It’s 2021 and time to kick off the 30 Day Pain Relief Challenge!

But first I want to acknowledge what’s on everyone’s mind.

2020 began with an unexpected crisis, the COVID-19 pandemic.  A new corona virus strain emerged; highly contagious and deadly for certain individuals, and for which there was no vaccine.  As of this writing, over 85 million people worldwide have contracted the virus, with 1.85 million dying from it.  The United States is being hit the hardest, with 20.8 million cases and 352,000 dead.   The numbers are expected to spike following the holiday season, thanks to many people choosing to get together in large groups and ignoring the risk.  So please, remain extra vigilant the next two weeks because chances are, there are more viruses around you than there were a month ago, ready to find a new host.

As we navigate through COVID-19 in 2021, life must still go on.  I know many have been hurt economically, and their number-one priority is to find a way to get back on their feet.  It is not an easy thing to do, especially if you lost your job and the life skills you possess are in an industry that has been permanently impacted by the pandemic.  If this describes your situation, I sincerely hope you find a way to re-position or re-invent yourself, to get back to earning a living. 

While COVID-19 dominates the news and peoples’ attention, we must not lose focus on the many other challenges life presents that also need our attention.  How would you rate your health at the start of the new year?  How about your energy levels and endurance?   

Quarantining and social distancing have a way of discouraging exercising and promoting over-eating, a terrible combination to health.   When one is restricted from going outside and going to a gym (although a gym is not necessary for staying fit, but I digress…) and constantly bombarded by news of doom and gloom, the tendency is to stay home, surf the web, and eat, more than you typically do (what else is there to do in such a scenario?).  And for many, the choice is high-calorie comfort food.  This can lead to unwanted weight gain, muscle atrophy, joint pain, and so on.

If you are not feeling 100%, then I encourage you to open all the emails I’ll be sending over the next 30 days—the 30 Day Pain Relief Challenge is about to kick off, and email is how it will be executed. 

And what exactly is the challenge?  It’s about challenging yourself to get out of your comfort zone and do all the things I will suggest in the coming days so that you can get out of pain, or significantly knock it down to levels you haven’t experienced in a long time. 

The other reward may be that you will lose 10 pounds or more; will have more energy, and will notice that your mind/ thinking is clearer.  This is because the methods I’ll go over target your body and all its systems; not just the area of pain.  It is wholistic.

But first let me explain how you will be measuring your results.   After all, pain is subjective.  You need some kind of tool to quantify your improvement, so read on.

Pain, aches, discomfort or whatever you want to call it affects your health.  There is mental health and physical health; both important to happiness in different ways.  Your physical and mental health are impacted, even just a little and perhaps unnoticeable to you, if you have chronic pain/aches/discomfort.  Less-than-optimal physical and mental health impacts quality of life.  Quality of life in this sense refers to your ability to physically do what you need or want to do; whether it be your job; recreational activity such as playing golf or swimming; or activities of daily living; i.e. taking care of yourself and your personal needs.

Why You Might Have a Disability if You Have Pain

If you live with chronic pain, you likely have some degree of disability.  

“Me disabled?” you might be thinking.  “No way!”

The word “disability” is often misconstrued.   Disability doesn’t necessarily mean “disabled” and in a wheel chair.  It simply means not being able to perform a certain task without some degree of difficulty or impediment; or not being able to do it at all.  

Doctors (medical examiners) who issue disability certificates or write medical-legal reports are tasked to determine the degree to which someone is disabled.  Their findings determine the patient’s disability compensation from the insurance company or government agency.  They use observation, physical exam procedures, diagnostic tests like X-rays and nerve conduction; and instruments to measure strength, pain perception, reflexes, coordination, and range of motion.   Any deficiency is expressed as a percent disabled, and there are laws that define levels of disability. 

For example, in the insurance industry, the loss of both eyes, or the loss of two limbs equates to “100% disability.”  Not being able to maintain a tight grip could be rated as 20% disability if the person’s occupation requires power gripping machinery.

Disability can also be subjectively quantified using Disability questionnaires where the patient rates his/ her ability to perform certain tasks on a scale of zero to some number; and the level of pain.  In some questionnaires, the zero rating means you have zero difficulty doing the task (best score), while in others the zero rating means you cannot do the task at all (worst score).

For example, the following is one section of the Oswestry Low Back Pain Disability Questionnaire.  Imagine having low back pain and rating yourself (0 to 5) on your ability to lift things:

LIFTING:

 0 – I can lift heavy weights without extra pain

1 – I can lift heavy weights but it gives extra pain

2 – Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

3 – Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4 – I can lift very light weights

5 – I cannot lift or carry anything at all

 When rating yourself, you must try to be as objective as possible—don’t over rate your ability; nor under rate it.  Give each question some thought.

