Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
Strengthening exercises, beyond general daily activities, are not advised for acute low back pain, but may be an effective way to speed recovery from chronic or subacute low back pain. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Health care providers can provide a list of beneficial exercises that will help improve coordination and develop proper posture and muscle balance. Evidence supports short- and long-term benefits of yoga to ease chronic low back pain.
Low back pain is not a specific disease but rather a complaint that may be caused by a large number of underlying problems of varying levels of seriousness.[25] The majority of LBP does not have a clear cause[1] but is believed to be the result of non-serious muscle or skeletal issues such as sprains or strains.[26] Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute to low back pain.[26] A full list of possible causes includes many less common conditions.[5] Physical causes may include osteoarthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, broken vertebra(e) (such as from osteoporosis) or, rarely, an infection or tumor of the spine.[27]

This Web site provides general educational information on health-related issues and provides access to health-related resources for the convenience of our users. This site and its health-related information and resources are not a substitute for professional medical advice or for the care that patients receive from their physicians or other health care providers.


When was the last time you got on your gym's abductor or adductor machine and got in a good workout? It's probably been a while. Both are machines that don't get a lot of use, and they are often the target of coaches' ridicule on those "useless gym moves we should all skip" lists. Perhaps rightly so, especially if you're hopping on those machines hoping for a slimming effect.
Poor Sitting Posture: The correct position of your low back should have a slight forward curve called a lordosis. When you sit slouched, this lordosis straightens out-or even worse-reverses itself. This loss of the forward curve in your spine can cause increased pressure on the small shock absorbing discs in your back. This increased pressure can displace your discs and lead to low back pain. Your physical therapist can teach you the proper way to sit to decrease, eliminate, or prevent your back pain.
Start kneeling on your mat with knees hip-width apart and hips directly over knees. Press your shins and the tops of your feet into the mat. Bring your hands to your low back, fingers pointing down, and rest palms above glutes. Inhale and lift your chest, and then slowly start to lean your torso back. From here, bring your right hand to rest on your right heel and then your left hand to your left heel. (If you can't reach your heels, turn your toes under; it will be easier to reach your heels in this modification.) Press your thighs forward so they are perpendicular to the floor. Keep your head in a relatively neutral position or, if it doesn't strain your neck, drop it back. Hold for 30 seconds. To come out of the pose, bring your hands to your hips and slowly, leading with your chest, lift your torso as you press the thighs down toward the floor.

While a sharp pain in the hip, groin, pelvis, or thigh is an obvious sign of a hip flexor injury, pain in the lower back and leg are easy to misdiagnose. After all, it’s natural to assume that radiating pain in the leg or lower back originate from these areas. Unfortunately, diagnosing the source of a patient’s pain is not always straightforward. In fact, it’s possible for patients to go years with a misdiagnosed injury.
Disk tear. Small tears to the outer part of the disk (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.
Im a skateboarder and a couple weeks ago i skated alot every day and my lefy hip was starting to get sore. But of course i couldnt resist skating so i kept skating and it got worse and worse to the point i couldnt really skate at all without my hip hurting but of course i would still mess around on the board doing tiny tricks but a couple days ago i was just skating around not really doing tricks and i slipped and kicked my leg out and REALLY hurt my hip and thought i tore a tendon or something and couldnt walk for two days, but its gotten alot better and i can walk fairly normal and i ice it everyday but whenever i stretch it its just a really sharp pain it doesnt feel like im stretching it. What do i do when all the stretch does is make a sharp pain? How do i strengthen my hip? And how long would it take to strengthen my hip to full strength again? Because i cant stand not being able to skate. Please reply so i can skate as soon as possible thank you
Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device consisting of electrodes placed on the skin over the painful area that generate electrical impulses designed to block incoming pain signals from the peripheral nerves. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that it elevated levels of endorphins, the body’s natural pain-numbing chemicals. More recent studies, however, have produced mixed results on its effectiveness for providing relief from low back pain.
The lower back where most back pain occurs includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.

