Some suggestions for preventing and treating lower back pain, for those who may find them useful

[juushika]

I've been dealing with chronic lower back pain for the last nine years. The problems cropped up in my teens, and I have every reason (personal and professional opinion) to believe that they will continue for the rest of my life. My back pain originates from severe lordosis, which is commonly referred to as sway back: an exaggerated anterior curvature of the lower back. My lordorsis is so severe that, in my natural uncorrected posture, my lower back forms nearly a 90 degree angle. (See a picture of it here—I'm nude, but nothing sensitive is visible.) My lodorsis is complicated by 5 degree scoliosis (side-to-side curvature of the spine), one flat foot, and other minor body imbalances. I have been diagnosed (including x-rays) and have undergone a few months of physical therapy (including transcutaneous electrical nerve stimulation) to prevent and treat my back pain. I have been dealing with it on my own for many years.

My chronic condition is a dull throbbing, which I've largely learned to ignore and only causes a mild discomfort. However, if my back is aggravated by any number of causes, often as simple as sitting or standing, the baseline pain level climbs and the throbbing is punctuated by sharper pain spikes and infrequent, stabbing spasms. My back is chronically tense and tight—to the point that it hurts to stretch, and I have low sensitivity in the muscles and partial numbness in the skin of my lower back.

Which is all to say: I am not a medical professional. My back pain is an individual condition with unique causes. However, I have a fair bit of experience for dealing with chronic lower back pain, and would like to offer some advice for preventing and treating it. Not all of this advice is correct or useful for everyone, but hopefully it can help someone. If I'm in any way unclear, feel free to ask questions! Back problems are painful and frustrating, and I would love to help others deal with theirs.

Prevention
The first step towards dealing with lower back pain is doing what you can to prevent or minimize its appearance.

• Posture: Stand straight: Pull your chest and shoulders up, tuck your stomach in, and push your tailbone forward. Alternately, take a deep breath and lift your head to stare straight ahead. Alternately, stand against a flat, narrow surface (a door jam or a wall corner), put your hands over your stomach, and coax your lower back towards that surface. You want to hold this posture often enough that it becomes second nature. It strengthens your back and abdominal muscles, prevents back pain, and if you're anything like me adds inches to your height.
  
  Sit straight: Don't slouch, and don't lean back without proper lower back support (avoiding the latter is more important than the former). Instead, take a deep breath and hold your head high. If you have a severe sway back, you may need to pull one or both legs up (rest them on a chair rail or a foot rest, pull them onto the chair seat) in order to correct the angle of your lower back.
  
  Above all, never increase the anterior curve of your lower back. Pull your knees towards you chest if you need to—whatever "correct posture" is for your body, make sure you don't make existing problems worse.


• Sleep: Sleeping positions, pillows, and mattresses are a personal aspect of back pain prevention—what matters most is finding what works for you. But some advice to keep in mind: If you sleep on your back and have a severe sway back, consider lifting your hips with a pillow to straighten the angle of your spine. If you're a stomach-sleeper and have a severe sway back, consider a pillow under your stomach to lift your lower back. If you sleep on your side, consider your body shape: do you need to arrange pillows to compensate for your hips or waist? (Straightening your spine side-to-side can be just as important as straightening it front-to-back.) Consider also sleeping in a fetal position, which will relax your lower back.
  
  My number one piece of advice for sleep is a body pillow, especially if you're a side sleeper. Use them between your thighs and knees to open up your hips as you sleep. Longer and wider than most pillows, they're easy to use and to a better job of keeping knees apart. Play with extra pillows, pillow placement, and a firmer, softer, or different material mattress—but a body pillow is invaluable.


• Take a break: Don't hold any one position for more than an hour; if you have severe back problems, don't hold any one position for more than half an hour. Take a break to stand up, or sit down, or lie down. Put your back in a new position for at least a few minutes. It's not necessary to stretch, although stretching can help.


• Don't stress your back: Or at least minimize stress. This is wide-ranging: Learn to lift properly. Always remember to give your back frequent breaks, especially from potentially painful positions. Avoid or modify potentially painful positions and activities—no matter what other people say. (This includes exercise: avoid motions which increase the anterior curve of your lower back, modify movements to keep your back straight). Keep stress symmetrical (such as using backpacks instead of messenger bags) to keep your body balanced.


