Cure My Low Back Pain

There are numerous causes of paraspinal pain. We will address many of them over time. However, this site is dedicated primarily to mechanical pain. Some topics will be equally applicable across all spinal segments, cervical through lumbar. Others will be segment specific, often lumbar.

This site is about alternative treatment, complementary treatment and self-care. It is not meant to replace service via your primary or specialty medical clinician, particularly for those of you who can afford it and are reasonably satisfied with services delivered to date. Rather, this site is intended to supplement your knowledge, point you to complementary/self-care tools and offer back pain care alternative perspectives and treatment ideas to steer you into directions that you may not have previously considered.

Look at discussion of: prescription medications, homeopathic medications, naturopathic medications, herbs, cannabis/marijuana, acupuncture, acupressure, electroacupuncture, electrical stimulation (various forms), chiropractic, physical therapy, inversion, traction, massage, trigger point intervention, light therapy (infrared, laser), hypnosis, psychotherapy, mental distraction, thermal intervention (heat, ice), dietary adjustments (foods and anti-inflammatory effects), spiritualism, weight control, exercise/stretching, treatment of concurrent diseases that contribute to the pain, other behavioral adjustments (e.g., quit smoking tobacco), and cessation of activities that worsen symptoms.

We are about back pain alternative treatment strategies. If you email us we will respond to questions and comments as time allows. More importantly, we hope that you enjoy this site.

Chinese Medicine, classical and traditional involves a range practices originating in eastern Asia. Although well accepted throughout China and many other parts of the world, it is considered an alternative medicine in the West. Practices include use of herbs, dietary adjustments, movement therapies, massage therapies, moxibustion and acupuncture.

While western medicine is based upon theories related to anatomical function and physiology, Chinese medicine is based upon at least five major theories relating the human body and its life energy to nature, the universe, and a higher being. Its practices have roots that are thousands of years old.

One aspect of Chinese medicine, acupuncture, is the procedure of inserting and manipulating very fine needles into points on the body to treat and cure medical disorders, including pain. Acupuncture points, stimulus placement sites, are situated along body meridians through which our theorized life energy flows. Modern acupuncture texts present meridians as conceptual targets. While there is no physical evidence to support their existence, consider that the only evidence of gravity is the fact that bodies attract each other in predictable manners (e.g., objects stay on the ground). Similarly, people respond to acupuncture stimulation along meridians in predictable manners. Moreover, acupuncture does not cause undesired side effects like most regularly prescribed medications.

The earliest recognized written record of acupuncture is from the second century BC. Different variations of acupuncture are practiced throughout the world. Acupuncture has been difficult to study by western medical researchers due to the invasive nature of the practice (having to place needles). Scholarly reviews are often biased by origin of the researchers. However, there is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and further research is ongoing. Alternative treatment approaches are available to the untrained and general public via electroacupuncture and acupressure. These are applied at the same points, along the same meridians, without the risks related to needle use by the novice, in case I wish to cure my own low back pain.

One extraordinary source of information on acupuncture is A Manual of Acupuncture, published by the Journal of Chinese Medicine Publications. Following research of many years, Peter Deadman, editor-in-chief of The Journal of Chinese Medicine, and colleagues created the primary reference for the study and practical application of acupuncture points and meridians. With subtle use of color to illustrate the acupuncture points and anatomical features in approximately five-hundred illustrations, it is a very comprehensive, attractive and user-friendly tool for the novice and professional. The index identifies every part of the body reached by each meridian, and there are separate indexes to direct readers to address health issues via Chinese medicine categorization and western medicine symptom approaches.

Whether you want to reduce back stress or fatigue or stimulate your blood circulation, an inversion table makes a great household accessory. An inversion table contributes to your body’s overall health via lumbar traction, relieving pressure on your vertebral discs and nearby structures, stretching muscles in your torso and promoting circulation. Additionally, when your back starts to relax, the rest of your body follows. For frequent and relentless symptoms, even reduced pain is a relative cure for your or my low back pain.  A table can also help with flexibility for improved athletic performance, reducing the apparent aging effects of gravity, relieving pain related to prolonged sitting or standing. Spine inversion is better than manual adjustments and it pays for itself within a few sessions.

