Browsing Posts in Back Pain

Do you have sciatica? If you’re experiencing back pain which radiates down one or both of your legs and you feel a tingling or a numbness, you should see your doctor for a correct diagnosis of the problem so that you can determine the appropriate treatment for your sciatic pains. Sciatica pain is a symptom of some underlying cause which needs to be identified before it can be corrected.

Sciatica pain is caused by the compression or pinching of the sciatic nerve. This nerve branches from the base of your spine, through the buttock and thigh muscles, continuing down the legs and into the feet. It’s the longest nerve in your body and is about the thickness of your finger. The pain can be constant and dull or excruciating – the symptoms vary from patient to patient which is why it needs to be diagnosed as soon as possible. The cause could be a herniated disc which is pressing on the nerve or spinal stenosis which is a narrowing of the spaces between the vertebrae, also causing pressure on the sciatic nerve. A correct diagnosis is critical so that the cause of your sciatic pain can be corrected.

Usually, sciatica is found in people between the ages of thirty and sixty and may be caused by wear and tear on the bones of the lower spine. Generally, it can be relieved within six weeks or so, but meanwhile, there are some changes you can make to help relieve the pinched nerve without having to take anti-inflammatory drugs or other pain medication. Walking is recommended – a gentle walk around the block to start off with. Make certain that your posture is good and swing your arms as you go. If you do this every day, you can soon extend your walk to about three miles, during which you’re stretching and strengthening your back, leg and abdominal muscles, all of which support your frame. They become supple and more flexible as you continue and your sciatic pains will start to diminish.

Your doctor or personal trainer can recommend stretching exercises for you, but these need to be appropriate for your particular type of sciatic pain, otherwise more damage can result. Do them regularly and you will find relief from your sciatic pains in a fairly short time.

If you’re suffering acute pain, you do, of course, need to rest. But try not to rest in bed as this will cause your muscles to weaken which will hinder your recovery. Sitting in a comfortable armchair which has good support is better for you and you could try alternating hot and cold packs on the affected part. Get up every hour or so and walk around a little to help keep the muscles flexible. Try not to sleep on your stomach; place a pillow under your hips so that your spine is supported.

Again, the opinion of a medical professional is essential so that you can take the right kind of exercise which is an important step to relieving your sciatic pains. Constant dull pain which prevents you from doing the things you love can rip all the fun out of life – and it’s not necessary as help is out there for you.

When you have intense pain running from your lower back down your legs due to sciatica, you’re looking for a source of pain relief that will curb your symptoms. Relief from sciatica pain comes in many different forms, such as pain killers, exercise, an anti-inflammatory and other non-surgical treatments, plus surgical treatments.

Not all sciatica cases require a radical form of treatment such as surgery. Most cases of sciatica are treated with pain killers. In very mild cases, ibuprofen, aspirin, or another over-the-counter medication will reduce the sufferer’s pain. Many sciatica sufferers are also prescribed non-steroidal, anti-inflammatory drugs to reduce symptoms and pain with the sciatica and the lower back in general. If the pain does not subside, stronger pain killers such as codein may be prescribed, but medications such as this come with the risk of addiction, and therefore should not be taken lightly. Muscle relaxers should also not be taken lightly. Although they will help alleviate symptoms associated with sciatica, they can also make the user drowsy, putting them at risk when driving.

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Exercise is the best way to reduce sciatica symptoms for the long term. With a proper exercise routine, you can train your muscles to become relaxed and strong, and therefore reduce the amount that these muscles are compressing on the sciatica nerve that runs through them. When other options have failed, a health care provider might opt to perform spinal surgery. When herniated discs are the cause of sciatica pain, your doctor might recommend doing a microdisectomy. It’s a procedure to physically remove what is compressing the sciatic nerve.

Sometimes sciatica pain and symptoms results from a condition known as spinal stenosis. This condition causes nerve compression and can be alleviated with a surgical procedure called a lumbar laminectomy. A lumbar laminectomy involves giving more space to the nerve bundles within the spinal column by removing bones from the vertebra.

