Back pain is not a disease, but rather may show up as myriad symptoms with no known cause. It affects people of all ages and races as well as both genders. The World Health Organization1 states it’s difficult to estimate the incidence, as your first episode likely happens by early adulthood and the symptoms of low back pain often recur over time.
The lifetime prevalence for anyone experiencing back pain at some point in their lives is estimated to be 60% to 70% in industrialized countries. It is the leading cause of mobility limitation and work absence, and it imposes a high economic burden for Americans, estimated at $100 billion in health care costs, lost wages and lost productivity every year.2
Researchers have found the prevalence increases beginning in the third decade of life3 and that it’s the single leading cause of disability, preventing many from engaging in everyday activities.4 It is one of the most common reasons for people to miss work and is the third most common reason people visit the doctor’s office.
Many cases are related to mechanical or nonorganic causes, which means they are not triggered by a condition such as arthritis, fracture or cancer.5 In one meta-analysis6 of 13 studies, researchers evaluated the prevalence and incidence of low back pain and found nine studies that identified risk factors including age, sex and race.
In four other studies the researchers identified high intensity physical activity, high spinal loading, lifting, bending and twisting as risk factors for low back pain.7 Although age, sex and race are not controllable, the activity factors are and respond well to lifestyle adjustments.
Stretches help mobilize your lower back
Your back and spine support much of your body’s weight while your abdominal core muscles help support your spine. Once you experience lower back pain, it may be a challenge to get up and move, but you’ll find low-impact activity often helps reduce the pain. It also speeds healing. Exercise and movement help to loosen tense muscles that cause pain.
Pain may become a vicious cycle, where you have spasms that make you not want to move; this triggers more back spasms. A daily exercise program with strength training and stretching may improve strength and flexibility, which will speed up your recovery and make it less likely to happen again.
One stretch you may be tempted to use to loosen your lower back muscles is a standing toe touch. However, there are multiple reasons why this is bad for your back.8 The goal of the standing toe touch is to stretch your hamstrings so that it reduces the pressure on your lower back. But, the stretch increases the burden to your lower back and places pressure on your lumbar discs.
When you push your legs together and lock your knees as you bend over it forces flexion only in the lower back and stresses the spinal discs. If you already have an injury to your lumbar discs, it may increase the risk for aggravation or further injury.9 Instead, consider these three stretches to mobilize your lower back:10
• Cobra pose — This traditional beginner yoga pose is a gentle backbend position accomplished from a face-down, on-the-floor exercise.11 The goal is to strengthen the spine while opening the chest. It is also an excellent counter activity to relieve overstretched upper back and tight chest muscles that often occur because of working over a desk.
Begin by lying on the floor on your stomach, stretching your legs behind you and placing the tops of your feet on the floor.12 Put your hands under your shoulders and keep your elbows close to your body. Press the tops of your feet, thighs and lower pelvis firmly into the floor while straightening your arms to lift your chest.
Go only as high as you can while maintaining connection from your lower pelvis through your toes on the floor. Hold this for 15 seconds to begin with, and then build to 30 seconds as you grow stronger. Inhale on the way up and exhale with your release on the way down.
• Cat-cow pose — This basic yoga pose is breath-synchronized and it warms up the spinal muscles.13 Begin with your knees and hands on the floor and your back straight in a table position. Your shoulders should be over your wrists, and your knees directly under your hips, with your weight balanced on all four evenly.
Move into a concave position as you inhale through your abdomen, tipping your belly toward the floor and lifting your eyes toward the ceiling. Exhale while drawing your belly button toward your spine and slowly move into an arched back position with your chin resting on your chest. Do not hold in the cat or cow position but move gently and smoothly through both.
• Child pose — This pose is a resting pose used between more rigorous yoga exercises.14 Start by kneeling with your feet together while sitting on your heels. Move your knees apart so they are as wide as your hips.
Exhale while lowering your body down between your thighs. Lengthen your lower back away from your pelvis and lay your hands on the floor, palms up along your body. In the beginning, start with 30 seconds and work up to two to three minutes as you’re comfortable.
Altering your posture may reduce lower back stress
Using good posture is about more than standing up straight and looking your best; it’s crucial to your long-term health. Posture affects your balance, food digestion and breathing. When you don’t use your body in the right way, it places additional stress on your back, hips and knees and increases your risk for pain and injury. The key to good posture is to place your spine in a neutral position.
Slouching or straining at your desk may increase your risk of back pain and neck pain, while using ergonomics to modify your workstation may reduce these risks. To stand properly and reduce the stress and strain on your lower back, you’ll want to bear weight on the balls of your feet and keep your knees slightly bent.15
As you stand and walk your feet should be about shoulder-width apart with your toes pointing forward. Stand straight and tall with your shoulder blades pulled down and your stomach tucked in. Keep your head and earlobes in line with your shoulders, as your head is heavy and keeping it forward adds stress to your upper back.16
While seated, your feet should touch the floor and you shouldn’t cross your legs.17 Keep a small gap between the backs of your knees and the front of your seat. Then, adjust the backrest of your chair so your lower- and mid-back are supported. Avoid sitting in the same position for long periods of time.
Instead, switch sitting positions often and get up frequently to stretch or walk around.18 Keep your shoulders back and relaxed so they’re not rounded forward. Improving your posture not only will help reduce wear and tear on your spine, but also will reduce neck, shoulder and back pain.
