A Answers (13)
First, if pain is severe talk your health care professional and receive a proper diagnosis. Often, a program of inhibiting overactive muscles, lengthening tight muscles, activating weak muscles and integrating small and large muscles into a coordinated movement pattern will help alleviate back pain. In the case of back pain, it is generally caused by imbalances in the muscles surrounding your hips. Specific muscle tightness in the hip flexors (muscles that flex the hip) hip rotators (hip muscles that work with your glutes) and hamstrings (muscles on the back of your thigh) often leads to misalignment of the hips and spine. As a consequence, or sometimes the cause, muscles that stabilize your spine like the deep abdominals (the transversus abdominis and small muscles of your spine) and glutes become weak. The cascade effect can lead to inefficient loading of the spine when you move, and poor distribution of forces throughout the body. This equates to increased poor posture, imbalanced movement, compensation and eventually, pain.
To ease back pain, your doctor will review the information gathered in your medical history and physical exam and may provide a range of treatments. The most common treatments include:
- Education and activity recommendations. Your doctor will talk with you about many of the same things presented in this handout, including avoiding bed rest, staying active, and practicing good body mechanics.
- Medications for pain relief. Your doctor may recommend over-the-counter or prescription strength anti-inflammatories (such as ibuprofen or naproxen) or acetaminophen. For more severe cases, your doctor may recommend a short course of muscle relaxers to help reduce muscle tension and increase ability to move. Acute back pain rarely requires treatment with steroids or narcotics.
- Referral to a physical therapist. A physical therapist can create and supervise an individual program of exercises to increase your flexibility and strength. So if your doctor refers you to physical therapy, don’t delay your visit. Early treatment tends to produce better results than later treatment. (If your insurance doesn’t cover physical therapy, ask your doctor for exercise recommendations.)
Ways to ease back pain include:
- apply moist heat twice daily to affected area (or bathe in a warm tub of water or use a Jacuzzi)
- do neck, hip, and back exercises
- focus on stretching and strengthening muscles
- do crunches to strengthen abdominal muscles
- swim to strengthen muscles, increase endurance and end fatigue (start slowly and increase gradually over time)
- work on quality of sleep and stress control
- lose weight
- talk to your doctor if medications are needed
You can get relief from over-the-counter anti-inflammatory medications, and by avoiding activities that aggravate the back pain, and by resting for a day or two. You should listen to your body and anything that aggravates the pain, is probably best to be avoided. If the pain improves, it is more likely to be a benign condition and nothing that serious. However, if the pain is really severe and does not improve, you should consult your physician.
To ease lower back pain: Physical therapy and exercise:
A physical therapist may apply a variety of treatments (such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques) to the back muscles and soft tissues to reduce pain. As pain improves, the physical therapist can teach the individual specific exercises to increase flexibility, strengthen the back and abdominal muscles, and improve posture. Regular use of these techniques may help prevent pain from coming back. Exercise can correct current back problems, help prevent new ones, and relieve back pain, particularly after an injury. Exercise also strengthens bones and reduces the risk of falls and injuries. Prescription medications:
A doctor may prescribe non-steroidal anti-inflammatory drugs (such as flurbiprofen or Ansaid® and celexocib or Celebrex®), muscle relaxants (such as cyclobenzaprine or Flexeril®), and narcotic pain relievers (such as hydrocodone or Lortab®). A skin patch containing an opioid called transdermal fentanyl (Duragesic®) may relieve chronic back pain more effectively than oral opioid drugs. Muscle relaxants, opiate agonists, and narcotic pain relievers may cause drowsiness. Narcotic pain relievers may also cause physical dependence and should be used with caution. Corticosteroid injections (steroids, such as dexamethasone or Decadron®) may be used if pain-relieving and anti-inflammatory medications do not offer relief. The long-term use of steroid medications can cause complications such as weakened immune systems and swelling. Tricyclic antidepressants, such as amitriptyline (Elavil®) and nortriptyline (Pamelor®), may be used for numbness, burning, aching, throbbing, or stabbing pains that shoot down the limbs. Side effects of these drugs include drowsiness, dry mouth, blurred vision, and constipation. Surgery
: Few individuals need surgery for back pain. Surgery is usually reserved for pain caused by a herniated disk. If the individual is experiencing unrelenting pain that is unable to be relieved by medications or progressive muscle weakness caused by nerve compression, surgery may be beneficial.
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One of the most important things you can do to help yourself recover from back pain is to stay mobile. A day or two of bed rest is fine if you're really hurting, but after that, muscles begin to atrophy, which will make your back muscles weaker and make future injuries and pain more likely. So try to stay mobile, even if you just take short walks while you recover. Here are some treatments that may help you get around more comfortably:
- Hot and cold therapy: Cold packs can help reduce swelling and inflammation if used the first day or two after injury. After that, the warmth of heating pads or hot water bottles can help relieve muscle tension and spasms.
- Pain medications: Over-the-counter acetaminophen, ibuprofen, naproxen, or aspirin can help provide short-term relief of back pain. But don't exceed the dosing instructions. And see your doctor if your situation does not improve.