One of the oldest surgical procedures to reduce back pain is called a diskectomy. This procedure involves removing the disc that is causing the problem, or that is diseased, from the spine. Once the disc has been removed, the pressure on the nerve is relieved and sciatica pain and symptoms are reduced.

One of the last options for patients with sciatica and back pain is to undergo a spinal fusion. When a spinal fusion is done, the doctor joins two or more vertebrae together in order to relieve irritation and compression. However, this procedure is only done when the spine has undergone years of physical injury, or when osteoporosis has set in. The reason this option is left as a last resort is because once done, the patient is left with very little movement within the spine.

Although the advances in medicine have been great for sciatica sufferers, pain relief is different for everyone. What might work for one person may not work for someone else. Therefore, you should always seek medical advice when it comes to relieving sciatica pain.

Back disorders are one of the chief causes of disability within the working population. They can occur gradually or from one single event. Over time, repetitive activity can result in microtrauma to the tissues; the onset is so slow that the condition often is ignored until the damage becomes debilitating. Microtrauma is likely to have weakened the back when a single event causes a back disorder as well. Injury to the back includes muscles, ligaments, vertebrae, discs, and combinations thereof. Reading the OSHA Technical Manual on back disorders and injuries, one finds a list of about 15 work factors associated with back injury. Considering the economic burden as well as human suffering experienced in a back injury, as well as the most common, they can be the most devastating. One career field that consistently leads in back injury and also occupational injuries and illnesses is nursing.

Nursing aids, orderlies, and attendants are exposed to most of the 15 work factors associated with back injury. While many of their job tasks like making beds, handling carts, and a multitude of other duties do contribute to their risk, lifting and transferring patients is the most likely element of the job to cause injury. The leading cause for all work-related injury and illness is overexertion – a very likely result for anyone who is lifting and pushing hundreds of pounds at a time. Over half of nurses complain of low back pain, and many end up leaving the field, transferring units, and missing work because of it.

Studying the various effects of the spine and causes of back pain would include volumes of literature, but there are a few basics to note. It is suspected that the intervertebral disc is the primary source of most low back pain in nurses. Disc degeneration and cumulative trauma are common in those who lift and bend for a living. Inside the vertebral endplate, microfractures are sustained and the resulting scar tissue weakens the structure making the spine more vulnerable to injury. These microfractures could easily be sustained not only from lifting patients, but also from pushing them in wheelchairs and frequent bending and twisting of the spine all day every day.

Given the nature of the job and the need for nurses, extensive research on how to help minimize risk is ongoing. There is a great focus in nursing education on patient handling safety. Manual aids to help lift patients are also evolving and, in certain cases, required to be in place for the safety of the staff. Even manual aids to make other aspects of the job more ergonomically friendly will help keep the spine as healthy as possible. Nurses are in a unique position when it comes to following ergonomic guidelines. Many solutions involve frequent breaks and rotations in job tasks. Nurses need to be able to do whatever is needed when it is needed. The development of tools to relieve some of the stress of their jobs is very important. It helps not only the nurses, but everyone who has ever needed health care.

A lot of people report that they feel more relaxed or numb once the “buzz” of a few drinks hits their system. But does this mean that alcohol can help relieve back pain? Others report that they actually experience an increase in back pain when they enjoy an alcoholic beverage. What’s really going on here?

To be honest, it really depends on what the cause of your back pain is. If the pain is due to a tense or contracted muscle that is putting pressure on the Sciatic nerve, for example, drinking alcohol may actually help.

For example, I used to suffer from Piriformis syndrome, which is a tense muscle in the pelvis that cause pain by crushing the Sciatic nerve. I found that an occasional drink would actually help to relax the muscles in my body and release the tension in my Pirifomris.