Quality products boast durable tubular steel frames that are light, yet strong. More importantly, inversion systems are a breeze to use. You rest your body against comfortable foam backboards, slipping your feet into the ergonomically molded ankle cushions, simply reaching your arms overhead to initiate your treatment. As your arms go up, your body gradually inverts, as far as 90 degrees as desired. All that is needed is you, your inversion table and gravity.

Quality tables have non-skid floor stabilizers, keeping the table stable, and extra-long safety handles to provide an easy return to upright. Tables weighing less than ninety pounds that can support frames up to 6 feet 6 inches, weights up to 350 pounds, with easily adjusted ratchet ankle locking systems are ideal for the consumer market. With chronic pain, even intermittent markedly reduced pain is a relative cure for your or my low back pain.  Spine inversion has been around for more than two thousand years.  Spine inversion is better than manual adjustments because it is effective and pays for itself within a few sessions.

A patient presented asking “Do you have an alternative approach by which I might cure my low back pain?” A few minutes into discussion I determined his low (lumbar) back pain symptoms to be relatively minor and not radiating into his legs or feet. However, he had substantial anxiety about a concurrent illness with which he had been suffering for years. Not curable by present western medicine and somewhat stigmatizing, he lived with recurrent anxiety, depression and insomnia. We completed the evaluation and determined that his primary concern was not the physical pain, rather the psychological issues that complemented his pain. He tried and disliked prescription medications, and formal medical counseling. He did not like disease associated support groups, feeling them to magnify the stigmata. He said his spiritual peers, atheists, had nothing to offer him.

After discussing numerous options, he was willing to try acupuncture and herbs. He had not grown up with traditional Chinese medicine or other herbal intervention. He did not have any prior scientific understanding or reference by which to accept the underlying mechanisms by which these alternative treatments might work. However, he stated “With hope and faith, I am willing to explore these approaches.” “Hope and faith”, maybe he should consider an alternative spiritual perspective as well.

Do you think hanging upside down to relieve back pain is unusual, or a new-age approach? Reconsider your perceptions. Spinal inversion probably goes back to the dawn of documented human medical care.

We know that inversion has been used at least since 400 B.C., when Hippocrates, the father of western medicine, first observed a patient have his knees and ankles tied to a ladder to be hoisted upside down for a dose of what has come to be known as inversion therapy.

The Greek theories on inversion are still valid, but today there is a much easier way to relieve the back pain than having your family and friends hoist you with ropes. The process is called spinal inversion therapy, and it can be the natural way to a better back and a better body.

Inversion-traction and Tissue Movement Studies

The journal – Spine: 1 May 1998 – Volume 23 – Issue 9 – pp 1061-1063

Study Design. Experimental study of 30 patients diagnosed with low back pain resulting from lumbar disc herniation, disc degeneration, and segmental instability. Patients underwent gravitational traction, and widening of the intervertebral space and posterior facets was measured on x-rays. This same procedure was performed with a group of 30 healthy individuals.

Objectives. To determine the effect of gravitational traction on the widening of the intervertebral space and the other vertebral structures in patients with low back pain and in healthy individuals.

Summary of Background Data. Gravitational traction is performed by suspending the patient in a hanging, upright position for an extended period of time. (inversion)

Methods. A specially designed apparatus was used to apply gravitational traction. Before and after inversion x-rays were obtained to study the changes in the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces. Other data was also collected.

Results. Inversion-Distraction/traction created more than 3 mm of increased intervertebral disc space in subjects.

Conclusion. Spinal gravitational traction (inversion) had a very measurable effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae.

Other studies

1) Kane, M, et al: Effects of Gravity-facilitated Traction on Intravertebral Dimensions of the Lumbar Spine. Journal of Orthopedic and Sports Physical Therapy. 281-288, Mar 85. Study found gravity-facilitated traction (inversion), produces significant intravertebral separation in lumbar spine.

2) Gianakopoulos, G, et al: Inversion Devices: Their Role in Producing Lumbar Distraction. Arch Physical Med Rehabil 66: 100-102, Feb 85. Study found all subjects experienced intervertebral separation in the lower lumbar vertebrae.

