February 17, 2025

LOW BACK PAIN IS COMMON! 

Do you have low back pain (LBP)? You are not alone! Up to 50% of the adults in the United States will experience LBP in any 3-month timeframe over the course of a year. 80 percent of adults experience low back pain at some point in their lifetimes. One in 10 people around the world suffer from LBP. It is the #1 cause for job disability, more than any other health problem.
 

Chronic back pain (pain that lasts 6 weeks or more) is associated with a number of changes in the body, including: 

• reduced body mobility.

• a lower quality of life.

• shorter longevity.

• thinning of certain regions of the brain, which may lead to cognitive impairments.

• increased rates of other health problems.

SYMPTOMS 

• The most common signs and symptoms of back pain can include: Muscle ache

• Shooting or stabbing pain

• Pain that radiates down your leg

• Pain that worsens with bending, lifting, standing or walking

• Pain that improves with reclining

• The bark of low back pain is usually much worse than its bite. The pain almost always makes it seem worse than it is. Very rarely is LBP a sign of something dangerous.

Symptoms to take seriously and get examined immediately (as in stop reading this and get help right now!) are: 

• Loss of bladder or bowel control (incontinence).

• True numbness around the groin and buttocks in a “saddle” pattern.

• Recent physical trauma, especially if you are elderly, on immunosuppression drugs or prolonged steroid use.

• Sudden foot drop or inability to push off foot.

“WHY DOES MY BACK HURT?”

Most cases of back pain are mechanical or non-organic (up to 97%) —meaning they are not caused by serious conditions, such as inflammatory arthritis,

infection, fracture or cancer.

Most people with an acute bout of back pain recover. However, the likelihood they will have another bout increases by 50% after the first, and then increases exponentially with each subsequent episode. For many, LBP can become chronic, meaning it lasts for 6 weeks or more.

For some there is a single trigger for their LBP. These are muscle strains (“pulled muscle" or "knots"), joint sprains, prolonged sitting, or injury.

For many there is a combination of causes that usually predispose you and contribute to your back pain.

These include:

• Age - back pain is more common as you age, especially over 50. 

• Herniated or ruptured discs – these can often cause pain or sciatica.

• Arthritis or disc degeneration – thinning of the spaces between your spinal bones (vertebrae) and bone spurs.

• Spinal curvatures – increased or decreased spinal curves can contribute to back pain.

• Mental or emotional stress – causes muscle tension in your back.

• Mental health factors – people with depression or anxiety experience more back pain.

• Prolonged sitting or standing – increases the stress on your spinal discs.

• Heredity or genetics – some spinal deformities and irregularities are inherited.

• Poor fitness – back pain is more common in people who are less fit

• Weak core muscle strength – lack of support for your spine.

• Diet – a diet that causes inflammation contributes to back pain.

• Overweight -being overweight increases the stress on your spine.

• Smoking – people who smoke are more likely to suffer back pain and sciatica due to reduced blood flow.

• Osteoporosis – thinning and weakening of the vertebrae which can lead to compression fracture.

• A history of trauma – damage to the spine can add up as you get older.

• Backpack overload in children – backpack should not be more than 15 to 20 percent of a child’s body weight.

HOW IS LOW BACK PAIN DIAGNOSED? 

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. An examination of how your back is functioning can often find the cause of most mechanical back pain. 

Patients with low back pain that indicate the need for an X-ray may include: 

• Age is over 50

• History of malignancy

• Fever or weight loss

• Trauma

• Weakness in your legs

• Steroid use

• Drug abuse

• Signs found on your examination

More advanced tests such as MRI, CAT scans, Bone scans, EMG, blood tests, etc. are usually not needed in most cases and are ordered as indicated by your history, examination, or your response to treatments. 

SELF TEST YOUR BACK PAIN: 

The following 5 self-tests can help you and your doctor determine the cause of your back pain. THESE ARE NOT INTENDED TO MAKE A DIAGNOSIS OR TREATMENT RECOMMENDATION. They are for informational purposes only. 

1. POSTURE:

Have someone take a picture of your posture from behind.

