So you’ve seen the signs around town or read articles on the internet about the benefits of hot yoga. Stretching in a heated room enhances flexibility and aids detoxification, studios promise. Then you see some funny yoga called Bikram while others just call themselves hot. What’s the difference between Bikram and hoy yoga?

The short answer: Bikram yoga refers to a specific set of 26 postures while hot yoga is normal yoga, just in a heated room.

Are you ready to sweat? Studio temperatures for Bikram and hot yoga range from 90 to 105 degrees. 

While yoga is an ancient practice rooted in India, Bikram yoga has more modern roots. Indian born and trained yogi Bikram Choudhury opened the first Bikram yoga school in California in 1974. The practice involves completing the set of postures and two breathing exercises in a specific order at a specific temperature–105 degrees with 40% humidity. Only licensed Bikram yoga schools may offer classes under the trademarked name. These schools frequently offer only Bikram yoga without supplementing their schedules with additional types. Other rules apply to Bikram too. There’s no music and the instructor’s dialogue follows a prescribed speech.

Hot yoga, on the other hand, involves a regular vinyasa or hatha yoga class that takes place in a heated room. Some studios merely bump the temperature to create balmy exercise conditions while others might crank the heater so practitioners really work up a sweat. Temperatures usually range between 80 and 100 degrees. As in traditional yoga classes, the instructor’s personality flavors the hour, with personalized music selections, themes, and sequencing of postures.

Some people prefer the discipline of Bikram–and the extreme heat–while others seek the gentle detoxification and free-flowing ambience of a traditional heated yoga class.   

Research on benefits of heated yoga for chronic pain is limited, even though many studies have shown pain-reducing benefits for traditional yoga. 

A study published in Complementary Therapies in Medicine found yoga benefited people with chronic low back pain more than traditional exercise. The practice reduced pain along with depression and anxiety. Meanwhile, a study presented at a European League Against Rheumatism conference showed that practicing yoga decreased disease activity for people with rheumatoid arthritis.

The hot yoga picture is much more mixed. Johns Hopkins Arthritis Center advises people with the condition against participating in hot yoga because of the extreme heat. On the other hand, Bikram’s official website says the exercise benefits people with arthritis and low back pain. And much anecdotal evidence touts the practice’s healing benefits for chronic pain. More research needs to be done before we can truly understand the potential benefits of hot yoga. 

As with all new forms of exercise, talk with your doctor first, listen to your body, and avoid pushing yourself too hard. If you feel dizzy or lightheaded, take a break. Otherwise, enjoy the benefits of exercise and have fun.

Have you tried Bikram or hot yoga? 

Image by digboston via Flickr

A chiropractor’s signature technique of treating low back pain is spinal manipulation, with the stereotypical popping noise that’s actually the sound of a gas bubble releasing between joints. Did you know that there are multiple types of spinal manipulation? Some are completed by hand and others require the help of a small, specially designed instrument.

In addition to classic adjustment methods, chiropractors use other special therapies that are designed to reduce pain and improve the health of the spine and surrounding structures.

The specific method your chiropractor will use with you depends on your physical condition and the cause for your underlying back pain. And while chiropractors approach low back pain with a holistic approach, by addressing nutrition, stress, and exercise, spinal manipulation is an important tool for making sure the musculoskeletal system is in optimal alignment and reducing pain.

Here are the most common spinal manipulation and adjustment methods.

Toggle drop

This technique involves the use of a quick, precise thrust to a specific area of the spine to relieve back pain. When applying a toggle drop, the chiropractor crosses his or her hands and then presses firmly down, using the controlled motion to improve mobility in the vertebral joints.

Motion palpation

Rather than an adjustment, motion palpation is a diagnostic tool. It’s a way of observing the spine to identify any areas in the spinal column that are out of alignment or not moving freely.

The practice involves the chiropractor placing his or her hands at specific places along the spine and then guiding the patient through a series of movements. The chiropractor will feel the entire spinal column—from lumbar to thoracic—to identify any areas that feel out of alignment.

Lumbar roll

The lumbar roll is one of the more common chiropractic techniques, particularly for patients with low back pain.

For this technique, patients lie on their sides while the doctor stands on the front plane of the body. The chiropractor applies a rapid, precise thrust to the problematic area, returning the vertebrae to proper alignment.

Release work

Chiropractic release work involves gentle pressure placed along the spine to gently separate the vertebrae and encourage free flow of the spinal column while reducing pain.

Table adjustments

This type of spinal manipulation involves the use of a table that has a drop piece—a portion of the table literally drops below the rest. For this adjustment, the chiropractor examines the patient to ensure the body is in the proper positioning. The chiropractor applies a rapid thrust to the area out of alignment, and the table’s drop piece lowers down at the same time the thrust is applied.

The act of the table dropping down allows the force from the chiropractic adjustment to dissipate, making the adjustment more comfortable for both the patient and the doctor.

While many manual adjustments require the back to be twisted, table adjustments do not require this. This method is highly effective, but also very specialized, requiring both special equipment and skill. Table adjustments are wonderful for unlocking the spine and encouraging total mobility while reducing back pain.

Instrument adjustments

This is a gentle type of spinal manipulation that is not as hands-on as the previously described techniques. Chiropractors use a spring-loaded activator instrument to adjust the spine while the patient lies face down on the table.

The instrument provides a gentle method of freeing vertebrae, and it can also be used on the extremities to encourage optimal alignment.

Humans aren’t the only ones to benefit from instrument adjustments; animals can, too.

Manipulation with anesthesia

Some patients with lower back pain who don’t respond well to traditional spinal manipulations may undergo full anesthesia or twilight sedation before receiving an adjustment. This procedure takes place in an outpatient hospital setting so patients receive full oversight by qualified medical staff.

This type of therapy is typically reserved for those patients whose pain is extremely intense. It’s usually used on patients with chronic low back pain, as opposed to those experiencing pain from an acute cause like an injury or other trauma, according to research published in the journal Chiropractic and Manual Therapies.

Because this treatment is more invasive than other types of chiropractic adjustments, it’s typically not a first-line therapy, and used only when other treatments have failed.

In addition to these methods for adjusting the spine and encouraging proper alignment, chiropractors also use release techniques.

Flexion-distraction technique

People with low-back pain or leg pain resulting from disc injuries may benefit from this commonly used procedure.

To start, the patient lies on a specially designed table that stretches the spine. The chiropractor isolates the area with the affected discs, flexing the spine in a gentle pumping rhythm. Patients should feel no pain.

This procedure is believed to work by moving the disc away from the nerve, which reduces inflammation and pain.

The technique is typically performed over multiple sessions and often in conjunction with other therapies, such as physiotherapy. Patients are usually given exercises to do at home to alleviate the pain related to lower back disc injuries.

If, at the end of 12 sessions, patients have not improved, they’re usually referred for further imaging or a spinal specialist to investigate the problem.

A study published in the Journal of Alternative and Complementary Medicine compared patients with chronic low back pain who received flexion distraction to those who participated in an exercise program. Researchers followed the patients for one year after treatment, and found those who received flexion distraction reported less pain than those who participated in the exercise program.

Pelvic blocking

Another treatment used for patients with disc-related, low back pain is pelvic blocking. This procedure involves the use of cushioned wedges that are placed under each side of the pelvis. The chiropractor begins specific, gentle movements that allow gravity to encourage separation between the disc and the nerve, lessening pain.

This gentle, non-forceful method creates space for healing to happen. In those cases where patients do not demonstrate improvement, they are referred for spinal imaging or a specialist for further review.

Have you experienced any of these treatment methods for low back pain?

Image by Steve Jurvetson via Flickr

There are some conditions in which myths prevail as truth; back pain is one such condition. Living with pain is hard enough, though, and all the back pain facts in the world won’t change that. But by sharing this list with your loved ones, you might be able to help them learn more about your condition and how they can help.