The shoes you wear also have an impact on your posture and may add additional stress to your lower back, legs and even your neck.19 For instance, high heels change your body’s alignment and may increase your risk of lower back pain. Seek out properly fitted, comfortable shoes that support your feet. If necessary, consider talking with a podiatrist or foot specialist.
Ice reduces inflammation and heat speeds healing
Using cold and heat are both effective ways to find relief from lower back pain.20 They each work differently. For instance, applying ice packs is most beneficial in reducing inflammation and pain. However, they also reduce blood flow to the area and are best used when you’re not going to move around for a while, like right before going to bed.
Consider purchasing a cold pack designed for pain relief, using a bag of frozen vegetables or making your own ice pack at home using isopropyl alcohol and water in a plastic bag. Fill the bag with half isopropyl alcohol and half water, then freeze it. The ice pack will not get solid, so it will conform well to your body. Whatever ice pack you use, cover it with a cloth to protect your skin.21
Adding heat improves blood flow to the area, which may also help reduce inflammation over time. Take care not to burn the skin with a heating pad or hot water bottle.22 You may also make your own hot pack by adding uncooked rice to a cloth bag and microwaving it. Test the bag before placing it on your skin.
Pain relief cream helps relax muscles
Sometimes what you need is immediate relief so you can function throughout the day. Creams containing capsaicin may help relieve pain, while those containing menthol have a cooling effect to temporarily dull back pain. In one study23 using capsaicin for the treatment of osteoarthritis pain, researchers wrote that they found that a topical application was “moderately effective” in reducing pain for up to 20 weeks.
In another study24 that investigated menthol as an analgesic, researchers found menthol affected diameter of the arteries (vasoactive), which accounts for the cooling effect. Topical application activated central analgesic pathways, but researchers found that applying too much could make an individual more sensitive to pain.
A third option is arnica oil, a homeopathic remedy applied directly to the skin. You may purchase products with arnica in creams and gels. The compound has a low side effect profile, and many find it helpful.25
In one case,26 an 82-year-old woman with extreme deterioration in her left shoulder from osteoarthritis used arnica oil massage, acupuncture and therapeutic ultrasound. After three weeks of treatment she experienced a reduction in her pain and continued to regain functionality over time.
After 36 treatments she canceled total arthroscopic surgery and continued using the combination of acupuncture, therapeutic ultrasound and arnica oil massage for pain control. This allowed her to maintain functional use of her shoulder.27
Strengthen your core to protect your back
Achieving and maintaining a strong core helps stabilize your lower back and reduce chronic back pain. In one study28 designed to compare the effectiveness of core stabilization exercises with routine physical therapy, researchers enrolled 120 people with nonspecific chronic low back pain.
Outcomes were recorded at the second, fourth and sixth weeks of treatment, after which the researchers discovered a significant reduction in pain across both groups. Greater stabilization and pain reduction were realized in those using core stabilization exercises rather than routine physical therapy.
Foundation Training, developed by Dr. Eric Goodman to address his own chronic back pain, is a simple yet powerful approach that is said to be profoundly useful for anyone who sits more than three hours a day.
Foundation Training teaches the muscles in your pelvis, hamstrings, glutes and adductors to work together through integrated chains of movement. By integrating these chains, the training strengthens and realigns your spine and core, which may alleviate back pain. If you want to read more about foundation training and the impact it has on back pain in, check out “An important exercise for back pain.”
Improve sleep and reduce stress
Disturbed sleep may worsen your pain29 and reduce your pain tolerance.30 A number of factors contribute to a lack of quality sleep, including an uncomfortable mattress, poor posture in bed and poor sleep habits. Comfort and alignment of your back are essential for good quality sleep and for reducing your pain level the following morning.31
Chronic pain is associated with sleep disturbance,32 and sleep disturbances are associated with increasing levels of pain.33 The cycle may be alleviated by practicing good sleep habits.
Several factors affect your sleep routine, including light in the room, temperature, electromagnetic fields and eating habits. You’ll find more information about the negative effects of lack of sleep and tips to help you improve your sleep at “Top 33 tips to optimize your sleep routine.”
Steer clear of opioid prescriptions
You may have low back pain lasting more than 12 weeks (chronic) or a few days to a few weeks (acute).34 In most cases, acute back pain will resolve but has the potential to become chronic. Unfortunately, low back pain is one of the leading reasons opioid painkillers are prescribed.35
Guidelines36 released from the American College of Physicians37 recommend spinal manipulation and other nondrug treatments to be used first, for both acute and chronic low back pain. In a survey38 of more than 2,100 physicians from a variety of specialties in the U.S., respondents described overtreatment as common, with 22% of medications prescribed unnecessarily.
While a prescription of opioid painkillers may have begun with pain, one investigative journalism piece39 found hundreds of doctors received in excess of $25,000 each from opioid manufacturers — and at least one doctor received more than $1 million.
The epidemic of opioid use has resulted in lower life expectancy for men and women. While there are several different opioids drugs, the most common forms involved in overdose deaths are methadone, oxycodone and hydrocodone.40
There are many options to treat your pain without drugs, beginning with the strategies discussed above. Considering the health risks connected to opioid painkillers, I strongly urge you to exhaust your other options first, including those discussed in “The US opioid epidemic — A war of a different kind.”