How to treat lower back pain

Rest and be patient. The spine is a complex system that includes joints, nerves, muscles, and blood vessels. Therefore, lower back pain can occur at various points along the spine due to improper posture, injury, or heavy pressure. However, lower back pain (even severe) can often resolve quickly without treatment, usually within a few days. This is because the body has a remarkable ability to heal itself, and most cases of back pain are due to lack of movement rather than damage. When experiencing lower back pain, it's essential to be patient, stop activities that aggravate the pain, and allow it to resolve on its own.

• Nowadays, bed rest is generally not recommended for most lower back pain cases. Doctors believe that light activities (walking, climbing stairs) can be beneficial because they stimulate circulation and help relax the affected joints or nerves in the spine.
• If the pain is caused by overexertion at the gym, it’s possible that you've overdone it or used improper technique. In that case, consulting with a personal trainer for proper guidance is advisable.
• If your job is contributing to the pain, it's essential to discuss with your employer to adjust your workload or modify your workspace, such as adding a cushion for foot support or changing to a chair that provides better lower back support.

Reduce lower back pain with cold therapy. While resting and being patient for a few days, cold therapy can be used. Apply an ice pack or gel to alleviate sudden or newly formed pain and reduce inflammation, as they numb the pain. Use crushed ice, ice cubes, gel packs, or even a bag of frozen vegetables, applying it to the affected lower back area for 10-15 minutes per hour until the pain begins to ease. Afterward, you can reduce the frequency to three times per day.

• Always wrap a thin towel around the cold pack before applying it to the lower back to avoid tissue damage or skin irritation.
• Use an elastic bandage to secure the cold pack in place to prevent swelling.
• Note that cold therapy is not suitable for chronic back pain as it may worsen symptoms. Instead, consider using moist heat to relieve the pain.

Use moist heat for lower back pain relief. For chronic back pain lasting for months or years, moist heat therapy is recommended, as it promotes blood circulation and relaxes tight muscles and other soft tissues. You can use a microwaveable herbal heating pad, particularly those with calming aromatic herbs like lavender. Heat the herbal pad in the microwave for a few minutes and apply it to your lower back while sitting or lying down for about 20 minutes. To retain heat and prevent it from cooling too quickly, cover the herbal pad with a towel.

• Another method to alleviate symptoms is to soak in an Epsom salt bath for at least 20 minutes several times a day. Epsom salt contains magnesium, which helps relax muscles and reduce swelling.
• Be sure not to make the water too hot to avoid burns, and always remember to stay hydrated. Hot salty water can draw fluid from your body and cause dehydration.
• Avoid using moist heat or soaking in hot salty water for acute back pain, as it may increase blood circulation and worsen inflammation.

Over-the-counter (OTC) pain relief medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin can provide temporary relief from acute lower back pain by reducing inflammation and controlling pain. However, for chronic back pain, OTC pain relievers like acetaminophen (Tylenol) are more appropriate, as they alter the way the brain perceives pain.

• NSAIDs can be harmful to the intestines and kidneys if taken in high doses for extended periods (over several months), so use caution and carefully read the label.
• Acetaminophen has a lesser effect on the intestines and kidneys but may impact the liver. Therefore, avoid excessive use of this medication.
• Alternatively, you can use topical creams or gels containing NSAIDs, acetaminophen, or natural pain-relieving ingredients like peppermint oil and capsaicin to relieve back pain without damaging the intestines, kidneys, or liver.

Adjust your sleeping posture. Sleeping positions and/or the sleeping environment can affect or cause lower back pain. For example, sleeping on your stomach causes excessive curvature in the lower back, putting pressure on the spinal joints and nerves. The best sleeping positions are lying on your side (with your body curled up like a fetal position, knees bent) or on your back (lying face-up with a pillow under your knees). Both positions relieve pressure on the lower back joints and reduce discomfort/pain.

• Changing your sleeping environment means ensuring your mattress is firm enough to support your spine. In general, overly soft mattresses can worsen back pain, while firm orthopedic beds can alleviate it.
• Everyone has different sleep needs, so the best way to determine if your mattress provides adequate support is to assess how you feel when you wake up. If you wake up with pain, it suggests your sleeping posture or environment isn’t ideal. If you only feel discomfort by the end of the day, it could be due to work/activity/exercise.
• Note that foam and spring mattresses have a lifespan of only 10 years, regardless of your weight. You should rotate and flip the mattress regularly (every time you change your sheets) to prolong its durability.