Then, you add up the numbers, divide it by the total number of points and multiply by 100 to get a percentage score. 

If the zero rating is assigned to “full ability to do the task” (like the Oswestry above), then the score is interpreted as “percent disabled.”  So, an individual with no low back disability whatsoever will score zero out of 50 and his rating will therefore be zero percent disabled; i.e. 100% functional.  If his score is 30, then 30/50 x (100) = 60% disabled.

Below is an example of an Oswestry Low Back Pain Disability Questionnaire completely filled out:

In the above example, the total points out of all ten questions is 19, which is considered a Moderate disability, out of No, Mild, Moderate, Severe and Total Disability.  In this case, 19/50 x 100 = 38% disabled due to low back pain.  Now this person has a baseline for his condition, and can set goals to lower it each time; perhaps to 20% after a month, then 10% after three months of therapy.

If the zero rating is instead assigned to “no ability to do the task,” the score is interpreted as “percent functional.”  This is how the Upper and Lower Extremity Disability questionnaires are designed.  So a score of zero in this case means zero percent functional (totally disabled), and 30% means you are 30% functional (you lost 70% function in that limb).

Please note that Disability questionnaires are used as tools to quantify and set baselines for pain and functional capacity; your scores do not officially establish any disability you may have, they simply provide a more tangible interpretation of pain.

Quantifying pain/disability, even if subjective, gives you a sense of how significant it is; i.e. how much it affects your life.  Secondly, it can be used as a tool to measure your improvement over time, after doing some therapy and/or rehabilitation (strength and coordination exercises).  This lets you know if what you did works for your condition, and therefore, whether to continue or discontinue it. 

For example, if your baseline Oswestry score was 60%, and you were prescribed some McKenzie exercises for one week and a follow- up score was 40%, it suggests that those exercises improved your condition and you should continue or progress to the next level.  If it was 60% or higher, you should discontinue the exercises and try another approach.

You don’t have to see a doctor to use Disability questionnaires to subjectively assess your disability.  They are fairly straightforward to use and you can download the forms from the internet (see below; I’ve done it for you). 

Determine Your Pain/Disability Baseline

If you have low back pain, neck pain, shoulder pain, or lower or upper limb pain then I suggest monitoring your condition using the appropriate disability questionnaire.   If you are getting therapy, your doctor should be having you fill these forms (or something similar) out each visit and going over the results with you.  It’s substandard care if you don’t know if the therapy you are getting or exercises you are doing is helping; these questionnaires will prompt you to think about the change or lack of change in your functional capacity, and will help you assess your care so that you can take appropriate action.

Below you will find forms to assess any musculoskeletal pain you are having.  If you wish to participate in the 30 Day Pain Relief Challenge, print out the appropriate disability questionnaire; rate your abilities as objectively as you can and calculate your score; set it aside, and be ready to fill out a new questionnaire after 30 days of diligently doing the things I will cover over the next 30 days.

My goal is for participants to experience at least a 50% improvement in their pain/ disability scores.  If you have any friends who might be interested in participating, please refer them to my site, https://PainandInjuryDoctor.com and have them enter their email in the opt in form.

Download the Low Back Pain Disability Questionnaire

Download the Neck Pain Disability Questionnaire

Download the Shoulder Pain and Disability Index Questionnaire

Download the Upper Extremity Disability Questionnaire

Download the Lower Extremity Disability Questionnaire

 

 

Low back pain continues to be a problem for many people. If not you, then most likely several people you know:  neighbors, co-workers, friends and relatives. That’s what the statistics tell us.

Since it is so prevalent throughout the world, “what causes low back pain?” is a question millions of people want answered. Is it normal and expected as we age? Is it genetic? Will you need to get surgery? As you can expect, the answer is different for different people. First of all, the pain is not identical from person to person. Some people get low back pain on the right side; some get it on the left side. Some get low back pain into the hip.

In this post, I will do my best to help you understand what causes low back pain and at the end of the article provide you a tool to pinpoint what is causing your particular low pain.

The Lumbar Spine and Its Significance

Your low back or lumbar spine engineering-wise is your body’s lynch-pin– along with your pelvis, it connects your upper body to your lower body and is tasked with balancing and moving your torso. If you injure your low back it can put you out of commission: any attempt at moving places a load on your low back and makes pain worse. In extreme cases it is even painful to take in a deep breath! Acute low back pain can instantly stop a 250 pound football player in his tracks; that’s the power it has.

While most cases of low back pain self-resolve over a few days, about 20% of them become chronic, or recurring. For some, it strikes every couple of months; for others, it’s enough to impede their daily activities and quality of life. In fact, low back pain is said to be the number one reason for lost work days (disability) in industrialized nations, and therefore lost productivity.

