Lumbar herniated disc. The jelly-like center of a lumbar disc can break through the tough outer layer and irritate a nearby nerve root. The herniated portion of the disc is full of proteins that cause inflammation when they reach a nerve root, and inflammation as well as nerve compression cause nerve root pain. The disc wall is also richly supplied by nerve fibers, and a tear through the wall can cause severe pain.
Low back pain has been with humans since at least the Bronze Age. The oldest known surgical treatise – the Edwin Smith Papyrus, dating to about 1500 BCE – describes a diagnostic test and treatment for a vertebral sprain. Hippocrates (c. 460 BCE – c. 370 BCE) was the first to use a term for sciatic pain and low back pain; Galen (active mid to late second century CE) described the concept in some detail. Physicians through the end of the first millennium did not attempt back surgery and recommended watchful waiting. Through the Medieval period, folk medicine practitioners provided treatments for back pain based on the belief that it was caused by spirits.[99]
A healthy diet is important for a number of reasons when you have lower back pain. First, eating well can help you maintain a healthy weight. Excess weight puts extra strain on your lower back, adding to your pain. Second, a diet that’s high in key nutrients can help promote bone growth and keep your bones strong. These must-have nutrients include:
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.
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.
Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain persists despite medical and surgical treatment.
The big idea of classification-based cognitive functional therapy (CB-CFT or just CFT) is that most back pain has nothing to do with scary spinal problems and so the cycle of pain and disability can be broken by easing patient fears and anxieties. For this study, CFT was tried with 62 patients and compared to 59 who were treated with manual therapy and exercise. The CFT group did better: a 13-point boost on a 100-point disability scale, and 3 points on a 10-point pain scale. As the authors put it for BodyInMind.org, “Disabling back pain can change for the better with a different narrative and coping strategies.” These results aren’t proof that the confidence cure works, but they are promising. 
The hip joint is designed to withstand a fair amount of wear and tear, but it’s not indestructible. For example, when you walk, a cushion of cartilage helps prevent friction as the hip bone moves in its socket. With age and use, this cartilage can wear down or become damaged, or the hip bone itself can be fractured during a fall. In fact, more than 300,000 adults over 65 are hospitalized for hip fractures each year, according to the Agency for Healthcare Research and Quality.
Hamstring squeeze. Use the machine that works your hamstrings; you will either lie on your stomach or sit with a pad behind your knee. Push against the pad, moving your knee up toward the ceiling or backward (depending on which position you’re in). “In other words, bend your knees,” Pariser says. But to avoid cramps in your hamstring muscles, don’t bend your knee so much that your heels are too close to your buttocks.
Since the hip flexors are so easy to overuse and strain, it is important to stretch them before exercise or strenuous activity. Because of their connectedness to other muscle groups in the legs (like the quadriceps), it is important to stretch the muscle group as a whole, not individually. This ensures that the entire area is warmed up and ready for the strain of exercise or activity, not just one or two individual muscles.
As the structure of the back is complex and the reporting of pain is subjective and affected by social factors, the diagnosis of low back pain is not straightforward.[5] While most low back pain is caused by muscle and joint problems, this cause must be separated from neurological problems, spinal tumors, fracture of the spine, and infections, among others.[3][1]
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves. Several channels may be made depending on how tissue needs to be removed to decompress the disc and nerve root.
Spartacus is worthwhile, but the sex and violence is over-the-top: there’s no sugar-coating it. Definitely not a family drama. But the dramatic quality is excellent. After a couple of campy, awkward episodes at the start, the first season quickly gets quite good: distinctive film craft, interesting writing, and solid acting from nearly the whole cast. Andy Whitfield’s Spartacus is idealistic, earnest, and easy to like. I found it downright upsetting when I learned that he had passed away — as did many, many other fans I’m sure. See my personal blog for a little bit more of a review of Spartacus. BACK TO TEXT
Sleeping in an awkward position can cause you to be in pain from the moment you wake up. The best sleeping position for lower back pain may be sleeping on your side with your knees drawn up close to your chest (also known as the fetal position). Placing a pillow or two between your legs, while sleeping on your side, helps to reduce stress on your lower back. Sleeping on a too soft mattress can also cause lower back pain. A firmer mattress is best.
