exercises, treatment, and prevention of back pain


In previous articles on this website, I discussed what fibromyalgia is and some of the criteria that must be fulfilled to receive a proper diagnosis. If you have already been diagnosed with fibromyalgia, then you are very much aware that there is no simple treatment. In most cases, it is what the patients can do for themselves rather than what the health care practitioners can do for them.


Like most chiropractors, I am currently treating many fibromyalgia patients. As with any syndrome, some patients respond well and others not so well. The muscles of a fibromyalgia patient are often very tight and extremely tender to the touch. These tight muscles attach to many different bones throughout the body. These bones may be the vertebrae of the spine (neck and/or back), the pelvis, the shoulders, and even the knees. When these tight muscles are applying a constant pull on the bones, the joints at that area will not have their full movement. When any joint has a restricted movement, it will eventually begin to feel “stiff” and “achy”. If this situation is left untreated, the joints can become quite painful. When any patient, with fibromyalgia or not, is experiencing pain in a joint, the body will try to protect that area by even further tightening the neighboring muscles. You can now see how the muscle spasm from fibromyalgia causes joint stiffness, which leads to joint pain, which leads to more muscle spasm, which leads to further joint stiffness, which leads to even more joint pain. This cycle propagates itself until you cannot sleep at night, you feel fatigued, and any amount of activity causes pain.


In terms of conservative or natural treatment, this is where the chiropractor and massage therapist come in. The chiropractor is well trained to identify what joints are being affected and how to restore their movement. This will allow the joints to function in a healthier state and become less painful. The chiropractic treatment is most successful when in conjunction with massage therapy. Without addressing the muscle spasm at the same time, the joints will just become stiff and sore again.

As I mentioned earlier, it is unreasonable for anyone to expect even a team of health care practitioners to decrease his or her fibromyalgia symptoms without the patient doing their part. Because people with this syndrome find it painful to move, they often limit their physical activity. Their muscles become weak and tight from inactivity and the tendons, ligaments, and cartilage are more prone to injury. Despite the extra pain that it may cause, patients should try to get even a few minutes of exercise per day. The key is to start gradually and do only low impact, higher repetition exercises.


If you were expecting to find out that there was a simple and quick treatment for fibromyalgia, I am sorry to say that it doesn’t exist. There are many potential causes of the symptoms and there is no one chiropractic doctor, medical doctor, or massage therapist that can do it all for you. It is generally a team approach that requires you to do your part as well.


Yoga Eases Low Back Pain


The next time your back acts up, maybe in addition to seeing your chiropractor you should try the “the great seal pose”, or the “upward facing dog”, or perhaps the “butterfly pose”. A study of 101 adults with chronic lower back pain compared the benefits of yoga, conventional therapeutic exercise, and the information contained in a popular back pain book. The result: those who took weekly yoga classes for 12 weeks experienced the most increase in function and the biggest decrease in the need for pain medication. The study suggests that for people who are looking to do something for themselves, one could confidently say that yoga eases low back pain.


The official results of the study, which was sponsored by the National Institutes of Health, appear in the Dec. 20 issue of the Annals of Internal Medicine. For the study, the participants chosen were between 20 and 64 years of age and suffered from chronic but not serious back pain — people who “see their primary care doctor because their back is bothering them, and they’re not feeling good”.


The participants, mostly women in their 40s, were divided into three groups. One group took classes in viniyoga, a therapeutically oriented style of yoga that’s relatively easy to learn and also emphasizes safety. The second group attended specifically designed therapeutic exercise classes taught by a physical therapist, which included strength and stretching exercises. The third group was given a copy of The Back Pain Helpbook and asked to read it.


The participants were interviewed four times during the 26-week study, including prior to the start the study and a follow-up at 26 weeks, to assess their ability to do daily tasks, pain level and how much pain medication they took. All three groups reported improved function. But, those who took the yoga class experienced the most improvement. Seventy eight percent of this group improved by at least two points on a standardized measure called the Roland Disability Scale, which assesses how people can perform daily tasks, such as walking up stairs without pain or bending over to tie shoelaces. Sixty-three percent who took the exercise class reported at least a two-point improvement, while 47 percent of those who read the book reported a similar benefit.