1. Lower back pain is the most common source of pain, seriously

The most commonly cited source of pain for those missing days of work is lower back pain. Back pain is both common and severe, affecting as much as 80% of the U.S. adult population at some point during their lives. Meanwhile, lower back pain ranks as the top cause of disability worldwide, according to the American Chiropractic Association. People spend at least $50 billion annually on medications and treatments in hopes of feeling better. This is the reason why sharing these back pain facts is so important.

2: You’re not just living with back pain, except on those days that you are

Maybe it’s an old injury that keeps flaring up, or maybe it is a new strain or exercise regimen that has you feeling like back pain is just a part of waking up every morning. But too many probably already think of your back pain like it’s always going to be part of you. What others don’t know is that you’re working to make your back pain better, using many of the back pain facts and techniques we’ll be talking about below. You’re trying, and that’s hard enough on its own.

And then again, some days, just surviving with the pain is actually enough. Seriously. Back pain makes you slow down and take life one day at a time.

3. You know how many treatments exist to help 

While it’s true that some types of back pain are harder to alleviate than others, pain specialists and researchers have many different tools at their disposal to help reduce or even eliminate back pain. You’ve probably talked about loads of them. A lot. (If you haven’t, we have some suggestions for treatments below.)

Your well-meaning relatives probably don’t realize just how many back pain facts you know. And it’s nice of them to make suggestions, but ultimately it is up to you and your doctor to work together to find which one works best for the back pain you have.

4. Just as many women suffer from back pain as men

More men than women in the U.S. tend to have blue-collar jobs that require heavy lifting and physical activity. So it stands to reason that men experience back pain at greater rates than women, right?

Wrong. Men and women have roughly the same rates of back pain at all ages, across race and income. Back pain is one physical ailment that is truly equal opportunity. It doesn’t matter if you are male or female, black or white, rich or poor, approximately 80-90% of people will experience back pain in their lifetime.

Rates of back pain within an age group tend to rise as that group gets older simply due to back pain conditions related to aging, such as osteoarthritis (considered a “wear and tear” condition). Back pain does not discriminate whether you are lifting babies at home or boxes in a warehouse, and it certainly doesn’t care if you are male or female.

Differences in the quality and quantity of care for back pain based on gender, race, and income certainly exist, but as far as incidence goes, back pain incidence affects everyone equally.

5. Daily activities can put a strain on your back just as bad as an accident

It seems like people who participate in extreme sports (or even regular sports like professional baseball and golf) would have more back pain, or that most back pain is caused by serious injury due to car crashes or other accidents. However, the vast majority of back pain is caused by misuse, overuse, or inadequate use.

Of course professional athletes experience back pain, but there is a far greater incidence of back pain in “weekend warriors,” those who play an impromptu game of softball at the backyard barbecue or go on a golf outing once every month or so. Professional athletes are trained and conditioned and use their bodies on a regular basis. Some soreness or strain over time may be normal, but in general, their bodies are used to physical activity. Pain specialists see more back pain cases due to misuse (working the back incorrectly, like lifting boxes with the back instead of the legs) or overuse (especially when combined with inadequate use).

The best way to prevent these types of injuries is to stay strong and active on a regular basis. If you go from spending most of your day sitting at a desk and most of your night sitting on a couch to a full weekend of touch football, chances are good that your back will sustain some type of injury. Getting at least 150 minutes of exercise a week (and including some core strengthening) will help you maintain overall good health while protecting the health of your back.

6. Exercise can actually help alleviate back pain

This is one of the most useful and beneficial back pain facts. Remember, back pain often results from poor posture or weak muscles, and so engaging in exercises that remedy these problems could help reduce discomfort. Top exercises include yoga, walking, Pilates, and swimming.

Some yoga poses strategically target the muscles supporting the lumbar spine, and others build strength in the core muscles, which promote stability in the entire body. A strong back and core supports good posture, so strength building helps to reduce back pain in more ways than one. Yoga is special because it includes a mindfulness component that reduces stress, which could provide further back pain relief.

Pilates is another wonderful way to minimize discomfort. There are a few types of Pilates, one that solely takes place on the floor and another that uses a special machine. Many Pilates movements resemble yoga postures, and people taking Pilates classes will enjoy similar physical benefits of stronger back and core muscles.

Swimming is also highly recommended for back pain. It strengthens muscles despite its low-impact nature. People with joint pain will likely find that swimming is both easy on the body and a rigorous workout.

7. But, some exercises can seriously worsen back pain

That being said, when exercising to improve strength and reduce pain, you know to play it safe and avoid activities that could make things worse.

The top back pain-triggering activity is anything involving a forward fold. That includes yoga or Pilates movements. If you’re in an exercise class and the teacher asks you to go into a forward fold, be sure to bend your knees and keep your back flat. Bending the lower back compresses spinal discs and could exacerbate pain or cause injury. By bending the knees and only bending over as far as you’re able to keep the back flat, you’ll reduce the chances for worsening pain.

Hamstring stretches also frequently involve forward folds. If you want to stretch the hamstrings, opt for variations that keep the back flat on the floor. Lift the legs into the air and stretch the legs toward the ceiling instead of having the back lower toward the floor while standing.

Sit-ups are also generally contraindicated for those with back pain because the exercise may strain lower back muscles. Instead of sit-ups, strengthen the abdominals and core with stability exercises like a plank, which involves holding the top of a push-up.

So, when your well-meaning friend insists you try a sit-up challenge, let them know that you’ve already found exercises that work way better for you and your back.

8. Certain foods influence your back pain severity

The foods you eat every day can provide nourishment and promote less pain. However, if you’ve been keeping a food and pain journal, you also already know that certain unhealthy food choices make you feel worse.

The top foods for less back pain include broccoli, cherries, onion, and garlic. Broccoli contains powerful Vitamin K, which helps to strengthen bones and decrease the risk of back injury. Cherries contain potent anti-inflammatory compounds that may actually strike at the root of pain. Garlic is another anti-inflammatory food. Researchers believe its inflammation-reducing compounds may be the same ones contained by over-the-counter medications like ibuprofen. Onions are also a potent anti-inflammatory food. As a bonus, they add a delicious taste to many foods. Ask your family to include more of those in their meals if they’re cooking for you.

9. Losing weight may help reduce back pain, to an extent

Excess weight is linked to an increased risk for herniated discs, absolutely. And any more stress or strain on your back could increase your pain. However, it’s not a catchall.

A sedentary lifestyle is the larger culprit here. It ups the risk for poor posture and weak muscles, which contribute to back pain. Participating in exercises that help to build strength and reduce weight supports a healthy back. Eating a healthy diet rich in fruit, vegetables, and healthy grains also reduces inflammation. This helps to minimize pain. You may not want to focus on losing weight exclusively to manage your back pain, and that’s okay.

10. Back pain and depression are linked

These two conditions may not be the first connected health problems that come to mind. But research shows that back pain may lead to depression and vice versa, that depression increases the risk for back pain. It’s one of the most important back pain facts to keep in mind when talking to your loved ones.

The daily stress of living with back pain, as well as the difficulty of performing daily life tasks may make someone depressed. Meanwhile, depression often materializes in the physical body as pain. In fact, aches and pains that do not respond to treatment are considered one of the symptoms of depression, according to the National Institute of Mental Health.

If you’re living with back pain, you already have our respect

Living with back pain can seriously impact your daily life. It can make it harder to walk your dog, hold your child, or put the groceries away. And that’s on the small scale. Living with back pain means making daily choices about how far you’re willing to drive in the car, what jobs you’re able to take, and how much time you can give to your family. It’s hard, and you have our respect just for the journey you’ve already taken with pain.

Need help treating your back pain?

