Healing Your Low Back Pain

Low back pain is the most common condition I treat here at Integrative Medicine of Pueblo and it affects my patient’s quality of life to an enormous extent. The pain prevents them from enjoying time with family and friends, doing their usual activities, sleeping well and just their overall mood. 

This is an extremely common condition, with almost every human experiencing some form of low back pain at some point in their life. 

Read on to learn ways to both prevent low back pain from happening to you as well as how to treat it if it does show up and disrupt your life.

#1: Move Your Body

Any movement will do. My first recommendation for all of my patients is to get some form of physical activity. Really, any sort of movement on a daily basis will be beneficial. No specific exercises have been shown to be clearly superior to another in reducing pain, but clinical studies have repeatedly shown that regular movement prevents and reduces low back pain. The most important thing is to just do something, anything! And do it consistently! Just choose an activity that you enjoy and commit to do it most days of the week. It doesn’t matter if it’s walking, swimming, riding a road or stationary bike, lifting weights, functional strength training, yoga. Like Nike says, Just Do It!

Try yoga or Tai Chi. Now if you are not a regular exerciser and are looking for some recommendations, two of my favorite types of exercise, especially for low back pain, are yoga and Tai Chi. There are a large number of high-quality trials with consistent findings showing reduction in pain and improvement in functioning for low back pain sufferers. If you’ve never done it before, it can be intimidating but that’s okay! Start out with videos on YouTube at home and if you feel up to it, work your way to a local yoga studio. If your mobility is limited, try chair yoga for starters. Another option for those with limited mobility is Tai Chi, which is an ancient Chinese practice that combines slow deliberate movements with deep breathing and meditation. It has great evidence not only for back pain but for other pain conditions as well. Again, you can find excellent resources on YouTube or you can head to Arthritis.org for free videos as well (https://www.arthritis.org/health-wellness/healthy-living/physical-activity/yoga/tai-chi-exercises-for-arthritis). 

Strengthen your core. A pattern that I see very commonly in my patients with low back pain is a weak  abdominal wall and weak glutes (butt muscles). This results in an exaggerated forward curvature to the low back, which puts a lot of strain on the muscles and connective tissue to keep the bony part of your spine in alignment. Proper exercise will naturally strengthen these two muscle groups (including yoga and Tai Chi), but it may be a good idea to ensure you are performing dedicated exercises to strengthen these muscle groups on a regular basis. I have given you an example workout you can do twice weekly and the end of this post:

#2: Eat an Anti-Inflammatory Diet

Inflammation and pain go hand-in-hand. The more inflammation you have, the higher your pain levels will be and vice versa. One of the best things you can do not only for your overall health, but to prevent and/or treat chronic pain, is eat an anti-inflammatory diet. 

Remove sugar and high glycemic index foods. Sugar and other similar high-glycemic index foods are extremely inflammatory. Eating these substances on a regular basis will cause a cascade of chemicals to be released in your body resulting in inflammation. My #1 recommendation for reducing inflammation in your body is to cut the sugar and other similar substances. You can google high glycemic index foods to get an idea of what foods to avoid, but I would prioritize processed foods over whole foods that are higher on the GI scale (such as whole grains and starchy veggies). You first want to rid yourself of soda, baked goods, cereals, white grains (white bread and rice), etc. If you need some sweetness, you can substitute very small amounts of honey or maple syrup or use Stevia or Monk Fruit extract. 

Increase your ratio of Omega-3:Omega-6 Fatty Acids. Omega-3 FAs are very anti-inflammatory while Omega-6 FAs are very pro-inflammatory in excessive amounts. Thus, you want to start decreasing  the Omega-6s and bump up your Omega-3s. Omega-6 FAs are found in the form of corn oil, cottonseed oil, safflower oil, soybean oil, sunflower oil and margarine and shortening (think lots of processed foods). While Omega-3 FAs are found in cold water fish (salmon, tuna, sardines, anchovies), flaxseed, chia seeds and walnuts. 

Increase polyphenols and antioxidants. These substances actively decrease inflammation in your body by seeking out inflammatory compounds and eliminating them. So you want lots of them. You’ve probably heard the recommendation to eat the rainbow, and this is one of the reasons why. A vast array of the beneficial chemicals are found in colorful fruits and veggies. They are also found in high amounts in herbal teas (such as green tea and oolong tea), a variety of spices (clove, allspice, cinnamon, turmeric, rosemary, oregano, thyme, marjoram, sage and tarragon) as well as nuts (walnuts, pecans, hazelnuts and almonds). 

#3: Consider Some Supplements

Fish oil. Fish oil supplements contain high levels of Omega 3 FAs, which as we covered in the last section, are anti-inflammatory. If you are able to consume high-quality fish listed previously at least 3 times weekly, you are unlikely to need a fish oil supplement. If you’re like the rest of us and are lucky to get fish in your diet once a week, a good fish oil supplement is usually beneficial. I recommend getting at least 1000-2000mg of EPA + DHA daily, so read the label because that sometimes adds up to 6 or 8 or 10 capsules per day. Nordic Naturals and Wiley’s are good brands that I often recommend. Also, if you suffer from stinky fish-oil burps, you can freeze the capsules so they get further along in your digestive system before they start to dissolve.

