Find Self-Care NowFind Self-Care Now

9 ways to get back into your swing!

1. Stay Active

Moving can feel sore, but activities like walking or swimming can strengthen back muscles and relieve pain.

2. Don’t Stay in Bed

Don’t stay in bed for more than a day or two, and only if absolutely necessary.

3. Get Back Into Your Routine

Pain isn’t always a sign of damage so start to move slowly and try to do more each day.

4. Pain Relief

Consider over-the-counter pain medication to stay active. Apply heat and ice to the affected area.

5. Go don’t wait

Keep your normal schedule. But take regular breaks and avoid repetitive or awkward motion.

6. Take care

Maintain good posture, take stretch breaks and don’t lift too much.

7. Mindfulness

Observe your thoughts without judging them as good or bad. Stay in the present moment.

8. Positive Attitude

With a plan to get better, you can take confidence knowing you’ll make progress in just a few weeks.

9. Prevention

Limit early morning bending. Make good lifting, posture, and movement decisions. Stay active!

Find ExercisesFind EXERCISES

“Spinal manipulation, physical therapy, yoga, massage, accupuncture, self-management, cognitive behavioral therapy, exercise.”

Young to not so young patients with lower back pain?

Click below to see extension exercises you can do in your own home.

View Exercises

Lift from prone pyramid up to prone extension to increase range of movement.

Standing extensions. Hands behind thighs, push mid-section out and bend backward.

Alternate between cat and camel postures to strengthen core and back.

Tips to avoid and prevent lower back pain
  • Early in the morning, avoid bending, leaning forward.
  • When lifting, bend at the knees and hips, not at the waist.
  • Avoid prolonged periods of sitting.
  • Get regular exercise.
  • Choose a diet rich in fruits, vegetables, and proteins.
  • Avoid artificial sweeteners, sugars, and processed foods.

Middle-aged or older patients with lower back pain?

Click below to see extension exercises you can do in your own home.

View Exercises

Try one knee or two knee raises to help flex and stretch lower back muscles.

Try knee rolls left and right to stretch and strengthen back muscles.

Try alternating between cat and camel postures to strengthen core and back.

Tips to avoid and prevent lower back pain
  • Early in the morning, avoid bending, leaning forward.
  • When lifting, bend at the knees and hips, not at the waist.
  • Avoid prolonged periods of sitting.
  • Get regular exercise.
  • Choose a diet rich in fruits, vegetables, and proteins.
  • Avoid artificial sweeteners, sugars, and processed foods.
Find Overused TreatmentsFind OVERUSED TREATMENTS

Do I need an MRI?

Click below to learn why an MRI may not be the solution.

Findings shown on an MRI are often not the cause of back pain, so an MRI is usually not recommended within the first six weeks of experiencing pain.

When to get an MRI
  • If you’ve had 4 to 6 weeks of radiating leg pain severe enough to warrant surgery.
  • If you’ve had 3 to 6 months of back pain severe enough to warrant surgery.
  • If the back pain includes related symptoms like loss of appetite, unexplained weight loss, fever, chills shakes, or severe pain while at rest.
  • If the pain is unrelenting and no change in position makes it feel better or worse.
  • If you’ve been diagnosed with spinal stenosis and are considering an epidural for pain relief.
  • If you’ve had back surgery and your pain doesn’t improve after 4 to 6 weeks.
When an MRI is needed immediately

An MRI is needed immediately is when someone has either:

  • Inability to go to the bathroom or control their urine.
  • Progressive weakness in legs due to nerve damage.

Questions? Text: #IQuestion or call 1.800.531.0987

Are steroid injections for back and neck pain usually necessary?

Care for back and neck issues should focus on physical treatments first. Steroid injections should only be considered when physical treatments aren’t progressing as expected. Click below to learn more.

A steroid injection can make sense
  • For diagnostic purposes
  • If justified by patient history
  • For physical exam
  • For imaging studies
  • For help in guiding further treatment

If there is radiating pain into the arms or legs a steroid can be justified by referral to a specialist to perform the procedure. Specialists include orthopedic surgeons, neurologist, anesthesiologist, physiatrist or a radiologist.

When a steroid injection can provide temporary relief
  • When there is inflammation or damage to a nerve, usually in the neck or the low back, it can help a patient engage in exercise therapy.
  • In cases of spinal stenosis, which can cause pain in the buttocks or legs while walking. An injection can relieve pain to allow for exercise therapy.

Questions? Text: #IQuestion or call 1.800.531.0987

An opioid is only an option when all other treatments have been considered.

Opioids are generally considered a short term treatment following a severe injury, illness or surgery. Long acting or extended release opioids are rarely appropriate for back pain. Click below to learn more.

What to expect from your physician

From moderate to severe back or neck pain, treatments other than opioids work better and have fewer risks.

