Low Back Pain

A review of clinical trials concluded that treating low back pain with spinal manipulation (chiropractic or osteopathic treatment) is as effective as, or more effective than, other common approaches, such as physical therapy, medication, and exercise.^104,105,106

Preliminary data indicate that smoking may contribute to low back pain.¹⁰⁷ One survey of over 29,000 people reported a significant association between smoking and low back pain.¹⁰⁸ Smaller people (children, women, those who weigh less) are most affected. A study involving people with herniated discs found that both current and ex-smokers are at much higher risk of developing disc disease than nonsmokers.¹⁰⁹ Other research reveals 18% greater disc degeneration in the lower spines of smokers compared with nonsmokers.¹¹⁰ Smoking is thought to cause malnutrition of spinal discs, which in turn makes them more vulnerable to mechanical stress.¹¹¹

One survey reported that people who drank wine healed more quickly after disc surgery in the lower back than those who abstained.¹¹² However, alcohol consumption may cause cirrhosis of the liver, cancer, high blood pressure, and alcoholism. As a result, many doctors never recommend alcohol even though moderate consumption has been linked to some health benefits. For those deciding whether light drinking might help with recovery from disc surgery, it is best to consult a doctor.

Regular exercise and proper lifting techniques help prevent low back problems from developing. Proper lifting involves keeping an object close to the body and avoiding bending forwarding, reaching, and twisting while lifting. Low back pain and disc degeneration are both more likely to develop among sedentary people than those who are physically active.¹¹³ However, long-term participation in some competitive sports may contribute to spinal disc degeneration.¹¹⁴

Therapeutic exercise helps people recover from low back pain¹¹⁵ and low back surgery.¹¹⁶ Less clear are details about how this should be done for greatest benefit. In other words, the best type of exercise, frequency, duration, and timing of a program still need to be determined. One study reported therapeutic exercise significantly improved chronic low back pain compared to exercise performed at home without professional guidance.¹¹⁷ Another trial discovered that women with chronic low back pain who began supervised back strengthening exercises at a fitness center were more consistent exercisers than those who started and continued therapeutic exercises at home.¹¹⁸ Both groups experienced significant improvement in pain. However, the supervised group experienced better long-term improvement.

While heavy lifting and other strenuous labor may contribute to low back pain, one trial found that people with sedentary jobs gained more benefit from an exercise program than those who have physically hard or moderate occupations.¹¹⁹ Motivational programs may also improve exercise consistency, which in turn decreases pain and disability.¹²⁰ People with low back pain who wish to embark on an exercise program should first consult with a physical therapist or other practitioner skilled in this area.

Supervised bed rest, for two to four days, coupled with appropriate physical therapy and therapeutic exercise, is often recommended by medical doctors for acute low back pain.¹²¹ However, reviews of bed rest recommendations have concluded that bed rest is, at best, ineffective and may even delay recovery.^122,123 It is better to try to stay active and maintain a normal daily schedule as much as possible.

General recommendations for people recuperating from low back pain include wearing low-heeled comfortable shoes, sitting in chairs with good lower back support, using work surfaces that are a comfortable height, resting one foot on a low stool if standing for long periods, and supporting the low back during long periods of driving.¹²⁴