Tag Archives: low back pain

Core Strengthening to Reduce Low Back Pain Risk

2 Apr

Low back pain is one of the most common and disabling conditions worldwide. It’s estimated that
nearly 200 million acute episodes of low back pain occur each year, of which roughly 20% persist for longer
than three months. With the aging of the global population combined with the obesity epidemic, low back pain
is expected to become an even more substantial physical health issue in the coming decades.
Because weakness in the core muscles that help stabilize the spine has been linked to up to a threetimes increased risk of new-onset low back pain, improving endurance and control in this muscle group may
help reduce one’s risk. The core muscles include the abdominals, back, and gluteal muscles. In addition to
stabilizing the spine to help stay upright, strong core muscles are important for maintaining balance through
proprioception and for supporting the wide range of motion the trunk performs—from rotation, to bending
forward, to side-bending, and backward movement. Key core-strengthening exercises include:

  • Front plank: Lie face down and prop yourself up on your elbows under your shoulders. Lift your body
    onto your elbows and toes (or knees for an easier version). Keep your body in a straight line from
    shoulders to heels, tighten your stomach and glutes, and avoid letting your hips sag or rise. Hold 10–
    30 seconds, repeat three to five times, working up to a 60-second hold.
  • Side plank: Lie on one side with your elbow directly under your shoulder. Lift your hips off the floor
    so your body forms a straight line from shoulders to feet. Keep your core tight and don’t let your hips
    roll forward or backward. For an easier version, bend your knees and lift your hips. Hold 10–25
    seconds per side and repeat three to five times.
  • Bird dog: Start on hands and knees with hands under shoulders and knees under hips. Tighten your
    stomach slightly and keep your back flat. Slowly extend one arm forward and the opposite leg
    backward. Keep hips level and avoid arching your back. Hold for five to ten seconds, return to start,
    then switch sides. Do eight to twelve repetitions per side.
  • Glute bridge: Lie on your back with knees bent and feet flat on the floor about hip-width apart.
    Tighten your stomach and squeeze your glutes. Lift your hips until your shoulders, hips, and knees
    form a straight line. Avoid arching your lower back. Hold three to five seconds at the top, then slowly
    lower. Perform ten to fifteen repetitions for two to three sets.
  • Dead bug: Lie on your back with arms straight up and knees bent at 90 degrees. Tighten your stomach
    gently so your lower back stays flat against the floor. Slowly lower one arm overhead and extend the
    opposite leg toward the floor. Only go as far as you can without your back arching. Return to start and
    switch sides. Perform eight to twelve slow, controlled repetitions per side.
    Further strategies to reduce the risk of low back pain include maintaining a healthy weight; improving
    workstation ergonomics; practicing good posture, especially when sitting and lifting; engaging in regular lowimpact aerobic exercise such as walking or swimming; following a balanced, minimally processed dietary
    pattern (such as a Mediterranean-style diet); avoiding tobacco use; and stretching before and after physical
    activity, especially the hamstrings which are often overly tight in low back pain cases. While these practices
    may not completely prevent low back pain, they can improve the changes for a speedier recovery as well
    reduce the risk of recurrence.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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The Pain Mechanisms of Chronic Low Back Pain

