Non-Specific Low Back Pain Exercise Therapy

As often discussed in my research reviews, pain in lower back remains an enigma in modern day health care. It is a common, disabling, and costly condition that we know relatively little about in terms or pathoanatomical causes and effective treatments.

This study was reported in the print and television media, so I felt it important to review here. As always, if you have any questions about this or any of my other reviews, please feel free to contact me.

The goal of this large meta-analysis was to evaluate the effectiveness of exercise therapy in the treatment of low back pain in adults. Exercise therapy was intentionally defined in this study as a heterogeneous group of interventions from general physical fitness interventions to various types of stretching and aerobic exercise protocols. 61 published reports of completed, randomized controlled trials comparing an exercise intervention to placebo, no treatment or other conservative treatments were included in the analysis. Patients suffering acute ( 12 weeks) low back pain were included in the studies (most of the studies involved chronic patients).

The trials evaluated provided the following insights:

there is clear evidence that exercise therapy is at least as effective as other conservative therapies for chronic low back pain, despite conflicting evidence that it is any better
for acute pain in lower back, exercise are not more effective than other conservative therapies (note that exercise therapy is not the same as advice to stay active, which is currently a recommended, evidence-based intervention for low back pain)
there is some evidence to support a graded-activity exercise program for sub acute low back pain in occupational settings

Conclusions & Practical:

This study concludes that evidence from randomized, controlled trials demonstrates that exercise therapy is effective for reducing pain and improving functional outcomes in patients with chronic low back pain. It appears that clinically important improvements are more likely to be seen in healthcare environments, meaning that exercise therapy may work better when supervised by a healthcare provider (see companion article regarding strategies for implementing exercise therapy for low back pain).

It seems intuitive that exercise would be an appropriate intervention for low back pain, provided that it is administered by qualified professionals in a safe, supervised environment. This seems to be a situation where the literature still needs to catch up to clinical practice. To this end, I feel more research needs to be directed toward the effectiveness of combining physical and clinical interventions commonly used in practice. I feel the absence of clear data on the treatment of low back pain is due to the lack of "clinical reality" of most randomized trials.

Most manual medicine practitioners combine a number of interventions in addition to exercise to treat these patients. In order to studies to reflect the benefit of such treatment regimens, more large-scale trials need to be performed with this type of design.

How to Relieve Lower Back Pain - 6 Simple Tips For Your Back Pain

How to relieve lower back pain is the use of interventions and therapies which involve blocking the conduction of nerves between specific areas of the brain and the body to alleviate pain, medications for short- term relief, exercises for strengthening and pain relief, surgery for relief of chronic pain and other disabilities.

Low back pain is very common among adults and it is often caused by overused of muscles causing strain or injury. Long hours of sitting and standing can also aggravate the condition. Since the lower part of your back makes the most of your movement in everything you do, it can also be the most affected when stressed and injured. As such, when people have such condition, they feel as if they want that pain to disappear in a second.

In the advance of technology these days, there are treatments to help relieve pain in the lower back that varies depending on the severity of the case. There some key points that we have to remember when dealing with the treatment options:

• Different treatments can help you stay as active as possible as it will help you understand that some continued or repeated back pain is not surprising or dangerous at all. Most low back pain can get better if you stay active, you avoid positions and activities that may be exhausting to your lower back, use ice for pain and inflammation, and take nonprescription pain relievers when you need them. Doctor's advice is necessary.


• When pain is no longer severe, you may be ready for gentle strengthening exercises for your back, necks, legs and to some different areas of the body.. Exercise may not only help decrease low back pain, but it may also help you recover faster, prevent recurrence injury to your back, and reduce the risk of permanent disability.


• Exercises to reduce low back pain may not be complicated and can be done at the comforts of your home without any special equipment.


• Don't be afraid of the pain and let it stop you from trying gentle activity. You should try to be active soon to prevent pain recurrence and other disabilities. Remember, too little activity can lead to loss of flexibility, strength, and endurance, thus causing more pain.

How To Relieve Lower Back Pain

1. Introduce lower back pain stretching exercises

Some relief from the early stages of lower back pain can be accomplished by performing simple stretches which are often advised by your therapist. Lower back strengthening exercises, along with cardio training exercises are keys to get rid of lower back pain. These will enable your body to become stronger and increase movement and flexibility.

The gentle motions of aerobic exercises such as swimming or riding a stationary bicycle will encourage blood flow through the muscles, increase your flexibility, and enable your body to release natural pain killers of the body into the blood stream thus relieving pain. Aim for 20 to 30 minutes of these exercises each day and you'll notice a significant difference in not only your lower back, but you'll feel better overall.

