This article was previously published January 8, 2019, and has been updated with new information.

Back pain is one of the most common health complaints across the globe, and the No. 1 cause of job disability.¹ It’s also one of the most common reasons triggering opioid dependence, the side effects of which can be lethal. In fact, by 2017 opioids were now the leading cause of death among Americans under the age of 50,² and more than 202,600 Americans died from overdosing on these potent pain killers between 2002 and 2015 alone.³

According to a recent population study,^4,5 opioids are the most commonly prescribed medication for people with chronic low back pain, and as you’d suspect, these drugs are typically used long-term in this population. This flies in the face of guidelines from the American College of Physicians, which recommend heat wraps and exercise as a first line of treatment, stressing that prescription drugs should only be used as a last resort.⁶

Another recent study^7,8 found a strong link between chronic back pain and mortality in women, and while the authors laid the bulk of the blame on decreased activity, the use of narcotic pain killers is another likely contributor.

Meanwhile, other recent research⁹ shows opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter (OTC) drugs such as acetaminophen, ibuprofen and naproxen. In fact, those taking nonopioid pain relievers actually fared “significantly better” in terms of pain intensity.

Lead author Dr. Erin Krebs with the Minneapolis VA Center for Care Delivery and Outcomes Research (formerly Chronic Disease Outcomes Research), told WebMD:¹⁰

“We found that opioids had no advantages over nonopioid medications for pain, function or quality of life in patients with low back pain … This is important information for physicians to share with patients who are considering opioids.”

Here, I’ll provide you with a variety of strategies that can help you avoid this toxic trap by building a strong, pain-free back.

Move More and Stand Correctly to Protect Your Back Health

Two effective means of preventing lower back pain are closely related: staying active and minimizing sitting. Both will improve muscle strength and coordination, reduce stiffness and improve blood flow, which may reduce back pain and lower your risk of developing back pain in the first place.

Oftentimes, back pain originates from tension and muscular imbalances. For example, sitting for long periods of time ends up shortening the iliacus, psoas and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis. When these muscles are chronically short, it can cause severe pain when you stand up as they will effectively pull your lower back (lumbar) forward.

By bringing these muscles into better balance, you will remedy many of these common pains and discomforts. Overuse and misuse of the muscles supporting your spine, poor muscle strength and inappropriate posture while sitting, standing and walking are other common causes of low back pain.

For instance, when walking with your toes pointed outward, the muscles in your hips and lower back tighten, increasing your risk for lower back pain. Sitting with your shoulders hunched over a computer screen stretches muscles in your upper back and places added stress on your lower back, increasing your risk for both lower and upper back pain.

Walking with your head down is yet another posture-related problem that has repercussions on the rest of your back and hips,¹¹ as your head is the single heaviest part of your body and will throw everything out of alignment. If poor posture is a culprit, consider doing some exercises to stretch out your shoulders, open up your hip flexors, and lift your chest.

That said, research suggests the treatment of choice for lower back pain is maintaining physical activity.¹² If the pain is severe, you may have to ease up on your usual activities, but continuing some activity is necessary. Studies have demonstrated bed rest may actually extend your disability by promoting muscle stiffness and spasms.¹³

3 Exercise Techniques That Address Back Pain

Several people have developed techniques to address back pain. Here are three with a good track record:

Consider Chiropractic Care

Spinal manipulation by a chiropractor can also ease back pain in many cases. In one 2017 meta-analysis¹⁴ of 26 studies, spinal manipulation was associated with “statistically significant benefits in both pain and function, of on average modest magnitude, at up to six weeks.”

The average patient reported greater ease and comfort in their day-to-day activities, such as walking, sleeping or turning in bed. However, while these results appear to be modest in nature, it is important to recognize the results are an average, and that the participants only underwent manipulation. In other words, they were not given any additional rehabilitative exercises designed to maintain functional movement of the spine gained after manipulation, or to reduce inflammation.

A more recent study^15,16 (which included chiropractic treatments as a component of a multidisciplinary team approach to low back pain in two large military medical centers) revealed a reduction in discomfort and disability greater than what was experienced with standard medical care.

Here, 750 active duty military service members already being treated for lower back pain were evaluated. All were receiving physical therapy and/or drugs to ease pain and inflammation. The team added chiropractic treatment to half the participants, including spinal manipulation, rehabilitation exercises and treatment with cold or heat.

On average, the chiropractic treatment group received two to five treatments over a six-week period. After six weeks, patients who received chiropractic treatments experienced greater improvements in their lower back pain and less disability than those who did not receive the treatments. Lead study author and chiropractor Christine Goertz, Ph.D., commented on the results, saying:¹⁷

“Spinal manipulation (often referred to as Hias chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.

It is also possible that manipulation impacts the way your body perceives pain through either the brain or spinal cord and or decreases pain from muscle strain, inflammation and or spasm in the muscles next to your spine.”

Aside from addressing any immediate spinal misalignment that might cause back pain, chiropractic care can also help address, prevent and treat deeper dysfunctions in your body. Chiropractic adjustments can actually affect the chemistry of biological processes on a cellular level, thereby reducing oxidative stress and improving immune function and DNA repair,¹⁸ for example.

Acupuncture, Massage and Breath Work

Acupuncture and massage also have their place. Research has discovered a “clear and robust” effect of acupuncture in the treatment of back, neck and shoulder pain specifically, while massage therapy releases endorphins that help induce relaxation, relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline. It also reverses the damaging effects of stress by slowing your heart rate, respiration and metabolism, and lowering raised blood pressure.

Certain breathing techniques can even be helpful. Compression breathing is actually an important aspect of Foundation Training that helps re-educate the muscles surrounding your axial skeleton (the spine of your rib cage), teaching them to be in a state of expansion rather than contraction.