If you still need help and suggestions for treating your back pain, complementary and alternative treatment options could help. These are best used alongside diet and exercise changes. Options include:

• Complementary medicine: Acupuncture, biofeedback, and mindfulness meditation are three types of complementary medical approaches to back pain. They have been shown to have some success in pain relief. These complementary medical approaches are safe and have very limited side effects.
• Injections: In addition to offering pain relief, injections can be a great diagnostic tool for pain specialists. Facet injections and epidural steroid injections both use numbing agents like lidocaine to numb the affected nerve. Pain relief lasts for varying amounts of time. These procedures can be repeated up to three times a year. Importantly, these injections offer pain relief that allows patients to begin a course of exercise or physical therapy.
• Minimally-invasive surgical procedures: These can include procedures like continuous catheter nerve blocks or spinal cord stimulator implants. In general, these procedures are done under local anesthetic and have minimal side effects (if any). Better yet, they can be completed in less than 15 minutes.
• Chiropractic care: Chiropractic care has been proven to reduce healing times and relieve back pain with just one treatment. It also reduces medical costs and the chances of surgery when it is used as a first-line treatment for back pain.
• Surgical intervention: In the case of herniated discs, pain specialists may recommend a discectomy to remove herniated tissue. Spinal fusion may also help to relieve back pain. Many types of back pain do not require more extreme types of surgical intervention. In some cases, though, they can offer tremendous pain relief.
• Talk to a doctor: A doctor can help you diagnose the exact source of your pain. This can help you find better treatment options going forward.

Do you suffer from back pain? What back pain facts do you want your friends and family to know? 

In the fight against lower back pain, many people and their doctors reach for the same weapons: common over-the-counter (OTC) and prescription medications. New research on commonly recommended and prescribed lower back pain medications has found that many may actually be virtually ineffective for treating lower back pain and that medication for lower back pain may actually do more harm than good.

Over-the-counter medication for lower back pain

NSAIDs are a standard go-to medication for lower back pain, but their effectiveness is being called into question. The common over-the-counter pain medications Tylenol, Advil, and Aleve are all types of NSAIDs. More powerful NSAIDs are also available by prescription from your physician. For many people with chronic back pain, it’s not unusual to keep a bottle of over-the-counter NSAIDs on hand to treat pain as needed.

A great many medications fall into the classification of NSAIDs, but all of them function in a similar way. NSAIDs block an enzyme called cyclooxygenase (COX), which in turn inhibits the production of certain inflammatory responses like fever, swelling, and pain. Since many instances of pain are caused by inflammation or swelling, inhibiting inflammatory responses should reduce pain.

However, COX enzymes also aid in protecting the stomach lining, which is why using NSAIDs can sometimes lead to ulcers or bleeding in the stomach. Potential side effects of NSAIDs include digestive symptoms like heartburn, diarrhea, vomiting, or stomach pain.

Research on Tylenol

Tylenol in particular has been widely advertised all over the world as a catch-all OTC medication for aches and pains of every variety. From acute back pain to achy knees and chronic pain, advertisements would have you believe that Tylenol is effective and safe for pain. A study from the BMJ (formerly the British Medical Journal) found that Tylenol’s claims of efficacy in the treatment of both back and knee pain were false.

A meta-analysis of randomized controlled studies focusing on Tylenol’s ability to relieve spinal pain and pain due to osteoarthritis found that for spinal pain, Tylenol showed no effect on pain in either short- or intermediate-term follow-ups. For osteoarthritis, the short-term efficacy of Tylenol for spinal pain was more pronounced than for intermediate use, but pain reduction was still rated as moderate. Any pain relief reported was clinically insignificant and similar to the placebo group. The studies included in the meta-analysis focused on just over 5,300 patients with lower back pain and knee pain and excluded any patients with previous surgeries for either condition.

Side effects of non-steroidal anti-inflammatory drugs

While some patients suffering from chronic and acute back pain may find that any minor reduction in pain is worth the risk, the side effects may not be worth it. Since 2011, the Food & Drug Administration has required medications that use acetaminophen to carry a “black box” warning that highlights its risk for liver failure.

Many who take Tylenol for pain do not realize that other medications (e.g. cold medicines) also contain acetaminophen. Exceeding the maximum daily dose by even a small amount can cause serious side effects and may even cause death. For anything other than acute, short-term pain, taking Tylenol is not recommended as a medication for lower back pain.

Opioid medications

Opioids are a narcotic pain reliever. Previously used primarily for short-term relief of acute pain, or for pain relief in patients with a chronic condition like cancer, opioids have become part of mainstream pain management over the last two decades. The number of prescriptions written for oral opioid medications, such as hydrocodone, oxycodone, or hydromorphone, has more than tripled over the last 20 years. Despite the risks associated with opioid medications, they are becoming increasingly widespread as a prescribed medication for lower back pain, even though new research suggests opioids aren’t very effective for this type of pain.

Opioids and spinal surgery risks

While the risks of opioids have been well-documented, a study by the American Academy of Pediatrics found that the use of prescription opioids is linked to fewer positive outcomes after spinal surgery. The study of just over 500 patients used patient reporting to measure health preoperatively and at three, six, and 12 months post-operatively. Differences in recovery, mental health, and decreased pain was significantly influenced by opioid use in the following ways:

• Patients who increased opioid use before spinal surgery did significantly worse post-operatively at three and 12 months
• For every ten milligrams of increase in opioid use, the study found a significant decrease in mental and physical health scores
• Patients who also suffered from comorbid conditions such as depression and anxiety were more likely to take opioids

Lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center had this to say about the treatment implications of study’s findings:

“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery.”

Even for those patients who choose not to undergo surgery, opioids have very little effect on chronic low back pain. While there seems to be some short-term analgesic benefit, the risk of dependence and other side effects likely outweighs the minimal benefit in intermediate- and long-term use for this medication for lower back pain.

Opioids for chronic pain

Researchers have also been reevaluating the trials and evidence that support the effectiveness of opioid pain medications, and the evidence doesn’t hold up. The National Institutes of Health (NIH) convened a seven-member panel to examine the evidence for opioid medications. An article by the University of Connecticut summed up the results, noting:

“A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.”

Additionally, a University of Colorado Boulder study showed that opioid use (specifically morphine) actually prolonged neuropathic pain in rats, suggesting that it could have the same effect on humans.

Opioids for lower back pain

Finally, the BMJ published a clinical review of the efficacy of opioids as a medication for lower back pain. The conclusions in this article include:

• Opioids don’t speed injured workers’ return to work
• Opioids don’t improve functional outcomes of acute back pain in primary care
• There is little evidence of opioid efficacy for chronic back pain

It was also pointed out that controlled trials of opioids for back pain tend to experience a high dropout rate among participants. The trials also have a short duration (generally four months or less) and have highly selected patients. This all suggests that the controlled trials that do support opioid efficacy for back pain are perhaps not reliable, or at least are not thorough enough.

Opioids also have a high risk of abuse and dependence. Using opioids before spinal surgery has been linked to a higher risk of negative surgical outcome. Slow-acting opioids, which have been assumed to be safer than fast-acting opioids, have been shown to make men five times as likely to develop low testosterone. More and more evidence continues to point to the fact that opioids are not a suitable medication for lower back pain, unless used for highly-controlled, acute cases.

Oral steroids

Steroids are commonly used to treat inflammation associated with back pain, but they may not be as effective as previously believed. Steroids, also called corticosteroids, are a synthetic (man-made) version of a hormone naturally found in the body. Steroids are used to treat many different conditions, largely because they are cost-effective and can be applied in many different forms (oral, injected, inhaled, topically, etc.). Long-term or illicit use of steroids is associated with several potentially-serious side effects, but when used as directed, steroids are generally considered safe.

