Excerpts c/o Mayoclinic Staff

Back pain is a common complaint. Most people in the United States will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work.

On the bright side, you can take measures to prevent or lessen most back pain episodes. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Symptoms of back pain may include:

* Muscle ache
* Shooting or stabbing pain
* Pain that radiates down your leg
* Limited flexibility or range of motion of your back
* Inability to stand straight

Back pain that lasts from a few days to a few weeks is considered acute. Pain that lasts for three months or longer is considered chronic.

When to see a doctor

Most back pain gradually improves with home treatment and self-care. Although the pain may take several weeks to disappear completely, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. Contact a doctor if your back pain:

* Is constant or intense, especially at night or when you lie down
* Spreads down one or both legs, especially if the pain extends below your knee
* Causes weakness, numbness or tingling in one or both legs
* Causes new bowel or bladder problems
* Is associated with pain or throbbing (pulsation) in your abdomen, or fever
* Follows a fall, blow to your back or other injury
* Is accompanied by unexplained weight loss

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.
Causes

Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks. Disks are the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.

Strains
Back pain most often occurs:

* From strained muscles and ligaments
* From improper or heavy lifting
* After a sudden awkward movement

Sometimes a muscle spasm can cause or be associated with back pain.

Structural problems
In some cases, back pain may be caused by structural problems, such as:

* Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But even so, many people who have bulging or herniated disks experience no pain from the condition.
* Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg.
* Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
* Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.
* Osteoporosis. Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

Rare but serious conditions
In rare cases, back pain may be related to:

* Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the “saddle” or groin area, and loss of bowel or bladder control.
* Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain.
* Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.

Factors that increase your risk of developing low back pain include:

* Smoking
* Obesity
* Older age
* Being female
* Physically strenuous work
* Sedentary work
* Stressful job
* Anxiety
* Depression

Treatments and drugs

Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is OK, but more than a couple of days actually does more harm than good. If home treatments aren’t working, your doctor may suggest stronger medications or other therapy.

Physical therapy and exercise

A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from returning.
Prevention

You may be able to avoid back pain by improving your physical condition and learning and practicing proper body mechanics.

To keep your back healthy and strong:

* Exercise. Regular low-impact aerobic activities — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
* Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
* Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
* Maintain a healthy weight. Being overweight puts strain on your back muscles. If you’re overweight, trimming down can prevent back pain.

Use proper body mechanics:

* Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
* Sit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
* Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

By: Kinesio Taping in Canada

Kinesio Taping gives support and stability to your joints and muscles without affecting circulation and range of motion. It is also used for Preventive Maintenance, Edema, and Pain Management.

Kinesio Taping is a technique based on the body’s own natural healing process. This Kinesio Taping exhibits its efficacy through the activation of neurological and circulatory systems. This method basically stems from the science of Kinesiology, hence the name “Kinesio”. Muscles are not only attributed to the movements of the body but also control the circulation of venous and lymph flows, body temperature, etc. Therefore, the failure of the muscles to function properly induces various kinds of symptoms.

Consequently, so much attention was given to the importance of muscle function that the idea of treating the muscles in order to activate the body’s own healing process came about. Using an elastic tape, it was discovered that muscles and other tissues could be helped by outside assistance. Employment of Kinesio Taping creates a totally new approach to treating nerves, muscles, and organs. The first application of Kinesio Taping was for a patient with articular disorders.

For the first 10 years, orthopedists, chiropractors, acupuncturists and other medical practitioners were the main users of Kinesio Taping. Soon thereafter, Kinesio Taping was used by the Japanese Olympic volleyball players and word quickly spread to other athletes. Today, Kinesio Taping is accepted by medical practitioners and athletes in Japan, United States, Europe, South America and other Asian countries.

The Kinesio Taping Method is applied over muscles to reduce pain and inflammation, relax overused tired muscles, and to support muscles in movement on a 24hr/day basis. It is non-restrictive type of taping which allows for full range of motion.

In contrast, traditional sports’ taping is wrapped around a joint strictly for stabilization and support during a sporting event obstructing the flow of bodily fluids… an UNDESIRABLE side-effect.

Kinesio Tape is used for anything from headaches to foot problems and everything in between. Examples include: muscular facilitation or inhibition in pediatric patients, carpal tunnel syndrome, lower back strain/pain (subluxations, herniated disc), knee conditions, shoulder conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, pre and post surgical edema, ankle sprains, athletic preventative injury method, and as a support method.