4 Mar

In simple terms, chronic low back pain is pain affecting the lumbar spine region that lasts
longer than three months. However, chronic low back pain is not simply acute (new) low back pain
that has failed to resolve. Rather, it often reflects an overlap of two or even three distinct pain
mechanisms, each of which may need to be addressed to achieve an optimal outcome: nociceptive,
neuropathic, and nociplastic pain.
Nociceptive low back pain arises from injury or irritation of non-neural tissues, including
muscles, ligaments, tendons, and joints. This type of pain is typically localized and may feel achy,
throbbing, or sharp with movement or certain positions. During a physical examination, a doctor of
chiropractic can often reproduce symptoms with palpation or specific movements. The term nonspecific low back pain is commonly used to describe pain that is predominantly nociceptive in
nature.
Neuropathic low back pain is caused by damage or disease affecting the nervous system
itself. In the context of chronic low back pain, this is most often associated with disk herniation
compressing a nerve root, degenerative changes (such as arthritis) narrowing the spaces through
which nerves travel, or postsurgical nerve injury. This form of pain is commonly described as
burning, shooting, or electric and often radiates along the course of the affected nerve. Patients may
also experience non-painful neurological symptoms, including numbness, tingling, weakness, or
altered reflexes.
Nociplastic low back pain typically develops over time in response to an initial injury or
episode of pain. This pain is characterized by altered pain processing within the nervous system and
is often associated with widespread or shifting pain patterns, heightened pain intensity, and increased
sensitivity to touch or movement. Patients with nociplastic low back pain may restrict movement and
daily activities out of fear of worsening their condition (kinesiophobia), describe pain in amplified or
distressing terms, feel poorly equipped to manage their symptoms, and commonly report poor sleep
and elevated stress. Coexisting conditions such as headaches, irritable bowel syndrome, or
fibromyalgia are also more prevalent in this population.
Because chronic low back pain often includes a combination of nociceptive, neuropathic, and
nociplastic components, treatment approaches must be individualized. A multimodal care plan may
include manual therapies, targeted exercises, physical modalities, and anti-inflammatory strategies
aimed at restoring normal motion and function to affected nerves, joints, muscles, tendons, and
ligaments. In addition, chiropractors may employ pain education and graded activity exposure to
address nociplastic factors and help patients regain confidence in movement. When appropriate,
referral to a medical physician or specialist may also be indicated—all with the goal of helping the
patient return to normal activities of daily living in the safest and most pain-free manner possible.

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The Evidence Map of Low Back Pain Treatment Options

5 Jan

Low back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
  • Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
  • Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
  • Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
  • Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
  • Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
  • Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
  • Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
  • Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
  • Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.

The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Risk Factors for Postpartum Low Back Pain

1 Dec

It’s estimated that as many as 50–70% of new mothers experience low back pain and
related disability, which can hinder their ability to carry out daily activities such as household
chores, self-care, and meeting the physical demands of infant care—including feeding, lifting,
and carrying. When severe enough, these physical limitations can contribute to stress, anxiety,
and postpartum depression, further interfering with the mother’s ability to bond with her
newborn and diminishing her overall quality of life. What are the underlying causes of
postpartum low back pain?
Interestingly, some risk factors may be present even before conception. Research
suggests that being overweight or obese, physically inactive, or exposed to occupational risk
factors such as whole-body vibration, poor ergonomics, and frequent lifting can set the stage for
low back pain both during pregnancy and after delivery. Women with a prior history of low back
pain are also at elevated risk for symptoms during and following pregnancy.
As the baby grows, the center of mass shifts forward in the body. To compensate, the
pelvis tilts anteriorly and the lumbar spine increases in lordosis, placing added stress on the
lumbar intervertebral disks and facet joints. The stretching of the abdominal muscles can reduce
spinal stability, while hormonal changes that prepare the pelvis for childbirth can increase joint
laxity, further affecting stability in the lower spine and pelvic region. To compound these effects,
expectant mothers may experience fluid retention, deconditioning from reduced activity, sleep
positions that strain the lower back, and psychosocial factors such as stress and anxiety that
heighten pain perception.
Childbirth itself can also contribute to postpartum low back pain. The physical effort of
pushing during delivery can strain the lower back, and the hormonal changes that allow for
ligamentous laxity during pregnancy may persist afterward, leaving the spine more susceptible to
mechanical stress. In cases of cesarean delivery, factors such as spinal anesthesia, post-surgical
immobilization, and prolonged bedrest can further delay recovery and exacerbate pain.
Unfortunately, it’s a common misconception that postpartum low back pain will simply
resolve on its own. In reality, studies suggest that up to 1 in 5 new mothers with low back pain
will develop chronic symptoms lasting a year or longer. While some risk factors for postpartum
low back pain are beyond a woman’s control, others—such as maintaining an active lifestyle,
avoiding prolonged inactivity, and seeking chiropractic care to help restore proper joint motion
and function in the lumbar spine during and after pregnancy—can play a key role in prevention
and recovery.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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Low Back Pain and The Importance of Sleep

27 Feb

Monthly Health Update: Whole Body

Low back pain is the leading cause of disability worldwide, and it’s estimated 619 million people suffer an episode each year. By 2050, it’s expected this total will jump to 843 million! In addition to the direct and indirect effects low back pain can have on the individual patient, the overall healthcare costs and productivity losses associated with this musculoskeletal disorder add up to more than $230 billion dollars each year in just the United States! This in mind, identifying and mitigating risk factors for low back pain by even a small amount can result in large societal gains. One risk factor for low back pain that isn’t typically imagined is sleep.