Imaging is indicated when there are red flags, ongoing neurological symptoms that do not resolve, or ongoing or worsening pain.[5] In particular, early use of imaging (either MRI or CT) is recommended for suspected cancer, infection, or cauda equina syndrome.[5] MRI is slightly better than CT for identifying disc disease; the two technologies are equally useful for diagnosing spinal stenosis.[5] Only a few physical diagnostic tests are helpful.[5] The straight leg raise test is almost always positive in those with disc herniation.[5] Lumbar provocative discography may be useful to identify a specific disc causing pain in those with chronic high levels of low back pain.[41] Similarly, therapeutic procedures such as nerve blocks can be used to determine a specific source of pain.[5] Some evidence supports the use of facet joint injections, transforminal epidural injections and sacroilliac injections as diagnostic tests.[5] Most other physical tests, such as evaluating for scoliosis, muscle weakness or wasting, and impaired reflexes, are of little use.[5]
Medications: A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:
When a muscle contracts, it shortens. Take the biceps for example. Without getting too technical, the biceps are attached at the forearm and shoulder. When your biceps contract, they shorten and bring those two points closer together. When you rest, the muscle returns to its normal length, and the two points move farther away. Constantly contracting your biceps over a long period of time would cause them to get shorter, even at rest.
For those with pain localized to the lower back due to disc degeneration, fair evidence supports spinal fusion as equal to intensive physical therapy and slightly better than low-intensity nonsurgical measures.[15] Fusion may be considered for those with low back pain from acquired displaced vertebra that does not improve with conservative treatment,[14] although only a few of those who have spinal fusion experience good results.[15] There are a number of different surgical procedures to achieve fusion, with no clear evidence of one being better than the others.[83] Adding spinal implant devices during fusion increases the risks but provides no added improvement in pain or function.[11]
Non-mechanical Disease Processes: Sometimes, non-mechanical disease processes like cancer, kidney stones, or a tumor may cause low back pain. These symptoms are usually, but not always, accompanied by other symptoms like unexpected weight loss, fever, or malaise that indicate a non-mechanical cause of your pain. These diseases are rare, but they can happen, so if your back pain continues for more than a few weeks after physical therapy treatment begins, a visit to your doctor is certainly in order to rule out a sinister problem.
Try Atrogel: Atrogel is amazing when it comes to soothing and easing pain, helping to relieve muscle aches, stiffness and bruising. It’s prepared using extracts of fresh arnica flowers and can be applied up to 4 times a day! Suitable for pregnant women and children, simply apply this lovely non-greasy formula to the affected area for some much-needed relief!
You’d think so. But consider this story of a motorcycle accident: many years ago, a friend hit a car that had pulled out from a side street. He flew over the car & landed on his head. Bystanders showed their ignorance of spinal fracture by, yikes, carelessly moving him. In fact, his thoracic spine was significantly fractured … yet the hospital actually refused to do an X-ray because he had no obvious symptoms of a spinal fracture. Incredible! The next day, a horrified orthopedic surgeon ordered an X-ray immediately, confirming the fracture & quite possibly saved him from paralysis.
Eleven updates have been logged for this article since publication (2009). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more When’s the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are “fine print,” but more meaningful than most of the comments that most Internet pages waste pixels on.
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]
Radiofrequency denervation is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals). Using x-ray guidance, a needle is inserted into a target area of nerves and a local anesthetic is introduced as a way of confirming the involvement of the nerves in the person’s back pain. Next, the region is heated, resulting in localized destruction of the target nerves. Pain relief associated with the technique is temporary and the evidence supporting this technique is limited.
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.
When your body comes under stress it can stimulate a reaction from your central nervous system, flooding your body with inflammatory chemicals – definitely not what you want if inflammation is the root of your suffering. Instead try to focus on what you can do and make sure you set aside time to rest. Don’t make the mistake of pushing yourself too hard or trying to do too much at once!
Icing a joint that’s inflamed because of arthritis or bursitis can lower inflammation and help with hip pain. “If it’s very painful, I sometimes tell patients to ice four or five times daily for about 10 to 15 minutes,” says Amy Humphrey, DPT, a physical therapist at Body Dynamics, Inc. in Arlington, Va. Use an ice pack, wrap a towel around it, and put it where you feel the pain.