The yoga participants also reduced their use of pain medicine more than those in the other two groups. By the end of the 26 weeks, only 21 percent in the yoga class were taking medication for their back pain; 58 percent had been doing so before starting the yoga class. The use of pain medicine for the exercise group dropped to 50 percent from 57 percent, while those who read the book increased their use of pain medication — from 50 percent to 59 percent.


This study tells us that specific yoga classes will help ease mild back pain. However, I suggest that everybody should participate in some form of regular exercise, yoga or not. In fact, everyone should be exercising and seeing their chiropractor regularly to prevent low back pain from occurring in the first place.


Back Strengthening Exercises

Weak Muscles Cause Back Pain.

Weak muscles are often at the root of back pain, especially lower back pain. This is particularly true for people in the baby boomer and elderly age groups. The muscles of the back, the abdomen, and the buttocks all support the spine. These muscles are called the “core” muscles and strengthening them can prevent, reduce and even eliminate back pain. Strong quadricep muscles (the muscles at the front of the thigh) are also important to prevent back injuries when lifting. When you lift properly, it is important to use your legs more than your back. If your legs are weak and unable to take most of the weight when picking something up, then you will put too much stress on your back. In this article, I will demonstrate numerous back strengthening exercises.


Strengthening exercises should be done three or four times per week. The days off give your body a chance to recover. To notice results from your workouts, it may take 6 to 8 weeks to notice results. Just as in stretching exercises, it is important to always do some warm-up exercises before attempting any strengthening exercises. Five minutes of walking, exercise bike, elliptical trainer, or even marching on the spot is enough. Not warming up before stretching leaves your back susceptible to injuries causing back pain. Warm muscles are more flexible than cold muscles and are less likely to be injured.


Many people tend to over do it when starting strengthening exercises for the back, resulting in back strain. Back pain caused by doing too much too soon sets one back even farther. But the ultimate goal is to be able to do the back strengthening exercises regularly and safely. Strengthening the back can’t be rushed. It takes patience but it is well worth the effort.


To prevent back pain, keep your back fit by doing the following strengthening exercises. Start with five repetitions of each exercise. If you can handle five repetitions without post exercise pain the next day, then slowly add a couple of repetitions each week until you reach 15 repetitions. If you are experiencing back pain or suffer from a back condition, ask your chiropractic doctor if the following exercises are appropriate for you to do.


Be sure to warm up before doing back exercises with five minutes of walking, or using an exercise bike or elliptical trainer, or even marching on the spot. Warm-up exercises prepare your back for strength exercises or stretching exercises by increasing circulation to the muscles. Do some stretching exercises after you strength train as contracting your back muscles tightens them up a little.


The Bridge: Strengthening exercises for several core muscle groups

bridge exercise

Lie flat on back; bend knees at 90-degree angle, feet flat on floor. Raise buttocks off floor, keeping abs tight. Shoulder and knees should be in straight line. Hold for a count of five. Slowly lower buttocks to floor. Repeat five times.

The Plank: Strengthening exercises for back and abdomen (also the arms and legs)

plank exercise

Lay on stomach, place elbows and forearms on floor. In a push-up position, balance on your toes and elbows. Keep your back and legs straight. (Like a plank) Hold position for 10 seconds. Relax. Repeat five to ten times. If this exercise is too difficult, use balance on your knees instead of your toes.

The Wall Squat: Strengthening exercises for back, hips and legs.

wall squat

Stand with your back against a wall, heels about 18 inches from the wall, feet shoulder-width apart. Slide slowly down the wall into a crouch with knees bent to about 90 degrees. If this is too difficult, bend knees to 45 degrees and gradually build up from there. Count to five and slide back up the wall. Repeat 5 times.

Leg lifts: Quad Strengthening Exercise

leg lift exercise

Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Keeping the right leg straight, slowly lift it to the height of the left knee. Hold for a count of 3. Repeat 10 times. Switch sides. Work up to 10 sets of 10 over several weeks.

*Safety Tip for Leg lifts:

Lifting both legs at the same time causes excessive stress on your lower back so only lift one leg at a time; the opposite leg should be kept slightly bent with foot on floor.

Crunches: upper abdominal exercise:


Lie on back, knees bent. Do not anchor feet under anything, since anchoring the feet or keeping both legs straight along the floor can strain the lower back. Keep the lower back flat on the floor. Exhale when raising your shoulder blades off the floor and inhale when lowering. Only raise your head and shoulder blades off the floor three to six inches. Sitting up all the way is hard on your lower back. Keep chin tucked in. You can use your hands to support your neck but be very careful not to pull your neck with your hands or you could strain a neck muscle. Do ten repetitions.