In a randomized controlled trial of 267 people with herniated disc, researchers found that there was no significant difference in pain relief between the group receiving oral steroids (prednisone) and the group receiving a placebo. Both groups saw improvement, but even after a year, there was no difference between the two (except in rate of disability, which was slightly lower in the prednisone group).

Likewise, a study originally published in the Journal of the American Medical Association (JAMA) looked at the efficacy of the oral steroid prednisone in treating sciatica-related back pain. In this study, half the participants were given a 15-day course of prednisone to treat sciatica resulting from a herniated disc, while the other half were given placebos to treat the same condition. Although both groups’ symptoms improved, there were no statistically significant differences in pain or disability by the end of six weeks.

Again, this is a case of the side effects outweighing the negligible benefits. In addition to headache, mood swings, and irregular heartbeat, long-term use of prednisone is a risk factor for osteoporosis, which may increase the risk of spinal injury leading to pain. Steroid injections, on the other hand, provide a targeted approach to using these medications which may work more powerfully for lower back pain patients.

What are non-medication options for lower back pain? 

With these common back pain medications increasingly debunked in the research, there are other treatment options to consider.

First, don’t stop your medication for lower back pain

Even with this research, this does not mean that you should stop your medication for lower back pain, especially if they’ve been prescribed by a physician.

If you’re taking a medication that relieves your symptoms of back pain, that’s great. Keep taking it. If your current medication doesn’t seem to be doing the job, keep taking it until you’re able to talk to your pain doctor and get an alternative medication or treatment (or are given the go-ahead to stop taking it). Stopping a medication prescribed by your doctor could be unsafe if you haven’t discussed it with them before.

And keep in mind that pursuing alternative, complementary, or interventional pain management techniques – either in conjunction with or (with your physician’s permission) instead of medication – might help you control your pain much more effectively than medication for lower back pain alone.

Exercise

Staying physically active is an important treatment option for lower back pain. While it may seem counterintuitive to move when you are in pain, keeping your muscles strong and engaged can be the key to a healthy back. Focus on stretches and core work, but don’t forget low-impact cardiovascular exercise such as biking, swimming, and hiking.

Dietary changes

Although it may not work as quickly as medication for lower back pain, eating a healthy diet full of anti-inflammatory foods can make a tremendous difference in treating chronic back pain. Adding these foods while eliminating common inflammation-causing foods like sugar, wheat, and dairy can help you manage pain.

Weight management

The more weight we carry on our bodies, the more stress there is on our joints. Maintaining a healthy weight with diet and exercise can be an important part of treatment for back pain, especially in cases where back pain is due to compression injuries such as herniated discs or inflammation caused by spinal stenosis.

Complementary medicine

Acupuncture is gaining traction as an effective treatment for low back pain. Chiropractic care can also be an excellent first-line treatment that minimizes the chance of spinal surgery in the future. Mindfulness meditation and biofeedback have both been shown to diminish the perception of pain. All of these treatments are nearly side-effect free, and many are now covered by insurance.

Interventional pain management

Finally, if your pain doesn’t respond to medication for lower back pain or these complementary approaches, you could try more targeted therapies for resolving your back pain. This will involve identifying the underlying causes of your back pain and finding a therapy that can work to resolve or treat the symptoms of your pain. Once a correct diagnosis is made, your doctor may recommend any of the following therapies:

• Epidural steroid injections
• Lumbar facet block
• Lysis of adhesions
• Percutaneous discectomy 
• Radiofrequency ablation
• Spinal cord stimulation
• Surgery

As more research uncovers medications that are not as effective as advertised, more people are turning to lifestyle changes and complementary medicine to manage chronic pain. To talk to a pain doctor about which therapies might work best for you, click here. 

Lower back pain is one of the nation’s most common health concerns. It accounts for 40% of all missed time from work. The good news is that 90% of patients will improve on their own without a doctor’s help. The best exercises for lower back pain can help you strengthen your muscles, while reducing the tension causing pain in the first place. In this list, we’ve pulled together six lower back pain exercises that aren’t commonly talked about when it comes to back pain prevention. All of these exercises are low-impact so they can be used by a variety of pain patients. If you haven’t tried these already, we encourage you to grab a friend and try them now!

Why is finding the best exercises for lower back pain so important? 

“For most people, back pain is not a disease,” says Dr. Mike Evans, a health care educator. That means it is possible to live without back pain.

The bad news is that many cases of back pain recur. About 30% of people with back pain will experience a recurrence within six months, and 40% within one year, according to Evans. The high rate of people who experience recurring or chronic back pain underscores the importance of treating the condition’s root cause.

Just because it’s possible to live without lower back pain doesn’t mean it’s effortless. Taking the right steps makes all the difference. One of those steps is finding the best exercises for lower back pain that work well for you.

The high rate of recurrence is because back pain is commonly caused by lifestyle factors that, when left unchanged, continue to create conditions ripe for pain. Fortunately, the lifestyle factors that lead to back pain are relatively easy to change. It just takes a dose of willpower and perseverance coupled with a positive mindset.

Why low impact exercises? 

Low impact exercises are some of the best exercises for lower back pain. Low impact aerobic exercise involves activities that put less pressure on the joints but still gets the heart moving. Instead of jarring the spinal structure and other joints with pounding activities like running, low impact activities get the blood moving and nutrients flowing through important structures of the back, supporting healing without pressure on sensitive bones and joints. Additional benefits include weight loss which takes the pressure off joints, less stiffness with regular movement, and increased production of endorphins, the “feel good” hormones the body produces after 30-40 minutes of exercise.

The most commonly recommended low impact exercises for lower back pain include walking and swimming. These are, seriously, two of the best exercises for lower back pain that you can do. However, you may be burnt out on walking and not have access to a pool. Or, you like trying something new when you’re getting your blood pumping. That’s why we recommend some new options for lower back pain exercises later in this post.

What are common lower back pain causes? 

Before we look at six of the best exercises for lower back pain, let’s take a look at what actually causes lower back pain.

Lower back pain is often caused by skeletal misalignment. The most common cause of back pain is mechanical—a misalignment or malfunctioning somewhere within the intricate network of bones, joints, and ligaments that make up the spine. The exact cause is often difficult to pinpoint. In fact, only about 15% of patients with back pain end up learning the exact reason underlying the pain, according to a report in the Journal of General Internal Medicine.

Looking a little bit more deeply, this misalignment typically doesn’t happen on its own. One of the top risk factors is a sedentary lifestyle, one spent mostly seated and with little physical activity. A sedentary lifestyle promotes poor posture and increases the likelihood of weight gain, both risk factors for lower back pain. Spending a great deal of time sitting also weakens back muscles, many of them important for supporting the spine and creating proper postural alignment. Poor posture mixed with weak muscles is an effective recipe for back pain.

You can learn more about the science of back pain in the following video.

The research on lower back pain exercises

Study after study has shown that physical activity is one of the best things a person can do to reduce back pain. The best exercises for lower back pain, as we’ll see, combine movement and activity with a sense of fun that keeps people coming back.

For example, a study published in the journal Clinical Rehabilitation found that patients with chronic lower back pain who walked on a treadmill twice each week experienced similar pain reduction to patients who sought more intensive medical treatment, reports the Huffington Post. Other good long-term options for reducing the risk of back pain recurrence include strength-building activities. Prevention is often the best medicine and will allow patients greater life enjoyment over the long term.

For many patients, realizing that it’s healthy to move around with back pain requires shifting their mindset.

Over the past few decades, doctors have recommended movement to alleviate lower back pain, but this wasn’t always the case. Until the 1990s, doctors recommended bed rest. Because of this, many back pain patients are scared to exercise, worried that they’ll aggravate the pain when in reality, physical activity is perhaps the No. 1 way to feel better.

Now we know how important exercise really is for reducing and preventing lower back pain. Let’s take a look at six of the best exercises for lower back pain that you probably haven’t tried yet.