  • Over-the-counter medicines include Acetaminophen (Tylenol® or generic), Ibuprofen (Advil®, Motrin IB® or generic), Naproxen (Aleve® or generic), topical non-steroidal anti-inflammatory drugs (NSAIDs), and heat rubs.
  • Non-Drug Treatments include exercise/activity, self-treatment methods, manual therapies/spinal manipulation, massage therapy/ acupuncture, cognitive behavioral therapy or injections such as steroids.
  • Other prescription drugs include NSAIDS, anti-seizure drugs, gabapentinoids and antidepressants.

A DOCTOR SHOULD NOT PRESCRIBE AN OPIOID PAIN RELIEVER WITHOUT A FULL EVALUATION OF YOUR CURRENT MEDICAL CONDTION.

This will include a physical and neurological examination to assess your pain including location, intensity, frequency and all the treatments you’ve tried.

Opioid effectiveness decreases over time

It’s quite common for people to develop a tolerance to opioids, which requires increasing the dose to help maintain the delivery of pain relief.

Potential side effects of opioids cannot be underestimated
  • Constipation
  • Drowsiness
  • Nausea
  • Vomiting
  • Chemical dependence
  • “Rebound” – increased severity of pain despite dosage.
  • Overdose
  • Death

There are more than 160 deaths per day in the U.S. from opioids.

What about non-opioid pharmaceuticals for back and neck pain?

Multiple professional organizations recommend starting treatment with non-pharmacological strategies. Click below to learn more.

What gives more pain relief? Placebo or...

OTC

Over-the-counter (OTC) medications such as Tylenol® , Advil®, or Motrin IB® are associated with only small effects on pain [relief] compared to placebo.

-Agency for Healthcare Research and Quality, February 29, 2016
https://effectivehealthcare.ahrq.gov/products/back-pain-treatment/research

Gabapentenoids – No more effective for chronic back pain or lumbar radicular pain.

-Shanthanna H, et al. Benefits  and safety of gabapentinoids in chronic  low back pain: A systematic review and meta-analysis of randomized controlled trials. PLOS Medicine, 2017; 14(8):e1002369. https://www.ncbi.nlm.nih.gov/pubmed/28809936

Systemic Corticosteroids – No better at pain reduction or improving function for spinal stenosis or radiculopathy.

– Chou R, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical  Practice Guideline. Annals Int Med 2017; https://bit.ly/2LnHilb on 4 April, 2017

“OTC medications are as effective as opioids for both pain control and function for chronic back pain and chronic degenerative joint disease pain in the knee and hip.”

– Krebs E, et al. Effect of opioid vs non-opioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018; 319(9):872-882. https://www.ncbi.nlm.nih.gov/pubmed/29509867

NSAIDs – Non steroidal anti inflammatory drugs are preferred as a first line pharmacologic therapy for acute, subacute and chronic back pain.

Duloxetine (Serotonin/NE reuptake inhibitor) is associated with reduced pain and improved function compared to placebo for chronic back pain.

Muscle relaxants are better than placebo for acute pain but are no better than placebo for chronic pain.

Acetaminophen is no better than placebo for pain, function or risk for serious events with acute back pain.

-Chou R, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals Int Med 20 17; https://bit.ly/2LnHilb on 4 April, 20 17

Do I need a surgical referral?

Maybe. Maybe not. Being referred to a surgeon too early may actually decrease the quality of care or result in an unneccessary operation. Cliick below to learn more.

"Red Flag" symptoms that require surgical referral
  • Inability to go to the bathroom
  • Can’t control urination
  • Groin area numbness
  • Severe muscle weakness in the legs
What might a surgical specialist recommend?

A surgical specialist may suggest further physical treatment, physical therapy, massage therapy, acupuncture or prescribe injections. But in situations where issues are not improving with physical care, surgery can help correct an anatomical condition. For example, low back surgery can help correct a spinal instability or nerve pinching that isn’t improving after non-surgical care. Whenever possible, most specialists will only turn to surgery when all other avenues have been pursued.

Be sure to consider all options before surgery

Surgery should always be a last resort, especially if fusion is suggested.

  • Always consider getting a second opinion.
  • Spine surgeons may hold different opinions about when to operate and what surgery to perform.

Questions? Text: #IQuestion or call 1.800.531.098

Find Treatment OptionsFind TREATMENT OPTIONS

There are many paths to treatment. Below are brief explanations of treatment disciplines and how they differ.

Chiropractor

A doctor of chiropractic, (sometimes referred to as DC’s) will focus on the relationship between body structure – mainly your spine – and how it’s functioning. Most chiropractors perform adjustments to your spine or other parts of your body to correct alignment problems, help alleviate pain, improve function and support your body’s natural ability to heal itself.

What is Diversified Spinal Manipulation

What is it?

Spinal manipulative therapy (SMT) is a term that describes a broad group of chiropractic techniques. Most clinical studies of SMT focus on high-velocity, low-amplitude (HVLA) technique, or “diversified manipulation.” Diversified manipulation is a technique specifically designed to treat spinal pain.

