6 Alternative Low Back Pain Treatments To Try Before Choosing Surgery From a Doctor of Physical Therapy

There are 16 million adults, 8 percent of all adults, who experience chronic and persistent back pain. As a result, they are limited in everyday activities leading to missing the important parts of life. Back pain is the sixth most costly condition in the United States. The required health care costs and indirect costs, due to back pain is over $12 billion per year. That’s a lot! 

 So what is the underlying issue when it comes to back pain and especially low back pain and lumbar back pain? What can you do before going under the knife or having surgery to attempt to correct your back pain and back problems? Let’s discuss some key reasons you may have back pain and what you can do to help your back, decrease your pain, and/or prevent back pain from occurring in the first place!

1. Stretching to Alleviate Back Pain:

    • We all know we need to stretch our muscles to feel better, before and after working out, to increase circulation and blood flow! But how many of us actually do it? Well, we all need to do it a lot more! As we age and get older we start to develop more adipose tissue, fat tissue, in our muscles. Our collagen formation begins to slow down, our circulation begins to worsen. And we need to stretch more often and for longer periods of time! Research studies show that in order to have a long term effect and change in muscle fibers you need to stretch for a minimum of 60 seconds per muscle if you are under the age of 40 and you need to stretch for a minimum of 4 minutes, per muscle, of you are over the age of 40. So let's learn about some key muscles to stretch to help your back pain! 

Hamstring length and range of motion to decrease back pain:

  • The hamstring muscle group is made up of three muscles; semitendinosus, semimembranosus, and biceps femoris. These muscles are engaged with lots of daily activities including running, walking, jumping, and many more! The hamstrings attach to your pelvis, ischial tuberosity, and insert on your tibia and fibula. Start stretching your hamstrings to put less pressure on your pelvis and lower back!
Hip Flexor muscle Tightness and stretching for back pain relief:
  • Back pain can be caused by hip flexor tightness. Your hip flexor muscle group is comprised of three muscles; Psoas major, Psoas minor, and Ilaicus. These muscles attach from your femur up into your pelvis with the Psoas Major and Psoas minor attaching onto the transverse process of your lumbar spinal vertebrae. Because these muscles attach to your spine, if they are tight they can create an abnormal spinal alignment and positioning that can lead to low back pain and dysfunction. It is important to stretch your hip flexor muscles to alleviate pressure and strain on your low back. 
Piriformis stretching for low back pain and hip relief:
    • The piriformis muscle is unique in that it can perform both internal rotation and external rotation of the hip/leg. Because of this, it gets used a lot to provide stability of our hips and lower extremities. Due to the extra use of this muscle and its small size, this is a site of a lot of pain and discomfort in many people! The sciatic nerve goes through the middle of the piriformis and is a common nerve entrapment point that often causes sciatica and radiating pain down the leg. We all want to take time to stretch the piriformis to alleviate pressure in our hips and low back
2.Strengthening for a better back:
    • There are a lot of muscles that help to stabilize the Transverse Abdominis Strengthening: There is a little-known abdominal muscle called the transverse abdominis. It is a large muscle that wraps all the way around your low back and abdomen that stabilizes your lumbar spine. If you have been shopping at a home supply store and notice someone wearing a back brace, these braces are mimicking the transverse abdominis. The Muscles help to support your spine and lower back when you are twisting and bending over! To strengthen this muscle, lie down on your back, supine position. Your spine naturally curves in your low back, this is called lordosis. To engage the transverse abdominis you want to flatten this curve to create a spinal neutral position, a flattened back. If you are having trouble with this think of trying to suck your belly button inwardly. Once you achieve a neutral spine position hold it for 5 seconds, relax, and repeat 10 more times! If this is easy for you add in alternating heel slides keeping your heel in contact with the ground making sure to maintain your neutral spine position in your low back!
Middle Trapezius Strengthening for upper back and shoulder pain:
  • The Middle Trapezius is another Muscle that is very important for posture and proper alignment in our upper back and shoulders is the middle trapezius portion of our trapezius muscle! The middle trapezius helps to adduct and retract the scapula. If the middle trapezius is weak it will cause our shoulders to biome more rounded and have a more forward flexed head position. The Middle Trapezius muscle fibers attach to the spinous process of the cervical vertebrae C1-C6 as well as the supraspinous ligaments of vertebrae down to T3. The fibers are coming from the acromion process and the spine of the scapulae. Perform STJ pinches and high rows to strengthen this muscle and to help your upper back and shoulders avoid back pain and chronic issues long-term! 
Erector Spinae Muscle Group:
  • The Erector spinae muscle group is comprised of three muscles on each side of your body that run the length of your spine along the lumbar, thoracic, and cervical sections: the iliocostalis, longissimus, and Spinalis muscles. These muscles serve to create extension movements in each section of the spine as well as stabilize and protect the spine into and out of dynamic extension movements. These are the only muscles the run vertically the length of the spinal column through all three sections. To strengthen these muscles you can perform; Back extension, Bridges, Bird dogs, prone superman, standing bird dog, standing superman, and a roman chair glute-ham raise.Lower Trapezius strengthening for mid-back stability: The lower trapezius is very important for shoulder and scapula function as well as for Thoracic Spine stability. The Lower trapezius becomes more and more activated the greater you reach up overhead above 90 degrees. Overhead shoulder and arm movements are important for strengthening the middle trapezius and creating more motor recruitment and activation. 