3) Nosse, L.: Inverted Spinal Traction. Arch Physical Med Rehabil 59: 367-370, Aug 78. Study found EMG activity (an indicator of muscle activity, which tends to be greater with pain) declined 35 percent within the first 10 seconds of inversion

4) Nachemson, Alf, et al: Intravertebral Dynamic Pressure Measurements in Lumbar Discs. 1970. The study measured internal disc pressure (in the 3rd lumbar disc) during a range of activities, including standing, sitting, bending and vertical and traction. The study results identified that a traction load equal to sixty percent of body weight was sufficient to reduce the internal disc pressure to zero. This suggests that pain related to intradiscal pressure can be relieved by inversion.

5) Sheffield, F.: Adaptation of Tilt Table for Lumbar Traction. Arch Physical Med Rehabil 45: 469-472, 1964. One-hundred, seventy-five patients who were unable to work due to back pain were treated. After eight inversion treatments, 155 patients were able to return to their jobs full time. Study concluded that the main basis for improvement was the stretching of paraspinal vertebral muscles and ligaments and possibly the widening of intravertebral discs. The study found significant improvements in patients with a variety of diagnoses including spondylolisthesis, herniated discs, lumbar osteoarthritis with sciatica, and coccydynia.

6) Dimberg, L, et al: Effects of gravity-facilitated [spinal inverson] traction of the lumbar spine in persons with chronic low back pain at the workplace. One-hundred sixteen people were enrolled in a randomized controlled trial that lasted for 12 months. The study compared inversion trained subjects to a control group who did not perform inversion to asses the effect of gravity inversion on pain level and absenteeism due to low back pain. After 12 months of training program, the employees performing inversion 1 or 2 times per day decreased sick days due to back pain by 33 percent. Moreover, the average number of sick days used due to back pain fell by eight days per individual in the inversion group.

If you have some disc bulging or herniation, and you are not a surgical candidate or do not wish to proceed with surgery, many of you will markedly decrease your pain with inversion-traction.

Over half of people who perform spinal inversion regularly do so to relieve back pain. But, to discount inversion as simply a back pain remedy would be to ignore a wide range of benefits that can be easily achieved by a passive, or more active, inversion session.

Inversion represents the quiet side of fitness, helping your body to recover from the compressive effects of gravity and daily activities. Doctors, physical therapists and sports trainers recognize spinal inversion as a safe and effective form of therapy for the spine and weight-bearing joints. In fact, the US Army is evaluating including spinal inversion into its worldwide physical training.

Whatever your reason for inverting, inversion equipment provides a comfortable and easy method to turn your painful world upside down.

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A patient presents for pain management. This is the initial visit.

Subjective: You present with chronic foot pain. The pain started approximately a week ago while you were putting equipment back into a shed. You state that it occurs intermittently during the day, is moderate and is exacerbated by excessive walking, and relieved by rest. You report a history of a back injury playing football in college, with rare flares of mild symptoms, for which you use 600mg ibuprofen as needed. You have otherwise gained a bit of weight and have a high cholesterol level and hypertension.

You report occasional pain in your lower extremities, but no other symptoms except rare light headedness. You regularly use a medication for lowering cholesterol and another for his blood pressure. You take a multivitamin daily, but no other dietary supplements. You perform nightly warm foot soaks.

You are an usher at a local Christian church. Additionally, you volunteer as an assistant to a scouting leader. You particularly enjoy the outdoors, hiking and camping activities.

Your family medical history is unremarkable.

You work full time as a salesman at a warehouse type hardware store, walking most of the day. Other than noted above, you are not involved in much in the way of non-vocational and recreational activities except for taking your dog for long walks of approximately two miles every other day.

You are single, with friends related to work, church, scouting and from the neighborhood.

Objective: You are a 35 y/o male, 6’ and 275 pounds, with a muscular build. You appear not to be distressed. Your blood pressure is 125/85. Pulses and general, peripheral circulation and sensation are normal. You exhibit tightness in musculature of lumbar back and lower extremities. You have mild tenderness in your plantar feet (soles). The remainder of your lumbar and lower extremity examination is normal. Tests for sciatica are negative, the lower extremity symptoms do not appear to be referred from the low back. X-rays of your feet and spine are normal.