The reason why low back pain is so prevalent is a societal phenomenon, made possible by evolution. You see, humans are the only bi-pedal animal on the planet. Dancing bears and meerkats don’t count because although they can walk a few steps their pelvic design is still quadri-pedal (walking on four limbs). When nature selected homo sapiens to be bi-pedal, it freed up his arms to carry things–heavy things. Carrying and lifting things and bending the low back places a tremendous load on the lumbar spine, and like any machine, the components bearing the most stress will be the first to break down.

Secondly, the invention of the chair and desk. When our ancient ancestors roamed the plains and forests 30,000 years ago there weren’t any chairs around to sit in for hours, placing pressure on the low back and weakening the postural muscles of the spine. Today, many jobs require sitting at a desk in front of a computer, doing just that. Also, food these days is abundant and much less nutritious causing humans to gain excess weight, placing constant stress on the low back throughout the day.

Causes of Low Back Pain

The vast majority of low back pain cases are mechanical in nature; meaning caused by a breakdown of some physical component of the lumbar spine. These components are the muscles, fascia (muscle sheath), ligaments and tendons; vertebrae, vertebral joints, and discs (which are technically ligaments). If the dysfunction causes compression of nerve roots, then nerve pain is involved, which usually means shooting / radiating pain and/ or numbness down the buttock to lower extremity; sometimes as far down to the sole of the foot.

Here are the main categories of mechanical low back pain:

Congenital Malformations

Sometimes there are abnormalities in the development of the spinal column which interfere with proper movement and balance placing excess stress on soft tissues and sometimes nerves, generating pain or constant stiffness and aches, and loss of range of motion/flexibility. Examples include fused vertebrae (two adjacent vertebrae fused together instead of forming a joint); scoliosis; spina bifida, pars defect, hyperkyphosis (hunchback); and hyperlordosis (swayback).

Injuries

Low back pain is often due to injuries to tissues: sprains to ligaments; ruptured intervertebral discs from a herniated or prolapsed nucleus pulposus (jelly-like shock absorbing substance in all discs); strains (tears, small and large) to muscles and tendons; muscle spasms, and fractures. These can be traumatic from a specific incident such as a sports injury, or can be cumulative over time, often years, from performing a certain movement repeatedly or sitting/slouching causing gradual degenerative disc disease. With acute tissue injury, the inflammatory response is initiated, which is responsible for the pain generation.

Degenerative Changes

Joints wear out over time. Most doctors will tell patients their condition is from “normal” wear and tear. But that’s not accurate. For some people, joints deteriorate at an abnormally fast rate, mainly due to lifestyle factors under their control. I’ve seen X-rays of 60 year-olds look much better than 30 year-olds, on many occasions.

Factors that promote lumbar spine degeneration include:

• Being overweight
• Genetic predisposition
• Sedentary lifestyle/ lack of physical activity
• Sitting frequently (airline pilot, police officer, truckers, data entry)
• Heavy labor job
• Contact sports, especially football
• Occupation or recreation that involve hard landings (basketball, gymnastics, parachuting, etc.)
• Previous injuries/accidents such as falls and car accidents
• Poor diet (your body needs proper nutrients to heal tissues)
• Smoking (smoking reduces oxygen to cells and may trigger inflammation)

Doctors use three terms to describe spinal degeneration:

• Spondylosis when referring to the vertebrae as a whole;
• Degenerative joint disease or DJD if referring to the vertebral joints: facet joints and intervertebral joints; and
• Degenerative disc disease or DDD if referring to the intervertebral discs

In all cases, the joint surfaces of the vertebrae lose their smooth borders and form jagged bone spurs called osteophytes. You can have a lot of osteophytes in your spine and not feel pain at all. In fact, if you are over age 40 you probably have them yourself. But if the osteophytes get big enough to narrow the openings where nerves pass through, called foramen, problems start. This narrowing of the foramen is called spinal stenosis and can occur with the intervertebral foramen (IVFs), the small holes formed by adjacent vertebrae which nerve roots pass through; and also the central canal where the spinal cord and cauda equina reside. This can lead to shooting pain down one or both legs; numbness and tingling in the legs, and leg muscle weakness, atrophy and loss of sensation.

Since osteophytes do not resorb (shrink) and only get bigger with time the only option is spinal decompression surgery which involves shaving off the osteophytes to make more room for the nerves.

And there is another problem:  when spinal discs degenerate, they lose height (this is part of the reason why most people get shorter as they age). A healthy L5-S1 disc can be in excess of 1 cm thick while a degenerated one can be just 2-3 mm thick. When this happens, the posterior and anterior longitudinal ligaments that run down the front and back of your vertebral column slacken, or buckle, at those levels. Like osteophytes, buckled ligaments can cause stenosis, compressing or irritating nerves and causing the same neurological symptoms.