Reverse Crunch: lower abdominal exercise:

crunch reverse

Lie flat on back, feet and legs straight up in the air. Bend knees 90 degrees. Place hands under buttocks for support and make sure your lower back remains flat on the floor. Tighten your lower abdomen and then lift your buttocks a few inches off your hands. Hold for a moment and lower back down. Do 5 to 15 repetitions.

Rotational Crunch: obliques exercise: (sides of the stomach)

crunch rotational

Rotational crunch is a slight variation of the regular crunch. The only variation is that when you raise your head and shoulders off the floor, you rotate your upper body one way. Now, give this a try. Lie flat on your back, with your knees bent, and your feet flat on floor. Do not anchor your feet. Rotate your upper body so that your weight is on your left shoulder blade. Then, keeping chin tucked in, bring your head and shoulders upward and raise your right shoulder higher than the left. Then lower the right shoulder back down to the floor. This is one repetition. Do the same on the other side. Do 5 to 15 repetitions. Make sure you end up rotating each way an equal number of times.

Backward Leg Swing: Gluteal exercise: (The buttock muscles help support the spine)

backward leg swing

While standing on the right foot, hold onto the back of a chair for support. Then, without bending your knee, slowly move your entire left leg backwards as far as you can. You should feel your left buttock muscle tighten. Then, slowly return the left leg back to the floor. Repeat 10 times. Switch sides.


When Is Back Pain An Emergency?

Surprisingly, severe back pain isn’t usually a medical emergency. Regardless, one of the most common reasons people go to the emergency room is severe back pain from a simple muscle strain and/or joint sprain. While these conditions can be extremely painful, it usually doesn’t indicate soft tissue or other structural joint/ligament damage to the back. However, there are some back-related problems that could very well indicate a medical emergency. So, the question is, when is back pain an emergency? You should seek medical help immediately if you experience any of the following symptoms.


1) Progressive weakness in the legs or loss of bladder or bowel control

The sudden onset of bladder and/or bowel incontinence and/or progressive weakness in the lower extremities can be an indication of a relatively rare but serious condition called Cauda equina syndrome. Anyone experiencing these symptoms should seek immediate medical attention. Typical symptoms of Cauda equina include:

• Altered sensation, or severe or progressive weakness or numbness in the lower extremities – the legs and/or feet.

• Loss of sensation or altered sensation in the “saddle” area (the area or your body that would sit on a saddle: inner thighs/between the legs, buttocks, back of legs, sacral region).

• Loss of control of bladder or bowels (including retention or incontinence).

• Pain, numbness or weakness in one or both legs that may cause difficulty walking.

Cauda equina syndrome is caused by the compression of nerves in the low back, which can happen from a trauma to the spine, any spinal condition that may compress the nerves (such as a disc herniation, spinal stenosis), or an infection. If left untreated, this syndrome can ultimately result in paralysis, as well as continued loss of sensation in areas below the lower spine.


2) Unexplained loss of appetite, weight loss, pain, or neurological problems

Weight loss from increased exercise or changes in diet can be healthy and can help reduce back pain. However, sudden weight loss and/or lack of appetite for no known reason can be indicative of a serious medical condition, such as cancer. Several symptoms of a tumor in the spine include:

• Pain in the neck or back, followed by weakness or numbness of the arms or legs. As well, a change in normal bowel or bladder activity.

• Back pain that does not diminish with rest, and pain that may be worse at night than during the day.

• Nausea, vomiting, or fever, chills or shakes in conjuction with back pain.


3) Fever, some types of increased pain, and other symptoms of infection

Fever typically indicates some form of infection. An infection of the spine can either occur quickly (e.g., within 1-2 weeks following fusion surgery) or develop over time (e.g. in elderly persons or those with compromised immune systems). Spinal infections are rare, but can be quite dangerous if the infection moves into the spinal canal and causes an epidural abscess (a pus-filled cavity in the epidural space). Pressure from an abscess pressing on the nerve structures in the neck or back can result in paraplegia or quadriplegia.


