WARNING!
This is an older article that may not reflect Dr. Mercola’s current view on this topic. Use our search engine to find Dr. Mercola’s latest position on any health topic.
By Dr. Mercola
Your lumbar spine, or lower back, is a complex structure of interconnecting ligaments, muscles, bones, joints and nerves all working together to provide support to your core and offer strength and flexibility. However, your lower back is also susceptible to injury and pain, based on how it's used and protected. Mechanical and soft tissue injuries are some of the more common causes of lower back pain, which can impact intervertebral discs, nerve roots and spinal joints.1
Lower back pain is a common problem worldwide2 and a major cause of disability. Although several risk factors have been identified, in most cases the trigger remains obscure and a diagnosis difficult to make. Low back pain has an enormous social, psychological and economic burden on the community and is estimated to affect up to 20 percent of adults in a single year.3 It is estimated nearly 80 percent of the population will experience at least one episode of back pain during their lifetime.
The pain may be experienced as dull, developing gradually, or sudden and sharp after an injury. There are also several bony conditions that can trigger lower back pain, including a herniated disc, vertebral fractures, osteomyelitis and spinal stenosis.4 Traditional treatments have often included physical therapy, pain medication and rest. Research again demonstrates application of chiropractic care alongside some traditional treatments may reduce disability and the use of pain medications.5
Adding Chiropractic Care May Reduce Your Pain
A study that included chiropractic treatments as a component of a multidisciplinary team approach to low back pain in two large military medical centers revealed a reduction in discomfort and disability greater than what was experienced with standard medical care.6 The researchers evaluated 750 active duty military service members already being treated for lower back pain. All were receiving physical therapy and/or drugs to ease pain and inflammation.7
The team added chiropractic treatment to half the participants, including spinal manipulation, rehabilitation exercises and treatment with cold or heat. After six weeks, patients who received chiropractic treatments experienced greater improvements in their lower back pain and less disability than those who did not receive the treatments.8 Lead study author Christine Goertz, Ph.D., commented on the results:9
"Spinal manipulation (often referred to as Hias chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body's ability to move correctly. It is also possible that manipulation impacts the way your body perceives pain through either the brain or spinal cord and or decreases pain from muscle strain, inflammation and or spasm in the muscles next to your spine."
Researchers noted lower back pain had a direct and indirect cost of treatment exceeding $234 billion in 2010. Interestingly, the participants who were assigned treatment from a chiropractor received only an average of two to five treatments over the six-week study period, yet experienced greater relief than those who did not. Some patients reported side effects while receiving chiropractic care, most of which were described as joint or muscle stiffness.10
Those who did not receive chiropractic treatments also reported side effects, including three who had drug side effects and four who had side effects from epidural injections. Results from the study suggest offering chiropractic care may improve outcomes in those suffering from lower back pain by reducing pain and improving function. Daniel Cherkin, Ph.D., of Kaiser Permanente Washington Health Research Institute, wrote an accompanying editorial, in which he stated:11
"All of these treatments have lower risks of harm than medications, injections and surgery. Because it has not been possible to predict which patients will benefit most from a specific treatment, trying several of these alternative treatments to find one that works is a sensible strategy."
Lower Back Pain Is a Leading Reason for Opioid Prescriptions
In response to a growing opioid epidemic fueled by prescription painkillers, guidelines released in early 2017 from the American College of Physicians recommend spinal manipulation and other nondrug treatments as a first line of therapy for acute and chronic lower back pain.12 Nearly 1 in 10 of all primary care visits are for lower back pain, and physicians are increasingly prescribing expensive scans and narcotic painkillers.13
Researchers from Beth Israel Deaconess Medical Center in Boston14 evaluated patient care records of nearly 24,000 office visits related to simple back pain between 1999 and 2010. The published data revealed physicians had increasingly been prescribing opioid narcotics, with a rise from 19 percent to 29 percent. In the same period of time, recommendations for over-the-counter painkillers declined from 37 percent to 25 percent.
In a survey of over 2,100 physicians from a variety of specialties across the U.S., questions were asked about the physician's beliefs concerning overtreatment and unnecessary medical care.15
By their own admission, the participating physicians describe overtreatment of their patients as "common" and that 22 percent of prescription medications, 24 percent of tests and 11 percent of procedures were unnecessarily prescribed despite years of emphasis from the health care industry to control costs by cutting out unnecessary procedures.
The most common reason cited for overtreatment was fear of malpractice and pressure from patients. Most cases of back pain are mechanical or nonorganic, which means the pain is not caused by serious conditions such as inflammatory arthritis, infection or fracture.16 This type of pain usually gets better within three months with gentle exercise, proper body mechanics and anti-inflammatory lifestyle choices.
Prescriptions of opioid painkillers may begin with lower back pain, but in an analysis by CNN and Harvard researchers, data revealed that in 2014 and 2015 hundreds of doctors received an excess of $25,000 each from opioid manufacturers for the prescription of medications.17 Those who prescribed the most opioids received the largest payments. In those two years, at least one doctor received more than $1 million.
In an assessment of the link between payments from drug companies and prescription habits, the team reviewed data from two federal government sources, one tracking government drug company payments to doctors and the other tracking prescriptions made to Medicare patients. Of the 811,000 doctors who wrote prescriptions for Medicare recipients during 2014 and 2015, more than 200,000 prescribed opioids and received payments from the drug makers.18
Lower Back Pain Is Related to How You Use Your Back
While guidelines from the American College of Physicians for treatment of low back pain were recently released, in an accompanying commentary on the research from Beth Israel Deaconess, Dr. Donald Casey19 remarked guidelines had previously conflicted on back pain treatment and it takes 17 years, on average, for new treatment standards to be widely adopted.