In the common presentation of acute low back pain, pain develops after movements that involve lifting, twisting, or forward-bending. The symptoms may start soon after the movements or upon waking up the following morning. The description of the symptoms may range from tenderness at a particular point to diffuse pain. It may or may not worsen with certain movements, such as raising a leg, or positions, such as sitting or standing. Pain radiating down the legs (known as sciatica) may be present. The first experience of acute low back pain is typically between the ages of 20 and 40. This is often a person's first reason to see a medical professional as an adult.[1] Recurrent episodes occur in more than half of people[23] with the repeated episodes being generally more painful than the first.[1]
Non-mechanical Disease Processes: Sometimes, non-mechanical disease processes like cancer, kidney stones, or a tumor may cause low back pain. These symptoms are usually, but not always, accompanied by other symptoms like unexpected weight loss, fever, or malaise that indicate a non-mechanical cause of your pain. These diseases are rare, but they can happen, so if your back pain continues for more than a few weeks after physical therapy treatment begins, a visit to your doctor is certainly in order to rule out a sinister problem.
Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure (impingement) by bone or other tissues, or from disease, anywhere along their paths -- from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See descriptions of these conditions below. 
Start in a runner’s lunge with right leg forward, right knee over right ankle and back leg straight. Walk right foot over toward left hand, then drop right shin and thigh to the floor, making sure to keep right knee in line with right hip. Allow left leg to rest on the floor with top of left foot facing down. Take a moment to square your hips to the front of the room. Hold here, or hinge at hips and lower torso toward floor, allowing head to rest on forearms. Hold for at least 30 seconds, then repeat on opposite side. You want to feel a moderate stretch in the outside of the right thigh, but if this pose hurts your knees or feels too uncomfortable, stick with Thread the Needle.
At the very least, the tension and/or spasm in muscles that cross over the hip and attach onto the pelvis can contribute to imbalance, in terms of how strong and flexible each muscle group is in relation to the others. But muscle imbalance in the hips and the spine may make for pain, limitation and/or posture problems. It can also increase the healing challenge put to you by an existing injury or condition, for example, scoliosis.
If certain activities or overuse are causing hip pain, stop those that aggravate the discomfort and talk to your doctor. Excess weight can put pressure on the hip joint, so losing the pounds can provide relief and help you avoid further problems. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, talk to your doctor about the possible causes and treatments.
The more than 20 muscles that make up your hips are responsible for stabilizing your pelvis, moving your legs from side to side, and shortening to draw your knees toward your chest every time you sit down, run, jump or pedal, explains Kelly Moore, a certified yoga instructor and co-founder of Mindfuel Wellness, which brings health and wellness initiatives to companies throughout Chicago.
It is sometimes hard for an aggressive athlete to consider changing training schedules. It is also hard to accept the fact that a serious disease may exist. All athletes who suffer from low back pain should seek medical advice. Some situations might require reducing or stopping athletic activity until the problem is resolved. The body's ability to be active is worth preserving.
Located deep in the front of the hip and connecting the leg, pelvis, and abdomen, the hip flexors— surprise, surprise— flex the hip. But despite being some of the most powerful muscles in our bodies (with a clearly important role), it’s easy to neglect our poor hip flexors— often without even knowing it. It turns out just working at a desk all day (guilty!) can really weaken hip flexors since they tend to shorten up while in a seated position. This tightness disrupts good posture and is a common cause of lower back pain. Weakened hip flexors can also increase the risk of foot, ankle, and knee injuries (especially among runners) Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, VT. Clinical Journal of Sport Medicine, 2005 Jan; 15 (1): 14-21.. So be sure to get up, stand up every hour or so! And giving the hip flexors some extra attention is not just about injury prevention. Adding power to workouts, working toward greater flexibility, and getting speedier while running is also, as they say, all in the hips The effect of walking speed on muscle function and mechanical energetics. Neptune, R.R., Sasaki, K., and Kautz, S.A. Department of Mechanical Engineering, The University of Texas, Austin, TX. Gait & Posture, 2008 Jul; 28 (1): 135-43..