Now, this isn’t an excuse to abuse alcohol. If you are suffering from pain caused by muscle tension, then you need to address this by naturally loosening the muscles and releasing the tension. The best way to do this is by stretching out the muscles and helping them to relax.

Relying on alcohol to treat back pain in this way is like using painkillers to treat back pain. You don’t really deal with the underlying problem, you are just temporarily getting rid of the pain. Never use alcohol as a “solution” to your back pain problem.

However, some people also complain of back pain that occurs when they drink alcohol.

Alcohol can also cause inflammation in your body too, which in turn can promote back pain. In this way, alcohol can be a double edged sword. On one hand, it can help to relax muscles, but at the same time, it may promote inflammation.

The story doesn’t end there though.

Now, I’m not a medical professional, so you should probably talk to your doctor about this. However, I do know that people can develop kidney stones which can cause pain like this.

Your kidneys are located in your lower torso and pain in your kidneys can easily be mistaken for a general pain in your back.

Alcohol acts as a diuretic, which means that it makes you have to urinate. When this happens, your kidneys produce more urine. But if there is an obstruction in your kidneys such as a kidney stone that might interfere with the production of urine, then you could experience pain.

If this is the cause of your pain, then other fluids such as coffee should also cause back pain to present itself.

There could be other causes to your pain as well. It can be difficult to diagnose the cause of back pain without knowing more about you and your lifestyle and overall health. It is important to seek the advice of your doctor to get a better understanding about what is behind the pain. Again, alcohol should not be used as a way to treat pain or to cope with any sort of health condition you may be suffering from.

Curing Back Pain

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One of the most irritating things man has to face daily is pain. But, no matter how discomforting or uneasy it may be, experiencing it has a very useful purpose in our body. It signals to our brain that something is not functioning well in our body and thus we are called to attention for the necessary treatment. Had there been no physical pain that exists, we wouldn’t be able to tell when our bones our breaking or our skin is burning.

One instance that exemplifies the simple usefulness of physical pain is the back pain. Simply put, it is pain felt in the dorsal area of the body. It can have many causes, among which are: the muscles, the bones, the joints, the nerves or the spine. But causes are not limited to these. Sometimes the cause may come from external factors such as being hit hard at the back or the back skin’s exposure to intense temperatures (both cold and hot).

Apart from these causes, there are also many kinds of this pain. It can be divided into two major areas of the back, the upper and lower back.

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  • For the upper back, it may be a neck pain or in the upper back.
  • For the lower back pain, it may be the lower back (lower back area behind the stomach) or even lower which is called the tailbone pain.

Indeed it can also have different durations. It may stay for quite a while, or it can just last for about a day. There are also different degrees of intensities, and this is where one can determine whether pain killers are needed or not. Sometimes, it may be dull soreness that can easily be endured, but sometimes, it may be sharp where it practically renders one ‘paralytic’ and may need immediate treatment. As earlier said, this pain can also have different durations. The one lasting only less than 4 weeks is called the acute back pain, while one that lasts for 4 to 12 weeks is the subacute. More than this, and it already falls under the chronic pain where treatment and heavy pain killers are needed.

Back pain may sound like a simple problem. Indeed one can treat it nonchalantly and may be remedied by simple domestic means such as sitting on a massaging chair. But for some types a massaging chair may be more than what is needed.

The more serious types of back pain can have other health implications, and would thus need treatment other than removing the pain away. Back pain may indicate a bone fracture in the dorsal area. In most cases, this would require an operation. It could also imply the development or the presence of back bone deficiency such as osteoporosis or scoliosis. These types of sickness can be remedied easily once in the earlier stages, but again just like back pain, may need serious treatment when continuously ignored.