As people age, they begin to complain more of pains in their muscles and joints. They seem to stiffen up with age, and such commonplace activities as bending over for the morning paper can make them wince.

Such pain can grip so fiercely that they are sure it begins deep in their bones. But the real cause of stiffness and soreness lies not in the joints or bones, according to research at the Johns Hopkins Medical School, but in the muscles and connective tissues that move the joints.

The frictional resistance generated by the two rubbing surfaces of bones in the joints is negligible, even in joints damaged by arthritis.

Flexibility is the medical term used to describe the range of a joint’s motion from full movement in one direction to full movement in the other. The greater the range of movement, the more flexible the joint.

If you bend forward at the hips and touch your toes with your fingertips, you have good flexibility, or range of motion of the hip joints. But can you bend over easily with a minimal expenditure of energy and force? The exertion required to flex a joint is just as important as its range of possible motion.

Different factors limit the flexibility and ease of movement in different joints and muscles. In the elbow and knee, the bony structure itself sets a definite limit. In other joints, such as the ankle, hip, and back, the soft tissue-muscle and connective tissue-limit the motion range.

The problem of inflexible joints and muscles is similar to the difficulty of opening and closing a gate because of a rarely used and rusty hinge that has become balky.

Hence, if people do not regularly move their muscles and joints through their full ranges of motion, they lose some of their potential. That is why when these people will try to move a joint after a long period of inactivity, they feel pain, and that discourages further use

What happens next is that the muscles become shortened with prolonged disuse and produces spasms and cramps that can be irritating and extremely painful. The immobilization of muscles, as researchers have demonstrated with laboratory animals, brings about biochemical changes in the tissue.

However, other factors trigger sore muscles. Here are some of them:

1. Too much exercise

Have you always believed on the saying, “No pain, no gain?” If you do, then, it is not so surprising if you have already experienced sore muscles.

The problem with most people is that they exercise too much thinking that it is the fastest and the surest way to lose weight. Until they ache, they tend to ignore their muscles and connective tissue, even though they are what quite literally holds the body together.

2. Aging and inactivity

Connective tissue binds muscle to bone by tendons, binds bone to bone by ligaments, and covers and unites muscles with sheaths called fasciae. With age, the tendons, ligaments, and fasciae become less extensible. The tendons, with their densely packed fibers, are the most difficult to stretch. The easiest are the fasciae. But if they are not stretched to improve joint mobility, the fasciae shorten, placing undue pressure on the nerve pathways in the muscle fasciae. Many aches and pains are the result of nerve impulses traveling along these pressured pathways.

3. Immobility

Sore muscles or muscle pain can be excruciating, owing to the body’s reaction to a cramp or ache. In this reaction, called the splinting reflex, the body automatically immobilizes a sore muscle by making it contract. Thus, a sore muscle can set off a vicious cycle pain.

First, an unused muscle becomes sore from exercise or being held in an unusual position. The body then responds with the splinting reflex, shortening the connective tissue around the muscle. This cause more pain, and eventually the whole area is aching. One of the most common sites for this problem is the lower back.

4. Spasm theory

In the physiology laboratory at the University of Southern California, some people have set out to learn more about this cycle of pain.

Using some device, they measured electrical activity in the muscles. The researchers knew that normal, well-relaxed muscles produce no electrical activity, whereas, muscles that are not fully relaxed show considerable activity.

Using resistance bands can be an effective component of any workout routine, and stomach exercises are no exception. There are a number of exercises targeting the midsection that incorporate resistance bands. Resistance bands come in a variety of difficulties, usually indicated by the color of the band itself (e.g., green can be little resistance, yellow may be medium, red for difficult, etc.). Choose a resistance level that is appropriate for you, then move up as necessary. Do not overdo it by immediately grabbing the most advanced band you can find, as this can lead to injury. As with any workout routine, be sure to consult a professional before beginning and always warm up properly to avoid injury.

Seated Crunch
This exercise provides the same benefits as the basic abdominal crunch, but with less neck strain and without the possible discomfort that comes with lying on the floor, since it uses a band rather than gravity to provide resistance. For this stomach exercise, you will need to be sitting in a straight back chair which you can somehow loop your band through. Sit up straight with your feet flat on the floor and about as wide apart as your hips. Contract your abdominal muscles, and slowly bend forward to about a forty-five degree angle. Repeat for an entire set. Be sure to keep your feet on the floor and your back as straight as possible.