• Exercise: Exercise stretches and strengthens muscles, and for some people it releases endorphins which improve mood and fight pain. Yoga is particularly useful exercise for those with lower back problems, since many of the stretches can be used to treat lower back pain. Pilates is similar but often more intense, and may provide a better workout. Also consider swimming and other water-based exercises, as water supports the body and relaxes the lower back. For all exercise, concentrate on strengthening abdominal muscles, in order to encourage better posture and offset the tightness of lower back muscles. However, all exercise has the potential to aggravate lower back problems. Always listen to you body, and stop if your pain increases. Never, in an exercise or a stretch, increase the anterior curvature of your spine. Always be willing to modify positions to decrease your range of motion or pull your knees towards you chest.
  

Treatment
The best prevention may not prevent all back pain, and treating existing symptoms will probably be necessary.

• Professional help and physical therapy: Both are useful for confirming your issues and establishing methods for dealing with back pain. In my experience, neither is a long-term solution. There is little that Western medicine can do to treat lower back pain. In some cases, prescribed pain medication may be the only viable treatment. Physical therapy can be useful for learning helpful stretches and massages, but it's expensive and rarely graduates to new treatments or solutions. However, physical therapy can provide transcutaneous electrical nerve stimulation, which increases circulation and relieves pain for some people.
  
  
• Heat and ice: Check out haikujaguar's handy guide: ice sharp pain, heat throbbing pain. But take it with a grain of salt: in my experience, cold can aggravate or even cause sharp lower back pain. Ice with care or a doctor's instruction; listen to your body and don't do anything that hurts. Heat, however, is invaluable. Lay in a comfortable position and use a hot pad for 15-30 minutes, to relax your body and ease lower back pain.
  
  I highly recommend a wet heat hot pad. Ordinary hot pads have never helped me, but wet heat is penetrative and much more effective. I own this one, and it is a dream come true.


• Stretching: Stretching relaxes muscles and increases circulation. It's invaluable as short-term and long-term pain relief. I use a number of stretches, and will list them here in the order I recommend them, best stretches first. Allow me to harvest links from all over the internet, since visuals help.
  
  Lying stretch: Lie on your back on a comfortable surface and elevate your feet. Bend your knees over a solid object (such as a chair seat), or straighten your legs against a wall. Make sure that your lower back is straight: if you have a severe sway back, your torso and thighs should be at at least a 90 degree angle, and probably more acute (pull your knees towards your chest). Consider lifting your hips with a pillow. Hold for at least 30 minutes. This stretch is time consuming, but it's the most effective stretch for long-term pain relief. Illustrated examples (but rest your legs against something so that you can hold this pose for an extended period of time.)
  
  Sitting (chair) stretch: Sit straight in a chair, and then lean forward until you're bent double. Wrap your arms under your knees or stretch your hands toward the ground. Hold. This stretches and takes pressure off of the lower back. Illustrated example.
  
  Fetal stretch: Lie on your back on a comfortable surface. Pull your knees towards you chest. Wrap your arms around your legs or under your knees. Pull your head towards your knees. Hold. This is a moderate to extreme stretch. Illustrated example (scroll down to "back stretch").
  
  Crouch stretch/standing fetal stretch: Stand with your legs at hip width, and then sink to a crouch. Balance on your toes and press your fingertips to the ground or support your hands on a nearby object or wall. You want to be in a standing fetal position, curled into a crouch but still balanced on your toes. For a deeper stretch, spread your knees and pull into a tighter ball. This is a moderate to extreme stretch. Unfortunately, I can't find a useful illustration.
  
  Yoga child pose: Kneel and sit on your feet, seperate your knees to hip-width. Lean forward until your head touches the floor, with your hands overhead or pulled back to your side. Hold. This is a mild stretch. Illustrated example.
  
  Yoga cat pose: Rest on your hands and knees. Tuck in your stomach and straighten your spine. Slowly tilt your hips back, pull your stomach in, roll your head down, and reverse the curve of your lower back from anterior to posterior. Release. This is a moderate lower back stretch. Illustrated here, but note: step two (increased anterior curvature of the spine) will increase lower back pain—avoid it!
  