4) Severe, unrelenting abdominal and lower back pain

The pain of an abdominal disorder can often extend to the back and be felt as acute, continuous low back pain. Acute lower back pain can be a symptom of an enlargement of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm. If the blood vessel ruptures or starts leaking blood this could become a serious medical emergency. The primary symptom of an abdominal aortic aneurysm is severe continuous abdominal and lower back pain. This is a life threatening condition. Anyone with these symptoms needs to seek immediate medical attention.


The above conditions are quite rare compared to the common causes of back pain, and most conditions that cause back pain do not require immediate medical care. Once your chiropractor or medical doctor rules out the above causes of low back pain, conservative treatment should commence. The most frequently used and successful treatment for mechanical low back pain is chiropractic treatment. Once the problem is corrected and the symptoms alleviated, then you should discuss with your chiropractor what lifestyle changes would help prevent it from occurring again.


What To Do When Back Pain Strikes


Back pain can strike almost anyone at any time. Therefore, I thought that this article should cover what you should do if you are unfortunate enough to experience an acute bout of back pain. Most of the recommendations given below apply to a new onset of acute back pain.

• When it comes to acute back pain, do not ignore the pain. It is the body’s way of telling us that something is wrong. Stop doing whatever started the pain attack in the first place and ease yourself gently into a more comfortable position.

• If you are working or exercising hard in a warm environment when the pain hits, drink two large glasses of quality water. This can sometimes give relief within minutes if the muscle spasms are due to dehydration. The body needs a minimum of eight 8-ounce glasses of water daily to keep acidic wastes from building up in muscles and other tissues, which will lead to painful muscle spasms.

• If the pain is severe, try lying on your back, hands by your sides, with your knees up. This takes the pressure off your back.

• If the pain follows an injury or sudden movement, apply ice (a bag of frozen vegetables from the freezer works well) numerous times for twenty minutes at a time, with thirty minutes between applications, for the first forty-eight hours. During this initial 48 hours, it is important to see your chiropractor for further advice.

• When getting up from lying down, roll to your side, draw your knees up, push up to a sitting position using your arms, and stand by pushing up with hands on your legs.

• If it doesn’t cause sharp pain, try doing some gentle stretches. Gentle stretches can actually help you heal more quickly, while inactivity will prolong your pain. Refer to the simple low back exercises available for free on my website (www.merrittchiro.com).

• In general and soon after injuring your back, do not do any bending, twisting or lifting.

• In general and after an acute bout of back pain, keep your knees a little higher than your hips when sitting. At the same time, keep your feet flat on the floor.

• Move around even just a little. Do not sit or lye in the same position for long periods of time. Remaining completely sedentary when you have acute low back pain will only increase your pain and prolong the recovery

• See your chiropractor right away. It is important to have a diagnosis made and appropriate treatment started as soon as possible.

There are also some things you can do to prevent acute back pain from occurring in the first place. I have listed some of them below.

• If you smoke, quit. Studies have shown that people who don’t smoke are more likely to experience long-lasting relief from back pain, including less persistent problems overall than those who do smoke. Smoking also makes the disks in your spine age faster, stiffen, and become brittle. This is because having motion in your spine keeps the water and blood circulating in all of your disks.

• Once the acute pain has subsided and your chiropractor has determined that it is safe, he or she can show you some simple abdominal strengthening exercises. This will strengthen the core muscles and help to prevent recurrences of the back pain.

• When carrying things on your shoulder, switch the weight to the other side from time to time. Carrying heavy shoulder bags/purses may produce neck, back, and shoulder pain.

• Always push large objects; never pull them.

• If you are a nursing mother, put pillows behind your back for comfort and bring your baby to your breast rather than strain your back by bending over your infant. If you’re nursing in a chair, make sure that it’s a chair with good back support.

• Do not sleep on your stomach with your head raised on a pillow. Instead, rest your back by lying on your side with your legs bent, so that your knees are about an inch higher than your hips. Sleep on a medium firm mattress with your head supported on a pillow. If your mattress is not firm enough, place a board between the box spring and the mattress.

• Maintain a healthy weight and get regular moderate exercise, as a lack of exercise can cause back pain. Activities that are good for the back include swimming, cycling, walking, and rowing.

• By seeing your chiropractor regularly, the mobility of the joints and flexibility of the muscles will be improved and maintained in the long term. This will play a key role in preventing your back from becoming sore in the first place.

Finally, if you have been suffering from back pain for quite some time (chronic pain), your chiropractor should examine you right away. Do not wait for it to simply “go away”. If the problem were going to go away on its own, it would have already.