1. Slow down with tai chi 

Tai chi is an ancient Chinese martial art that combines slow, fluid movement, breathing, and meditation. Descended from the combative martial art Tai Chi Quan, tai chi focuses on alignment, balance, stamina, and control rather than combat. Because of this, tai chi has many health benefits, one of which is the alleviation of lower back pain. This focus on steady, sustained movements makes it one of the best exercises for lower back pain. And, since it’s so low-impact, patients who also have knee or hip pain can also practice it easily.

The exercises in tai chi flow from one to another fluidly. The speed can vary based on experience and ability, so the focus can be on proper form, not building cardiovascular strength or completing a certain number of repetitions.  For people with lower back pain, this slow movement helps them increase their range of motion without moving too quickly or abruptly. It also helps to strengthen the muscles surrounding the spine to offer more support.

The benefits of tai chi

Beginners to tai chi will spend quite a bit of time learning the sequence of movements, and doing so helps to improve strength by increments. The physical demands of tai chi are not intense or immediate. Instead, movements are learned individually and then gradually put together. Because tai chi is so low impact, people of all ages can practice and garner significant health and pain-relieving benefits.

Another benefit to tai chi for back pain is that it incorporates the whole body, often in different directions. The arms may go up while the legs sink down, or they may flow to the left while the torso moves to the right. These twisting motions improve coordination and balance, as do the inclusion of small movements and big movements simultaneously.

A final benefit is not felt immediately but builds up as you practice. Aches and pains in the joints and vertebrae in the back may be the result of a lack of synovial fluid. Mary L. Jurisson, MD, a physical medicine and rehabilitation specialist at the Mayo Clinic in Rochester, MN, who has taught tai chi, notes:

“When you repeatedly compress the joints, the synovial fluid flows in the cartilage better. That nourishes it, which makes the ends of joints slippery so they can move smoothly.”

2. Get in your “oms” with yoga

Yoga exercises mind and body and is easily adaptable for all body types, from NFL players to grandmas! We’ve covered yoga for back pain extensively on this blog and PainDoctor.com (our partner site). To get started immediately, check out our post “Yoga For Lower Back Pain Is Awesome (With 7 Poses To Prove It).”

3. Hit the mat with Pilates

Any exercise that strengthens the core will help heal and strengthen the lower back. Pilates is the ultimate in core-strengthening, and it’s a low impact exercise that will definitely get the heart pumping! This combination makes it one of the best exercises for lower back pain.

Our post on Pilates for lower back pain covers all you’ll need to know about finding the right equipment and creating an at-home practice.

Remember, before starting any new exercise, talk with your doctor. Then make sure to exercise under the supervision of a professional. If you have never done yoga before, it is best to start with a yoga class. Most studios offer free or low-cost introductory offers. Many gyms will also offer trial memberships or a free consultation with a personal trainer. Take it slow, and listen to your doctor and your body.

In addition to tai chi, yoga, and Pilates, we’ve included three more out of the box options for reducing lower back pain.

4. Get in your strides on the elliptical

The elliptical machine works arms, legs, back, and core simultaneously. Plus, it feels like walking on air. This low-impact combo can help you get in some exercise whether at home or at the gym.

5. Try rowing, seriously 

What could be better than one exercise to work every muscle in the body at once? Rowing, on a machine or out on the river, is one such exercise. Whether you get to take in the local scenery or sweat it out Francis Underwood style in your basement, rowing is a great option for exercising your lower back.

6. Get in the water with kayaking

Not everyone has access to a kayak or a body of water. Kayaking, though, is an excellent way to build a strong core to support the long muscles of the back. It’s similar to rowing. The added back-and-forth motion can really help you work out the back muscles and strengthen your core.

Creating a lower back pain plan 

Physical activity that incorporates the best exercises for lower back pain, plus a cohesive health care team, can help you find lower back pain relief.

To reduce the risk of recurrent back pain, you should consider developing a back pain resilience plan. The plan will ideally include a variety of self-care activities like:

• Reducing stress
• Getting a good night’s sleep
• Incorporating plenty of movement into your day

A targeted back pain resilience plan will reduce discomfort for about 90% of back pain patients. Although back pain almost never indicates a more serious condition, there are a few red flags that a more serious condition could be present. Those red flags are a sustained fever, a change in bowel or bladder control, or pain resulting from a fall or trauma that could indicate a fracture. If you are experiencing any of these red flags, it’s important that you talk to a back pain doctor right away.

Outside of those few red flags, most patients will experience relief just from exercising more. For many people, adopting a regular exercise program is easier said than done. Creating an empowered mindset, knowing that you do have the power to reduce back pain through healthy lifestyle choices, is essential.

Treating your lower back pain 

Another critical component of a back pain resilience plan is establishing a team of health care providers in a variety of specialties. Lower back pain is a complex problem and requires a treatment plan that hits all angles. This is especially true if your lower back pain doesn’t resolve with exercise. Even with a healthcare team, though, getting involved and active in your treatment is one of the best ways to find lower back pain relief.

An effective health care team may include a chiropractor, acupuncturist, masseuse, and physical therapist. To be truly effective, though, patients must be willing to participate in their healing. This can happen through movement, stress reduction, and healthy eating. A treatment plan that involves patient participation is known as active treatment. Patients engaged in active treatment are less likely to experience back pain recurrences. Meanwhile, people who prioritize passive treatment, which is treatment received that doesn’t require patient participation, are more likely to experience chronic lower back pain.

The difference in outcomes represents one of the major hurdles of managing a potentially chronic condition: mindset.

People who believe they have the power to create health and an optimally functioning body often enjoy a life with minimal pain or none at all. They make the necessary changes without relying on health care providers for health. Creating that mindset, acknowledging the pain while not allowing it to defeat you, is important to developing the will to exercise and maybe push yourself beyond what you think is possible.

To get started on your journey to less pain, click here to talk to a back pain doctor. They can help you find a variety of treatment options to help you tackle your lower back pain.

Back pain affects millions of people in the U.S. every year and is the leading cause of disability all over the world. According to the American Chiropractic Association, 80% of the world’s population will experience back problems at some time in their lives. The best solution to combat back pain is to find an exercise and flexibility routine that will help strengthen your muscles to relieve the pain and help prevent future problems. The best stretches for lower back pain can help relieve tension in the back, reduce pain, and increase flexibility.

The basics: The 5 best stretches for lower back pain

The best stretches for lower back pain are those that help reduce muscle tension while also strengthening the core muscles that support the body. We’ve listed five of what we think are the best stretches for lower back pain below. When performing any of these stretches, you should be able to approach them at the level that feels best for you. You can modify any of these if they don’t work.

Some good practices for exercise is to always warm up before you start stretching, especially if you haven’t exercised a lot recently. A great warm-up is a quick walk, walking in place, or some light dancing. Don’t try to push yourself too hard in the beginning or it will only lead to more pain and not wanting to exercise. Remember being in pain is not a normal part of exercising.

Always have good breath control when you do any exercise. You never want to hold your breath, but instead you should exhale during a stretch and inhale when you release the stretch. Always consult your pain doctor before starting a new routine, as they will be able to best provide you with suggestions based on your condition. They will also be able to advise against certain stretches that may exacerbate your condition.

And finally, before trying any of these stretches for lower back pain, it’s a good idea to know the basics behind what back pain is and what causes it. This quick video from PainDoctor.com gives a great introduction to the science behind back pain.

1. Lying knee twist

This is a great exercise to stretch the spine and strengthen the core. Lay down on your back in a fully extended position. Then, take your right leg and lay it across the left leg as far as it can go to allow for a gentle stretch through the back and glutes. Hold this for 20 seconds and then slowly rotate back to center. Now do the other side. Repeat this three times for maximum effect. Place a block under your crossed knee if this sideways motion is pulling too much.