When the degenerative changes involve deterioration of cartilage, you have bone on bone contact. The cartilage in your spine is located in the encapsulated facet joints, located behind the vertebral bodies. This triggers inflammation, which leads to osteoarthritis. It’s the same process as osteoarthritis of the knees and hips, occurring in the spine.

Like knee osteoarthritis, people with spinal OA will feel burning pain in their lumbar spine especially when standing, and stiffness which is worse upon waking in the morning. Osteoarthritis is a chronic, degenerative disease that is best managed by lifestyle modification (anti-inflammatory diet, exercises, stress reduction). Those with severe cases sometimes elect to use prescription anti-inflammatory medication.

Non-Mechanical Causes of Low Back Pain

Less than 1% of low back pain cases are due to other factors, most of which are “red flag” cases that require immediate medical attention. These include pelvic tumors, kidney stones, metastatic cancer (usually from prostate cancer), infection, and endometriosis. A brain tumor is capable of causing sciatica-like symptoms if it affects the sensory neurons that go to the leg.  While rare, if you have low back pain that does not improve with physical therapy or rest, it is a good idea to see your doctor and get some tests done to rule out these conditions. 

Summary and Main Take Aways

If you have low back pain, chances are very good it will go away with rest. Apply ice for the first 1 to 2 days. If severe, you can try taking over the counter anti-inflammatory medications (NSAIDs) such as Motrin or Ibuprofen to knock down some of the pain. And if you are lucky to have a cryotherapy center near you, you can do a couple of visits to shorten the healing time.

If the pain lasts more than 4 days, then it usually means something is perpetuating it:  perhaps you are not resting it properly; are re-aggravating it; or have some kind of contributing factor such as a rotated vertebra or disc protrusion. These issues can be dealt with by visiting a good physical therapist or chiropractor. You can even do some home exercises and home therapy for low back pain on your own and still get great results.

While most cases of low back pain go away, it doesn’t mean that it will stay away for the rest of your life: 20% of people who get low back pain will experience it again in the future; either from a new injury/event or a flare-up of a pre-existing injury.  And remember, some cases become chronic (pain decreases, but the improvement plateaus and remains, with some days worse than others).  Your prognosis will depend on what is causing your low back pain (see below for a self-diagnosis tool) and other factors related to your medical history and daily activities.

When dealing with low back pain, besides focusing on reducing the pain think of what things caused it and eliminate those causes as best you can. It may mean:

• Getting a stand up desk (standing puts less stress on your low back than sitting)
• Losing some weight
• Eating a healthier diet
• Stopping smoking
• Exercising more often
• Reducing emotional stress in your life
• Improving the ergonomics of your work station
• Learning how to lift properly
• Getting your back adjusted by a chiropractor periodically to improve joint movement and joint health

And lastly, remember that low back pain should noticeably and progressively improve each day after initial onset. If you notice that pain does not get better with rest, express your concern to your doctor: demand an X-ray, MRI and/or a blood test. Red flag cases like cancer are often misdiagnosed by doctors (dismissed) as general back pain due to spasms because doctors know that the medical literature estimates red flag cases to be 1% or less of all low back pain cases. Remember to be persistent; it is your life you are dealing with.

Below is a low back pain algorithm I created to help you diagnose your particular low back pain so that you can take appropriate action. Use the top one if your low back pain onset was sudden; use the bottom one if the onset was gradual. This is only a guide; always check with you doctor who can examine you, to get an accurate diagnosis.

Lumbar traction is one of the things you can do to manage low back pain yourself, and not have to spend $$ on the chiropractor or physical therapist.

It involves stretching the lumbar spine in the axial plane; i.e. length-wise; causing slight separation between the vertebral bodies and smaller facet joints. The traction force has to be strong enough to overcome the resistance from muscles and ligaments in order to derive benefit; otherwise it’s just a muscle stretch.

Why Your Height Changes Throughout the Day

Do you notice how you have to adjust your car’s rear-view mirror in the morning in order to align it properly with the rear window?

That’s because you are sitting higher in the morning, and are actually taller; perhaps a full centimeter.
When you stand or sit throughout the day, the force of gravity compresses the discs in your spine; mostly the thick ones in your low back (lumbar). At the end of the day, the discs are slightly thinner due to this constant pressure, and you are shorter. If you drive your car around this time, you probably don’t notice that you have to adjust your rear-view mirror downwards.

When you sleep, you are in a horizontal position and the effect of gravity on your discs is reduced. As you sleep, your discs slowly re-hydrate themselves, like a dry sponge soaking up water, and you become taller overnight!

Most of your upper body’s weight is supported by your lumbar spine, or low back. That’s why the lumbar vertebrae and discs are the thickest and strongest in the spine (compared to those in the neck and torso). The discs/vertebral bodies absorb 80% of the weight placed at that level; the two facet joints behind the vertebral body bear about 10% each.