2. FORWARD BENDING TEST:

Stand up straight. Bend forward and try to touch your toes. If you have pain bending down or coming back up, then you have a back problem likely caused by muscular problems or the intervertebral discs. If you can’t bend past your knees then you have spinal and/or hip stiffness.

3. BACK BENDING QUADRANT TEST:

Look up, arch your back, and bend backwards. Come back to standing straight. Twist your body to the left and then bend backward again. Then twist to the right and bend backward. Pain on either these movements indicates a back problem, likely in the back (facet) or sacroiliac joints. If holding these positions causes pain or tingling into the legs, it’s possible you have spinal stenosis. 

4. SIT TO STAND TEST:

Sit upright in a chair. Keeping your back straight, try to stand up. If you get a pain or a “catch” coming up, need to bend at the waist, or you need to lean to the side and use your hands to “walk” yourself up, you likely have a back problem related to loading the intervertebral discs or sacroiliac joints.  

5. SLUMP TEST:

Sit in a chair and straighten out your leg by extending your knee. Then pull your foot towards you, tuck your head and curl your body forward. If any of these produce sharp, burning, or tingling into your lower back and especially the back of your leg, you may have a sciatic nerve irritation or disc problem (Sciatica). 

TREATMENT OPTIONS: 

There are several treatment options for patients with low  back pain. Here are a dozen of the most common and the evidence of their benefits and risks. 

1. Chiropractic Manipulation on (Adjustments) and Manual Therapy

Benefits: Among the benefits of chiropractic care are included:

• Relief from back and neck pain. 

• Relief from headaches.

• Relief from pregnancy related backache.

• Correction of hip, gait, and foot problems

• Improved flexibility, stability, balance and coordination. 

• Prevention of work-related muscle and joint injuries.

• Improved function and ability to better perform normal activities of daily living.

• Reduced odds of using opioid drugs or having surgery.

• Chiropractic care protects against or slows declines in functional and self-rated health among Medicare patients.

• The use of chiropractic adjustments is the most effective method of care for most people with spinal pain and other conditions, whether used by itself or in combination with standard medical care. 

Risks: Any treatment that increases movement in people (including manipulation, stretching, exercise, massage, etc.) commonly produces transient symptoms. (5) The most common side effects of chiropractic manipulation are temporary muscle soreness, stiffness, headaches, fatigue or a temporary increase in pain. Occasionally dizziness, nausea, radiating discomfort, or bruising may occur. These are self-limited and resolve without further problems within 24-48 hours. (6) Serious complications are rare and remote, with estimates ranging from ~ 1 in 2 million to ~1in 8 million. These may include disc injury, dislocations, fractures, or possible damage to the arteries of the neck that may lead to complications such as stroke. (7) Many reported injuries of Chiropractic manipulation occur with non-Chiropractic providers attempting to apply Chiropractic-like procedures, without the highly developed skill and experience of a doctor of Chiropractic. (8) The relative risk of all chiropractic manipulation and manual therapy is estimated to be 37,000–148,000 times safer than drugs and 55,500–444,000 times safer than spinal surgery. (9) 

2. Over the Counter Drugs

Benefits: Over the counter drugs such as Aspirin, Ibuprofen (Motrin, Advil) , Acetaminophen (Tylenol), Naproxen (Aleve) and other non-steroidal anti-inflammatory medications (NSAIDs) can be used to temporarily reduce pain and inflammation in mild and moderate pain joint and muscle conditions. 

Risks: Short-term use (~ 1-2 days) usually cause no significant problems, although side effects such as nausea, vomiting, rashes, dizziness, and allergic reactions may occur. (10)

Approximately 1 in 50 people taking NSAIDs have an adverse reaction, most commonly of the GI and cardiovascular systems. Long term use of NSAIDs can cause serious side effects in the form of stomach and intestinal irritation, ulcers, and bleeding in as many as 60% of users. (11)  Always take NSAIDs with meals to help decrease this risk. There is an increased rate of heart attacks and stroke with prolonged NSAIS use. (12) People most at risk are those older than 60 years of age; are already taking an anticoagulant, corticosteroids, and/or low-dose aspirin; have a history of peptic ulcer disease; have had stomach problems before; have cardiovascular disease; have Helicobacter pylori infection. (13)  Acetaminophen has no pain-relief effect on back pain, accounts for more than 50 percent of drug overdose related liver failure and about 20 percent of liver transplant cases, as well as kidney disease. (14) Each year, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths. (15) 