Assessment
• Pain-probable plantar fasciitis.
• Pain-minor strains of hamstrings and calves
• Probable repetitive strain related to prolonged standing at work and non-work
activities
• Pain-lumbar, chronic
• Hypertension, hypercholesterolemia, obesity
• Lightheadedness, cause unsure

Plan – In your case, like most, you have a lot of options. The effects of some interventions will take a while to be fully realized. Engaging others may be limited by a number of factors. The following are not prioritized, rather are listed regarding how they may contribute to the plan.

1. prescription medications – anti-inflammatory and analgesic types.
2. homeopathic medications – not available via your allopathic physician.
3. naturopathic medications – not available via your allopathic physician.
4. herbs – may complement or replace use of prescription medications.
5. cannabis – not available legally in all States, but has anti-inflammatory and
analgesic properties.
6. acupuncture – may complement intervention options 1-5.
7. acupressure – may complement intervention options 1-5.
8. electroacupuncture– may complement intervention options 1-5.
9. electrical stimulation (various forms) – may function very similarly to 6-7,
overlapping benefit.
10. manual intervention may complement all 1-9  stretching the tissues from lumbar
distally, including hamstrings and plantar feet, increasing circulation, and
relieving pain.
11. light therapy –  may provide circulatory support.
12. hypnosis, psychotherapy – patient exhibits no adjustment problems related to
symptoms.
13. distraction (mental) – all healthy, non-contributory activities that distract
patient from symptoms may be considered.
14. heat – analgesic and improve circulation.
15. ice – if swells acutely
16. dietary adjustments – needs dietary consultation and plan for losing 50 pounds.
17. spiritualism – positive attitudes are probably reinforced as result of his
participation in church activities.
18. work, non-vocational activities and recreation should be changed to decrease
physical stress within the framework of your ability to do so.

Discussion

Evaluation and consideration of alternative treatments of hypertension, hypercholesterolemia, obesity, and light headedness in this case are beyond the scope of this post. Otherwise, your initial plan and subsequent adjustments will follow preferences, resources, limiting factors and response/effectiveness.

You are aware that there are various means to address low back pain. As alternatives may differ substantially, this suggests that there are a variety of paths to the same endpoint, some duplicative of others, some complementary or synergistic.

Clinicians unaccustomed to frequent engagement in pain management often apply increasingly more or stronger variations of an inadequately efficient intervention, increasing undesired side effects without increased pain resolution.

Instead, the treatment plan should acknowledge the presence of abnormalities, dysfunction and/or diseases and apply a treatment plan founded upon a reasonable model. If the assessment and model are sufficiently congruent you may expect to reasonably address the pain.

In the following model, your pain exists as an entity in the brain. As such, given your pain precipitated by injury, dysfunction or disease, the treatment plan may need to address all the following elements.

• wounds
• concurrent injuries (acute, cumulative, degenerative) and osseous disorders
• organ diseases
• iatrogenic contribution (e.g., past surgery)
• psychological contributors
• behavioral contributors (e.g., smoking, malnutrition, etc.)
• external factors (e.g., work)
• current treatments with undesirable side effects

Pain management is then a treatment plan that is multi-factorial and directed at all eight layers of the assessment model. Moreover, the specific interventions applied should address different portals/pathways. By analogy, presume you were asked to create a flavorful dish of food, and you initially apply a substantial amount of cayenne pepper. If the outcome is that cayenne pepper is insufficiently flavorful, then more cayenne would also be insufficient. You would need an alternative, complementary spice to add to the mix, providing a complementary flavor via an alternative source (i.e., portal, pathway).

In the example of acute lumbar pain in an otherwise healthy young man, how do we apply the model? A comprehensive pain evaluation would include:

• Description of the pain.
• History of the onset of the pain, frequency, intensity and exacerbating and
alleviating factors.
• General medical history.
• Current symptoms related to all other body systems.
• Medications, supplements and other interventions presently used, regularly and
at lesser frequencies.
• Spiritual/other beliefs, particularly about health and responsibility for health.
• Family medical history.
• Work, non-vocational and recreational activities.
• Support system data (family, friends, etc.).
• Physical examination
• Assessment – Pain, related to multiple factors.
• Plan (interventions)

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Discussion

The brain interprets signals acutely as well as develops recurring pain signal loops if receiving adverse stimulation too long. The patient may also develop some psychopathology if required to live with pain of significant intensity too frequently or for a prolonged period.