- Rub-on relief: Pain-relieving ointments, gels, creams, and salves are applied directly to the skin and may help reduce stiffness and muscle soreness.The good news is that about 90 percent of people with acute low back pain get better within 4 to 6 weeks.
Physical Medicine & Rehabilitation,
Accurate diagnosis of the sources of back pain will indicate the type of treatment you should receive. However, after structural reasons of back pain have been ruled out (such as a herniated disc), the majority of patients are diagnosed with 'non-specific low back pain'.
What we find clinically is that traditional interventions such as medications and injections, although perhaps needed and based on a physician's recommendation, provide short-term relief.
There is growing research and clinical attention on trying to diagnose or sub-group 'non-specific low back pain'. This can include movement dysfunction, fascial restrictions, muscle control dysfunction, myofascial trigger points, psychosocial variables, pelvic pain, nerve referred pain, or internal/systemic issues such as referred pain from internal organs or hormonal/vitamin deficiencies.
It is important to find a clinician that is able to differentially diagnose the various contributing factors of back pain, and then be able to provide effective treatment for those sources -- and then coordinate with other practitioners that can address other needed areas. Especially in chronic low back pain management, a multi-disciplinary team of health practitioners is usually needed.
The primary treatment for most back pain is non-opioid analgesics. These include nonsteroidal anti-inflammatory drugs, like aspirin and ibuprofen, along with other over-the-counter painkillers like acetaminophen. Bedrest is not recommended beyond a day or two, but it may be necessary for you to avoid activities that caused the injury. Exercise and physical therapy can be useful, especially in chronic cases. Gradual training will help increase flexibility and improve posture. Depending on the cause of the pain, doctors may prescribe a variety of different treatments, including opioid analgesics, corticosteroid injections, antibiotics, anticonvulsants, surgery, tricyclic antidepressants, or alternative treatments like acupuncture.
Back pain can be excruciating and interfere with every part of your life. Sometimes, alternative therapy is used for back pain, such as steroid epidural injections or physical therapy. Your physician may also be able to recommend specific exercises for you to do to strengthen the muscles in your back.
It depends on what caused the back pain in the first place. If the pain is the result of an activity or injury that strained the muscles of the back, then try ice and heat applications, brief periods of rest, and NSAIDs like ibuprofen.
The pain could be the result of bad posture at your work station or improper sleeping positions, two situations that can be rectified with proper ergonomics and possibly a mattress that is moderately firm or one with adjustable firmness.
If back pain persists, see a doctor. Physical therapy may be prescribed along with medications for the pain.
Most back pain is caused from muscle spasm but can have underlying causes which might prolong the course. NSAIDs like ibuprofen, massage, ice or heat packs coupled with stretching can usually ease most back pain. If the pain persists over a week then a doctor’s visit with a prescription for muscle relaxants and physical therapy could be beneficial. If the pain persists beyond 6 weeks then further investigation by a pain physician would be helpful. After a thorough history and physical your pain physician will review imaging to look for potential underlying causes. If surgically correctable problems are identified then a referral is made. If not then an individualized treatment plan which could include injections and/or medications would be recommended to try to limit the pains impact on your daily living.
Not all back pain episodes require a doctor’s visit. You can often manage your pain on your own and return to normal activities as soon as you’re ready. Try these suggestions:
- Keep moving. It’s natural to want to avoid using your back when it hurts. However, for most types of back pain, inactivity -- especially bed rest -- has been shown to do more harm than good. Bed rest can slow the healing process and make your muscles weaker, tighter, and more painful.
- Find a comfortable position. When you do rest, you may have to experiment with positions to relieve your pain. One position that works well for many people with back pain is to lie on your back with your hips and knees bent, with pillows under your thighs. Lying on your side with your knees bent and a pillow between your legs may also help.
- Apply heat or cold. Cold can lessen your pain, while heat can loosen tight muscles. Apply ice or heat for 15 minutes at a time each hour. Some people find that alternating heat and cold works best. For cold, try an ice pack or a bag of frozen peas. For heat, try a hot water bottle or a heating pad -- or take a warm bath.
- Try simple pain medication. The simplest and safest pain relievers arev also usually the most effective. These include the following over-the-counter medications:
1) Anti-inflammatories, such as ibuprofen (generic, Advil, Nuprin, or Motrin) or naproxen (Aleve). These medications not only help relieve your pain, but also help reduce inflammation.
2) Acetaminophen (generic, Tylenol, Excedrin) can also help with pain relief.
Pain medication may not eliminate your pain, but it should control the pain enough that you can be active. Keep in mind that if you take medication for any other medical condition (such as high blood pressure, diabetes, or arthritis), check with your doctor before taking any over-the-counter pain reliever. Also, be sure to follow the usage directions on the packaging.
Back pain treatment is dependent on the causes. Not all back pain is caused by the same thing. You must be individually assessed for your back pain and given a plan of treatment according to the issues that are found causing it.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.