Nowadays, a lot of people suffer from lower back pain most specifically the lumbar area. The lumbar area can be found below the thoracic region and just above the sacral region of the spinal column. This pain phenomenon results from varying causes ranging from overuse and some of the times under use of the spinal bone most commonly referred to by many as the “back bone.” Although most back pains can be remedied by over-the-counter medicines such as acetaminophen and NSAIDs (non-steroidal anti inflammatory drugs), it is when this pain becomes chronic that a much different approach is needed to alleviate any suffering.
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Technically speaking, medical textbooks would say that a pain lasting more than six months is already categorized as chronic pain. However, this is not saying that any pain lasting less than six months is not chronic because pain is a relative thing that can only be correctly measured by the person suffering it. The time period was created to gauge and make categorizing pain simpler. Of course, many other factors are still necessary to be able to correctly diagnose any symptoms associated with any kind of disease, in this case back pain.

A person suffering from lower back pain most likely will go to their family physicians for consultation first. And most often than not, after requesting that the patient undergo several diagnostic tests, a treatment program will be suggested to manage such pain. However, not all general practitioners understand the intricacies of pain management, thus a patient should be made aware that back pain specialist services are available.

Back pain specialist services can be received from a range of several doctors specializing in pain in the lumbar region. In most cases, lumbar back surgery is suggested as a means to counter the pain that has become chronic and can no longer be managed through the simpler means like over-the-counter medicine intake and alternate treatment therapies. In other words, when all other remedies fail a lumbar back surgery becomes the only option. Several surgeries targeting lumbar pain exists at present. And right now these surgeries have become more technologically advanced that in some cases a patient can go home a day or two after the procedure. Of course, these are for procedures that only a small puncture is done and only local anesthesia has been used. The most common surgeries that are being done are laminectomy, discectomy, foraminotomy among others.
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Patients suffering from chronic lower back pain, more often than not, obtain back pain specialist services. And when all other pain remedies fail, lumbar back surgery is done to treat such pain.

Back pain, is a common complaint in the U.S. The pain comes from the bones, ligaments, tendons, nerves, joints, muscles and other matter surrounding the spinal cord. Lower back pain seems to be the most common form of back pain in the US. It is in fact the fifth most reason why patients seek treatment from a chiropractor or a medical doctor.

The pain can come on suddenly such as after a strenuous work -out or heavy work such as lifting heavy items or an injury. It can also be a chronic problem and the patient may only feel the pain at one spot or on several areas over the back as well as the limbs. The pain experienced, may be dull ache, a stabbing pain or a burning sensation.

Treating back pain

If the pain arises in the course of or immediately after heavy work, rest should ease it and this can be considered self-limiting pain that does not progress. Interestingly, psychological factors may also cause back pain with the result of the pain going away when stressing matters are sorted out.

If pain persists with no apparent cause, or lasts for more than a few hours and keeps returning, should be treated by a medical or a chiropractic doctor.

When back pain is being treated, the aim will be to reduce if not completely resolve the pain and as fast as possible so that an individual can perform their usual duties without any difficulty. Different courses of treatment work for different people.

Types of treatment

For immediate relief, back pain can be treated with ice or heat therapy, such as ice pack or moist heat, depending upon how long the pain has been experienced and weather the pain is acute or chronic. When visiting a Santa Monica chiropractor, he or she may want to use physiotherapy modalities such as ultrasound, electrical stim, massage, or traction to relieve low back pain. Prescription drugs are also often prescribed by MD’s to treat the pain and here, muscle relaxants, painkillers, and anti-inflammatory drugs may be prescribed.

Tips for Back pain prevention

  • Sleep on a mattress with medium firmness
  • Remain active-this is very important
  • Warm up before any kind of activity or exercise
  • Maintain a healthy diet
  • Lift with knees and not your back
  • Maintain a proper posture-get more information from your Santa Monica Chiropractor
  • Wear low heel shoeTreating back pain with chiropractic therapy

When visiting your chiropractor, he or she may use ice and/or heat to start treatment. Using the ice verses, the heat depends upon how long the patient has experienced pain. In addition, the chiropractor may recommend X-rays of your back to see if there is any misalignment or other conditions may be present. A chiropractor, whose specialty is the musculoskeletal system, uses a hands-on approach to adjust the spine working from the premise that illness or in this case back pain, could be resulting from misalignment of the vertebrae also called subluxation.