One-Arm Band Pull
Put the chair away and stand up, again with feet hip width apart. Put your hands above your head, holding the band about eighteen inches apart. Keeping your left hand overhead, bring your right hand out to the side, elbow bent at about a ninety degree angle. Hold your left arm still as you contract your abdominals and lower your right arm until your hand is in line with your chest. Hold this position, then slowly return. Repeat for an entire set, then switch hands. Keep your back straight and avoid bending or leaning at the waist. For an additional challenge, do this exercise standing on one foot. Perform the exercise with both hands while standing on your left foot, then do it all again on your right foot.

Twisting Roll-Back
For this stomach exercise, you will need to sit on a flat surface, preferably the floor. Use a mat or towel for cushioning to ease possible strain on your tail bone. Sit down with your legs bent and heels on the floor. Your toes should be pointing up– do not put your feet flat on the floor. Loop the band around your feet, put one end in each hand and put your hands together. In a rolling motion, lower your torso toward the floor about forty-five degrees. As you do this, twist to the right and spread your hands to the sides. Hold for a second, then rotate back to the middle and raise your torso back to start. Your heels should remain on the floor throughout the exercise. Do a full set, then switch to the left side.

By: Darrow Wellness Institute L.A. Ca.

Most patients are familiar with diagnostic ultrasonography or “ultrasound” which is used to discern problems deep in the body without breaking the surface of the skin, by bouncing and measuring high frequency sound waves to create audio “images”. Less common is the awareness of this remarkable technology as a therapeutic tool.

Therapeutic Ultrasound is one of the most common electrophysical modalities used by physicians in today’s technologically advanced nations, and has been for several decades. Its effectiveness has been enhanced over the years by studies which helped determine optimum techniques and patterns of application, and a wide range of injuries have shown to be responsive to this popular, non-invasive therapy.

A deep tissue heating modality reaching underlying tissues as deep as 1 to 5 centimeters, it is used to treat musculo-skeletal injuries, back and joint conditions, limited range of motion, soft tissue injuries, and chronic conditions.

Treatment is administered directly which penetrates the tissues, increases blood flow, relaxes muscle spasms, repairs damaged tissue, and dramatically speeds the healing process. It creates permanent, physical changes and repairs both hard and soft tissues problems.

One of the major advantages of ultrasound is that it is nontoxic and nondestructive. The healing response is directly proportional to the input of ultrasonic energy and is somewhat dependent on ultrasonic frequency, which are highly variable and, although proven to be effective in many case studies, is being continually refined through newer studies designed to measure the effects of time, frequency and intensity of applications on various body structures and conditions affecting them.

For soft tissue healing, ultrasound uses high frequency sound waves, well beyond the range of human hearing, which cause molecules in the tissues to vibrate, producing heat and mechanical energy.

The main piece of equipment is a high-frequency generator, which provides an electrical current through a coaxial cable to a transducer contained within an applicator. The crystal in the ultrasound head expands and contracts which produces the necessary sound wave.  By adjusting the frequency of the waves,  the therapist can target tissues for either healing or destruction,  or simply use the device to reduce pain.

Ultrasound therapy can be applied directly to the skin or through a water medium. When applied directly, it must be performed using a coupling gel. Ultrasound can also be done in a tub of water or through gel packs.

Ultrasound is commonly used by athletic trainers. In fact, ultrasound therapy has become the most commonly used deep therapeutic heat modality in sports medicine, valuable for the rehabilitation of many different injuries because it stimulates the repair of soft tissue injuries and also relieves pain.

Although simple in principle, the use of ultrasound as a therapeutic modality requires a comprehensive  understanding of its effects on the body tissues and of the physical mechanisms by which its effects are produced.  The lower the frequency used, the deeper is the penetration of the waves into the body. And by varying the frequency from continuous to intermittent, the amount of heat applied can likewise be controlled by the practitioner.

Early practitioners used continuous or “thermal mode” ultrasound to treat contusions and muscle injuries, but it was quickly determined that pulsed or intermittent waves were more practical for most therapeutic applications. While providing highly effective “micromassage” which is thought to assist in the reduction of swelling and edema,  pulsed ultrasound is free of the intense, possibly tissue-damaging “heating effect” on tissues when using the non-pulsing thermal mode. The thermal mode is used primarily where heat is an essential element of the treatment.