As you age, your lumbar discs lose some of their ability to resorb fluids. That is one reason you tend to get shorter as you reach 60 and beyond. Like a car tire or other moving machinery part, its function degrades over time.

Factors that accelerate disc wear and tear are being overweight; having an occupation that requires prolonged sitting (desk job, truck driver, airline pilot, etc.); injury to your low back in sports or an accident; and having parents who had back problems.

If any of these describe you, then definitely try doing home lumbar traction periodically. If you currently have low back pain, traction can alleviate some of it by reducing pressure to your discs and facet joints, which do have nerve endings. If you don’t have low back pain, traction can be done to help prevent your discs from degenerating; or at least arrest the progression of disc degeneration. This can save you from major back problems in the future; perhaps even surgery.

What are your home traction options?

The most effective traction is done by the professional equipment used by chiropractors and physical therapists. Sometimes referred to as “non-surgical spinal decompression,” it basically involves lying prone or supine on a special table that has a movable lower section that glides on rails.

You are secured to the table by some contraption, and a harness is placed around your pelvis. A cable connects the harness to a special motor, which can be programmed to pull in different patterns.

For example, there can be settings for frequency of pulls per session; strength of pull; duration of hold time; and pull patterns (step up, step down, constant, variable). The machine must be able to overcome guarding (involuntary contraction) of the erector spinae muscles of the lumbar spine, which are quite strong by the way, so that the traction affects the spinal discs and joints which start to separate only after the back muscles let go.

Now, if you want to get this level of traction you have to find a center that offers this and make an appointment.

Consumer-level home traction devices are entirely different. Most of them leverage your own body’s weight to do the traction.

Watch this video, as I review four devices that can be used for lumbar traction:

Most cases of sciatica involve a bulging disc in the low back pressing on the S1 nerve root, left or right side; less commonly on both sides. The S1 nerve root is one of several that form the sciatic nerve, the largest/ thickest nerve in the body that controls muscle contraction and sensation in the legs.

The S1 nerve root may also be pinched by a thickened spinal ligament or an osteophyte (bone spur) in the foramen (hole) where the nerve comes out of the spine (notice the left vertebrae in the image below demonstrating this).

Sciatica can also arise from tight muscles in the buttock (hip rotator muscles) squeezing it. If you had a fall or injury that misaligned your sacrum, lumbar spine or hip joint it could throw those butt (gluteal) muscles out of balance, causing them to scissor the sciatic nerve where it passes between these muscles.

Lastly, the worse kind of sciatica is from spinal stenosis. This is when the central spinal canal in the lumbar spine narrows, pinching the nerves that lead to the legs. The canal narrows due to degenerative joint disease in the lumbar spine. Some people in this group walk in a crouched forward position, because it seems to provide relief.

Treating Sciatica Yourself

If you have some low back pain along with sciatica, or a history of it, chances are your sciatica is due to a bulging disc.  The strategy then is to reduce the bulging disc; i.e. decrease its size so that it doesn’t pinch the nerve.
Lumbar extension exercises at various angles can be helpful in reducing bulging lumbar discs.  The key is to find the right angle, as all disc bulges don’t behave the same in response to certain movements.  The correct movement causes the lumbar vertebrae to “pinch” the bulge back to center.   Watch this video where I demonstrate how to do this.

You can also use the PosturePump.  This is a device that extends the lumbar spine in the non-weight bearing position (while lying down).

If your sciatica is caused by pinching of the sciatic nerve in the buttock, try stretching your gluteal muscles (piriformis) muscle to lengthen it.  There are several ways to do it.  One is to cross your legs while sitting (bad leg on top), clasp your hand over the top knee and bend forward as far as you can go (may be difficult if you have a large belly).  Hold for about 15 seconds; relax.  Repeat 6 times twice a day.

You can use a power massager like the Max2 Percussion massager to “shake” the spasm out of the piriformis muscle.  Watch this video where I demonstrate this technique.

If you have canal stenosis, and your symptoms are unbearable, get a consultation from a spinal surgeon on your options.

Sciatica often affects those who sit frequently, for long hours.  Sitting places a lot of pressure on the discs and promotes bad posture.  It also places pressure on the sciatic nerve, especially if you don’t have much fat in the buttocks for cushioning and if you have a hard chair.  Wearing a thick wallet in your back pocket can cause more pressure to the nerve.

One of the best ways, in my opinion, to reduce the bad effects of sitting is to use a stand up desk.  Many employers will pay for this, since studies are coming out showing how prolonged sitting damages health over time.  The VariDesk  is an affordable option for a standing desk.

Other considerations

-Get good shoes with arch support.  This alone may ease your sciatica.
-Strengthen your low back, hip and butt muscles by doing kettlebell swings.
-Seek out an Active Release Technique (ART) practitioner.  This is a special massage designed to normalize muscle contraction and joint movement.