3. Prescription Medicines: Muscle Relaxant, Anti-inflammatory, and Pain Relief Medications

Benefits: Short-term use of prescription pain relievers can temporarily reduce pain and inflammation and are used in severe cases. The short-term use of steroid (e.g., prednisone, cortisone, and methylprednisolone) and non-steroidal anti-inflammatory COX-2 inhibitor medications (e.g., Celebrex, Vioxx, Voltaren, Cataflam. and Diclofenac) may help decrease inflammation and the pain it causes temporarily. The short-term use of muscle relaxants has been shown to be questionable. 

Opioid drugs such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are used to treat severe pain after surgery, and sometimes to treat chronic pain. They are powerful painkillers that block messages of pain to the brain, decrease the body's perception of discomfort, and may also create a feeling of euphoria. 

Gabapentinoids (Gabapentin and Pregabalinare) are also used for chronic back and nerve pain. Studies have shown little to no benefit from their use, and an increase risks of dizziness fatigue, visual disturbances, and cognitive functions. (16) Muscle relaxants are no more effective than NSAIDs, and the combination of muscle relaxants and NSAIDs brings no further benefit. Antidepressants have shown no benefit for spinal pain. (17)

Risks: Short term use of prescription drugs usually causes no significant problems, but side effects such as nausea, drowsiness, vomiting, rashes and dizziness may occur. No research supports the long-term effective use of these drugs. Long-term use could cause a number of significant complications that vary from drug to drug. COX-2 inhibitor drugs are NSAIDs that have less GI complications than their over-the counter counterparts, but have found to have a 42% increase in heart attacks (myocardial infarction) and adverse effects on the liver and kidneys. (18)  Opioids are harmful and come with many risks, including addiction. Long-term opioid use may cause nausea, itching, drowsiness, constipation, bowel distention, falls, slowed reaction time, and slowed breathing. Taking opioids for 4 weeks or longer puts you at risk for dependence or addiction. The World Health Organization estimates that worldwide, about 0.5 million deaths are attributable to drug use. More than 70% of these deaths are related to opioids, with more than 30% of those deaths caused by overdose. (19) 

4. Hospitalization

Benefits: In-patient hospitalization is unnecessary and ineffective for almost all back problems. The only clear candidates for hospitalization have had severe trauma or injury, spinal fracture, internal disease, or need surgery.  Chiropractic care provides more effective long and short-term benefits than hospital treatment.  

Risks: The average hospital stay for back or neck pain is about 5 days. (20) Hospitalization increases one’s chance of a hospital-acquired infection, muscle weakness, falling, and medical error. (21, 22, 23, 24)  Research by Harvard Medical School found a 1% risk of serious injury due to medical error during a hospital admission. (17) 

5. Physical Therapy

Benefits: Modalities such as electrical muscle stimulation, TENS, ultrasound, hot packs, ice packs, etc. have very limited benefit and short-term effectiveness. (25, 26) Chiropractic manipulation and manual therapy are more effective than physical therapy for back and musculoskeletal problems. (27, 28) 

Risks: Various risks depending on the specific form of therapy utilized. No serious consequences when applied by a professional under the direction of a chiropractic, DPT or medical doctor.  

6. Surgery

Benefits: There are many different types of surgery for the spine for various conditions. These include fusion, laminectomy, minimally invasive, neurostimulator insertion, etc. Potential benefits from surgery are variable and specific to each patient. Patient selection is essential, and a patient should always get a second opinion before consenting to spinal surgery. Only 1% of spinal cases (like fractures, dislocations or certain nerve damage cases) can reliably benefit from surgery. The benefits of most spinal surgeries by itself are regarded as small. (29) Lumbar fusion surgeries have poor outcomes and commonly require reoperation. (30, 31, 32) Repeat spinal surgery have diminishing returns with each additional surgery. (33)

Risks: Complications include blood clots, infection or sepsis, wound infections, pneumonia, superficial wound infections, and reactions to anesthesia. The overall complication rate for spinal surgery is varied depending on the type of surgery, the patient’s health status, etc.. (34,  35)  1 in 5 spinal surgery patients develop PTSD.

