A lumberjack went to his doctor complaining of back pain. He was told he didn’t have enough lumber support.
Now that I’ve put you through the most certifiably awful dad joke I could find, let’s chat about back pain. Stats from various sources show that at least 80% of people will suffer back pain at some point in their lives (I would have guessed 100% but what do I know?). Back pain is also the 3rd most common complaint that sends people to their doctor’s office looking for help. If you have back pain, you may have even been to your doctor already and have been told that you have some arthritis in your low back or that it’s just a muscle strain or spasm but you might feel left without a lot of helpful solutions for managing your pain at home. Maybe you’re looking for solutions that don’t involve gulping down half a bottle of Advil every week only to have your pain come back once you stop taking it. If that’s you or someone you know, keep reading.
First things first: Most back pain is benign (cause by something that’s irritating but not dangerous). Some can be a sign of a more serious problem You should always chat with your doctor about your back pain before trying to treat yourself at home. If you experience any of the following, you need to scamper on over to your doctor or the emergency room to get checked out ASAP: sudden onset over the age of 55; loss of bowel or bladder control; numbness or weakness in the lower extremities; back pain that comes with unintentional weight loss; a history of HIV, tuberculosis, or cancer; fever; numbness in the groin region; significant injury or trauma preceding onset, especially in older people or people with poor bone density; or pain directly over the vertebrae (Moses, 2021).
So we’ve gotten the big, bad, and scaries out of the way but what do you do when you’re dealing with low back pain (or any back pain) that you just can’t seem to kick? Over the years, I’ve dealt with quite a few patients and their back pain (and even my own) and have compiled a few help tips and tricks for managing both acute and chronic back pain. We’re going to chat about medications, chiropractic care, diet, dry needling, massage, physical and/or occupational therapy, activity, supplements, and more. The table below provides an overview of these things. If you’re interested in learning more than the table covers, several topics are covered in more detail afterwards.
| Medications | NSAIDS: anti-inflammatory medications like ibuprofen and naproxen can be helpful in reducing inflammation and discomfort. Tylenol: this is a non-NSAID medication that can also help with general discomfort. Muscle Relaxers: these are prescription medications that help to reduce muscle spasms. Opioids: I would consider this the absolute last resort when it comes to managing back pain but these narcotic pain medications do have a place in severe, refractory back pain. They can come with side effects and dependency issues so their use is highly monitored. |
| Chiropractic Care | This involves the manual manipulation and adjustment of the spine to treat various kinds of back pain. I’ll discuss below the benefits of chiropractic care and how to choose your chiropractor. |
| Diet | Eating an anti-inflammatory diet can help reduce overall inflammation which can reduce back pain. Focus on whole foods like fatty fish, brightly colored fruits and veggies, greens, healthy fats like avocado or olive oil, nuts, and some seeds. Avoid foods that promote inflammation like heavily processed foods, saturated fats, and refined sugars. This may also help you achieve a healthy body weight which reduces stress on the back. |
| Dry Needling | This is a treatment that involves inserting small, stainless steel needles into muscle knots to relieve tension. You may have also heard this called trigger point injection. How exactly dry needling works isn’t completely understood but it seems to break the tension of the muscle fibers reducing pain. |
| Massage | Various forms of massage can help reduce low back pain. This includes getting a professional massage, convincing a loved one to step in to help, or the use of home-based massage tools like this one that allow you to work out those knots yourself (the one I linked is the cream of the crop version that I’ve used myself a time or two but there are many other cost-friendly options on Amazon that do a wonderful job working out those tight spots). Massage not only directly works on knots but can improve blood flow and lymphatic drainage which are both healing for the body. |
| Physical and Occupational Therapy | Your doctor may recommend that you see a physical therapist or occupational therapist to help manage back pain. These specially trained therapists can do an in depth evaluation of your back pain and recommend exercises to be done both in the office and at home that may improve acute flares and prevent future flares. This includes exercises to strengthen the back and the core. Occupational therapists evaluate your daily activities, body mechanics, and overall lifestyle and help to come up with problem solving skills and lifestyle changes to improve and prevent back pain. You may only see the PT/OT once or you may establish a more frequent visit schedule. Either way, your PT/OT will find a schedule and treatment method that is tailored to your needs. Find out from your insurance company if you need a referral from your primary provider, in many cases you can refer yourself and save yourself a visit. |
| Activity | Low impact activities like aquatic exercise, yoga, stretching, gentle core exercises, and moderate aerobics can improve flexibility, core strength, and help achieve a healthy body weight; this combination can serve to improve back pain. If you see a PT/OT, they can be incredibly helpful in determining safe and beneficial activities in regards to your back pain. In general, avoiding long periods of inactivity is best. Bedrest is no longer recommended. This can actually make things worse. |
| Supplements | There are a million of supplements on the market and they’re touted as a miracle for everything under the sun. In brief, making sure that you’re getting enough Vitamin D and calcium are critical for maintaining bone health. Omega 3 fatty acids (fish oil in most cases), Devil’s claw, turmeric, and capsaicin have also all shown some benefit in managing back pain. Some experts also recommend glucosamine and chondroitin though there are no studies specific to their effect on back pain. Read below for specifics about these supplements. |
Medications
Medications absolutely have a role in managing back pain. Perhaps the most important thing to remember when using medications to help with back pain is that they should never be used as the only treatment. They should always be used in combination with other treatments in order to see their full benefit. This includes things like stretching, yoga, core exercises, diet changes, and the use of chiropractic or physical/occupational therapy.