If you have a history of injury involving your low back and/or pelvis, get checked by a chiropractor.  Chiropractic adjustments can re- position the area, removing abnormal pressure to muscles and nerves. 

When your low back hurts, you know the next couple of days aren’t going to be fun.  Your low back, or lumbar spine is like the foundation of a house:  it bears and balances all the weight above it, so if there are mechanical problems, the whole structure is affected.  In fact, some cases of low back pain cause obvious tilting of the upper body to one side when standing, due to the structural imbalance.

There are countless studies on low back pain– how it develops; what causes the pain; who is at most risk for developing low back pain; how long it lasts and so on.  For “non-specific” low back pain where there is no injury event, it is unclear which structures are generating the pain.   It may be the back muscles, a vertebral ligament; a disc, nerve root, sacroiliac joint; or even referred pain from an organ.  This makes treatment, especially invasive treatment (surgery, injections) challenging and often ineffective.

What is known is that if you have low back pain that continues down your buttock, and perhaps down the back of  your thigh and leg all the way down to your foot, then it is very likely due to a bulging disc in your low back pressing on a nerve root.  If this describes you, don’t give up hope.   I’ve seen cases like this resolve with targeted exercises, spinal adjustments and time.  But I’ve also seen cases like this turn into back surgery cases, where the surgeon goes in and removes part of the disc that is compressing the nerve, and sometimes the entire disc and fusing the adjacent vertebrae.

Non-radiating back pain can be equally bad.  If the back muscles spasm, the pain can be incapacitating.  I’ve seen many cases like this where the patient dropped to the floor, wincing in pain and avoided any type of movement.  Aside from a cortisone injection, there is not much one can do initially for acute back spasm other than ice and rest until the muscles let go; then attempt things like chiropractic adjustments, PT, stretching and modalities like laser therapy.

Then of course, the rare causes of low back pain — cancer, tumors, bone cysts and other diseases; spinal stenosis, referred pain from kidney stones; fractures, and spondylolisthesis (slippage of vertebrae during movement).  These will require diagnostic testing and proper management.

But for the vast majority of low back pain cases, there are things you can do to reduce their effects and reduce their incidence of occurrence.  Here are my Top Five low back pain relief strategies:

Lose weight

(if you are overweight).  This is just basic, common sense.  If you are 30 pounds overweight, it’s like a normal weight person carrying a backpack full of rocks all day.  Excess weight centered around the abdomen changes the center of gravity of your body.  This bends your spine abnormally when you are standing, sitting, and even sleeping; setting the stage for back pain.

The best and fastest way to lose fat weight is to restrict carbohydrates in your diet, practice intermittent fasting, and exercise 30-60 minutes at least 3x/day.  If you have to cut one of these out; I’d say the exercise.  Caloric restriction burns fat cells on a much larger scale than exercising does.  The reason is that simply by being alive, your body, depending on your mass, burns 1500-3500 calories per day.  If you consume less than what you burn, you will lose fat weight.  So, try eliminating bread, pasta, bagged and boxed snacks, sugar and fruit juice from your diet.  Drink only water.  Eat between the hours of 9 am and 4 pm, or 12 pm and 6 pm only.  This gives you an 18 hour fast, where your body will start burning its fat stores.

Stand more

When you sit, the natural inclination is to round your lower back.  You may try to force yourself to sit erect for a few minutes, but after a while, your low back muscles fatigue and allow your lumbar spine to bow out again.  This posture weakens the lumbar spine’s structural integrity because it separates the facet joints (see middle image below), which makes the lumbar spine less sturdy (“unlocks” it).  The angle of the vertebral bodies also apply a backwards force to the disc that can encourage posterior disc bulging or herniation.

The bad health effects of prolonged sitting goes way beyond back pain.  The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study published in the Annals of Internal Medicine.  This is significant, because computers are firmly integrated into the fabric of life– just about every business from farmers to tech giants rely on computers, and as for now, they are mostly used at a desk.  Low back pain cases can only go up if more and more people spend their work hours sitting behind a desk.

A low tech solution to this is to use a standing desk, like the height-adjustable Vari Desk.  The Vari Desk is actually a large monitor stand that sits on a standard desk and can easily switch from normal height to standing height.  This way, you can gradually increase your standing hours, allowing you to build up your tolerance to working while standing.  For example, for the first week you can try standing 30 minutes every two hours; then work up to standing 30 minutes every hour, then up to three hours straight.  Standing activates the erector spinae spinal muscles (which are inactive when sitting, leading to weakness and atrophy); but best of all standing naturally causes you to form the stronger lordotic curve in your low back.  The lordotic curve is the opposite of bowing and is the “strength” position of the lumbar spine as the facet joints in the back interlock, offering stability and protection to the discs.