There is evidence that chiropractic treatment relieves many types of musculoskeletal pain, and helps restore normal range of motion. Spinal adjustments may take stress off surrounding tissues – muscles, tendons, and ligaments – to relieve pain and restore normal function. Some chiropractors may use different types of physiotherapy such as electrical stim, ultrasound and different types of exercises and stretches before adjusting the spine. Also massage may be performed on a patient followed by adjustment of the spine. Spinal traction may or may not be applied. Your Chiropractor may advise you on correct posture, to avoid heavy physical work and other ways to protect your back.

Chiropractic is a holistic form of alternative therapy and no drugs or surgical procedures are used. As is the case with any disease, better and faster results are achieved if treatment is sought early on rather than after the condition has deteriorated.

What if you knew that in 2005 the U.S. spent $86 billion on neck and back pain? What if you also knew that expenses increased 65% from 1997 to 2005 and yet the same surveyed patients got 4% worse? This was the finding of a recent study published in the Journal of the American Medical Association. So what’s the problem with the typical methods back and neck pain is treated? This article aims to answer that question and offer a solution to improve your whole-body health and end your back or neck pain for good.

Back and neck pain is complex to the point that 50% of cases are classified medically as “other or unspecified disorders of the back”. This indicates that typical treatment methods don’t know the cause of the problem they are attempting to treat. So what is the likelihood that treatment will “fix” the problem or possibly have the opposite effect and cause damage?

Pain is a symptom of dysfunction – a signal that something is not right, however in many instances typical treatment looks rather to control and repress it.

Typical methods to treat back and neck pain fail predominantly for one simple reason: they fail to treat the body as one unit as a means to access the cause. Chronic musculoskeletal pain rarely originates from the source of the problem. This is because the human body was designed for survival and is able to adapt and compensate for muscle weakness and imbalance in other areas.

Pain is experienced where the body can no longer compensate, which quite often is the spine since our organs and extremities are attached to it and it has to hold us upright and move us against gravity.

The root cause of most chronic musculoskeletal pain is dysfunction resulting from imbalance in the “core muscles” – muscles of the trunk and pelvis that act as a foundation providing stability and structure to the spine. The dysfunction is global, decreasing the function of the entire body.

For example, if the foundation of a house is compromised, the whole structure is compromised. Doors and windows won’t close properly and walls, pipes and beams are exposed to stresses that eventually cause them to break. This example is grounded in one of the most integral laws of design; both man-made and those observed in nature – “form follows function and function follows form”.

Is it possible that the solution to improve your back or neck pain as well as improving the health and wellness of your whole body could be as simple as restoring the integrity of its foundation? The answer is yes! As humans we like to believe in complex things and make things complex. We have been conditioned as a culture to believe that complex surgery and drugs are the only things that can help our health.

They won’t – and the statistics confirm this.

While the solution may seem simple, the actual restoration of balance to and strengthening the core muscles is more complex. Here’s why. Since the brain is programmed for survival, it naturally favors and hardwires “dynamic” muscles that cause gross movement to move the body out of danger or push something dangerous away.

Muscles that provide stability like the core muscles are less likely to be favored and more likely to become weaker since they oppose movement. To maintain some degree of function, the dynamic muscles must now do “double duty” and compensate by tightening since they have to assume the role of the weaker stabilizer muscles too.

Compensation is a brilliant survival technique to move you out of the path of a speeding bus but complicates things when you are trying to access the root problem – the strengthening of the weak core muscles. So it doesn’t matter how many sit-ups or how much “core training” you do, you will most likely just reaffirm and engrain the muscle imbalances further, which is could explain why even physical therapy is rarely successful in eliminating spinal pain.

