Lower back CT scan

More than one in four adults in the U.S. say they have recently suffered from low-back pain. Americans spend at least $50 billion a year trying to make their backs feel better, but research has raised questions about the effectiveness of common medical approaches like surgery and steroid injections. We examine the latest research and treatment options for bad backs.

Paul Slosar, orthopedic spine surgeon at SpineCare Medical Group
Amy Selinger, physical therapist and owner of Back to Life Physical Therapy
Esther Gokale, creator of The Gokhale Method

  • Chemist150

    For me, it was to strengthen my muscles. At the time, I was active in sports and riding a bike every week. I had had chronic back aches and I started going to the gym. It really didn’t help until I used the machine that you sit in bent over, lock in you legs and push the weight up and back with the padding pressing on your back. It takes all of 5 minutes.

    It targeted my lower back muscles and I’ve not had a lick of trouble since.

  • thucy

    For me, it’s been Masters swimming (try USF, it’s affordable and huge), or even regular lap swimming with a quarterly coached supervision. It’s maintained deep core strength in ways that Pilates and Yoga couldn’t touch, stretching and building all the muscle tissue that supports the spine.

    Both breast and free-style strokes have been modernized. The new breast stroke technique involves an underwater gliding movement followed by an extension that is pure heaven in building the strength that eliminates lower back pain. Ironically, the new focus, less on “work” and more on “glide”, better builds the muscles that support the back. The new free-style stroke has your torso rotating and stretching in ways that are surprising, fun, and great for your back.
    But in the end, whatever movement works for you, keep doing it, and keep exploring other motion exercises. The worst thing is to get in a rut with one strategy or one fix-it machine.

    • Tim Dougherty

      Not sure I swim like you… But it hurts my back. Were all different and so are our mechanisms for pain IMHO. It still swi. Regularly at sjsu

      • thucy

        “But it hurts my back. Were all different and so are our mechanisms for pain IMHO.”
        You are so right on that. I had some pain before I did a coaching session to update technique. If you still swim, maybe it’s worth your time to hire a one-on-one coaching session through one of the swim teams? Best fifty bucks I ever spent…!

  • Jake

    Sit less, sit better, for better back (and general) health.
    If you are able, try to be on your feet as much as possible during each day.
    Here is a fantastic graphic, explaining the health consequences of sitting too much, and some preventative measures you can take:

  • geraldfnord

    For me, it’s about two days’ worth of naprosyn and codeine—about 180mg of the latter, with some acetaminophen to hack the liver’s metabolising the lot—on hand to start taking at the first twinge; experience shows this to prevent descent into a {muscular damage}/pain/inflammation/damage… cycle better than anything else. Learning that heat exacerbates the problem for me, and that cold must be applied until it were uncomfortable in order to help, picks up the spare.

    I use no special exercises, as I hate the fantastic boredom of exercising and the hours of pain it (with one exception viz sub) brings (‘Endorphins? What are those?—I hit the wall and then slide down it on my face. ‘); instead I walk nearly everywhere.

    Your figurative mileage will almost certainly vary; shop as usual, and avoid panic buying.

    Note that I resort to this 3-5 times in a usual year, so it’s not (for me) the primrose path to junkiedom. I’m glad that the medical profession have as yet not been sufficiently cowed by the current clamp-down as to make this solution impossible…I resent the addicts who may yet spoil it for the rest of us, but that is quite unfair: it is the State’s reaction to them that were to blame.

  • Bob Fry

    I started Lower Back Pain in my 30’s…too much slouching in front of a computer maybe. It’s a real shock the first time it happens, you think you’ll be in a wheelchair all your life.

    Anyway, mine is under control with regular (2-3 times a week) stretches and exercises recommend by a licensed, professional physical therapist. These people know what they’re doing, and will get you straightened out with proper exercises. I’m sure some severe cases need drugs or surgery, but for most people the correct exercises should work. They take maybe 20 mins each time, but you gotta do them the rest of your life.

  • Kate

    I hurt my back 25 years ago. At that time the dr told me to strengthen my ab muscles (long before anyone spoke of Core work). Knock on wood, 15 minutes of ab and core work every day has kept my back happy. I also walk or run every day watch my weight. Having a big belly to carry around is going to strain your back

  • Norman

    I had mild back pain for several months in my late 20’s and after I realized that it wouldn’t go away on it’s own, I went to a chiropractor and to physical therapy for a few months, but those strategies didn’t help. One day I decided to try out a harder mattress and after one night on that bed, I haven’t had back pain since. Give it a try!

    • Chemist150

      Weights helped mine but my bed now…. It’s not helping.

  • ellen

    I’m curious to know if anyone had successful treatment with inversion therapy?

    • zach

      I had total success with inversion therapy! I was one of the callers on this show.

      I modified a pair of work boots and raised the foot of my bed. This gave me the ability to get a lot of quality “mild” decompression, while taking no extra time out of the day to do so. I made a quick and dirty D.I.Y. slide show on you tube.