2. Chair hamstring stretch

This is one of the best stretches for lower back pain and the perfect alternative to the toe touch. As you’ll read below, in the poses we advise against for lower back pain, a toe touch can put unnecessary pressure on your lower back.

Instead of standing, start this hamstring exercise by sitting on the edge of a chair with your back straight and your feet firmly planted on the ground.

Extend one leg outward in front of you and reach toward your toes. This will give your hamstrings a workout and it won’t have the side effect of putting a lot of pressure on your back. Hold this for 15 seconds and then switch legs. Try to stretch out both legs at least three times.

3. Cobra pose

This yoga move can help stretch out your lower back and abdominal muscles. Begin by lying down on your stomach and stretching your legs out behind you. Plant your elbows and palms on the ground and make sure your arms make a 90° angle with the floor. Slowly contract your abs, and use your abs strength to push your body off the ground. There should be little pressure on your arms or elbows. Go only so far as your movement is still controlled by your abs. Don’t let your hips leave the ground and once you reach a good stretch hold for ten seconds.

4. Cat/Cow

This is one of the best stretches for lower back pain and it also hits the neck and shoulders. Get down on all fours with your shoulders directly above your wrists and your knees above your ankles. Keep your neck straight to start. On an inhale, lift your head and bottom, while allowing your stomach to drop. Hold at the top of the inhale. Then, as you exhale, tuck your chin and begin to curve your back upwards (like a Halloween cat). Push slowly and steadily with your hands on the ground until you can feel the stretch across your shoulders and lower back. Inhale and repeat the back bend. Exhale and repeat the curl. Do this for ten repetitions, or as long as feels good for you.

5. Child’s pose

This stretch will help elongate the back and can really be a stress buster. Start on all fours and stretch your arms as far out in front of you as possible. Then, bring your glutes back so they hover just above or on your heels. Place your forehead on the ground. Now hold this for twenty seconds and repeat as many times as feels comfortable for you.

Finding even more of the best stretches for lower back pain

There are many ways to strengthen your back muscles to help relieve pain, besides what we think are our five of the best stretches for lower back pain. One of the most entertaining and useful ways uses video instruction to really help you understand the intricacies of each workout. With an internet connection, an iPad or laptop, and a yoga mat, you can start hitting some of the best stretches for lower back pain (along with some light exercises) right in your living room! Here’s a list of lower back pain videos that can help you combat pain and keep you coming back for more.

1. 3 Stretches to Help Low Back Pain 

Our video is a simple and easy tutorial that runs through three effective stretches to warm up your back. A helpful narrator from Pain Doctor describes each stretch in detail as a volunteer performs the movements in the background. Click “Show More” in the description for a transcribed version of the video and some great links to Paindoctor.com’s social media accounts.

2. Stretches for Back Pain Relief, How to Stretch Routine, Beginners Home Yoga 

Not the most concise title, but with three million views, it is hard to argue with. Listen to tranquil music and follow yoga instructor Jen Hilman in a series of poses designed to target pain throughout the entire spine. Jen is easy to understand and you will feel just like you are in the studio getting a private lesson.

3. Five Back Pain Stretches 

This video shows a sequence of five gentles stretches from our friends at WebMD. These lower back pain exercises are guided by a physical therapist as he shows them on a patient. A header pops up that also provides the suggested reps and time to spend on each exercise. The narrator also provides useful tips on how the stretches should be performed and what muscles they target.

4. Toning Lower Back Workout Routine

Fitness Blender’s video runs through eight 50-second lower back pain exercises that require no equipment. There is no down time in this video so it goes by fast, but each move is expertly shown by the model. The narrator does an excellent job of describing the form and instructing you on how to get the maximum effect out of each movement. The timer is a great help that can help you stay on and give you a heads up of your next exercise.

5. 5 Steps to Lower Back Pain Relief 

Dr. Saranjeet Singh, sports medicine specialist, demonstrates his five steps to lower back pain relief. The video starts out with some common causes of lower back pain. He then moves in to the best stretches for lower back pain he uses. The catchy music and simple stretches makes this a fun video to follow along with. He also provides some safety measures at the end that are useful for every workout.

6. Best Stretches to Relieve Low Back Pain 

Cassy Ho from Blogilates shows us her routine to get rid of back pain in this short YouTube video. Not only are the stretches easy to follow, but her quirky personality makes following along a treat. The only issue you might have while watching this video is stopping every now and then to laugh at a funny story or a humorous remark.

7. 1 Minute Lower Back Pain Exercises 

Have lower back pain, but can only spare a single minute for exercise? Well then, this is for you! This video runs through a few basic exercises in a little over one minute. Each exercise will also give you the suggested reps, so you can add one or all of these stretches to your next workout.

8. 20 Min Lower Back Rehab

This workout can help your back and might make you sweat a little. This video comes in two parts. The first is a handful of lower back stretches to get you warmed up as well as relieve pain, and the second is focused on strengthening your muscles to prevent pain. Follow along as Coach Kozah does the whole routine so you don’t have to watch the clock.

What to avoid when doing stretches for lower back pain

Knowing what not to do is just as important as incorporating the best stretches for lower back pain into your routine. Mild discomfort is common as you start stretching as your muscles are not yet used to the strain. However, if mild pain lasts for more than a few minutes, you should stop immediately. This is a good indication that the exercise is aggravating your back problems, rather than helping.

Some stretches you should avoid when getting started include:

• Standing toe touch: This stretch can put a lot of pressure on the discs and ligaments in your spine as well as overstretch supporting muscles such as the hamstrings
• Leg lift: It is important to have a strong core to alleviate back pain, but a weak core will force you to overcompensate with the back in this exercise, leading to even more pain
• Full sit-up: This is another common exercise that can lead to back pain as it puts a lot of pressure on your lower back

Always be aware of your posture when doing any stretch. Even the best stretches for lower back pain can cause issues if they are done incorrectly. Never sacrifice technique for a deeper stretch as it can cause a lot more pain and hinder the rest of your workout.

And, as always, talk to your doctor before performing these or any other lower back pain stretches. Your specific pain condition may be exasperated by these stretches, if done incorrectly or not at all. Your doctor may be able to recommend stretches that work better for you or suggest modifications.

Pain is a complex thing and it is the number one reason why people in the U.S. search for help via the healthcare system. According to the U.S. Department of Health and Human Services, chronic pain is the most common cause of long-term disability. It can also be a barrier to treatment, accounts for a large portion of healthcare costs, and is the biggest reason for work absenteeism. But what do you do when your chronic pain doesn’t respond to standard treatments such as medications, steroid injections, or physical therapy? One approach is called spinal cord stimulation (SCS).

What is spinal cord stimulation?

Spinal cord stimulation has been around for about four decades. A permanent spinal cord stimulator device is made up of small, thin wires that have electrical leads on the end. These are placed along the spinal column. The wires are capable of delivering electrical pulses to the epidural space via a power source called an internal pulse generator. This can help relieve pain in some patients.

This treatment approach focuses on treating neuropathic pain. This is pain that develops as a result of damage to the central or peripheral nervous system. This is a major reason why spinal cord stimulation is so useful for patients of failed back surgeries. It can help alleviate pain even when the underlying cause has yet to be identified.

How does spinal cord stimulation work?

Spinal cord stimulation can be very effective in reducing overall pain, especially that from failed back surgery. This is likely because the electric charges produced by this medical device mimic the body’s natural neurological system. This has the effect of interrupting some of the pain signals being created by the body before they can reach the brain.

The spinal cord device comes with an exterior remote that allows the patient to send pain-blocking signals to the spinal cord as desired. This gives the doctor and patient some degree of control of these signals. The machine can be adjusted as needed to provide different levels of relief and can be turned on and off as the patient would like.