3. Diet:

What we put into our body is an important indicator of what we are going to get out of our body and the way that we feel day to day. There are many great ways to address our body's issues by looking at and addressing our diet.

Achieve a Healthy Weight:

    • It should not come as a shock that in a world full of convenience and fast everything there are more and more barriers to achieving a “healthy” weight. It is important to talk with your doctor and discuss what an ideal weight is for you based on your unique genetic and physical limitations and makeup. But the statistics show that 70 percent of adults in the USA are considered overweight and out of those 40 percent would be considered obese or morbidly obese. We all need to look at what our input is, what we eat, what our output is, how much do we exercise. Every 1 pound of fat equals 3500 calories. It's an unfortunate reality, but it does take a long time to put on weight and it takes even longer to get rid of it. Fat is easier to burn between 50-60 percent of our max heart rate. You can use a heart rate monitor to calculate your heart rate during exercise, but if you don't have access to a heart rate monitor a good rule of thumb for being in your optimal fat burning range is to exercise at a pace that you are pushing yourself but at a pace that you can still carry on a conversation while you are doing it. This would be a brisk, fast, walk or a light jog for most people. Consult with a healthcare professional to figure out a place to fit your specific needs.
Bone Density:
    • As we get older it is very common to start to lose bone density. It is even more common as we get older to start and develop impairments and diagnosis the effect our bones such as osteoporosis, osteonecrosis, osteogenesis Imperfecta, bone infections, and sometimes even bone cancers, but for most of us, these types of conditions are rare. For most of us, it is just a natural process of aging to have a decrease in bone density. It is accepted that men and women will lose 3-5 percent of cortical bone mass per decade after the age of 45 years old. The interesting thing with our bones is that they are constantly being broken down and being built back up by different cell pathways. Osteoclasts break down and dissolve bone tissue and osteoblasts create and form new bone tissue. This process is always ongoing and can be aided and improved with some help from use. Calcium and Vitamin D are essential for these cells to work and for their continued help in strengthening our bones. Be sure to check with your primary care physician and get a blood panel done to see if you are lacking in calcium or vitamin D. If you are lacking in either of these vitamins an increase in the supplemental intake could improve your pain and your bone condition affecting your back pain and possibly much more! In addition to proper nutrition, our bodies are made to move and to have pressure placed on them and through our bones. This pressure that comes through exercise helps to increase the ability and performance of osteoblasts and osteoclasts to continue to break down and build up our bones to make them stronger!
    • Our bodies become inflamed and swollen for many different reasons and the inflammation leads to different disease processes. There are many different ways to fight inflammation in our bodies. Here are some of the things that you can do to fight inflammation:
  1. Turmeric: Many recent studies have shown that turmeric helps to prevent and reduce inflammation that occurs in our joints and in our bodies. It can lead to a reduction in pain, stiffness, and inflammatory arthritis. If you take too much it can lead to an upset stomach so pay attention to how much turmeric you decide to take!
2.Fatty Fish: Other studies show that fatty fish such as salmon, sardines, tuna, and mackerel contain higher levels of Omega-3 fatty acids that help to reduce inflammation and the effects that inflammation has on our bodies!
3.Vitamin E - Vegetables: It has been shown that vegetables filled with vitamin E help to reduce inflammation and the effects of inflammation. Vegetables that are high in vitamin E are; Broccoli, Kale, Asparagus, Spinach, Swiss Chard, and Brussels sprouts. Eat up and enjoy less inflammation and painful joints!
4.Healthy Oils: There are many healthy oils that help to aid in the fight against inflammation.  Avocado, Canola Oil, and Olive oil are High in monounsaturated fats and anti-inflammatory compounds that are also antioxidants! These oils are among the most-studied fats and oils, with many many known health benefits! Take the time to pick out one of these oils to decrease the inflammation in your body!
5.Eat some nuts: Almonds, Walnuts, Pecans, Hazelnuts, Peanuts, and Pistachios many people love and some of you may dislike them, but they contain high amounts of; Calcium, Fiber, Magnesium, Vitamin E, and Zinc which all have anti-inflammatory effects! So pick your favorite nut and get cracking down on your body's inflammation!
6.East some seeds: Chia and flaxseeds are high in omega-3 fatty acids which are proven to fight inflammation in the body and aid in inflammatory disease processes. It's so easy to add into your diet just add a spoonful of ground flaxseeds or chia seeds to your oatmeal, cereal, or Greek yogurt, baked goods, or blend it up into your smoothie!