The combination of a lengthy time for guidelines to be adopted and kickback schemes from opioid manufacturers may mean greater responsibility lies on your shoulders to direct your health care away from narcotic painkillers and avoid potential life-threatening and damaging addiction.
By reducing your lower back pain, chiropractic care may have a significant impact on the opioid crisis. Many chiropractors are adept at evaluating how you use your back through analysis of your posture while sitting, standing and walking, as well as a thorough physical examination. Recommendations will often include gentle exercises and stretches, as well as improving mechanical use and posture of your core muscles.
The recommendations and guidelines you receive from your chiropractor will be individualized to your specific case. However, there are some preventive measures you may take each day in order to reduce your risk of experiencing lower back pain or injury during activity.
Posture
Walk, sit and stand with good posture, keeping your weight balanced, your core muscles engaged, a slight curve in your lumbar back, shoulders back and your head balanced over your shoulders as if there were a string attached to your head pulling toward the sky.
Don't slouch when standing or sitting. Remember to keep your shoulders back, core muscles engaged and feet flat to the floor while sitting. Don't sit with one leg tucked under the other as it shortens muscles in your lower back and increases your risk for discomfort and pain. Wear comfortable, low-heeled shoes to reduce strain on your lumbar back. |
Flexibility
Always stretch before any strenuous physical activity. It would be wise to engage in a regular stretching program to ensure flexibility and reduce strain on the surrounding muscles, tendons and joints. |
Support
Use good lumbar support in chairs or cars, which improves your subjective measure of comfort and reduces flattening of the lumbar curve.20 |
Positions
Switch sitting positions at least every 10 minutes to relieve tension; get up and gently stretch your muscles. Chronic sitting is a risk factor for poor health and pain. For more information see my previous article, "Principles of Natural Posture for Health and Pain Relief." |
Lift correctly
When lifting something heavy, don't bend over from your back but, rather, bend your knees while keeping your back straight and your lumbar area supported by engaging your core muscles. |
Exercise
Get at least 30 minutes of exercise each day. This improves circulation to your muscles and tendons, helps strengthen them and control your weight. |
Natural Alternatives to Prescription Painkillers
There are many different methods to help reduce the inflammatory response in your body. As they work together, you experience greater benefits. When you incorporate chiropractic care into these strategies you reduce your time to recovery and the potential you'll need a prescription pain medication. I strongly recommend exhausting all other options before resorting to a narcotic pain reliever. The risks associated with these drugs are great and addiction is a very real concern.
Prescription opioid pain relievers should be the last choice for pain relief and not the first. In circumstances when pain is so severe a prescription drug may be necessary, including other options in addition may help reduce the dosage needed and the time the drug is necessary. Many of the following options work best in conjunction with each other to reduce inflammation and pain.
Eliminate or radically reduce most grains and sugars from your diet
Avoiding grains and sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses. |
Take a high-quality, animal-based omega-3 fat
Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, anti-inflammatory painkillers work by manipulating prostaglandins.) |
Optimize your vitamin D level
Get regular, sensible sun exposure, which will work through a variety of different mechanisms to reduce your pain, including keeping your bones and muscles strong. Have your vitamin D levels tested twice a year. An ideal level for health and disease prevention is currently thought to be between 60 and 80 ng/mL. |
Emotional Freedom Techniques (EFT) and mind-body techniques
EFT is a drug-free approach for pain management of all kinds. It borrows from the principles of acupuncture as it helps balance your subtle energy system, helping resolve underlying, often subconscious, negative emotions that may exacerbate your physical pain.
By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain. Methods such as yoga, Foundation Training, acupuncture, meditation, hot and cold packs, and other mind-body techniques can also result in pain relief without any drugs. |
K-Laser Class 4 Laser Therapy
If you suffer pain from an injury, arthritis or other inflammation-based pain, I'd strongly encourage you to try K-Laser therapy. It can be an excellent choice for many painful conditions, including acute injuries. By addressing the underlying cause of the pain, you will no longer need to rely on painkillers.
K-Laser is a class 4 infrared laser therapy treatment helping reduce pain and inflammation, and to enhance tissue healing — both in hard and soft tissues, including muscles, ligaments and bones.
The infrared wavelengths used in the K-Laser target specific areas of your body, and can penetrate deeply to reach areas such as your spine and hip. For more information about this groundbreaking technology, and how it can help heal chronic pain, please listen to my previous interview with Dr. Phil Harrington. |
Acupuncture
This treatment is effective for many kinds of pain. Research has discovered a "clear and robust" effect of acupuncture in the treatment of: back, neck and shoulder pain, osteoarthritis, and headaches. |
Physical and massage therapy
You may experience positive results as good as surgery for painful conditions such as torn cartilage and arthritis with physical therapy and massage therapy without the risk. |
Astaxanthin
This one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and you may need 8 mg or more per day to achieve this benefit. |
Ginger
This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice. |
Curcumin
In a study of osteoarthritis patients, those who added 200 milligrams of curcumin per day to their treatment plan had reduced pain and increased mobility.21 A past study also found a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein triggering swelling and pain.22 |
Boswellia
Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients. |
Bromelain
This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful. |
Cetyl myristoleate (CMO)
This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. |
Evening primrose, black currant and borage oils
These contain the essential fatty acid gamma linolenic acid, which is useful for treating arthritic pain. |
Cayenne cream
Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells transmitting pain signals to your brain. |