Spinal cord stimulation effectiveness is heavily dependent on the person, so this treatment option always starts out with a brief trial period. The trial usually lasts between three and 15 days to see if a patient will actually find relief from the device. A reduction of pain by at least 50% from the baseline with no major complications is required to consider a trial successful.

The science behind spinal cord stimulation

There has been quite a bit of research done on the effectiveness of spinal cord stimulation in the last 40 years. Much of it has shown that these devices are safe. It also shows that they are very good at managing certain kinds of pain. While there are many benefits to this treatment, there are still some complications inherent to the procedure.

One study, conducted by Dr. Young Hoon Jeon, MD, showed that SCS greatly improves the quality of life, daily function, and overall satisfaction of patients that undergo this treatment. It also revealed that most complications in this procedure are related to hardware issues. However, these issues were generally minor if the operation was overseen by someone with the proper expertise.

In another study, by KJ Burchiel et al, all 219 patients underwent a trial period for a SCS device of which only 182 patients obtained a permanent version. Of those who responded after one year, all of the pain and quality of life measurements used were significantly higher during the treatment year. Furthermore, complications were shown only to affect 17% of those patients. Overall, the study showed that spinal cord stimulation is a great pain management tool. It also has significant value in treating chronic pain in the lower back and extremities with minimal complications.

Spinal cord stimulation for failed back pain patients

A literature review was conducted by Michael Frey et al to exam the evidence and to evaluate the effectiveness of spinal cord stimulation, specifically relating to failed back surgery syndrome. This was measured by first measuring the pain relief provided in these studies. Then they took into account secondary measures that included functional status, psychological status, reduction of opioid medications, and the patient’s ability to return to work after the procedure. Overall, it was found that the evidence showing the effectiveness of SCS in relieving chronic pain from failed back surgery syndrome was obtained from well-designed trials. Further, case-controlled analytics studies backed the efficacy of spine cord stimulation on a long-term basis.

What is it like to have a spinal cord stimulator?

The procedure itself takes anywhere between an hour and 90 minutes to complete. During that, the pain doctor will place the leads near the spinal column with a needle. If the treatment is deemed successful, a more permanent spinal cord stimulation device is surgically implanted.

With spinal cord stimulation, you will first use a trial device. It comes with a preset program for the temporary electrical generator that you wear on your waist like a cell phone. If spinal cord stimulation is successful, a tiny electrical generator is implanted in the abdomen or upper buttocks via a small incision. The incision for the generator is so small that it will not be visible on the body. It will not inhibit any other activities, such as swimming.

The generator only requires new batteries every two to five years depending on use.

Risks of spinal cord stimulation

This treatment option is considered safe and easily reversible. However, there are a few reported complications to be aware of, although serious complications are very rare.

As with all surgeries, there is a risk for infection. Implanting a spinal cord stimulator also carries with it the possibility of scar tissue to build up around the wires and generator.

Other issues that can occur include:

• Migration of the electrode
• Unpleasant stimulation of the chest and ribs
• Cerebral spinal fluid leak
• Numbness or paralysis
• Hardware failure
• Allergic reaction
• Pain at the incision site

Have you ever received spinal cord stimulation for failed back surgery?

By Ted Swing, Ph.D

New treatments for many different medical conditions are being developed, tested, and approved all the time through the process of clinical research. We feel this research is incredibly important, and we are committed to advancing the practice of pain medicine by taking part in clinical trials. This means enrolling and treating certain selected patients and following up their progress for a specified period of time. We currently have several actively recruiting clinical trials.

Complex Regional Pain Syndrome Research Study

In most cases when a person suffers an injury to an extremity, such as a sprain or a broken bone, the injury heals over time and the pain decreases. In certain rare cases, though, the injury triggers a process beginning with unusual sympathetic nervous system activity. This process can lead to a condition known as complex regional pain syndrome (or CRPS). Instead of becoming less painful over time, the injured limb becomes more painful and undergoes changes in color, temperature and sensitivity. This condition is complex and can be difficult to treat.

One of the promising methods for treating CRPS is a class of drugs called bisphosphonates. These drugs are widely used for treating bone conditions. We are taking part in a clinical trial that is ongoing in the U.S. and Europe of a bisphosphonate called neridronate for the treatment of CRPS. In this study, qualifying patients receive four intravenous infusions of either neridronate or saline over a period of a couple of weeks. A previous study found that patients experienced significant relief of their CRPS symptoms a year after receiving such infusions.

Amputation Pain Study

Patients who have undergone the amputation of a foot or leg sometimes continue to experience chronic pain, either in the stump of the amputated limb or phantom limb pain (pain perceived to be in the missing portion of the amputated limb). In cases where this pain does not respond to other treatments, it is sometimes treated with implanted devices called neurostimulators. These devices work by delivering electrical stimulation to the nerves that blocks out much of the pain signals that would be sent to the brain. The current standard neurostimulation devices deliver stimulation at a low to moderate frequencies that produces a mild tingling sensation in the targeted area.

We are currently working on a clinical trial testing a new type of neurostimulation device. This device delivers high frequency stimulation (10,000 Hz), which generally produces no sensation in the targeted limb at all. Some early research suggests that high frequency stimulation can be even more effective in alleviating pain. The current clinical trial is testing the device in patients who have had an amputation of a single lower limb that is causing them chronic pain. Qualifying patients will have this new device implanted. For a three-month period, half of these patients will receive high frequency stimulation and half will receive control stimulation. After that period, all implanted patients will have their device adjusted to deliver the high frequency stimulation as follow up continues.

If you are interested in learning more about one of these studies and whether you might qualify for it, you can discuss this study with your pain management providers. For additional information about this study you can contact me directly at TedS@arizonapain.com.

Ted Swing has more than 11 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

People will try just about anything to find back pain relief, and thanks to the never-ending parade of emerging treatments, patients aren’t short of new ones to try.

In the world of alternative therapies, it’s sometimes difficult to differentiate the weird-sounding-but-effective from the not-so-great. Some of these recently popularized treatments may even cause harm, and understanding the risks is important before experimenting.

Complicating matters, many alternative treatments are not well-researched, which means their efficacy is unknown beyond anecdotal evidence. If you do try any of these treatments, keep in mind that your body is your best guide. If something hurts, steer clear of it. A method that works for one person may not work for another.

Back pain is especially complex because even though patients have in common the area of pain, the causes may differ wildly. That means the treatment that will work for you will depend on the cause of your back pain, your individual body structure, and any pre-existing injuries or areas of pain.

Trying new treatments to find what works for you is generally a good idea, but proceed cautiously and always talk to your doctor before trying any of these.

1. Inversion tables

Inversion tables are specialized pieces of equipment that support back pain patients as they hang upside down. The tables are adjustable, and so people aren’t typically straight up and down, but rather on an adjustable incline.

The idea is that hanging upside down removes gravitational pressure from the spine and gives the vertebrae breathing room, which theoretically reduces pain.

Studies haven’t shown the tables provide long-term relief from back pain, according to Mayo Clinic. Additionally, hanging upside down is not safe for people with high blood pressure, glaucoma, or heart disease. Patients with these conditions should avoid inversion tables entirely.

However, some patients experiencing back pain from spinal disc compression may find inverting helps to alleviate pressure and reduce pain, Mayo Clinic adds. Anecdotal evidence is divided. Some patients on a WebMD forum reported the tables provided great relief, while others said they’re best used in conjunction with other treatments, like core-strength building and targeted stretching.

Inversion tables are a wonderful technique for reducing stress, though, which could in itself help reduce back pain, according to Weber State University.

The verdict: Inversion tables are probably safe to try if you don’t have a contraindicated health issue, and they may be effective, depending on the source of your back pain. If you’re looking for simple stress relief and don’t want to dish out for a table, try the simple legs-up-the-wall yoga pose.

2. Laughter therapy

The old adage says laughter is the best medicine, and emerging research shows that may be true. Although the physical act of laughter may sometimes cause spasms of back pain, overall it releases feel-good brain chemicals that could reduce suffering.