As such, in developing the pain treatment plan you must rank order probable factors contributing to the pain by acuity, relative need for intervention and estimated percentage of contribution to pain regarding:

• wounds
• concurrent injuries (acute, cumulative, degenerative) and bone/joint/musculo-
ligamentous disorders
• organ diseases
• iatrogenic residuals (e.g., past surgery)
• pain signal pathways to brain
• brain/psychopathology/psychological contributors
• behavioral contributors (e.g., smoking, malnutrition, etc.)
• external factors (e.g., work, play)
• current treatments with undesirable side effects

You subsequently develop a multiple element plan based upon the preferences of the patient, available resources and within the framework of that allowed by the organization, state laws and insurance systems to which you may be obligated.

Treatment Alternatives

1. wound repair, surgery
2. prescription medications
3. homeopathic medications
4. naturopathic medications
5. herbs
6. cannabis
7. acupuncture
8. acupressure
9. electroacupuncture
10. electrical stimulation (various forms)
11. chiropractic, physical therapy, massage
12. light therapy (infrared, laser)
13. hypnosis
14. psychotherapy
15. distraction (mental)
16. heat
17. ice
18. dietary adjustments (see foods and anti-inflammatory effects)
19. spiritualism
20. weight control, exercise, stretching)
21. treatment of co-morbidities
22. other behavioral adjustments (e.g., stop smoking)
23. cease activities that exacerbate symptoms

As a Table A, cross treatment alternatives with pain factors to treat. As a Table B, cross treatment alternatives with options within the alternatives.

Tables A & B jointly reflect the treatment alternatives and option subsets available to address pain contributors associated with identified factors. Numerous challenges to their application include:

• Collection and interpretation of information during the diagnostic process.
• Acknowledgement of contributing factors.
• Understanding and recognition of alternative treatment options.
• Access to and affordability of treatment options.
• Willingness and ability of patient to participate in the relevant treatment
alternatives and option subsets.

Patients and non-pain specialists should recognize the complexity of many of these cases, acknowledging the efforts of those willing to fully participate in considering alternative pain management pathways. It is also important to recognize that the patient has a significant role in healing him/herself.

You hurt your back at work and are not sure what to do. Most people self-care for minor injuries. For this injury you may do the same. However, if your symptoms are not localized or are incapacitating regarding your ability to work, what will you do?

You may report the symptoms and incident to your employer and file a workers’ compensation injury claim. Or, you may avoid filing a claim and see a clinician in your personal health care system. The merits to the alternatives are beyond the scope of this article.

However, if you file a claim, remember that your clinician’s diagnostic and treatment options are dictated by the workers’ compensation insurance regulatory systems in your State. As such, your clinician, whether selected by the insurance carrier, the employer or you, has the following obligations:

1. Offer an interim diagnosis.
2. Offer an opinion about the relatedness of your back pain to work activities.
3. Recommend a treatment plan.
4. Offer an opinion regarding your ability to continue to perform your usual and
customary work or other limited, gainful activity.

Given that the case is accepted by the insurer as compensable (meriting coverage by the insurer), future diagnosis and treatment options and timelines will be significantly dictated by the insurance system. You can get your low back pain managed successfully. However, be aware that a full spectrum of complementary and alternative back pain treatment options will not be covered by your workers’ compensation insurance.

You (patient) present to your primary care physician in the following manner.

Chief complaint – low back pain.

Subjective data – You report no prior lumbar pain with the recent onset of pain occurring after engaging in excessive lifting while helping a a friend move. You report to not be in treatment for any other medical conditions. You report no other symptoms or health concerns. You claim to work out at the gym regularly.

Objective findings – You are a 35 y/o male, in no apparent distress. You are 6 ft. tall and weigh 220 pounds, with a very muscular build. Your physical examination is unremarkable except for reporting slight tenderness in the lumbar area. No radiological studies are deemed necessary today.