7. Acupuncture & Dry Needling

Benefits: Acupuncture may give short-term easing of chronic low back pain, neck pain, osteoarthritis/knee pain, and headaches. (42) Acupuncture produces poor long-term results. (43, 44) 

Risks:  The most common side effects of acupuncture include bleeding, soreness, or bruising at the site of needle insertion. When applied by a licensed professional, there is a very rare chance of significant problems.  

8. Bed Rest

Benefits: Bed rest may reduce pain, but should not exceed 1 to 2 days. Bed rest is never recommended as the sole treatment method for spinal problems. (45) However, good mattress and pillow support is crucial for healing. 

Risks: Exceeding 2 days of bed rest slows recover and weakens the muscles and bones of the spine – which can lead to chronic back problems. (46) 

9. Exercise

Benefits: Exercise is an integral component of any successful rehabilitative spinal program. When performed properly, exercise can improve the strength and endurance of spinal muscles and reduce pain. There is no evidence that some specific types of exercises are superior to others. (47) Strengthening exercises, endurance or stretching exercises have shown to be beneficial as part of an overall plan in the treatment of chronic neck pain, cervicogenic headache and cervical radiculopathy. (48)   Exercise is mildly beneficial in the treatment of acute and chronic back pain, but is moderately helpful in preventing recurrences of back pain. (49)  Mind-body movement exercises such as yoga, tai chi, chi-kung, and Pilates are helpful. (50, 51) Aerobic exercise is helpful.

Risks: Under the supervision of a doctor or therapist there are little risks. However, when performed improperly, exercise can complicate and worsen a spinal condition. 

10. Injections: Epidural Steroid, Facet & Sacroiliac Joint, Medial Bundle Branch Blocks, and Trigger Point Injections.

Benefits: Short-term benefits were found in some studies; other studies have found no benefit. (52, 53) 

Risks: Common side effects after an epidural include nausea, headache, dizziness, fainting, temporary headache and flushing. Serious complications are possible, including infection, bleeding, and allergic reactions. (54, 55)  

12. Psychological Therapies

Benefits: Cognitive Behavior Therapy, Hypnosis, Mindfulness, and other forms of psychological and behavioral therapies can be helpful with all kinds of chronic pain conditions. They can be incorporated into a holistic treatment program. 

Risks: Virtually none if done under professional care and training. The main risk is using these as stand-alone treatments and ignoring the physical and chemical factors.

11. No Treatment

Benefits: Some minor and acute spinal pains might go away without treatment (Ask about the 3-day & 2-week rules). Pain is not an accurate indicator of the need for treatment.

Risks: Delaying treatment can result in reduced mobility and increased scarring of spinal tissues. Acute pain may go away, but the underlying condition remains and progresses silently into a chronic condition that is often more difficult to treat. It might turn a simple case into a complicated condition that will be costlier to treat and will yield less favorable results. (57, 58)

Most back pain can be managed with a combination of professional help, exercise, and good self-care. You do have options! Don’t let back pain ruin your life.  

Our chiropractic office specializes in treating patients with all kinds of low back pain. We use cutting edge hands-on care, traction, focused exercise, nutrition, and other effective therapies.  If you have any questions or would like to discuss how our care may help you, your family members, or friends, feel free to contact me by phone or email at:

David I. Graber, DC, DACBSP 

GRABER CHIROPRACTIC CENTER 

140 Littleton Road Suite 200 

Parsippany, NJ 07046 

973-335-1100

drgraber@drgraber.com 

www.DrGraber.com 

Dr. David Graber is a nationally recognized Chiropractic Sports Physician who has been in practice since 1987. Thousands of patients over the past 30 years have found relief through his care. He is the 2012 New Jersey Chiropractor of the Year, and lectures around the country for several chiropractic colleges on the diagnosis and non-surgical treatment of the spine and extremities. He has developed over 25 cutting edge hands-on courses on chiropractic adjustments, manual care, and rehabilitation. 