Improve posture. Slouching while sitting or standing can increase pressure on the lower back, leading to discomfort and pain. Improving your posture helps relieve pressure and alleviate back pain. In fact, you can prevent recurring back pain by focusing on better posture. However, this requires consistent effort on a daily basis.

• Strengthening your abdominal muscles is a great way to improve posture. These muscles, located in the lower back, abdomen, and pelvis, are all connected to the spine and/or pelvis, helping to maintain an upright position.
• For proper standing posture: distribute your body weight evenly on both feet and avoid bending your knees. Engage your core and hips to keep your back straight. Wear supportive shoes and avoid muscle fatigue by placing one foot on a chair periodically.
• For proper sitting posture: choose a firm chair with armrests. Keep your back straight, relax your shoulders, and place a small cushion behind your lower back to support the natural curve of your spine. Keep your feet flat on the floor, using a footrest if needed.

Lift objects properly. Although there is some debate on the best lifting techniques, you can apply different methods depending on the situation. However, you should follow these basic principles.

• Check the weight of the object beforehand to avoid dropping it due to its heaviness. If needed, ask for help.
• Stand close to the object before lifting it, keeping the load as close to your body as possible while carrying it.
• Avoid twisting or stretching your hips; keep your back straight. If you need to change direction, turn your whole body instead.
• Proper lifting postures include squatting (bending the knees and hips while keeping the back straight), bending over (keeping your legs straight while bending your back), or using a high squat position to lift the object using your thighs.

Visit an orthopedic doctor. These doctors specialize in the treatment of the spine and joints. They can treat back pain using natural methods, such as manual spinal manipulation. Spinal manipulation, also known as spinal adjustment, is used to relieve or correct misaligned spinal joints, which can cause inflammation and back pain.

• Spinal adjustment can effectively reduce lower back pain, but you may need three to five treatment sessions to see results. Keep in mind that insurance typically does not cover chiropractic treatments.
• Orthopedic doctors also use other therapies to relieve muscle tension and strains related to back pain. Some therapies include electrical muscle stimulation, ultrasound therapy, and electrical stimulation.
• Spinal traction using an inversion table can also help reduce back pain. Some orthopedic doctors use inversion tables, which allow you to lean back and use gravity to reduce pressure on the spine.

Massage therapy for the lower back. As mentioned earlier, not all lower back pain is related to joint issues. Many cases are due to muscle strain. Muscles become overstretched when fibers tear, causing pain, inflammation, and muscle spasms. Massage therapy can reduce mild to moderate muscle tension, as it helps alleviate spasms, inflammation, and promotes relaxation. You should get a 30-minute massage performed by a certified physical therapist, focusing on the lower back and pelvic area.

• A 30-minute massage can relieve lower back pain, but several sessions are needed to improve the condition. For chronic back pain, increase the massage duration to one hour, including massage of the middle back and/or legs.
• Drink plenty of water after your massage to flush toxins from your body. Otherwise, you may experience muscle soreness, headaches, or mild nausea.
• As an alternative to professional massage, you can place a tennis ball under your lower back and gently roll on it for about 15 minutes several times a day until the pain subsides.

Try acupuncture therapy. This traditional Chinese method uses fine needles inserted into specific points on the body to reduce pain and inflammation. Acupuncture for lower back pain is particularly effective, especially for acute pain (pain that has just begun). It works by stimulating the production of various substances, including endorphins and serotonin, to reduce the sensation of pain.

• Some studies suggest that acupuncture can help alleviate lower back pain, though the results may vary depending on the case.
• The acupuncture points used to treat back pain are not always located in the pain area. Some points may be found elsewhere on the body, such as the hands.
• Acupuncture is increasingly being practiced by many healthcare professionals. It’s important to consult a licensed practitioner.