When it comes to alleviating back pain, Swiss researchers have found that laughing increased study subjects’ pain tolerance. The effect was so dramatic that researchers recommended laughter therapy be included with other interventions as a primary form of treatment.

In the study, subjects watched funny movies, and the resulting laughter reduced muscular tension and spurred production of endorphins, the same natural happy brain chemicals linked to exercise. Researchers emphasized that laughter needs to “come from the heart.” In this case, faking it until you make it doesn’t apply.

Laughter is also tied to stress relief, reports Mayo Clinic and causes the body to release natural painkillers—another benefit for those looking to fight chronic back pain.

The verdict: Incorporating more laughter into your life is always a good thing and could very well help reduce back pain.

3. Cupping

This alternative therapy is growing in popularity, and limited studies show it likely offers benefit for back pain. Although cupping has only recently hit the mainstream U.S., the practice dates back to ancient Chinese, Egyptian, and Middle Eastern systems of medicine.

Cupping involves the use of cups applied to the back. The lids of the cups are heated, and when they’re applied to the skin, the heat creates a suctioning effect. Advocates say cupping improves blood flow and reduces tension.

A review of studies published in the journal Acupuncture in Medicine found that cupping shows promise for treating back pain and has a low risk profile. Some of the studies reviewed found that cupping was superior to traditional Western medication when it came to reducing pain.

As a note of caution, cupping tends to temporarily leave round scars on the back in the shape of cups, so keep that in mind if you plan to bare your back in the near future.

The verdict: Cupping may provide some benefit for back pain patients.

4. Magnets

The idea of treating pain with magnets has been around for centuries, and recent studies have found magnets are beneficial for alleviating migraines, but the same has not held true when it comes to treating back pain.

Research published in The Journal of the American Medical Association found patients who used magnets for six hours per day, three days each week experienced no reduction in pain, reports WebMD.

Researchers said they weren’t prepared to definitively state that magnets were ineffective for back pain, but studies so far have not revealed a benefit. WebMD contacted a representative for a medical magnet company who said the study was flawed. The wrong type of magnet was used and the duration of treatment was not long enough, the representative said.

In the study, researchers used a bipolar magnet, in which both the north and south poles face the skin. Other commercially available magnets have just one pole facing the skin. Meanwhile, some patients anecdotally say magnets have helped reduce their back pain. Yale University Dr. David Trock tells WebMD:

“We really need to keep an open mind about the use of magnets. I’ve heard a number of anecdotal stories on both sides.”

Verdict: Magnets might be effective for back pain, but no studies currently show that’s true.

Have you tried any of these therapies for back pain?

Image by Garry Knight via Flickr

The benefits of yoga are vast. Students can expect to gain flexibility, strength, and improved balance from continued practice, while those with chronic pain may find the practice improves quality of life.

Although many people aren’t sure how to start practicing, the best way is to attend a live class with a registered yoga teacher (RYT). While there isn’t much government regulation of those teaching yoga, teachers carrying a RYT designation are registered with the Yoga Alliance, the industry’s largest non-profit. To earn the ability to register, teachers must take at least 200 hours of class at a registered school. The training program covers yoga philosophy, alignment, and safety concerns for teaching special populations, including those with chronic pain.

Most teachers at studios, gyms, and other healthcare facilities have earned the RYT designation, although taking a training class isn’t required by law to teach yoga. If you’re not sure, it’s always a good idea to ask.

Why does taking a class with a registered teacher matter?

Many people new to yoga may start by trying out a few poses in their bedroom, or following along with a video or DVD. While this is a fine option for many people, it’s important to take a live class with a registered teacher to learn proper form and breath technique, particularly for those with chronic pain.

Learning the proper form and optimal sequencing is essential to enjoy the most benefits from yoga practice. Consider low back pain, a common problem. Some poses are contraindicated for those with back problems, especially spinal issues like bulging discs. Even a simple forward fold can aggravate back issues. In this example, a modification like bending the knees would be helpful for keeping the lower back safe.

Practicing proper form

Many yoga poses look deceptively simple. When practiced without proper form, they could cause injury. Stay safe and learn from a teacher.

Another risk of practicing yoga outside the scope of a qualified teacher is choosing the wrong type of poses for your health concern. For example, many people with low back pain might gravitate toward poses that stretch the back. However, back pain is best helped by poses that strengthen the back, a common area of weakness for those who sit a lot.

During yoga classes, a knowledgeable teacher will help you by demonstrating modifications to make the poses more accessible and reminding you of proper form throughout the practice. Be sure to let the teacher know ahead of time any areas of pain, and she will let alert you to the poses that could impact the affected area.

While people with chronic pain may have additional concerns, some alignment cues are important for everybody, regardless of age or physical health. Keeping the knee over the ankle in standing poses, for example, helps to protect the knee joint.

Other alignment cues are less important for preventing injury, but important for achieving the full benefit of the pose. In some poses, a person may sacrifice alignment to access what appears to be a deeper expression of the pose, but is in actuality missing the very muscles and connective tissue the pose targets.

When practicing at home alone, it’s hard to see your alignment, even if you practice in front of a mirror and know proper form. A teacher frequently issues gentle reminders about proper form that are important for preventing injuries.

Learning about the spiritual side of yoga 

Beyond the physical practice of yoga, called asana, there is a rich spiritual tradition of yoga that encourages mindfulness and compassion. Many yoga teachers teach breath work, called pranayama, and meditation in addition to the physical postures. These complementary practices do wonders for calming the nervous system, improving a person’s ability to manage stress, and generally creating a joyous sense of peace.

Meditation has been found particularly helpful in reducing the suffering of those living with chronic pain.

To access the full benefit of yoga, it’s important to match the breath to movement, a feature that can easily be lost when novice yogis practice at home. Yoga uses a special type of breath called ujjayi that’s powerful in calming the mind, particularly when linked with body movement. During yoga classes, teachers remind you to return to the breath and can answer questions about ujjayi or other yoga terms.

Teachers over time convey the deeper, spiritual meaning of the practice which many people find enjoyable. Most yoga classes don’t include meditation, but having a relationship with a yoga teacher could be helpful if you’re establishing a practice and need to ask a question. The ancient yogis saw the physical practice as a way to prepare the body for meditation.

Once you have a solid practice, practicing at home is fine and even encouraged. However, establishing a firm foundation is important to practice safely for many years.

I’m on a budget. How can I practice at a studio?

Fortunately, practicing yoga doesn’t have to be expensive. One good option is to join a fitness center that offers yoga along with other cardio classes. You won’t find the variety or the spirituality that many studios offer, but it’s a good option for people wanting to find affordable yoga classes.

Another affordable method is searching coupon sites like Groupon for deals in your area. You might find a large percentage off class packages or a month-long option of unlimited classes. Most studios offer discounts for purchasing packages of five or ten classes as opposed to the drop-in rate for a single class. Some studios offer weekly community yoga that’s free or low-cost. These rates and times change frequently, so contact a studio near you to inquire about a potential class.

If you’re in the Phoenix area, visit the Spirit of Yoga in Tempe. The school trains yoga teachers and offers free classes taught by students in exchange for filling out a feedback form. An experienced instructor supervises the classes, so rest assured your practice will be safe.

Keep an eye on the local events calendar. Fitness apparel stores like Lululemon and Lorna Jane offer free classes. Lululemon holds free yoga classes at its Biltmore and Chandler Fashion Center locations.

Many Lorna Jane stores have an in-store fitness studio where they hold classes. There’s typically a placard outside the store with each week’s schedule, or you can call for times. Valley locations include San Tan Village in Gilbert, Biltmore Fashion Park, Kierland Commons, and Scottsdale Fashion Square.

Have you ever attended a yoga class?

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