allan Frankel, who is one of the leading medical cannabis physicians in the U.S.
He can do consultations on the phone if one needs specific questions answered.Astaxanthin Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs.
Higher doses are typically required and you may need 8 mg or more per day to achieve this benefit.Ginger This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice. Curcumin In a study23 of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility.
Another study24 also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.Boswellia Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients. Bromelain This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful. Cetyl Myristoleate (CMO) This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory.
I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.Cayenne Cream Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
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