Curcumin. Curcumin is the specific compound within the turmeric plant that gives turmeric its bright yellow coloring as well as anti-inflammatory properties. Similar to fish oil, if you don’t use turmeric frequently in your cooking (multiple times per week), you may benefit from a curcumin supplement. You can start with 500mg taken twice daily and increase up to four times daily as needed. Make sure to get a brand that includes piperine as this will enhance its absorption in the gut. Also, it has been associated with gallbladder issues. If you are currently suffering from gallbladder disease, avoid this supplement (it is safe to take after the gallbladder is removed).

Magnesium. In my humble opinion, everyone should be on a magnesium supplement. It is helpful for so many things! It helps with anxiety and sleep, blood pressure and cardiovascular health, and it is a great natural muscle relaxer. Try magnesium glycinate 400mg at bedtime to start and then work up to 600 or 800mg as needed/tolerated. Most people tolerate this supplement well with few adverse effects, but it can have some stomach side effects (loose stools or diarrhea). If this is the case for you, try a topical formulation that you can apply directly to your low back. Finally, if you have kidney disease, please discuss adding a magnesium supplement with your primary care doctor or nephrologist prior to starting it. 

#4: Other Treatment Recommendations 

Osteopathic Manipulative Treatment. If you have long standing back pain that either never goes away or waxes and wanes with time, come see me for an OMT session. OMT is a hands on treatment (think combination of massage, physical therapy and some chiropractic-like techniques) with the goal of restoring alignment and normal functioning to the body (see a more detailed description of what OMT is here).  There are multiple studies showing improvement in pain for short-term, intermediate and long-term cases and it’s an extremely low-risk intervention with few side effects. If you’re looking for a natural way to treat your pain, this is worth a try!

Ensure proper ergonomics. This applies at work, at home and in bed. If you sit frequently throughout the day, it’s important to make sure your body is in proper alignment. I like the common yoga adage of “head over heart, heart over pelvis”. Also make sure that your neck and chin are in a neutral position, neither pointing up nor downwards. If you use a computer frequently, you want your eyes to be roughly at the same level as the top of your screen. Finally, invest in a proper bed and pillow. For patients with chronic back pain, I usually recommend a firm mattress to support your body in normal alignment while you sleep. If you haven’t replaced your mattress in over a decade, it may be time to make a new purchase. 

Mindfulness. The mind and body are intimately connected. Additionally, although pain is felt in the body, it is interpreted in the mind. Therefore, it makes sense to not only treat the body in the setting of chronic pain, but also the mind. If you don’t believe me, just look at the evidence. There is a strong association with the development of low back pain with other conditions such as anxiety, depression, insomnia, low job satisfaction and so many others. There are many ways to practice mindfulness, including meditation, moving meditation (yoga and Tai Chi), mindfulness based stress reduction and progressive muscle relaxation. Search for videos in any of these areas on YouTube or check out these free resources: https://www.freemindfulness.org/download. What’s most important with any of these techniques is that you practice them consistently to receive the best benefit. 

Core Strengthening Routine 

Abdomen Exercises

1. Plank

   • Get into a push-up position, but rest on your forearms.

   • Keep your body straight from head to heels.

   • Hold for 20–60 seconds.

   • Repeat 2-3 times.

2. Bicycle Crunch

   • Lie on your back with your hands behind your head.

   • Bring your right elbow towards your left knee while straightening your right leg.

   • Alternate sides in a pedaling motion for 10-20 reps on each side.

3. Leg Raises

   • Lie flat on your back with your legs extended.

   • Lift both legs to a 90-degree angle and slowly lower them back down.

   • Keep your lower back on the floor throughout.

   • Repeat for 10 reps.

4. Bird-Dog

   • Start on all fours.

   • Extend your right arm and left leg simultaneously, keeping your core tight.

   • Return to the starting position and alternate sides.

   • Perform 10 reps on each side.

5. Seated Knee Tucks

   • Sit on a chair or bench.

   • Lean back slightly and lift your knees towards your chest.

   • Slowly return to the starting position.

   • Perform 10-20 times.

Glute Exercises

1. Glute Bridge

   • Lie on your back with knees bent and feet flat.

   • Lift your hips towards the ceiling while squeezing your glutes.

   • Lower back down slowly.

   • Perform 10-20 times.

2. Squats

   • Stand with feet shoulder-width apart.

   • Lower into a squat by pushing your hips back and keeping your chest up.

   • Return to standing.

   • Perform 20 reps.

3. Donkey Kicks

   • Start on all fours.

   • Lift your right leg, keeping your knee bent, and press your foot toward the ceiling.

   • Lower and repeat on the other side.

   • Repeat 20 times on each side.

4. Step-Ups

   • Step onto a sturdy platform or step with your right foot, driving through your heel to stand.

   • Step back down and alternate legs.

   • Perform 10 reps on each side.

5. Side-Lying Leg Lifts

   • Lie on one side with legs stacked.

   • Lift the top leg while keeping it straight and lower slowly.

   • Repeat on the other side.

   • Perform 20 reps on each side.