Low back pain – Part 3: Treatment and resources

Low back pain – Part 1: Causes and prevention  
Low back pain – Part 2: When to see a doctor

If you suffer from low back pain, there are several simple measures you can try at home, including rest, pain medications and use of a heating pad. Lying on your back with pillows under the knees is typically the most comfortable position for back pain sufferers. Doctors used to recommend total bedrest for back pain, but we now know that activity is more helpful (as long as you avoid activities, like bending or twisting or lifting, which could worsen the pain). Anti-inflammatories, like ibuprofen or naproxen, are the most effective over-the-counter back pain medications. However, not everyone can take anti-inflammatories (due to allergies, interactions with blood thinners, heart disease, ulcers or kidney problems, for example). Tylenol can help alleviate pain if you cannot take an anti-inflammatory. 

How will my physician treat back pain?

If your healthcare provider suspects a pulled muscle, or lumbar strain, then treatment usually begins with anti-inflammatory medication, perhaps muscle-relaxing medication, and some simple home exercises. The home exercises initially just begin to work on motion, then over time help you to build strength in the "core" muscles of the belly and low back. They also help you to work on stretching the hamstring muscles. Most people with muscular low back pain, in my experience, will feel at least 75% better in a week with rest, medication and home exercises. For some people, home exercises just aren't enough, in which case physical therapy is prescribed (perhaps an hour at a time, 2-3 times per week for 3-4 weeks).

If, however, your provider feels you have a pinched nerve, he or she may prescribe other types of medication. Nonsteroidal anti-inflammatories can be helpful, but so can steroid medication (like prednisone or Medrol) or even special medications to treat pinched nerve pain (like gabapentin). Sometimes, a narcotic medication is prescribed to treat severe, acute low back pain; however, these medications are to be used sparingly and are not recommended for daily use with chronic low back problems. Physical therapy (PT) might be recommended at your first visit, since PT is very helpful at reducing pain and improving your ability to be active. The vast majority of people get better with medication and PT. When back pain doesn't respond to medication and PT, further testing (like x-rays, MRI, or nerve conduction studies) can help pinpoint the underlying cause of the pain. 

Are there any resources available for treatment of back pain?

There is a good DVD available for purchase on Amazon, entitled "Say Goodbye to Back Pain," by Dr. Hans Kraus. I have found this program to be particularly helpful for people with muscular or pinched nerve pain. If you can get past the early 80s workout attire (short shorts and long, striped tube socks), I think you'll find this DVD to be really beneficial.

If you have a herniated disc/pinched nerve, check out the YouTube video below, featuring the McKenzie back exercises, which you can do at home.

Here are some slides from the Mayo Clinic demonstrating back exercises; I think these are good, but be careful not to overdo it, and don't forget to stretch your hamstrings! (Ham stretches are not depicted in these slides, but are important.)

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