Low back pain affects 60 to 80 percent of the adult U.S. population at one
time or another. Low back problems affect the spine's flexibility, stability,
and strength, which can cause pain, discomfort, and stiffness.
Signs and Symptoms
Tenderness, pain, and stiffness in the lower back
Pain that radiates into the buttocks or legs
Difficulty standing erect or standing in one position for a long
Discomfort while sitting
Weakness and leg fatigue while
What Causes It?
Low back pain is usually caused by strain from lifting, twisting, or bending.
However, some low back pain can be a symptom of a more serious condition, such
as an infection, a rheumatic or arthritic condition, or ovarian cysts. It may be
caused by a ruptured or bulging disk, the strong, spongy, gel-filled cushions
that lie between each vertebra. Compression fractures of the bones in the spine
can also cause low back pain, especially in older women with osteoporosis. In
addition, poor overall fitness, smoking, and general life dissatisfaction
increase a person's risk for low back problems.
What to Expect at Your Provider's Office
Your health care provider will ask you to stand, sit, and move. He or she
will likely check your reflexes and perhaps your response to touch, slight heat,
or a pinprick. He or she may also recommend strength testing on a treadmill. You
may also need a blood test, X rays, a magnetic resonance imaging scan, or
computed tomography scan.
In general, low back pain can be relieved and prevented with lifestyle
changes. Exercising to strengthen your muscles, maintaining a healthy weight,
and practicing good posture lowers your risk. Learning to bend and lift
properly, sleeping on a firm mattress, sitting in supportive chairs, and wearing
supportive shoes are important factors. For long-term back pain, your provider
may recommend stronger medications or surgery.
Nonsteroidal anti-inflammatory drugs
(NSAIDS)—for example, ibuprofen, can help relieve pain
Oral or epidural steroids—reduce
Complementary and Alternative Therapies
Alternative therapies can be effective for easing muscle tension, correcting
spinal imbalances, relieving discomfort, and averting long-term back problems by
improving muscle strength and joint stability.
B-complex: B1 (50 to 100 mg), B2 (50 mg), B3 (25 mg), B5 (100 mg), B6
(50 to 100 mg), B12 (100 to 1,000 mcg), folate (400 mcg per day) are all reduced
with stress and pain.
Vitamin E (400 IU per day), vitamin C (250 to 500 mg twice
Calcium (1,500 to 2,000 mg) and magnesium (700 to 1,000 mg) to
regulate muscle contraction and ease spasm
Bromelain: (250 to 500 mg three times per day on an empty stomach)
anti-inflammatory, works especially well with
Herbs may be used as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Teas should be made with
1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or
flowers, 10 to 20 minutes for roots. Mix three to six of the following (one cup
tea or 30 to 60 drops of tincture three to six times per day).
Relaxants: Black haw (Viburnum prunifolium) relaxant;
petasites (Petasites hybridus), acute muscle spasm, not for long-term
use; valerian (Valeriana officinalis), antispasmodic, especially with
sleeplessness; wild yam (Dioscorea villosa), antispasmodic, especially
with joint pains and long-term stress; turmeric anti-inflammatory, especially
with digestive problems; Jamaica dogwood (Piscidia piscipula),
Pain relief: White willow bark (Salix alba), anti-inflammatory
and analgesic; devil's claw (Harpagophytum procumbens), analgesic,
anti-inflammatory; St. John's wort (Hypericum perforatum),
Circulatory stimulants: rosemary leaves (Rosmarinus
officinalis), especially with digestive problems; gingko (Ginkgo biloba),
especially with poor circulation
Topical treatment may be helpful for acute problems. Mix 1 to 2 drops
of essential oil or 5 to 10 drops of tincture into 1 tbsp. vegetable oil, and
rub into the affected area. St. John's wort for nerve pain; leopard's bane
(Arnica montana) anti-inflammatory, external use only; lobelia
(Lobelia inflata) antispasmodic
Some of the most common remedies for this condition are listed
Aesculus for dull pain with muscle weakness
Arnica montana especially with pain as a result of
Colocynthis for weakness and cramping in the small of the
Gnaphalium for sciatica that alternates with
Lycopodium for burning pain, especially with gas or
Rhus toxicodendron for stiffness and pain in the small of the
Chiropractic or osteopathic manipulation can help relieve
Contrast hydrotherapy. Alternate hot and cold applications. Alternate
three minutes hot with one minute cold. Repeat three times to complete one set.
Do two to three sets per day.
Castor oil pack. Apply oil directly to skin, cover with a clean soft
cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to
60 minutes. Do this for three consecutive
Reviews of scientific studies have found some support for the use of
acupuncture for low back pain. In addition, acupuncturists frequently report
success in treating low back pain and the National Institutes of Health
recommend acupuncture as a reasonable treatment option for this condition. An
acupuncturist's management of low back pain often involves a comprehensive
approach including specialized massage, application of warming herbal oils, and
Treating low back pain with acupuncture can be complex because many meridians
(including the kidney, bladder, liver, and gallbladder) affect this area of the
body. Local treatment to the painful areas and related sore points is often
performed as well, with needles and/or moxibustion (a technique in which the
herb mugwort is burned over specific acupuncture points).
Spinal manipulation is among the most extensively studied and accepted forms
of treatment for acute low back pain. According to a comprehensive review
conducted by the Agency for Healthcare Research and Quality, spinal manipulation
and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two most effective
treatments for acute low back pain. Of these, only spinal manipulation was
judged to both relieve pain and restore function.
Spinal manipulation also appears to be effective for chronic low back pain,
but the evidence is less conclusive. In one study, 174 individuals with chronic
low back pain were randomized to receive either spinal manipulation or NSAID
treatments. Both groups were also taught strength training exercises.
Participants in both groups improved significantly over time, but those who
received spinal manipulation required less pain medication at a 1-year follow-up
visit. In another study, individuals with chronic low back pain who were treated
with spinal manipulation reported a significant reduction in pain compared to
those in a control group who only received pamphlets about exercise and body
mechanics. Pain relief continued even after the spinal manipulation treatments
Massage may be helpful both acutely and to prevent chronic
Chronic low back problems can interfere with everyday activities, sleep, and
concentration. When symptoms are severe, your mood and sexuality may be
affected. While depression is usually not the cause of chronic low back pain, it
often complicates treatment.
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Review Date: August 1999
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative
Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section
October 2001) St. Vincent's Catholic Medical Center, New York, NY; Eric Wellons,
MD, Department of Surgery, Union Memorial Hospital, Baltimore, MD; Terry Yochum,
DC, Rocky Mountain Chiropractic Center, Arvada, CO; David Zeiger, DO, ABFP,
HealthWorks/Integrative Medical Clinic, Chicago, IL; Ira Zunin, MD, MPH, MBA,
(Acupuncture section October 2001) President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
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