So what is the solution to accessing the weak core muscles? Wouldn’t it be ideal if there were a technique that could “activate” and strengthen the weak muscles to help restore muscle balance and function to the entire body and in the process eliminates pain for good?

The good news is there is a technique call Myotonix that does exactly that. It is a manual technique grounded in the principles and techniques of osteopathy and acupuncture to improve the well-being of the entire body by improving its structure. The results are instantaneous and often astounding.

This article has highlighted the complexity of treating spine related pain and has offered some helpful advice on alternative treatment. True health and full function of our bodies will only be realized when we begin to treat the body as it is – one body, not a collection of body parts operating independently.

The spinal column is the mainframe of the human musculoskeletal system. Every limb, the rib cage, and the pelvic girdle are supported by it. Being the very back-bone of existence, any pain occurring in it should in no way be ignored. The back should be meticulously taken care of.

Most back pains are caused by muscle strain and sprain. Some are idiopathic in nature whereas some are specific pains as a result of disc compression and degeneration, radiculopathy secondary to fracture, spinal stenosis, or injury.

The aged are more susceptible to back aches. However, it is not surprising to note that even young people are at times prone to dorsalgia; hectic and hyperactive lifestyles being the main reason for its occurrence.

Back Ache Causes

Lifting light or heavy objects awkwardly and at random pressurizes the muscles and tendons of the back; moving the body structure with jerks; sudden twists and turns of the body; working on improperly-designed work tables; poor body posture; over weight; walking with high-heeled shoes; and acute emotional disturbances give rise to back aches. Besides spinal injury, osteoporosis, disc degeneration, and fibromyalgia equally trigger back aches. The back being the most neglected part of the body, it is only when pain is experienced there that one tends to notice its discomfort.

Identify Early Symptoms

Onset of back aches are due to mild-to-acute pain in the spinal and lumbar back regions, aches that originate in the area of the coccyx and radiate downwards into the gluteal muscles, hips, and the lower extremities. This is usually accompanied by weakness, numbness, and tingling in the limbs. Further, tightness and stiffness of the neck and back muscles are felt. In acute cases the bowel and bladder too dysfunction.

In the event of any of the above occurring, medical advice must be solicited instantly.

• Dorsalgia gets worse with coughing or sneezing.

• Numbness, tingling, and pain radiates downwards into the lower extremities.

• Unable to sleep due to acute aches.

• Bladder and bowel dysfunction.

• Bowel and bladder incontinence.

Any of the above indicates crucial nerve injury or an underlying health problem. There are other diagnoses as well. However, it is suggested that early signs and symptoms of back aches be identified and remedial measures taken accordingly..

Low back pain is one the most pervasive and costly conditions in medicine today. Approximately 80% of Americans will experience a significant episode of low back pain at some point in their lives. Even worse is the fact that the peak incidence occurs between the third and fifth decades-one of the most productive periods in life. Low back pain consistently ranks in the top 10 list of reasons people seek medical care, and cost estimates range in the billions annually. LBP accounts for 1/3 of Workman’s compensation claims, which average $8,000.00 per claim.

Despite the frequency, disability and cost to the public a 1994 government funded committee determined that there was insufficient reliable data on which to base treatment recommendations. At this time, national guidelines for the treatment of chronic low back pain still do not exist. The good news in all of this is that 80% of the time insidious low back pain will resolve on its own without intervention within two weeks. It is the other 20% of these cases that do not show dramatic improvement in two weeks that account for the majority of treatment resources and time.

In a more recent visit to this problem Dr.’s Atlas and Nardin incorporated recent findings in an attempt to develop an evidence-based approach to the evaluation and treatment of Low Back Pain.

They concluded:

1. History and physical exam provide clues to uncommon but serious sources of LBP.
2. Diagnostic tests should not be a routine part of the initial evaluation, but should be used selectively based on history, exam, and response to treatment.
3. Patients without neurologic impairment should receive activity modification, education, and nonnarcotic analgesics.
4. Patients who do not recover in 2-4 weeks should be referred for physical treatments. Patients with or without radicular symptoms and no neurological deficit should receive conservative care.