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18 Hennekens CH, Borzak S. Cyclooxygenase-2 Inhibitors and Most Traditional Nonsteroidal Anti-inflammatory Drugs Cause Similar Moderately Increased Risks of Cardiovascular Disease. Journal of Cardiovascular Pharmacology and Therapeutics. 2008;13(1):41-50.. 

19 https://www.who.int/news-room/fact-sheets/detail/opioid-overdose. 

20 https://www.boneandjointburden.org/2014-report/iib2/hospitalization. 

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27 Cambron JA, Gudavalli MR, McGregor M, et al. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Chiropractic and Osteopathy 2006:14:19. 

28 Khodakarami N. Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation. Healthcare (Basel). 2020 Feb 24;8(1):44.  

29 Bogduk, Nikolai, and Gunnar Andersson. “Is spinal surgery effective for back pain?.” F1000 medicine reports vol. 1 60. 27 Jul. 2009, doi:10.3410/M1-60 

30 Nguyen TH, Randolph DC, Talmage J, Succop P, Travis R. Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study. Spine (Phila Pa 1976). 2011 Feb 15;36(4 

31 Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R. Lumbar spine fusion: what is the evidence? Intern Med J. 2018 Dec;48(12) 

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33 Daniell, James R, and Orso L Osti. “Failed Back Surgery Syndrome: A Review Article.” Asian spine journal vol. 12,2 (2018) 

34 Schoenfeld AJ, et al. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. The Journal of bone and joint surgery American volume. 2011 Sep 7;93(17): 

35 Wolters Kluwer Health. "New model predicts complication risks in surgery for spinal cord compression." ScienceDaily. ScienceDaily, 21 June 2016. 

36 Oregon Health & Science University. "One-fifth of spine surgery patients develop PTSD symptoms." ScienceDaily. ScienceDaily, 28 September 2012. 

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39 Diederik C Bervoets, et al, Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review,Journal of Physiotherapy,Vol 61, Issue 3,2015,Pages 106-116, 

40 Furlan  AD, Giraldo  M, Baskwill  A, Irvin  E, Imamura  M. Massage for low‐back pain. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD001929. 

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42 National Center for Complementary and Integrative Health (NCCIH). Acupuncture: In depth. January 2016. https://nccih.nih.gov/health/acupuncture/introduction. 

43 Gattie Eric, et al, The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis, Journal of Orthopaedic & Sports Physical Therapy 2017 47:3, 133-149.

44 Mu  J, Furlan  AD, Lam  WY, Hsu  MY, Ning  Z, Lao  L. Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013814.

45 Koes B. Moderate quality evidence that compared to advice to rest in bed, advice to remain active provides small improvements in pain and functional status in people with acute low back pain. Evidence-Based Medicine.

2010;15(6):171-172.

46 Fernandez M, Hartvigsen J, Ferreira ML, et al. Advice to Stay Active or Structured Exercise in the Management of Sciatica. Spine. 2015;40(18):1457-1466.

47 Malfliet A, et al. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J Clin Med. 2019 Jul 19;8(7):1063. doi: 10.3390/jcm8071063.

48 Gross A, et al.  Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004250.

49 Choi BKL, Verbeek JH, Tam WWai-San, Jiang JY. Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555.

50 Juyoung Park, Cheryl A. Krause-Parello, Chrisanne M. Barnes. A Narrative Review of Movement-Based Mind-Body Interventions. Holistic Nursing Practice, 2020; 34 (1):

51 Yamato TP, et al. Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010265.

52 Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis & Treatment of Low Back Pain. North American Spine Society. 2020.

53 Ter Meulen BC, Maas ET, Vyas A, et al. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):215. 

54 Manchikanti L, Buenaventura RM, Manchikanti KN, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199-245. 

55 Ter Meulen BC, Maas ET, Vyas A, et al. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):215. 

56 Castelnuovo, Gianluca et al. “Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.” Frontiers in psychology vol. 7 115. 19 Feb. 2016. 

57 A Feizerfan, FRCA, G Sheh, BHB MBChB FAFRM(RACP) FFPMANZCA, Transition from acute to chronic pain, Continuing Education in Anaesthesia Critical Care & Pain, Volume 15, Issue 2, April 2015, Pages 98–102.
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