How to: Get into a high plank position on the floor, hands planted under your shoulders, butt down (a). Engage your abs by pulling your belly button in towards your spine (b). Squeeze your left glute to lift your left leg two inches off the ground, keeping your leg straight (c). Tap your left leg out to the side, then back to starting position. Repeat, then switch legs (d).
2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.
Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.”
Overall, the outcome for acute low back pain is positive. Pain and disability usually improve a great deal in the first six weeks, with complete recovery reported by 40 to 90%.[2] In those who still have symptoms after six weeks, improvement is generally slower with only small gains up to one year. At one year, pain and disability levels are low to minimal in most people. Distress, previous low back pain, and job satisfaction are predictors of long-term outcome after an episode of acute pain.[2] Certain psychological problems such as depression, or unhappiness due to loss of employment may prolong the episode of low back pain.[13] Following a first episode of back pain, recurrences occur in more than half of people.[23]
Strong muscles support and protect your joints. “Strengthening the lower body takes some of the pressure off of the hip and knee joints,” says William Oswald, DPT, a physical therapist and clinical instructor of rehabilitation medicine at NYU Langone Health. This can relieve some of the pain and protect against more damage. “It can also make daily tasks, such as climbing the stairs, easier,” he says.
As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own understanding and perception of their particular situation. British researchers found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.
Stop focusing on a specific diagnosis. Up to 85% of low back pain can be classified as "non-specific." This means that the origin of your pain cannot be localized to one specific structure or problem. While common diagnostic tests for low back pain can show the bones, discs, and joints with great detail, no test can tell the exact cause of your pain with 100% accuracy.
Keeping your hips mobile is important for overall hip function and athletic performance. Mobility refers to the ability of your joints to move through a pain-free, unrestricted range of motion. For cyclists, hip mobility is critical since pedaling occurs in one plane of motion, and after miles and miles in the saddle, hip tightness and restriction may develop. The following movements will help with hip mobility.
Intradiscal electrothermal therapy (IDET) is a treatment for discs that are cracked or bulging as a result of degenerative disc disease. The procedure involves inserting a catheter through a small incision at the site of the disc in the back. A special wire is passed through the catheter and an electrical current is applied to heat the disc, which helps strengthen the collagen fibers of the disc wall, reducing the bulging and the related irritation of the spinal nerve. IDET is of questionable benefit.
Women may have acute low back pain from medical conditions affecting the female reproductive system, including endometriosis, ovarian cysts, ovarian cancer, or uterine fibroids.[28] Nearly half of all pregnant women report pain in the lower back or sacral area during pregnancy, due to changes in their posture and center of gravity causing muscle and ligament strain.[29]

While leg lifts, certain ab exercises, and even hula hooping can all help work the hips, the hip flexors can still be a tricky part of the body to stretch Kinetics of hula hooping: An inverse dynamics analysis. Cluff, T., Robertson, D.G., and Balasubramaniam, R. School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada. Human Movement Science, 2008 Aug; 27 (4): 622-35.. To get them even stronger and more flexible, try these five simple hip flexor stretches:

If you’re lucky, you won’t notice your hips are tight until you’re trying to do the Half Pigeon pose in your yoga class. But if you’re not so fortunate, your tight hips are making themselves known every time you so much as walk to the bathroom or sit on the couch—expressing themselves in the form of lower back pain and muscle stiffness. Tight hips can even shorten your stride, slowing your 5K goal time!
The side of the pain on its own doesn’t tell us much, and most of the one-sided sources of pain are viscera that usually cause abdominal pain instead of back pain, or in addition to it. In other words, the only reason to worry about right or left lower back pain is if it is otherwise worrisome: if you have other red flags or significant non-back symptoms.
Before recommending exercises, physical therapists evaluate their patients to develop a routine that’s appropriate for their specific condition. Pariser says the following exercises, done at home and at the gym, are generally safe for everyone. “If a patient has already received a total hip replacement, however, certain precautions should be taken,” he says.
^ Jump up to: a b c d e f g Hughes SP, Freemont AJ, Hukins DW, McGregor AH, Roberts S (October 2012). "The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain" (PDF). J Bone Joint Surg Br. 94 (10): 1298–304. doi:10.1302/0301-620X.94B10.28986. PMID 23015552. Archived from the original (PDF) on 4 October 2013. Retrieved 25 June 2013.
Recurring back pain resulting from improper body mechanics is often preventable by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture. Using ergonomically designed furniture and equipment to protect the body from injury at home and in the workplace may reduce the risk of back injury.
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
It is unclear if among those with non-chronic back pain alternative treatments are useful.[84] For chiropractic care or spinal manipulation therapy (SMT) it is unclear if it improves outcomes more or less than other treatments.[18] Some reviews find that SMT results in equal or better improvements in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up;[19][20][85] other reviews find it to be no more effective in reducing pain than either inert interventions, sham manipulation, or other treatments, and conclude that adding SMT to other treatments does improve outcomes.[17][21] National guidelines reach different conclusions, with some not recommending spinal manipulation, some describing manipulation as optional, and others recommending a short course for those who do not improve with other treatments.[3] A 2017 review recommended spinal manipulation based on low quality evidence.[6] Manipulation under anaesthesia, or medically assisted manipulation, has not enough evidence to make any confident recommendation.[86]
It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. "For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak," he says. "This combination negatively affects our ability to walk, maintain proper posture, and the stability of our spine."
The hip flexors play an important role in everyday mobility and exercise. Involved in pulling the knee toward the hip, most movements either directly or indirectly use the hip flexors. That’s why even the slightest injury can cause great discomfort. Learn how you can recover from a hip flexor injury, and what precautions can be taken to avoid them.
If you develop a sudden onset of low back pain, a visit to your physical therapist can help you determine the correct things to do to manage your acute pain. Your physical therapist should be able to analyze your lifestyle, movements, and overall medical history to help determine the likely cause of your pain. By focusing on these mechanical causes of back pain, you can make a change that may give you relief.
Pain in the hip can result from a number of factors. Sometimes diseases that affect other joints in the body, such as the inflammation resulting from arthritis, can be the cause of pain in the hip. Depending upon the cause of hip pain, the pain may occur when walking, running, or engaging in activity. Trochanteric bursitis is the most common type of hip bursitis and causes pain at the point of the hip.