Medical studies have shown therapeutic ultrasound to be a versatile tool with a wide range of uses.

by: Elaine Moore

New studies show that hydrotherapy benefits patients rehabilitating from strokes, traumas, and other injuries as well as connective tissue diseases and asthma.

Hydrotherapy refers to the medicinal use of water, including hot tubs, cold water treatments, ice packs, vapors, saunas, mineral springs, hot springs, sitz baths, wet towel applications, water exercises, and water massage. Hydrotherapy immersion waters available at spas may be rich in specific minerals or enhanced with aromatic oils or herbs. Many different forms of hydrotherapy are available. It’s important to use the correct type of treatment since extremes of heat or cold and could be dangerous for some people.
Benefits of Hydrotherapy

Hydrotherapy increases blood circulation, including circulation of the immune system’s white blood cells. Hydrotherapy also increases the body’s production of endogenous opioid peptides, particularly endorphins. Enhanced circulation and increased endorphins strengthen the immune system, reduce inflammation, heal injured tissue, improve well-being and energize the body.

Hydrotherapy also supplies fresh nutrients and oxygen to injured tissue and helps with the removal of waste products. In injuries alternate applications of heat and cold accelerate healing by improving blood vessel integrity and muscle tone. Heat causes peripheral (surface) blood vessels to dilate or expand. Cold causes peripheral blood vessels to constrict and drives blood back to the organs.
Conditions that Benefit from Hydrotherapy

Hydrotherapy aids the rehabilitation process in injuries and stroke, and it improves respiratory infections. Hydrotherapy is also known to reduce pain and inflammation in arthritis and other rheumatologic conditions. In addition, hydrotherapy reduces the effects of stress by increasing endorphin production, improves sleep, and prevents headaches.

Hot tub hydrotherapy is also reported to improve blood sugar levels in patients with diabetes, lower blood pressure, and reduce symptoms in patients with multiple sclerosis, fibromyalgia, tendonitis, scoliosis, carpal tunnel syndrome and bursitis. Recent studies also show that cold water treatments, including swimming, are potentially effective treatments for depression and also offer pain relief. In patients undergoing strength training, hydrotherapy has also been found to improve recovery times.

by: Gerwin,R.; Harris,R.E.; Clauw,D.J

Myofascial pain syndrome (MPS) is a condition characterized by chronic and, in some cases, severe pain. It is associated with and caused by “trigger points” (TrPs), which are localized and sometimes extremely painful contractures (“knots”) found in any skeletal muscle of the body. The symptoms can range from referred pain through myofascial trigger points to specific pains in other areas of the body.

MPS may be related to a closer-studied complex condition known as fibromyalgia. By accepted definition, the pain of fibromyalgia is generalized, occurring above and below the waist and on both sides of the body. On the other hand, myofascial pain is more often described as occurring in a more limited area of the body, for example, only around the shoulder and neck, and on only one side of the body.

Neither MPS nor fibromyalgia is thought to be an inflammatory or degenerative condition, and the best evidence suggests that the problem is one of an altered pain threshold, with more pain reported for a given amount of painful stimuli. This altered pain threshold can be manifest as increased muscle tenderness, especially in the certain areas, e.g., the trapezius muscle. These syndromes tend to occur more often in women than in men, and the pain may be associated with fatigue and sleep disturbances.

The precise cause of MPS is not fully understood and is undergoing research in several medical fields but there are some systemic disorders, such as connective tissue disease, that can cause MPS. Unfortunately, many practitioners consider it too generalized and, since physicians’ specializations have become so narrow, they do not want, nor have the necessary current information, to treat the condition.

A new form of therapy called myofascial release, using gentle fascia manipulation and massage, is believed by some to be beneficial and pain-relieving.

Myofascial pain syndromes can arise of distinct, isolated areas of the body, an example being urologic chronic pelvic pain syndromes (UCPPS). People who suffer from this syndrome are many times in “unbearable” pain which moves at will from one point in the body to the next. It has been found that mild pressure on “trigger point” areas may relieve some of the discomfort by calming down the nerve pain.

Three different categories are effective in the treatment of myofascial pain. 1) Anti-depressants: Primarily SNRI’s 2) Calcium channel blockers: Pregabalin (Lyrica) 3) Musculo-Skeletal relaxants: Baclofen 4) Muscle stretching 5) Cryo-therapy