 

 

Do functional exercises

While your back is not hurting, why not strengthen it to keep it that way?  This will decrease the incidence (occurrences) of low back pain.  Functional exercises include squats, medicine ball exercises, planks, kettle bell swings and “bootcamp” style exercises that focus on strengthening the muscle orchestration of all the muscles in the body at the same time, rather than one type of muscles (for example, biceps curls is not a functional exercise).

Do Back extensions

For most people with back pain, back extensions are helpful.  Again, this arcs the low back in the lordotic curve, which can press the disc material back to center.  You can do them standing, or prone (yoga cobra position).  Do about 10 extension exercises twice a day.

Spinal Adjustments

If you have a history of back pain and/or stiffness; trauma to your body such as prior car accidents or previous involvement in gymnastics, football or basketball; and/or a history of prolonged sitting you are a good candidate for periodic spinal adjustments, or spinal manipulation.  Spinal manipulation, the practice of moving segments of the spine using manual (by hand) techniques, can reduce the symptoms of lower back pain.  Chiropractors provide most spinal manipulation in the U.S.  Some physical therapists and osteopaths do it as well.

Chiropractic adjustments are quick, low amplitude-high velocity manipulations to the spine, which differs from “long lever” movements (joint mobilization, passive stretching).   They are done to impart better movement and also to “fire” nerves involved in pain and spinal muscle contraction.  This can reduce pain and muscle spasm and restore proper movement to a joint segment.  When a lumbar joint segment moves better, it improves hydration to the discs and ligaments.  When it is properly aligned, it won’t wear out as fast.

Consistency in approach varies greatly from chiropractor to chiropractor as there are more than one ways to manipulate the spine, and different target goals (pain relief vs. attempting to change curves of the spine, etc.).  Then there are “holistic” chiropractors who promote spinal adjustments for general health maintenance.  I recommend that you find an experienced chiropractor with a good, local reputation who focuses on short term care to relieve pain and can advise you on home care exercises after your pain has subsided.

Below is a video I made that explains the logic behind lumbar spinal adjustments for low back pain:

Integrate these five practices, and I believe that low back pain will not be a factor in your life for a long time to come.

If golf is one of your favorite recreational activities, you likely are aware of the unique demands the game places on your body.  Perhaps you even sustained an injury or developed pain related to your golf game.  Let’s take a closer look at the physical demands of playing 18 holes.

First of all, let me start out by saying that besides being a popular sport, golf is a good opportunity to exercise (especially if you carry your own clubs and don’t use a cart).

Number one, it involves a lot of walking.   The best part about walking is that it keeps you away from sitting.  It may not sound like a big deal, but it is.  Excessive sitting, science is finding, is  associated with deleterious health outcomes regardless of physical activity.  This means too much sitting is so bad for your health that exercising later cannot recoup the damage it does.

Secondly, you are outdoors exposed to sunshine.  Getting adequate sunshine is essential to maintaining normal Vitamin D levels, which promotes strong bones, teeth and supports the body’s immune system.  Being outdoors among trees and grass on the weekend is especially beneficial to your health if you have a high-stress office job during the week.

So if you abhor exercising in a gym, perhaps you should investigate the game of golf, if you haven’t already.

Now, back to the topic.  Here are the potential problems that can come with playing golf:

Driving.  Each hole starts out with a driver, the longer clubs with bigger, heavier heads.  These clubs are designed for distance and therefore require a big swing radius (a big wind-up).

Well, that wind-up involves over-rotation of your lumbar spine.   That feeling of discomfort when you swing a driver is occurring at the lumbar facet joints, the small joint surfaces behind the vertebral bodies that interlock with adjacent vertebrae above and below.

Most rotation movement of the torso is produced by the thoracic vertebral joints, from the base of the neck down to the beginning of the lumbar (low back) spine.  This is because facet joints of thoracic vertebrae  are relatively flat and in the same rotational plane, as illustrated below:

 

Lumbar vertebrae, on the other hand, have deeper, concave facet joint surfaces that act as limiters to rotation.  Basically, lumbar vertebrae do not like to twist.

You can feel the pressure in your low back when you have the driver at the top of back swing position and again towards the end of the swing.   The rotational (twisting) force is reduced when  you lift and turn in your rear foot as you follow through the swing, but if that foot motion is delayed the lumbar spine absorbs more of the rotational force.

Over time, repeated over-twisting of the lumbar spine can cause the lumbar facet joints to degenerate and  even develop fractures.  This can lead to other problems, like pinched nerve roots from foraminal stenosis (narrowing of nerve passageway due to bone and/or ligament occlusion).  Tiger Woods used extreme lumbar rotation in his swing and it caught up to him; he had four low lumbar surgeries over his careerr and now suffers from chronic low back pain.

