Category Archives: Low Back Pain

Back pain being mismanaged, warn experts in The Australian

Chronic low back pain patients were some of the most difficult to manage back when I had an office-based medical practice. From The Australian:

Most cases respond to simple physical and psychological therapies aimed at keeping people active and able to stay at work, according to a series of papers published in The Lancet.

Instead experts claim many back pain sufferers are wrongly being treated in hospital emergency departments, referred for scans or surgery, encouraged to rest and stop work, and prescribed powerful opioid pain killers.Co-author, University of Sydney author Professor Chris Maher said millions of people across the world are getting the wrong care for low back pain.

“More care does not mean better care. More aggressive treatments for low back pain have little proven benefit and have the potential to make things significantly worse for patients,” Professor Maher warned.

“Evidence suggests that low back pain should be managed in primary care, with the first line of treatment being education and advice to keep active and at work.”However, in reality, a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, are commonly referred for scans or surgery, or prescribed pain killers including opioids, which are discouraged for treating low back pain.”

Source: Back pain being mismanaged, warn experts

I suspect back extension exercises are a key preventative measure.

One of the article’s quoted experts said it’s important to address obesity. I’m doing my best.

Steve Parker, M.D.

Antibiotics Cure Chronic Back Pain!!??

This is either an earth-shaking discovery, a scam, a hoax, or a red herring. The Guardian has a few details. The headline suggests four out of 10 sufferers may benefit from 100-day course of antibiotics.

Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize.

Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.

The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114.

Update May 15, 2013:

Here’s Dr. Harriet Hall’s opinion on the matter.

More On Lumbar Extension Exercises for Low Back Pain

Sean Preuss has another good blog post on chronic low back pain and the exercise that can improve it.   A quote:

…people with lower back pain become less active, which leads to a decreased range of motion, weaker muscles, and an increased risk of further injury. All of those results lead to even more pain, and then people respond by using their backs even less often, which continues the downward spiral of Deconditioning Syndrome.

I see that all the time.

Sean says that folks with surgically fused lumbar vertebrae shouldn’t do lumbar extensions.  Furthermore…

If you have lower back pain, you should see a physical therapist or other personal health professional to receive a diagnosis. After that, get his or her opinion on lumbar extension exercises and other potential treatments.

For Low Back Pain: Another Vote for Lumbar Extension

Sean Preuss writes at his blog:

In the last seven years, I’ve used [lumbar extension] with dozens of clients who had lower back pain, and the majority of cases resembled mine: pain has mostly or completely subsided.

Sean shows you how you can do lumbar extensions without expensive machines.  I know James Steele II and The Old Spartan are advocates of lumbar extension exercises.

Are Back Extension Exercises the Key to Preventing and Treating Low Back Pain?

The Old Spartan thinks so.  If memory serves me, James Steele II is also an advocate.

The 10 Warning Signs of Serious Low Back Pain

By “serious” back pain, I mean potentially life-threatening or disabling.

The warning signs in no particular order:

  1. recent trauma
  2. recent intravenous drug abuse
  3. unexplained weight loss
  4. osteoporosis
  5. history of cancer
  6. prolonged pain
  7. disabling symptoms
  8. immunosuppression (compromised immune system for any reason)
  9. age over 70
  10. progressive focal neurologic deficits, such as loss of bowel or bladder control, numbness, weakness on one side, impaired gait
A position you'll see in the Five Tibetan Rituals for prevention and treatment of back pain

A position you’ll see in the Five Tibetan Rituals for prevention and treatment of back pain

Low back pain is the most common musculoskeletal disorder worldwide.  Eighty percent of us will suffer from it at some point.  For most, a specific cause cannot be established with certainty.  But if you have one of the 10 warning signs of serious back pain, be sure to see a doctor soon.

Steve Parker, M.D.

Exercises For Low Back Pain

Flexibility and strengthening exercises help to reduce the pain and disability of chronic nonspecific low back pain.  Hoping to find a simple straightforward program to suggest to you, I reviewed “Exercise-based therapy for low back pain” at UpToDate.com.

Unfortunately, I didn’t find much.

By the way, exercises don’t help with acute low back pain (under 4 weeks duration).

You need to work with your personal physician for a diagnosis and treatment plan.  I’m not your doctor.  He may well refer you to a physical therapist, which is a good idea.

Some factoids from UpToDate:

  • low back pain is the most common musculoskeletal disorder worldwide
  • 85% of us experience low back pain at some point
  • in the U.S., yearly total cost of low back pain exceeds $100 billion

Here’s a quote that may shock you:

For most patients with low back pain, a specific etiology [cause] cannot be established with certainty.

I bet your doctor, chiropractor, or massage therapist never told you that.

The UpToDate folks suggest a combination of core strengthening (especially abdominal and trunk extension), directional preference (e.g., McKenzie method), general physical fitness, flexion and extension movements, aerobics, and functional restoration programs.  Some studies found benefit with Alexander technique, yoga, Pilates, and tai chi.

They didn’t mention Dr. John Sarno (“Your pain is from repressed anger”) or the Five Tibetan Rituals.

I hate to leave you empty-handed, so take this:

Again, if low back pain is a significant issue for you, it’s a good idea to work with a physical therapist.

What’s worked for you?

Steve Parker, M.D.