Consider cognitive behavioral therapy (CBT). Cognitive Behavioral Therapy (CBT) focuses on identifying negative thoughts and beliefs, then replacing them with more positive thinking patterns. Specifically, CBT for back pain targets how you react to and perceive the pain. Studies have shown that CBT can effectively reduce stress and chronic back pain in many patients.

• CBT should be considered as a last resort for back pain when other treatments have proven ineffective.
• Consult with your doctor, psychologist, or insurance provider to get recommendations for CBT practitioners in your area. It’s advisable to meet with several professionals before making your decision.

See a doctor. If at-home remedies and alternative treatments are not effective in alleviating your back pain, it is essential to consult a doctor. They will examine you to determine if the pain is caused by serious spinal issues, such as a herniated disc, nerve compression, bone infection (osteomyelitis), osteoporosis, fractures, severe arthritis, or cancer. To ease your pain, the doctor may prescribe NSAIDs or stronger painkillers.

• X-rays, bone scans, MRIs, CT scans, and nerve conduction studies are common diagnostic tools used to examine the spine.
• The doctor may also run blood tests to check for rheumatoid arthritis or spinal infections (osteomyelitis or meningitis).
• You may eventually be referred to a specialist (orthopedic, neurologist, or rheumatologist) to get a precise diagnosis for your back pain.

Consult a physical therapist. If you suffer from chronic back pain (lasting for months or even years) due to muscle weakness, poor posture, and/or degenerative conditions (such as osteoarthritis), you should consider spinal rehabilitation therapy as recommended by your physician. A physical therapist will guide you through stretching and strengthening exercises for the lower back, which will help reduce pain over time. Physical therapy should be performed three times a week for 4-8 weeks for noticeable improvement in chronic back pain.

• For spinal rehabilitation therapy, the physical therapist may use exercise balls, medical balls, elastic bands, electrical muscle stimulators, and/or ultrasound therapy.
• To strengthen your back muscles, activities such as swimming, rowing, yoga, and back stretches are recommended.

Apply myofascial trigger point therapy. Back pain can be linked to muscle injury or tension at trigger points, which may cause pain at the site or radiate to other areas. Therefore, even if you're experiencing lower back pain, the trigger point might be located elsewhere on the body.

• Consult a doctor trained in identifying and treating myofascial pain. The doctor will use trigger point massage techniques to address the issue.

Consider steroid injections for back pain treatment. If strong medications and/or spinal rehabilitation are ineffective, a corticosteroid injection into the joints, muscles, tendons, or ligaments of the lower back can rapidly reduce inflammation and pain, making movement easier. Corticosteroids, which are natural body hormones with strong anti-inflammatory properties, include drugs such as prednisolone, dexamethasone, and triamcinolone. Your doctor may refer you to an orthopedic specialist for the injection if they determine it’s beneficial.

• Possible side effects of steroids include local infections, excessive bleeding, ligament weakness, muscle atrophy, nerve irritation/damage, and reduced immune function.
• The effects of steroid injections can last anywhere from a few weeks to a few months. Doctors usually do not administer more than two injections per year.
• If corticosteroid injections do not provide significant relief from back pain, surgery (there are various types of surgery) may be considered as a final treatment option.

• Rolling on a firm foam roller is an effective method for massaging the lower back and alleviating pain. You can borrow a foam roller from a yoga instructor, physical therapist, or orthopedic specialist, or purchase one at a sports or general store.
• In addition to foam rollers, you can use a tennis ball or massage ball to apply pressure to the lower back. Place the ball under your back and roll it until you find a painful spot. Hold the position for a few seconds before moving to another area. Repeat daily until the pain subsides.
• Stress-relieving techniques such as meditation, tai chi, yoga, health-boosting exercises, and deep breathing can also help relieve and prevent lower back pain.
• Quit smoking, as it impedes blood circulation, leading to insufficient oxygen and nutrients reaching the lower back and surrounding muscles.
• Maintain a healthy weight, as lower back pain is more common among those who are overweight or obese.

• Seek immediate medical attention if you experience any of the following symptoms:
  • Lower back pain radiating down your legs
  • Severe pain when bending your legs
  • Worsening pain at night
  • Unexplained fever and sudden weight loss along with back pain
  • Back pain accompanied by sudden loss of control over urination
  • Back pain along with leg numbness or weakness