  Yoga plough pose: A fairly advanced yoga pose, described and illustrated here. Stop at step four, or perform step six with a posterior curve to the back. This is an intense stretch (the most effective I found, but its rapid release of tension can be painful), so perform with caution.
  
  
• Massage and spinal manipulation: Amateur massage is more or less harmless, and can help stretch muscles, increase circulation, and otherwise relieve pain. I have remarkably little advice on this subject—I don't know how to give massages, only how to receive them. However, I can say: Communicate with your massager and listen to your body. The lower back can be a difficult place to massage, so consider lying with a pillow under your stomach and hips, to raise the lower back, stretch the muscles, and make them easier to reach. A lot of lower back tightness finds its center not in the lower back but in the sacrum; haikujaguar has a useful illustrated guide for finding and massaging this area. Remember that pain breeds pain, and lower back pain can climb up the spine to cause upper back and neck tightness, and massage in these areas may help. Finally, using oil in massages reduces friction on the skin, making the massage less painful for both parties and making it easier to get deep into muscles.
  
  Vibration can be a useful form of massage. A tool specifically designed for back massage will provide more intense, effective stimulation than a vibrating pad or seat. I use this back massager, and recommend it.
  
  If you can, consider consulting a professional massage therapist or, possibly, chiropractor.
  
  For severe lower back pain and lordosis, the average massage may not reaching deep and stretch muscles enough to do significant good. Personally, I find vast majority of massages only minorly effective (and because my muscles are so tight and my skin so numb, I can't even feel them). So to treat my back pain, Devon (my significant other) "squishes" my back: I lean over the edge of the bed (everything from my hips up lying on the bed, legs partially supported by the floor); he stands behind me and provides sharp, firm pressure in short upwards moments along the length of my spine. This is an intense, often-painful stretch and a brief deep massage, and it provides immediate, remarkable relief. It makes my back pop at least a dozen times, and I usually regain an inch or two of my height. It is not for everyone, and may not be medically sound. But I argue: back treatment is a personal effort. Medical professionals can offer some help, but the solution you find may be extreme or unusual. Always listen to your body, don't cause further damage, but do what you need to do to cope.


• Other methods for increasing circulation: Exercise and spicy foods both increase circulation and help treat stiffness and pain. My secret trick: massages using hot oil (oil infused with hot peppers; cinnamon oil may also be effective; alternately, use a rub made for this purpose, like Tiger Balm). Hot oils can burn, so use with caution (for you and your massager), but they can be invigorating, penetrative, and wonderful pain relief when combined with massage.


• Medication: There are two ways to approach pain management through medication: treating the symptom, or treating the problem. Severe, immediate pain sometimes needs to be treated with pain killers which decrease the body's sensitivity to or awareness of pain. I currently refuse to treat my back pain this way, and so I have little advice on the subject—I'd recommend consulting a medical professional.
  
  Other medication, including any medication with anti-inflammatory properties, can help treat the underlying problem by relaxing tight, inflamed, painful muscles. I use over-the-counter anti-inflammatory medication infrequently (and so I can't advise on prescribed muscle relaxants; against, consult a medical professional). All medication carries a risk of addiction, dependency, and increased tolerance—often not a severe or immediate risk, but in my experience it's still true that the less often you take medication, the more effective it will be. Despite the extent of my chronic tightness and pain, a half-dose of ibuprofen is enough to provide complete pain relief from my most severe back spasms—but I only take it when I'm having these severe back spasms.
  
  If you do chose to take medication, always combine it with prevention and other treatment options. To avoid building a dependency or tolerance, take it as infrequently as you can. But medication can be an effective, immediate treatment for back pain, so don't dismiss it.

It's possible that there are other methods for coping with lower back problems, and you are welcome to discuss them in the comments. Questions and clarifications are also welcome. However, I'll mention one last time: Pain is a private, personal matter. Each suffer's pain has different traits, causes, and symptoms; each sufferer has different methods of coping and curing. The information and advice here is the product of my personal struggle with back pain, and I hope that it's useful to someone. Pain is emotional, frustrating, self-perpetuating—and always difficult. I wish the best of luck who those who are wrestling with this beast.