• Aerobic exercise - this is done to condition your heart and other muscles, maintain health, and increase oxygenation to the different parts of the body


• Tread milling, swimming, riding on a stationary bike, brisk walking, jogging, aerobics.


• Strengthening exercises - this focuses on your back, stomach, and leg muscles.


• Prone hold, chest life, opposite arm leg raises, roll outs, super man.


• Stretching exercises - this is done to keep your muscles and other supporting tissues flexible and less prone to injury.

If you have low back pain, avoid:

• X Straight leg sit-ups.


• X Lifting both legs while lying on your back (leg lifts).


• X Lifting heavy weights above the waist.

2. Hot and cold treatment

The early stage of lower back pain can be treated with Alternate hot and cold compress. You have to try out whether ice will work better for you than heat. Experiment to determine which one do you prefer and which one is more effective for you. Try to use ice pack for pain and inflammation for at least 10-15 minutes. Once the pain has subsided, apply some hot pack and do it for another 10-15 minutes.

3. Medications

The most common medications for back pain is the over the counter pain killers and non-steroidal anti-inflammatory drugs (NSAIDs). These are highly recommended to alleviate back pain. They both work differently so they usually are taken at the same time. Prescribed drugs such as muscle relaxant, anti- depressants are used for prolong relief of pain.

• Pain killer such as Acetaminophen (Tylenol) is the single most effective non prescription drugs for lower back pain and it has fewer side effects. It relieves pain by working its action into the brain to turn off the pain perception.


• NSAIDs such as Aspirin decreases swelling on the affected area. However, aspirin is not usually taken because of its life threatening effects.


• Prescribed Steroids which are effective in treating swelling; however, these drugs have a lot of adverse effects so the dose should be exact and be given regularly and on time.


• For the dose, frequency and duration of the drug, consult your health care provider for safety.

4. Transcutaneous electrical nerve simulation is a method employed to bring lower back pain relief. A battery-powered device is used to send mild electric pulses going to the nerve fibers in order to block pain signals to the brain thus alleviating the pain.

5. Ultrasound is a non-invasive method that works by warming the internal tissues of the body that results in the relaxation of muscles at the back.

6. Surgical therapy is one of the many methods on how to relieve lower back pain but it is the least thing to do when the patient does not respond to therapies. It is depending on the doctor's advice if surgery is really needed and consent from the patient must also be considered.

Exercises For Lower Back Pain - Reduce Back Pains

How to Exercise Back Pain Relief Using an Exercise Ball

The exercise ball isn't just for yoga! If you want more back support or have an interest in back stretching, then simple exercises for lower back pain such as the exercise ball can be an alternative to back therapy. In reality, when mixed with back treatment, back stretching on an exercise ball can be effective exercises for lower back pain for reducing pain and even speeding recovery from back surgery. You must use this form of exercises for lower back pain constantly, as it'll help in helping you recover much faster and will strengthen your back in the process.

Consider the following Exercises using only your body weight and a ball.

Sitting Exercise Ball Stretches

One of the exercises for lower back pain you can stretch and bolster your back just by sitting on an exercise ball with your feet flat on the floor. Start by lifting just your heels from the floor, one at a time. Then raise each foot, then each leg up higher and higher. Do not go up high enough to cause more pain, as the goal is back stretching not making the difficulty worse.

On days when you have more major agony, you may want to do some exercises for lower back pain like : just sit on the ball and balance your body for short periods of time. Just the act of balancing can be of benefit, since the balancing act comes from your core muscles. This implies there are truly no excuses for not using the ball even on days where you are experiencing slight pain.

Lying Exercise Ball Stretches

Start by lying over the ball on your stomach with your hands and feet on the floor. Carefully lift one arm and the opposite leg up in the air, then lower and switch to the opposite side.

It isn't hard coming up with exercises for lower back pain, particularly if you get a ball and just spend a while checking out different positions. You might also want to try a session of back therapy to get an idea of further moves. There are also workout videos that are available in particular for showing you the way on exercises for lower back pain to effectively use the ball for strengthening your back.

Chiropractic and 3 Easy Exercises: The Answer to Your Low Back Pain!

Back pain is the single biggest reason people go to the doctor. It has been reported that 80% of the population will make a visit to see some type of healthcare specialist because of their back pain. I can tell you, as a chiropractor, that the vast majority of the people that I see in my office for back pain:

A. Have had similar episodes of this back pain in the past
B. Can't link their pain to a mechanism of injury (this is just a fancy way of saying that there is no good reason for their back to hurt).
C. Will have more episodes of back pain in the future, which will get
worse and more frequent, unless they do something about it.

The healthcare industry does not have any great answers to treat chronic back pain. This is why there are so many different types of practitioners who treat it. Chiropractors, Physical Therapists, Family Medicine Doctors, Orthopedic Surgeons, Neurosurgeons, Physiatrists, and the list goes on.