Sleep is considered essential for survival. Many vital functions occur during slumber including tissue growth and repair, cytokines production to bolster the immune system, heart rate and blood pressure regulation, memory consolidation, and brain detoxification, just to name a few. If an individual suffers from insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, or sleep bruxism, these critical processes are impeded, which can make the body more susceptible to developing musculoskeletal pain, including low back pain.

In one study, researchers looked at health data concerning 6,285 older adults and found that an individual’s risk for low back pain increases by 13.6% for each hour less than seven hours of sleep he or she averages a night. However, any additional sleep beyond seven hours does not confer additional low back pain reduction benefits. Interestingly, this finding held true even after adjusting for age, gender, income level, education level, and occupation.

Not only can poor sleep increase the risk for low back pain, but it can stimulate changes in how pain is perceived, leading to greater pain sensitivity, which in turn results in increased disability and avoidance behaviors. One study, published in December 2020, found that older adults with moderate-to-severe sleep disturbances will likely accumulate chronic neuropsychiatric and musculoskeletal conditions at a faster rate than seniors with good sleep hygiene. To complicate matters, the American Academy of Sleep Medicine reports that 80% of American adults experience daytime sleepiness, meaning they either aren’t sleeping enough each night or the quality of their sleep is poor. So what can be done to improve sleep hygiene?

The Centers for Disease Control and Prevention (CDC) offers the following tips for better sleep: be consistent with bed times; make sure your bedroom is quiet, dark, relaxing, and kept at a comfortable temperature; remove electronic devices from the bedroom; avoid large meals, caffeine, and alcohol before going to bed; and get some exercise during the day. If low back pain is keeping you up at night, be sure to let your doctor of chiropractic know. They may be able to recommend additional strategies to improve your sleep and if necessary, co-manage your case with an allied healthcare provider.

If you are struggling with sleep, come on in for a visit!

Watching your back,

Dr. B

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

 717-697-1888

Painreliefcare.net

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Low Back Pain and The Importance of Sleep

6 Feb

Low back pain is the leading cause of disability worldwide, and it’s estimated 619 million
people suffer an episode each year. By 2050, it’s expected this total will jump to 843 million! In
addition to the direct and indirect effects low back pain can have on the individual patient, the overall
healthcare costs and productivity losses associated with this musculoskeletal disorder add up to more
than $230 billion dollars each year in just the United States! This in mind, identifying and mitigating
risk factors for low back pain by even a small amount can result in large societal gains. One risk
factor for low back pain that isn’t typically imagined is sleep.

Sleep is considered essential for survival. Many vital functions occur during slumber
including tissue growth and repair, cytokines production to bolster the immune system, heart rate and
blood pressure regulation, memory consolidation, and brain detoxification, just to name a few. If an
individual suffers from insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, or
sleep bruxism, these critical processes are impeded, which can make the body more susceptible to
developing musculoskeletal pain, including low back pain.

In one study, researchers looked at health data concerning 6,285 older adults and found that
an individual’s risk for low back pain increases by 13.6% for each hour less than seven hours of sleep
he or she averages a night. However, any additional sleep beyond seven hours does not confer
additional low back pain reduction benefits. Interestingly, this finding held true even after adjusting
for age, gender, income level, education level, and occupation.

Not only can poor sleep increase the risk for low back pain, but it can stimulate changes in
how pain is perceived, leading to greater pain sensitivity, which in turn results in increased disability
and avoidance behaviors. One study, published in December 2020, found that older adults with
moderate-to-severe sleep disturbances will likely accumulate chronic neuropsychiatric and
musculoskeletal conditions at a faster rate than seniors with good sleep hygiene. To complicate
matters, the American Academy of Sleep Medicine reports that 80% of American adults experience
daytime sleepiness, meaning they either aren’t sleeping enough each night or the quality of their
sleep is poor. So what can be done to improve sleep hygiene?

The Centers for Disease Control and Prevention (CDC) offers the following tips for better
sleep: be consistent with bed times; make sure your bedroom is quiet, dark, relaxing, and kept at a
comfortable temperature; remove electronic devices from the bedroom; avoid large meals, caffeine,
and alcohol before going to bed; and get some exercise during the day. If low back pain is keeping
you up at night, be sure to let your doctor of chiropractic know. They may be able to recommend
additional strategies to improve your sleep and if necessary, co-manage your case with an allied
healthcare provider.

Watching your back,

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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