| NSAIDS Non-steroidal anti-inflammatory drugs including ibuprofen and naproxen. | This includes medications like ibuprofen and naproxen. Dosing for ibuprofen is 400-800mg three times daily, not to exceed 3200mg daily. Naproxen immediate release can be taken in doses of 200mg to 500mg twice daily or extended release 750mg once daily. Daily dosing should not exceed 1500mg. As always, chat with your personal doctor about dosing and side effects as some underlying conditions like kidney problems and bleeding issues may mean that NSAIDS aren’t safe for you to take. |
| Acetaminophen Commonly known as Tylenol. | Acetaminophen is a pain reducer that falls outside the NSAID class, making it an option for people who can’t take NSAIDS. General dosing is 500-1000mg three times daily, taken with food. Daily dosing should not exceed 3000mg and people with liver problems should avoid use. |
| Muscle Relaxers The most commonly known muscle relaxer is cyclobenzaprine but others may be prescribed. | These medications help to reduce muscle spasms which are involuntary muscle movements associated with low back pain. The use of these medications helps to ease tension, relax muscles, and improve the efficacy of other treatments like stretching, yoga, chiropractic care, physical therapy, etc. These medications are prescription only and are intended for short term use. They’re typically also used in conjunction with other medications and treatments to manage acute back pain. |
| Opioids | As previously mentioned, opioid pain medications have a very limited place in treating back pain and come with many side effects and addiction potential. They are sometimes necessary but this is case dependent and requires consistent follow up and monitoring. This is something you should discuss with your personal doctor to determine if this is appropriate for you. |
Chiropractic Care
When used in conjunction with other modalities, chiropractic care can prove incredibly beneficial for a myriad of musculoskeletal ailments including back pain. Chiropractors operate on the premise that derangement of the spine can cause issues with the nervous system, including low back pain. When done properly, chiropractic treatment has the potential to restore the structural integrity of the spine and improve back pain (Yeomans, 2013). The overall goal is to bring the spine back to its normal position and resume normal functioning through manual adjustment.
Choosing a Chiropractor
Not all chiropractors are created the same there are a plethora to choose from. Finding one who will efficiently, safely, and effectively serve your needs is important. Choose a chiropractor who completes a detailed baseline evaluation before performing any adjustments. This includes collecting a personal and family medical history, taking into account current complaint, your occupation, recreational history, diet habits, and a thorough physical exam (may include x-rays). Many chiropractors also spend time addressing other factors that can help augment the results of chiropractic adjustments including the use of massage, diet changes, and other lifestyle factors so look for that when making your final choice (Yeomans, 2013).
Anti-Inflammatory Diet
Wait, diet matters when it comes to back pain? Indirectly, yes, but changing your diet certainly isn’t a quick fix solution. First and most obviously, maintaining a healthy diet and activity level helps to maintain a healthy body weight which helps to reduce stress on the spine overall, especially the lumbar spine (low back). I could go on for ages about the most ideal diet but, frankly, everyone’s needs are different and when it really comes down to it, best just to focus on whole foods which includes lean meats, fresh fruits and vegetables, and complex carbs (beans, whole grains, etc) (Said, 2020).
Some experts also tout the importance of an anti-inflammatory diet when it comes to controlling back pain. A large portion of the population consumes a relatively pro-inflammatory diet that lacks fresh fruits and veggies, contains a lot of high fat meat, heavily processed foods, and a lot of refined sugar. Conversely, an anti-inflammatory diet boasts a diet rich in seafood, blueberries, strawberries, raspberries, green leafy vegetables, legumes, nuts, seeds, olives and olive oil. Certain herbs and spices also possess anti-inflammatory qualities including ginger, turmeric, garlic, oregano, cinnamon, rosemary, cloves. Simply put, there’s no single magic food that will cure back pain but making sure you’re consuming foods that are on the anti-inflammatory spectrum may be helpful as an adjunctive method for preventing and dealing with back pain (Said, 2020).
Dry Needling
I’m a huge fan of dry needling after spending the last 6 months having various aspects of my mid- and upper back dry needled by my incredibly talented friend Ashley Speros who is an occupational therapist in Cumberland, WI. She first turned me onto the practice after a minor neck strain left me unable to move my head and in quite a bit of pain. After just one session, my mobility had improved and my pain was significantly less. Fast forward 6 months, I’ve been dry needled over a half dozen times and my neck and back continue to loosen up and stay that way. Years of tension and knots from working out and daily computer use have resolved thanks to Ashley’s incredible skills.