Lie on your back with your knees bent and your feet flat on the floor. Tighten your buttocks and lift your hips off the floor. Tighten your abdominal muscles and lift one foot a couple of inches off the floor. Then put it down and lift the other foot a couple of inches, all while remembering to breathe. “It’s like taking alternate steps,” Pariser says. Work up to doing 30 steps at a time.
There are a few most common causes of hip pain. The first thing to distinguish is to identify which pain is coming from the hip, as opposed to some other source. So there are four causes of hip pain, and the pain can come from muscles, ligaments, tendons, and within the joint itself. But those types of pain present in different ways. So those are the most important distinguishing factors to find out if the hip actually is the cause of the pain.
Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back.[4] Pain can vary from a dull constant ache to a sudden sharp feeling.[4] Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).[3] The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.[5] The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people completely better by six weeks.[2]
If you develop a sudden onset of low back pain, a visit to your physical therapist can help you determine the correct things to do to manage your acute pain. Your physical therapist should be able to analyze your lifestyle, movements, and overall medical history to help determine the likely cause of your pain. By focusing on these mechanical causes of back pain, you can make a change that may give you relief.
Tight hip flexors can result in lower back pain, hip pain and injury.  A lot of strain is put on those muscles during activities that involve sprinting and kicking.  For example, runners are more prone to hip flexor injuries because of the small, repetitive movement during running.   But even if you’re not an athlete, hip flexor injuries can occur during everyday activities (for instance, slipping and falling or running to catch a bus).  When those tight muscles are suddenly stretched beyond what they are accustomed to, you might also experience pain in the upper groin region, typically where the hip meets the pelvis.   
Stop listening to other people’s horror stories. You know the scenario: You are bent over in obvious pain, waiting to see the doctor, and the person next to you tells you a 10-minute tale of how their Uncle Gordon had low back pain that required injections and surgery. But the pain still didn’t go away. Stop listening to these terrible stories. Most low back pain is short-lived and can be managed quite effectively with exercise and postural correction. Of course, some low back conditions are serious and require surgery, but that is a conversation you should have with your doctor, not the guy in the waiting room.

In addition to strengthening the core muscles, it's also important to address any mobility problems, says Jacque Crockford, M.S., C.S.C.S., exercise physiology content manager at American Council on Exercise, which can sometimes be what's causing pain. If specific movements like twisting or bending or extending your spine feel uncomfortable, there may be mobility (flexibility) issues at play. Doing some gentle stretching (like these yoga poses) might help. (If it gets worse with those stretches, stop and see a doctor.)

Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.

Spondylolisthesis. This condition occurs when one vertebra slips over the adjacent one. There are 5 types of spondylolisthesis but the most common are secondary to a defect or fracture of the pars (between the facet joints) or mechanical instability of the facet joints (degenerative). The pain can be caused by instability (back) or compression of the nerves (leg).

In the elderly, atherosclerosis can cause weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause a pulsating low back pain. Aneurysms of certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.
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