A Few Words About Diagnostic Imaging
We live in a world with amazing technology and this is no exception when it comes to medical imaging tests (xray, CAT scan, MRI…). More often than not patients presenting with low back pain have either had some sort of imaging done and/or have questions about the influence of these results or the necessity of more expensive testing (MRI, CAT scan etc..) The interesting thing about diagnostic testing is that blinded studies of these images alone do not allow physicians to predict who has pain or dysfunction. In fact, studies indicate upwards of 30% of populations have positive findings on standard diagnostic tests yet have no symptoms or dysfunction. So patients age 30-55 with diagnostic findings of osteoarthritis, degenerative disc disease and even disc involvement would be incorrect assuming that these findings are the source of their pain or that these findings sentence them to a life of pain or dysfunction. Having said that, it is imperative that the decision to have testing done and the interpretation of any results is made by a physician, who has evaluated the patient to rule out serious disease processes and orthopedic/neurologic concerns. It is for these reasons in part that the evidence-based approach does not recommend routine diagnostic testing (see point #2).

Treatment Options in Physical Therapy
Despite these ugly truths the good news is that major progress is being made in our understanding of low back pain and its rehabilitation, although sorting through the immense varieties in treatment approaches and providers is often frustrating. With this in mind, I have evaluated numerous models and approaches for treatment. I have decided to focus on approaches that emphasize a Postural/Structural model. Below are brief reviews of four of the best approaches for mechanical management of low back pain available in conservative care today.

McKenzie Mechanical Diagnosis &Therapy
The McKenzie approach was developed by Robin McKenzie a few decades ago. The McKenzie Institute is an International Organization that certifies clinicians in mechanical diagnosis and treatment of spine dysfunction. This approach is commonly misunderstood as only extension exercise. In reality, the approach is based on a mechanical movement exam designed to determine directional bias for restoring motion and centralizing symptoms. The result of this exam is a treatment and exercise strategy that may include flexion (forward bending exercises), extension (backward bending exercises), sidebending or rotation. Studies on centralization indicate it is consistently one of only a few good predictors of a good outcome. This type of evaluation may be helpful in decisions regarding the need for diagnostic testing or more invasive procedures. Robin McKenzie has authored two books designed for self treatment of neck and low back pain.

Manipulation-Manual Therapy
Manual therapy has a long history and involves a large spectrum of techniques ranging from high velocity to indirect myofascial. A 2003 study in Spine found significantly larger improvements in pain, disability and return to work both short and long term with manipulation versus exercise alone. The use of manipulation is recommended for patients with acute low back pain in the first month of symptoms according to the US department of Health and Human Services. The term manipulation is used here to include osteopaths, physical therapists and chiropractors, all of whom provide these services albeit under differing philosophies.

Dynamic Core Stabilization
Recent studies on lumbar function have identified key patterns of muscle activation, and more importantly found differences in these patterns between subjects with and without low back pain.
This information has led to implementation of new exercise strategies to ensure that the patient is able to activate these mechanisms. This is particularly beneficial in postoperative patients or patients with hypermobility. Assessment and implementation of these exercises should be done under the care of a physical therapist. People often find that starting core/abdominal exercises that they have heard or read about only aggravates their symptoms, which leads to unnecessary frustration and pain. The reason for this is that existing muscle imbalances require specific strategies and cueing to be resolved.

Traditional Adjunctive Modalities
Moist heat, ice, massage, ultrasound, electrical stimulation, traction, and topical lotions all fall into the category of passive treatment modalities. While these treatments often feel good and provide short-term decreases in pain they are insufficient as stand alone treatements in chronic back pain. Despite the lack of high quality research for these modalities, they can often be helpful to the patient when part of a complete mechanical treatment program.