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When the pain is all behind you, just keep movin’. That’s a suggestion from Kaixuan Liu, MD, PhD, medical director of the Atlantic Spine Center and a world-renowned endoscopic spine surgeon, who says chronic, non-specific lower back pain may be best treated with low-impact exercises, yoga, Pilates, heat, massage therapy, physiotherapy, and other “non-medicinal” approaches.

His comment echoes that of the American College of Physicians (ACP), which advised doctors in February 2017 to avoid, whenever possible, giving lower back pain patients prescription drugs or subjecting them to costly medical therapies or surgery. Experts writing in a March 2018 issue of the journal, Lancet, said educating patients and encouraging them to remain active and at work should be the first step doctors take in treating complaints of lower back pain.


In a corroborating report, published online April 16, 2018 in JAMA Neurology, researchers indicated that chronic back pain patients experienced significant relief when enrolled in an experimental program of “neuroscience education” to revise their perceptions of pain and “cognition-targeted motor-control” therapy involving a combination of exercises, including stretching and strengthening of back muscles.

Although underscoring the importance of patient education and activity, Dr. Liu says some of the experts’ back-pain recommendations may be “oversimplified.” That’s because the lower back, or lumbar, region, which includes vertebrae Li-L5, is a complicated structure of overlapping ligaments holding the vertebrae in place, tendons, muscles and an array of nerves emanating from the spinal column – all of which make diagnosing the source of a patient’s back pain a sometimes-difficult task, he explains. Affecting an estimated 540 million people worldwide, lower back pain is a leading cause of disability – and early retirement. In the United States, approximately 80 percent of the population experiences this problem at some point in their lives.“Frankly, the lower back supports most of the upper body’s weight. Pain in that area can be truly debilitating,” Dr. Liu explains.

Most lower back pain is the result of biomechanical problems, caused by muscle strains or ligament tears; obesity; spinal discs that wear out due to age; ruptured discs and the nerve compression from herniated or “slipped” discs; injuries that occur in sports, car crashes or falls; and spinal stenosis, a narrowing of the spinal column, Dr. Liu says.Less commonly, the pain may be due to underlying medical conditions, including osteoporosis, inflammatory joint disease, kidney stones, even tumors. Dr. Liu agrees that, for certain types of lower back issues, recommended self-care emphasizing low-impact aerobics, stretching and other forms of activity oftentimes proves sufficient for resolving lower back pain. But, some patients will require additional medical help, such as prescriptive muscle relaxants, pain-relief medications, epidural steroid injections, pulsed radiofrequency or transcutaneous electrical nerve stimulation, spinal manipulation or physical therapy, to ease their pain, he says.

“Surgery, such as microdiscectomy to fix a herniated or deteriorated disc, could later prove necessary, depending on diagnosis and achievement of a satisfactory level of improvement using non-surgical approaches,” Dr. Liu says. Most lower back pain eventually resolves on its own. Dr. Liu, however, advises patients to contact a physician if intense, acute pain persists for a month or more or pain develops into a chronic problem (endures beyond three months). Lower back pain is the driver for an estimated 2.6 million visits annually to hospital emergency departments, where care is costly and not always provided in ways recommended for back pain. In fact, some 60 percent of back-pain patients are simply prescribed opioid medications when they go to the emergency room, according to statistics.