I have found over the years that the best way to treat Chronic Low Back Pain is to not get it. The best way to do that is to maintain low back and hip mobility, alignment and strength. In my office, I utilize various manual therapies such as spinal manipulation (Chiropractic Adjustments), Soft Tissue Techniques (think highly specialized massage therapy), and various types of stretches in order to increase mobility and spinal alignment, to great effect. The true secret, however, to maintaining the mobility and alignment that is achieved in the office, is specific exercises performed by you at home on a habitual basis. The following three exercises are my favorites for keeping the low back/ hip complex strong.

1. Squats - Begin with your feet about shoulder width apart and your toes slightly pointed out. Begin the movement by moving your butt back and down, while hinging forward at the waist (do not round your back). I like to move my hands up to parallel with the floor as I go down. Squat down as deeply as you can. You have a good idea that you are doing this exercise correctly if you look down, while at the bottom of the squat and your knees are in line or slightly behind your toes. Return to standing. Repeat 20 or 30 times.

2. Lunges- Begin this movement standing with your feet about 6-8 inches apart. Step forward with your right foot (take a big step), and lower yourself so that your left knee is almost touching the floor. Make sure that your back is straight and that you are not bent forward at the waist. Also, make sure that your knee is in-line with or slightly behind the end of your toes. Next, stand up and then bring your right foot back to where you started. Repeat the exercise with the opposite leg. Do 10-15 on each leg.

3. 1-leg Romanian Dead Lift- Place a dumbbell or Kettlebell that weighs 10-20 pounds on the floor and stand with it right in front of you. Stand on one foot. Bend down (at the waist with a flat back and abs held tight) to pick up the weight with your opposite hand. Stand up with the weight. Bend down to return the weight (from the waist with a flat back and abs held tight). If this is too difficult for you, skip the weight and just try to touch your toe or your knee. Just make sure that your lower back remains flat and that you keep your abdominals tight. Repeat 10-15 times. Do the other leg 10-15 reps.

That's it. If you can do these exercises correctly and you do them on a regular basis (3-5 days per week), chronic low back pain will have a hard time finding your address. I have found that by combining these exercises with regular but infrequent chiropractic treatment, my patients generally manage to stay pretty pain-free. Of course, the more regular you are about doing the exercises, the more "infrequent" your chiropractic treatment will be.

How to Treat a Pinched Nerve in Your Lower Back

If you are suffering from pain caused by a pinched nerve in in your lower back you are not alone. Millions of people are suffering just like you. Not only in the United States but throughout the whole world.

Luckily, there are a multitude of treatments that can effectively get rid of your pain.

Always make sure that you practice proper body posture and mechanics throughout the day. Simple things like bending your knees when you are picking something up from the ground and even sitting and standing upright instead of slouching can often times provide dramatic relief.

Simple stretching exercises also work wonders to alleviate symptoms.

Strengthening exercises of the abdominal and lumbar spine muscles should also be incorporated into your routine. These muscles support and protect your spine and spinal discs. In a way they are the armor of your body.

Stay active. Many people mistakenly believe that bed rest is the best treatment for back pain. This is a huge misconception. Clinical studies have proven that staying active is one of the best ways to get rid of your symptoms. Bike riding is one of the best exercises for staying active and not putting a great deal of stress on your body.

If these suggestions do not do the trick, then you definitely want to see your Family Chiropractor and Medical Doctor. Sometimes, your symptoms can be caused by a disc herniation and your Doctor will have to order the appropriate diagnostic studies like an MRI to properly diagnose your condition.

The Key To Lower Back Pain Relief

The quickest and easiest way to get lower back pain relief is to take a packet of Nurofen, or if the pain is breath-takingly excruciating, a packet of Oxycontin. This is the medical industry gold standard treatment for lower back pain.

Whilst a lot of doctors encourage people to take the drug route, and to be sure, if the pain is bad enough, it might be the only thing that brings sufficient relief to start getting on with life, it will be a tortuous route if it's the only one you take.

On the one hand lower back pain is not caused by a lack of Nurofen or Oxycontin. On the other hand taking a drug to mask the pain diverts people's attention away from doing what they really need to do to permanently relieve their pain.

The medical industry logic goes like this; 'Take the tablet, pain goes away, problem fixed! Next!'

Well, it doesn't work that way. A problem masked is not a problem fixed. It's the great medical industry legerdemain. The pain in the foreground may have gone, but the problem that caused it is still lurking in the back ground, ready to flare up again at the slightest provocation.

Then there's the big worry. Not only does taking Oxycontin not treat the underlying cause of the pain, you could compound your back problem with an opiate addiction problem.