Assessment – lumbar sprain/strain

Plan – It is my perspective that “to a hammer, the whole world is nails.” By analogy, if your doctor were a carpenter he would try nailing you back together. As such, consider your clinician’s training and experience when pursuing an evaluation and intervention. If s/he is a Internist expect the focus of treatment to be on prescription medicines. If a surgeon, s/he will be primarily concerned about determining the merits of operative intervention. If you visit a chiropractor you will hear about your skeletal misalignment and need for adjustment. Others will refer to body energy, conditioning status, need for modalities application, psycho-spiritual status modification, and/or invocation of dietary/supplement consumption changes and use of herbs. There will be some with multiple skills and experiences, but not every clinician will match your expectations. The initial treatment plan will probably reflect the intersection between their training, experience, beliefs, organization affiliation, and recognized models/insurance standards of care versus your beliefs and expectations. Sometimes the intersection is nominal and you feel that you are being inadequately treated. However, a very fine carpenter doesn’t become a experienced electrician simply because you ask. Maybe s/he can nail you back together, or maybe you need to seek an alternative clinician.

While causes of back pain may not be all in the mind, experiencing the symptoms is all in the mind. That is to say, in the absence of a neural connection between that which you are experiencing in your back and signals transmitted to your brain, there would be no pain (i.e., if a tree fell in the woods all alone, did it make noise?). As such, when considering back pain alternative treatment, consider working on your mind.

For many, the mental aspects of pain management are another significant tool in their armory. These back pain alternative care approaches are referred to by some as “self-regulation strategies” including biofeedback, distraction, hypnosis, relaxation techniques and spiritual healing. These approaches are reduce the perception of pain signals by a variety of methods.

With biofeedback your train yourself to focus upon relaxation and well-being when you recognize a precursor signal that precedes cycles of increased pain. Via distraction you singly or with a partner engage in a healthy activity that is very pleasant or pleasurable, or induces laughter, pleasant thoughts or otherwise distracts one mentally without impairing function. Hypnosis is essentially induced biofeedback, relaxation programmed into your behavior by a skilled practitioner of hypnotism. A variety of relaxation techniques may be applied at any time, with or without the willful efforts of biofeedback or subconscious actions of hypnotism. Lastly, there are spiritual approaches to pain management. These are beyond the scope of this post, and may range from simple relaxation via meditation and altered states of consciousness, to permanently altered brain perceptions of stimulus and changes in underlying pathology depending upon the belief systems and faith in beliefs.

Often, pain management is about determining where you and the professionals with whom you wish to work can meet in the middle. Care of low back pain is a team effort. There is no single treatment that is right or effective for everyone. Cognitive behavioral therapies, care via mind-body experience, play a significant role in back pain alternative intervention.

People present to clinicians every day with the objective of management. Presuming the validity of the pain, consider the following treatment options.

First, identify removable sources of pain and remove the causes as you are able. For conditions for which the source(s) of pain are not completely removable, consider the following alternatives as legal in your State/country of origin.

Alternative Management Approaches

1. prescription medications

2. homeopathic medications

3. naturopathic medications

4. herbs

5. cannabis

6. acupuncture

7. acupressure

8. electroacupuncture

9. electrical stimulation (various forms)

10. chiropractic, physical therapy, massage, mechanical intervention (e.g., inversion)

11. light therapy (infrared, laser)

12. hypnosis

13. psychotherapy

14. distraction (mental)

15. heat

16. ice

17. dietary adjustments  (see foods and anti-inflammatory effects)

18. spiritualism

19. weight control, exercise, stretching

20. treatment of co-morbidities

21. other behavioral adjustments (e.g., stop smoking)

22. cease activities that exacerbate symptoms.

Unfortunately, patients frequently fail to acknowledge the various contributors to their symptom complex. Single remedies are frequently inadequate because they do not address all of the relevant issues. Moreover, medical and insurance systems often fail to support all of the potential treatment options. That said, if you are a pain patient with unmet needs, consider your diagnoses, co-morbidities, behaviors and your willingness to look at alternative intervention before you classify your pain management to be a failure.