What does the evidence say?

The available clinical evidence shows that shows that the diversified manipulation technique results in better outcomes than traditional care for spinal pain and pain-related disability.1,2 These outcomes include pain reduction, pain-related functional disability reduction, perceived benefit, and patient satisfaction. Diversified manipulation has outcomes like other conservative care treatments for low back pain. Several studies show that diversified manipulation helps patients suffering from neck pain and headaches.3,4,5.

What are the risks?

In 2019, a group of medical researchers systematically reviewed over 10,000 clinical trial cases. One patient reported a side effect that was unlikely the result of spinal manipulation.4

1. Goertz CM, Long C, Vining R, Walter J and Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among U.S. Service Members With Lower Back Pain: A Comparative Effectiveness Clinical Trial. https://doi.org/10.1001/jamanetworkopen.2018.0105.

2. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials. BMJ. 2019 Mar 13;364:l689.

3. Wong JJ, Shearer HM, Mior S, Jacobs C, Cote P, Randhawa K, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016;16:1598-1630.

4. Rist P. M., Hernandez A. , Bernstein C. , Kowalski M. , Osypiuk K. , Vining R. , Long C. R., Goertz, C. , Song R. and Wayn, P. M. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis. Headache: The Journal of Head and Face Pain. 2019;doi: https://doi.org/10.1111/head.13501

5. Mesa-Jimenez JA, Lozano-Lopez C, Angulo-Diaz-Parreno S, Rodriguez-Fernandez AL, De-la-Hoz-Aizpurua JL, Fernandez-de-Las-Penas C. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. 2015;35:1323-1332.

What is Flexion Distraction Manipulation

What is it?

The chiropractic technique flexion distraction (FD) manipulation is also sometimes referred to as Cox decompression manipulation, non-thrust manipulation or low velocity, variable-amplitude (LVVA) manipulation.

What does the evidence say?

The available clinical evidence for FD across several studies shows that it reduce pain and pain-related disability above and beyond traditional care and minimal conservative medical care.1,2,3,4 Several studies also suggest FD may help patients suffering from neck pain5 and headaches6,7.

What are the risks?

In 2019, a group of medical researchers systematically reviewed over 10,000 clinical trial cases. One patient reported a side effect that was unlikely the result of spinal manipulation.4

1. Xia T, Long CR, Gudavalli MR, Wilder DG, Vining RD, Rowell RM, Reed WR, DeVocht JW, Goertz CM, Owens EF Jr, Meeker WC. Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults with Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation; Spine (Phila Pa 1976). 2016 Jun;41(12):E702-9.

2. Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain; J Manipulative Physiol Ther. 2009 Jun;32(5):330-43

3. Goertz CM, Long C, Vining R, Walter J and Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among U.S. Service Members With Lower Back Pain: A Comparative Effectiveness Clinical Trial. https://doi.org/10.1001/jamanetworkopen.2018.0105.

4. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials. BMJ. 2019 Mar 13;364:l689.

5. Wong JJ, Shearer HM, Mior S, Jacobs C, Cote P, Randhawa K, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016;16:1598-1630.

6. Rist P. M., Hernandez A. , Bernstein C. , Kowalski M. , Osypiuk K. , Vining R. , Long C. R., Goertz, C. , Song R. and Wayn, P. M. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis. Headache: The Journal of Head and Face Pain. 2019;doi:https://doi.org/10.1111/head.13501

7. Mesa-Jimenez JA, Lozano-Lopez C, Angulo-Diaz-Parreno S, Rodriguez-Fernandez AL, De-la-Hoz-Aizpurua JL, Fernandez-de-Las-Penas C. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. 2015;35:1323-1332.

Physical Therapy

Physical therapists (referred to as PT’s) are experts at muscle and body movement. They help optimize healing through hands-on care, prescribed exercises to rebuild strength and education. They’ll examine your individual issue and develop a plan using treatment techniques that help your ability to move, reduce pain, restore function and prevent disability.

Massage Therapy

Massage therapists practice using touch – like pressing, rubbing or manipulating muscles – to pressure the soft tissues of the body to help relieve stress and feel better. There is scientific evidence that massage may help with back pain and improve quality of life for people with chronic conditions.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine. Research suggests that acupuncture can help manage certain pain conditions.

Osteopathic Medicine

Osteopathic medicine recognizes a person’s body as an integrated whole and treats it as such, rather than just treating specific illnesses or symptoms. A doctor of osteopathic medicine understands the ways an injury or illness in one part of the body can affect another. Combining an osteopathic approach with other evidence-based medicine, you get a very comprehensive solution that also focuses on preventative health.

Primary Care

Services that cover a range of prevention, wellness and treatment for common and chronic health issues fall under Primary Care. Consulting with a primary care physician (either an MD or DO) about a back or neck pain issue is common, especially since they often have maintained a long-term relationship with you, and can therefore advise, treat and if needed recommend an appropriate course of action based on your health history.