But, turning attention away from the quick fix, the key to lower back pain relief comes in two parts.

First find out what's causing the pain.

No motor mechanic would stay in business for long if they didn't know the cause of a particular problem. In fact motor mechanics are much better at diagnosing the causes of misalignment in various moving parts of motor cars than doctors, radiologists and surgeons are at diagnosing the causes of misalignment in the moving parts of human bodies.

In the sit down society the cause of the problem is rarely at the site where it's painful. So rubbing, crunching, heating and vibrating the bones in your lower back will not do much to fix the underlying cause of the pain.

It's highly likely that the cause of your lower back pain comes from a pelvis that's been drawn out of alignment. Once the pelvis moves out of alignment the bones above it are drawn out of alignment as well, stretching ligaments, tendons and muscles beyond their pain threshold and causing discs to herniate.

You think there's something wrong with your lower back, which there undoubtedly is, but the cause usually lies in weak and tight muscles attached to your pelvis - front, back and sides.

Tight muscles have taken the pelvis out of alignment. Weak muscles have fallen down on the critical job of giving support to its structural alignment.

Which brings us to the second key to lower back pain relief, which is, to start doing the strength and flexibility exercises designed to support the bones throughout your body, and particularly your pelvis, in better alignment.

Loosening tight muscles can be done with a range of exercises, some of which, like 'static back' and the 'supine groin stretch', require absolutely no effort at all. All you have to do is lie on the floor for an hour each night while you watch TV and let gravity do the work for you.

Most of the other exercises you need to do don't take much effort either, exercises like the 'hip crossover', the 'wall sit', the 'sit up straight' buttock stretch and the 'prone frog'.

So how long each day do you need to spend waiting for pain relief to kick in?

I'd say that if you spent a couple of hours a night on the stretching program and if you went to the gym three times a week to do a good set of strength exercises, in a couple of months you should be feeling a whole lot better.

Most people say they don't have two hours a day to spend on an exercise program, yet the average American spends well over three hours a day watching TV. You can do your exercises while watching your favourite programs. It's called multi-tasking and it's not all that difficult.

Large number of people have been conned into believing they can't fix themselves, so they put themselves in the hands of the rubbing and crunching industries. It doesn't work that way either. Sooner or later you have to do something to yourself.

So, if you knuckle down, buckle up and spend a couple of hours each day, on the floor while you're watching TV or reading a book, letting gravity and your own muscles do the work, then in 10 years time you'll be able to look back and say you've been pain free for the last 9 years and 10 months.

In the meantime stay tuned, highly tuned and remember, I can give you the exercises but I can't do them for you.

John Miller

Chronic Low Back Pain Relief - What Kind of Mattress is Best?

In a recent nationwide survey on back pain, most survey participants reported using a firm mattress with a 2 cm plywood bed board between it and the box spring. But many of those who expressed the most enthusiasm about their sleeping arrangements suggest omitting the box spring and putting an extra-firm mattress on a platform bed.

If you have the option, don't use a brand-name mattress. Instead, have a foam-rubber company make you a, 15 cm (6 inch) thick, extra-firm mattress. It's less expensive than purportedly corrective mattresses and at least as firm and comfortable.

Futon mattresses on platforms are the next choice of US survey participants. But if your hips, buttocks or thighs are painful, you will probably find the futon too thin and hard, and the cause of unwelcome pressure.

If your bed is too hard (as may be the case with some 'orthopedic beds'), try placing a duvet between the under-sheet and the mattress. This gives a softer surface, especially for a more petite sleeper. Remember that what feels firm to someone of 50 kg (8 stone) is very different to what feels firm to someone of 115 kg (18 stone).

Of the 15 US survey participants who turned hopefully to water beds, 8 switched back to firm mattresses and bed boards, complaining that the bed couldn't be made hard enough to suit them. They also said that the water produced a 'rolling action' that made it difficult for them to control their movements and positions. (However, this has become less of a problem with more recent advances in water-bed technology.)

The other 7 were happy with their water beds so long as the mattresses were kept 'filled to the top' and 'firm'. They said the water enabled the spine to align more comfortably, and that the floating sensation eased the pressure on the spine and muscles. You can also regulate the temperature of water beds, which can be an advantage for treating chronic low back pain.

Some back sufferers give up mattresses altogether and take to the floor when their back pain flares up. But lying on the floor is not recommended for incapacitating pain and muscle spasm, primarily because getting up from and down to the floor may add to your pain. Also, if your low back pain is accompanied by pain and spasming in the hips arid upper legs, even a carpeted floor can put too much pressure on inflamed and sensitive areas, causing more pain and spasm.

If, however, you find yourself stuck between a hard floor and a sagging mattress, take the floor until you can make other arrangements.