Dry needling is the process of inserting solid core, stainless steel needles directly into the muscle belly with the intent to break tension and relieve knots. You may have also heard this practice called trigger point injections because the goal is to deactivate the trigger point that’s causing tension and tightness. The exact mechanism behind the effect of dry needling isn’t 100% known but along with releasing tension, there’s also some thought that it actually serves to block pain pathways as well. Dry needling has been shown to improve back pain, especially when combined with some of the other modalities mentioned in this post (Davis, 2019). A number of healthcare providers can perform dry needling including physical and occupation therapists, acupuncturists, chiropractors, doctors, and advanced practice providers. The important thing is to make sure that whoever is performing your dry needling is certified in the practice and has a healthy understanding of underlying structures where they plan to needle. Give it a try and let me know how it goes for you!
Supplements
Like I said above, there are a million supplements on the market and they’re not all created equal. First, before you start any dietary supplementation, chat with your doctor as some of these can worsen chronic conditions or interact with other medications that you may be on. Supplements aren’t monitored or approved by the Food and Drug Administration but there are a number of 3rd party groups that evaluate supplements for their content in an unbiased manner. These third party groups also ensure that the supplements are produced safely and according to the law and that they’re free of harmful additives or ingredients, especially those that are banned. Look for seals of approval from USP (United States Pharmacopeia), a third party, non-profit groups dedicated to ensuring the safety and quality of dietary supplements.
Vitamin D and Calcium
Getting adequate sunlight exposure can help you absorb Vitamin D naturally as can eating salmon, tuna, and eggs. Drinking vitamin fortified milk and orange juice can also help. You should note that calcium actually can’t be absorbed by the body without adequate vitamin D. If you’re supplementing, most experts recommend 400-800 IU/day depending on age and gender. As with Vitamin D, getting adequate calcium from natural dietary sources is ideal. However, if you know that your dietary intake isn’t adequate, supplementation in various forms can help improve calcium stores and, subsequently, bone density. See this helpful article regarding how much calcium you might need based on your age and gender and what form is best for you.
Devil’s Claw
Devil’s Claw is a native African plant that has been shown to reduce inflammation when its active ingredient, harpagoside, is dosed at 50mg daily (Theobald, 2015). Here is more information on Devil’s Claw, its dosing, benefits, potential side effects, and some general contraindications to consider before taking it.
Omega-3 Fatty Acids
My favorite form of omega-3’s is in the form of liquid fish oil, specifically this one which is in liquid form (not capsule so you take it by the spoonful) and is also fortified with 1,000 IU of Vitamin D so you’re killing 2 birds with one stone. If you’d rather take your fish oil in pill form, there are a myriad of brands available that are all equally good as long as they contain fish oil that contain both EPA and DHA (specific acids found in fish oil). DHA (docosahexaenoic acid) is a particularly important omega-3 fatty acid that is essential for brain development during pregnancy and early childhood and is also associated with improved heart health, better vision, and reduced inflammatory response (hence the connection to back pain). Check out this source for age specific recommended dosing for omega-3’s.
My hope is that even part of this smattering of information helps you to better manage your back pain, strengthen your body overall, and improves your quality of life. There’s so many things to enjoy in life and back pain shouldn’t be what slows you down. As always, please feel free to comment below on what’s helped you manage your back pain, especially if you’ve tried something that works that’s not listed here.
For notifications on blog posts and other content, subscribe below. I appreciate your support!
References
Bagley, C., MD. (2018, September 20). 10 alternative back pain treatments to try before choosing surgery: ORTHOPAEDICS and REHAB: UT Southwestern Medical Center. Retrieved February 14, 2021, from https://utswmed.org/medblog/alternative-back-pain-treatment/
Davis, D., MPT-MTT. (2019, May 14). What you need to know about dry needling for low back pain. Retrieved February 15, 2021, from https://www.spineuniverse.com/treatments/physical-therapy/what-you-need-know-about-dry-needling-low-back-pain
Highsmith, J., MD. (2019, May 10). Muscle relaxants for back pain and neck pain. Retrieved February 14, 2021, from https://www.spineuniverse.com/treatments/medication/muscle-relaxants-back-pain-neck-pain
Mallon (2019) CCME EM Board Review, Las Vegas, accessed 02/13/2021
Moses, S. (2021, February 04). Low back pain red flag. Retrieved February 13, 2021, from https://fpnotebook.com/ortho/sx/lwbckpnrdflg.htm
Theobald, M. (2015, January 22). 7 supplements that help back PAIN: Everyday Health. Retrieved February 15, 2021, from https://www.everydayhealth.com/pictures/best-worst-supplements-help-back-pain/
Uptodate. (n.d.). Retrieved February 14, 2021, from https://www.uptodate.com/contents/naproxen-drug-informationsearch=naproxen&source=panel_search_result&selectedTitle=1~149&usage_type=panel&kp_tab=drug_general&display_rank=1#F199859
Said, L., MS. (2020, December 07). Is an anti-inflammatory diet good for back pain? Retrieved February 15, 2021, from https://www.goodpath.com/learn/is-an-anti-inflammatory-diet-good-for-back-pain
Yeomans, S., DC. (2013, March 13). Chiropractic treatments for lower back pain. Retrieved February 14, 2021, from https://www.spine-health.com/treatment/chiropractic/chiropractic-treatments-lower-back-pain
Healthcare Way Up There 