  • Cjramin

    Thanks, Penny — soon my book, The Fragile Column: How to Beat the Back Pain Industry at Its Own Game, will be ready. In the meantime, you might like to take a look at the resource page on my website, at http://cathrynjakobsonramin.com/resource-intro/ Your guests have very specific agendas. My goal is to help patients set in context what’s being offered to them.

    • tomas

      your specific agenda appears to be selling a book.

      • Cjramin

        Not quite sure my prior response made it through! Yes, you are right about that, Tomas! I hope it will allow patients to truly understand all their options, pitfalls and benefits.

        • tomas

          i hope you balance your discussion with the good work that is done by most doctors, the success stories that come from technology and devices, and the benefits of pharma (as seen two comments down) – otherwise you will just look like another conspiracy theorist railing against “industry”… but then again, there is always a market for that!

  • Katherine Poppy

    Judy Foreman’s new book “A Nation In Pain” is a wonderful resource. Please let people know about it. Thank you.

  • You are all having a great conversation. I haven’t heard anything about chiropractic care. What do the panelists have to say about Doctors of Chiropractic and chiropractic care?

  • Daniela

    I have a height-adjustable desk at work and wonder what is best for my back: standing all day, sitting all day, or mixing it up? If mixing it up is best, how many hours of standing is recommended before sitting down? Thank you!

  • C.A.

    What about the latest fitness craze Crossfit? Is this super intense workout going to lead to future back pain for many?

  • sean.benward

    What is the difference between muscle spasms and bone pain. Once when it was cold and standing outside for for a few hours. When I sneezed, I felt sharp pain in my back. I am wondering is that a muscle issue? I don’t have this issue otherwise.

  • Fay Nissenbaum

    15 years ago I entered a back rehab program based on posture and strength training combined with an hour of Iyengar Yoga (that’s the precise kind). Iyengar teaches to push the femur heads back in the hip socket to create the space to bend in the hinge technique mentioned. The pelvis is like a bowl and tipping the front edge slightly up also creates space for lower vertebrae. What isn’t being mentioned is most insurance plans cover expensive surgery but do not cover long term physical therapy and alternative disciplines being mentioned today. As a “cash patient”, you will face significant expenses. Please comment on that.

  • Tom

    Just a quick suggestion for an office chair that has done wonders
    for curing my chronic low back pain: the SwingChair.

    It’s unique in that the seat pan is hinged so that it moves to
    counterbalance the movements you make when you sit in it. Because the
    seat and backrest counterbance your movement, you’re supported in any
    position. It’s hard to describe in words—basically you’re never in a
    static position; your hips and legs and back are constantly moving.

    Have your panelists heard of this chair, and if so, what do they think
    of it?

    The webiste is swingchair.com

  • Fay Nissenbaum

    Stupid comments about yoga – you are not mentioned the discipline – Yes, hot yoga less mindful than Iyengar – the branch that brought props into the poses to enable postures that dont injure. Physical therapy has evolved little since its “shake and bake” origins and physical therapists can be the really clueless about exercise.

  • halrhp

    Every one of us is different, and we even change over time. In the ’90s, I had severe, disabling sciatica pain and tried everything… chiropractors, accupuncture, anti-inflammatories, among others. I learned to pay attention to my posture from a teacher of the Alexander Method. After about 10 years, the sciatica pain dissipated without any clear association between any particular cause. Back pain returned around 2010 and injections of steroids by a pain medicine specialist helped. The best thing I know of is to lie flat with my legs up on a couch or chair, small book under my head, stretching the back before assuming the position, and breathing consciously. This is painful when I first get into the posture, but the pain dissipates after about 20 or 30 seconds and I am OK. Relaxing, helpful for me. Not a prescription for everyone. We are all different!

  • Annabelle Casablancas

    American Bone Health recommends using our Drills for Desk Warriors if you’re hunched at your desk all day. Your bones will thank you! http://americanbonehealth.org/component/k2/item/download/118_542ff864e356d30bde18484972c46919

  • BC

    Feldenkrais movement lessons (which are gentle) developed by Moshe Feldenkrais help to balance the body so that you move efficiently, effectively and pain free. I have much less pain and am much less prone to injury since I started doing these once a week

  • halrhp

    Biggest danger – overgeneralization! We are all different and we change over time.

    • Tim Dougherty

      I agree. I’ve become fatigued hearing about what worked for others, but some of these new modalities seem to be patient specific with a lot of self feedback.

  • Guest

    My physical therapist said that a fancy chair a la Aeron is not necessary.
    He recommended a $20 chair from Staples.

  • halrhp

    Alexander Technique is also an important source for help, but a good teacher is critical, and not all certified are good.

  • Check out the cover story on the British Medical Journal in August, 2008 featuring Alexander Technique. http://www.alexandertechnique.com
    Differences from other solutions:

    Doesn’t take an hour or so out of your day to get the benefits, (aside from the time needed to learn it, which is similar to music lessons.)
    It works by changing mannerisms at the level of the first reaction for beginning to move.