4. Let's look at your shoes: 

  1. Our feet are very important to how the rest of our body responds to our daily activities and how to disburse and distribute force throughout our body.  Depending on what type of shoes you are wearing can affect your ankle, knee, hip, and back alignment.
    • High Heels: If you are wearing high heels or a wedge you are turning off your gluteus maximus, butt, and walking with more emphasis on calf contraction. Because of this, your glute muscles become weak and your low back becomes unstable and can lead to low back pain. Don't put away your heels for good, just try and mix it up, and don't always wear high heels, but rather put on some flats now and then to create some variety!
    • Variety: It is important to not wear the same pair of shoes day in and day out, but rather mix it up! We tend to wear down our shows with our gait pattern that is unique to us. If you look at the bottom of your shoes you will notice a “wear pattern”. Over time this gets more and more worn down and will lead to abnormal distribution of force up through our legs and into our low back. Make sure that you are changing out your shows and wearing different ones so that your body doesn't get used to the same “wear” patterns.
5.Smoking, are you surprised?:
  • Smoking decreases the absorption and uptake of oxygen into our bloodstream through our lungs which limits the amount of oxygen and nutrients that are delivered through our bloodstream and circulatory system to all the different tissues of our body. Smoking decreases the ability of our circulatory system to expand and contract, vasodilation and vasoconstriction, creating a decrease in the ability for our bodies to regulate and circulate blood flow which leads to greater inflammation and decreases the ability of our bodies to fight against chronic pain impairments. 


6. Pelvic Rotations due to imbalances
  1.  Everyone tends to favor one side of their body more than the other side. We all have a more dominant arm and leg that we tend to use more than the other. Because of this over time it leads to muscular and strength imbalances that cause joints to come out of alignment leading to pain! When it comes to low back pain we need to look at the alignment of our pelvis. When our pelvis is out of alignment it will cause our spine to also be out of alignment and instabilities leading to chronic condition and back, hip, and sciatica pain problems! 
    • Frontal plane rotations: Rotations in the frontal plane would be considered an outflare or an inflare in either your left or right innominate, side of your pelvis. This can be out of alignment for different reasons, but if stuck in this position you would want to look at and compare the muscles supporting this plane of motion; piriformis, gluteus medius, gluteus minimus, and adductor muscles. If there is an outflare and you want to fix it you first need to lie on your back, in supine, and bring your hip up to 90 degrees. Have your Physical Therapist, or someone else,  push the knee/hip towards the middle, medially, until a restrictive barrier is felt. Then you will use your abductor muscles to push your leg laterally against the thigh of your Physical Therapist, hold this isometric contraction for three to five seconds. Repeat up to 5 times as needed. If there is an inflare that you want to correct that is affecting your left or right pelvis first you will want to lie on your back, in supine, bring your hip up to 90 degrees on the affected side. Next, have your Physical Therapist, or someone that is working with you, bring your leg outward, laterally, until a restricted barrier is felt. Next, you will start to push your leg against the hands of your Physical Therapist moving against resistance inwardly to contract your adductors. Hold this isometric contraction for three to five seconds and repeat this muscle energy technique up to 5 times as needed. 
    • Sagittal plane rotations: As many as 70 percent of people have a leg length discrepancy with one leg that is slightly different in length because of this tendency towards using our dominant side of our bodies more. Usually, the discrepancy is small, less than a centimeter, and for most people, it doesn't start to create pain symptoms until many years. But many researchers link these discrepancies in one leg being shorter and one leg being longer to playing a large key role in developing knee, hip, and back pain over time that leads to chronic back pain issues.  When looking at your pelvic alignment you can sit or lie down and look at your leg length on each side. If your pelvis is out of alignment, in the sagittal plane of motion, one leg will be shorter than the other. The Leg that is shorter means that the pelvic innominate on that side is rotated posteriorly, backward, and the longer leg means that the pelvic innominate on the longer leg side is rotated anteriorly, forward. Using a muscle energy technique you can contract the shortened legs hip flexors and the hip extensors on the longer leg and start to rotate the pelvic innominate’s opposite directions and back into optional alignment while also strengthening and correcting the strength deficits that created the malalignment in the first place.