The lesson here is to make sure you lift your trailing foot at the appropriate time of the swing to avoid excess rotational pressure to  your lower back (and be mindful not to over rotate, otherwise risk having back problems in the future).

Another joint that bears a lot of stress during driving is the lead knee.  As you follow through with the swing, your pelvis rotates with your spine.  Tightly connected to each side of your pelvis are the femoral heads– one half of the hip joint.  When you lift your trailing foot, it reduces rotation to your lumbar spine by removing a stabilizer, but at the price of putting a greater rotational burden on the lead knee and ankle.  As the pelvis rotates and reaches end-range, it pulls the femur with it.  But the femur and tibia remain stationary (golf shoe spikes dug into the turf ensure this; plus more of your weight shifts to the lead leg towards the end of the stroke).  This results in a torsional force generated through the lead leg, internally rotating the hip, knee and ankle.   This can cause strain to the hip joint, meniscal tears in the knee and sprain to the ankle ligaments.

So the lumbar spine and leading hip, knee and ankle are joints that absorb significant rotational stress during a driving swing.

To a lesser extent, the leading shoulder joint and wrist absorb stress due to their awkward positions; the shoulder with acute internal rotation and the wrist acute radial deviation.  This can strain the shoulder rotator cuff and ligaments and tendons of the wrist.

Putting (and driving).  It may not seem like a lot of movement is going on during putting, but the putting position is indeed strenuous to the lower lumbar discs.  You are bent at a 30 degree angle or so at the waist for an extended time (most people concentrate and take their time before their putt attempt).  This is one of the worst positions for your low back as it places tremendous pressure on your L4 and L5 discs. especially if you have a weak core (abdominal and low back muscles).

The hydrostatic pressure builds up in the disc, enough to cause a disc herniation in some people.

In the picture above, the golfer is preparing to hit the ball with a driver.  Notice the angle of the torso relative to the legs.  The fulcrum is exactly at the L5-S1 joint and the lever is the torso, with the load being the gravity vector of the torso (weight).  The force (F) is partially distributed to the back muscles, but the discs still bear significant pressure in this position.

The Solution

If you’re an avid golfer, a little sore back isn’t going to stop you from playing, right?  That is usually the case in those who love their sport or hobby.

So my advice to you is:

1. Always use proper form and good posture.  When driving, emphasize generating power from your core muscles– abdominals, especially obiques–then your latissimus (“lats”) muscles. Lift your trailing foot at the precise moment to lessen lumbar rotation during a wide swing.
2. If you are prone to low back pain, modify your driving swing to protect your back.  You may have to use less lumbar rotation and more power from your arms and shoulders.  Practice your custom swing and hone it so it becomes natural during game time.  For example, if you are getting low back pain, shorten your lumbar rotational arc by 30 degrees and generate more power from your latissimus muscles to compensate.
3. Minimize rounding (flexion) of your low back during putting and driving.  A straighter or even concave low back is stronger than a flexed low back.  This is called “hinging.”  You keep your lumbar spine and pelvis locked, and hinge at the hip joints to lower your torso to the ground.
4. Exercise and stretch the swing muscles.  The muscles you should target for stretching are the trapezius, latissimus dorsi, rhomboids and triceps.
5. Strengthen your shoulder joints by lifting light dumbbells in all directions/angles (from 12 o’clock position to 6 o’clock position) with palm facing down.  Starting position of arm is down to your side; ending is as high as you can go.
6. Stretch your shoulder joints using a 5-10 lb dumbbell or kettle bell, letting it hang straight down as you lean over and stabilize with the other hand on a chair or your opposite, bent knee.  Make small circles with the weight, increasing in size; then reverse directions.
7. Strengthen your core:  abdominals and low back, using medicine ball exercises.
8. Seek out an Active Release Technique (A.R.T.) therapist in your area.  This is a special form of massage that involves engaging certain muscles while the therapist works them and is great for improving range of motion.

And last but not least, my standard mantra:  your body will work  better for you if you feed it well and give it enough rest.  Make at least 80% of your diet naturally-occurring foods (as opposed to processed and prepared foods) emphasizing colorful vegetables, animal protein (grass fed/ pastured when you can) and healthy fats (olive oil, nuts, seeds, eggs, coconut, avocado, fish).  A well-nourished body can heal injuries quicker and more completely, which is especially important if you play any kind of sport.

Also, don’t expect to be sedentary all week and be able to do activities physically demanding on the weekend.  Excessive sitting/ lack of exercise de-conditions muscles.  It makes them less coordinated, smaller and weaker.  This is a recipe for injury (“weekend warrior” injuries).

A simple hack to passively get more exercise if you are a desk jockey is to get a standing desk.   It’s better for your back, and your overall health (see below).

Now, go and have fun on the golf course! (with this information in mind).