  • Fay Nissenbaum

    Insurance is terrible for covering most of alternative and physical therapies. Most coverage for physical therapy covers three or four visits where they give you those stock exercise sheets and send you home to fix yourself.

  • BC

    Feldenkrais Movement Lessons (gentle)

  • Kate

    Symmetry for Health has been amazing for relieving my chronic back pain that began in high school. Symmetry prescribes exercises that are specific to bringing my body back into alignment.

  • Leslianne Lee

    Glad to hear yoga mentioned as also a mindset. I offer Viniyoga Therapy to help people become more aware of unconscious patterns in the body, breath, and mind to help relieve pain, stress, poor movement patterns and imbalances, have more peace of mind and more function overall.

  • Lani Mein

    What is the least stressful sport.Tennis,golf,skiing.riding?

    • Tim Dougherty

      They all sound painful to me. Maybe golf? I assume you mean horseback riding which should work core.

  • Barbara

    I had extreme lower back pain 5 years ago and was told that I had blown my L5 disc. The pain continued and eventually I had an MRI that showed nothing was structurally wrong with my back. I was very frustrated since the pain was very real and refereed down my leg. I found this book written by a Spine surgeon “Back In Control” Dr. Hanscom, that explained Chronic Pain and explained how Neuro pain pathways are formed and permanent. This book gives simple self directed exercises and after 4 years of struggling, I am pain free as long as I do my writing exercises. Understanding this Mind Body connection has been a Godsend. (www.back-in-control.com)

  • befofsf

    I injured my low back nearly 30 years ago, was never well diagnosed but likely had a soft tissue injury that became intractable sciatica. I was completely disabled w/pain for nearly 20 years, nothing worked, spent too much time flat on my back. iyengar yoga has been the best single therapy–but not any other type of yoga, as it’s set up to be therapeutic. even so, it was possibile to hurt myself, so communicated often w/the teacher. it helped realign the muscles in a way that chiropractic could only do w/the spine temperorarily. talk therapy to discuss the psychic pain around all the physical pain, all the (self) accusations of it’s all in my head (what isn’t, after all?). regular massage. a pain specialist md to help set up a medication regime, if necessary, to manage the pain w/o self-medicating. working out w/a coach to to track me, so I can strengthen against reinjury. 12 step recovery for food, overexercise, and codependency issues that the injury brought into high relief.

    finally, pain support groups through the american chronic pain association were really helpful for networking, being w/others going through or having gone through the same issues as myself. it was powerful to know I wasn’t alone, and not overly burden my spouse. they’re national w/groups in every state and how I found my pain md. empahsizes not on complaining or medical talk. it has a very positive focus. also chronic pain anonymous groups, both physical and online meetings for those who can’t get to a meeting.

    after many years, I’m well enough to get my clinical psychology doctorate in 2 mo. so I can work w/other sufferers as a wounded healer. I want to become the kind of healthcare worker I wished I’d had at the beginning. the takeaway: it’s possible to be healed w/o being cured.

  • In 2008, the British Medical Journal reported on a randomized
    controlled trial involving 579 back pain patients that compared the
    effects of Alexander Technique, massage, exercise and no treatment for
    chronic back pain. [See: http://www.bmj.com/content/337/bmj.a884 ]

    Measurements taken one year after the study showed:
    —After 24 Alexander Technique lessons patients averaged only 3 days of back pain per month
    —After just six Alexander Technique lessons and a program of daily walking patients averaged 11 days of back pain per month.

    By contrast, the study showed that:

    —With no treatment, patients averaged 21 days of back pain per month.
    —After 24 sessions of massage, patients still averaged 14 days of back pain per month.

  • JR

    Can anyone provide a link to the Jackson and McManus study on the “J Spine” that Esther Gokhale referenced on the show?

  • I have a different chronic pain condition; chronic pelvic pain. Nonetheless, I’ve been immensely helped by both physical therapy including yoga, and mind/body relaxation techniques including meditation. I also take a couple of medications designed to work with each other on the nerve and musculoskeletal aspects of my pain condition, but without the non-medication therapies I practice on a daily basis, my pain relief would be MUCH less. Too many pain patients sit back and only pop pills, obsessing on their medications and giving in to the descending spiral of not trusting your weakened body to be able to help its own pain relief through physical therapy.

    I was referred to an aquatherapy program at Laguna Honda that was perhaps the single most effective physical therapy I’ve encountered in my long co-existence with chronic pain, and it really focused upon strengthening your core. I noticed the effects very quickly–it was quite dramatic. I can’t recommend this therapy highly enough–it was WONDERFUL, and in the 90 degree therapy pool, both luxuriously relaxing and a lot of fun. I’d imagine that back patients needing core strengthening would reap as many benefits from aquatherapy as I did–definitely look into it!

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