You’ll find a demonstration of this technique in the video below. When done properly, it will help lengthen your hip flexors, stabilize your spine and support your core using transverse abdominal muscles. This strengthens your back and keeps your chest high and open:

1. Whether sitting down or standing, put your thumbs at the base of your rib cage, positioning your pinkies at the pointy bones at the front of your waist. Think of the space between your fingers as a measuring stick.
2. Pull your chin back so your chest is lifting upward. Take three slow deep breaths as instructed below.
3. The distance between your thumbs and pinkies should increase as you breathe in.
4. When you breathe out, tighten your abdominal muscles so your torso will not collapse back down. This is the most important step: Do not let your torso drop back down toward the pelvis as you exhale. It should be challenging, allowing you to feel your abdomen engage as you exhale.
5. With each breath, your aim is to increase the distance between your thumb and pinky fingers, as well as increase the width of your upper back. This occurs as you elongate the back of your rib cage. Each inhalation expands your rib cage, and each exhalation will keep the abdomen extended and tight. So, each in-breath fills up your rib cage, and each out-breath maintains the height and width of your rib cage.

Repeat five to 10 rounds with three to four breaths per round. Over time, your muscles will get stronger and your seated posture will gradually improve.

6 Simple Stretches to Help Relieve Lower Back Pain

Aside from core strengthening exercises such as Foundation Training, stretching is also important, as tight and stiff muscles and lack of flexibility will contribute to back pain. There are many options here, including the six highlighted below.¹⁹ If these stretches cause pain, stop doing them and consult your doctor, chiropractor or massage therapist before continuing.

You may experience mild discomfort when you begin doing these stretches, especially if you are new to exercise or it has been a long time since you last exercised. My advice is to take it slowly and gradually increase your tolerance to these stretches over time.

Baby cobra — Lie on your stomach with your legs together, arms bent and palms on the ground at chest level, elbows bent. Begin with your forehead on the ground. Inhale and lift your chest, keeping the back of your neck long and your chin relaxed. Exhale and return your forehead to the mat. Repeat a few times, focusing on your breath.

Bird dog — This stretch engages your back muscles, buttocks and hamstrings, as well as your core and shoulders. Begin on all fours, then lift and extend one leg and the opposite arm at the same time. Hold for three to five breaths. Switch sides and raise and hold the opposite arm and leg for three to five breaths.

Cat/cow — Begin on your hands and knees and place your hands directly under your shoulders and your knees under your hips. On your inhalation, drop your belly and lift your gaze up to the ceiling. When you exhale, round your spine so your tailbone drops between your thighs and your head lifts between your arms. Repeat multiple times, slowly, to gently increase spinal mobility.

Psoas lunges — Your psoas muscle extends from your lowest vertebrae to the top of your thigh, putting it in a good position to stress your lower back when it becomes tight. A great way to stretch your psoas is through lunges. Begin with your right leg in front of you and your left knee on the floor. Tuck your buttocks slightly and place your hands on your forward knee or your hips. Allow your hips to gently shift forward as you breathe for three to five breaths. Change legs and repeat on the other side.

Squat — Separate your legs a little more than hip-distance apart and bend your knees so your thighs are parallel to the ground. Keep your heels on the ground. Press your palms together and hold them at chest height. Use your elbows to release your knees apart. If this is too hard on your hips you can sit on a yoga block, stool or a few books. Maintain the position for three to five breaths.

Twist — Twists help rotate and lengthen your spine and can be performed sitting in a chair or while lying or sitting on the ground. Begin on your back and bring your knees up to your chest. Gently allow your legs to fall to one side and turn your torso in the opposite direction, extending your arm. Breathe in this position for 30 seconds and then repeat on the other side. You can do this stretch sitting by raising your arms and twisting gently from your torso. If seated in a chair, you can grip the arm of the chair with one hand and put the other hand on the opposite leg. Extend your spine on the inhale and twist a little further on the exhale. Repeat on the other side.

Many Cases of Back Pain Have an Emotional Root

Last but not least, there’s evidence that back pain may originate in, and is certainly exacerbated^20,21 by, psychological or emotional issues. The late Dr. John Sarno, a professor of rehabilitation medicine, gained notoriety using nothing but mind-body techniques to treat patients with severe low back pain.

His specialty was those who have already had surgery for low back pain and did not get any relief. This is a tough group of patients, yet he claimed to have a greater than 80% success rate using techniques like the Emotional Freedom Techniques (EFT). As noted by Sarno in the documentary “All the Rage” — a four-minute trailer of which is included above — “I tell [my patient] what’s going on, and lo and behold, it stops hurting.”

The “what” that is going on is not a physical problem at all — it’s emotions: anger; fear; frustration; rage. When these kinds of emotions are suppressed, your brain redirects the emotional impulses to restrict blood flow to certain parts of your body, such as your back, neck or shoulders, thereby triggering pain.

This pain acts as a distraction from the anger, fear or rage you don’t want to feel or think about. The pain essentially acts as a lid, keeping unwanted emotions from erupting. You may feel anger at the pain, but you won’t have to face the fact that you’re actually angry at your spouse, your children or your best friend, or that you hate your job, or the fact that you feel taken advantage of.

As noted by Sarno, working hard and constantly trying to do everything perfectly to keep everybody around you happy, “is enraging to the unconscious mind.” The term Sarno coined for this psychosomatic pain condition is “tension myoneural syndrome,”²² and he firmly believed most people can overcome their pain by acknowledging its psychological roots.

While many of Sarno’s patients got well without psychiatric help, he would often recommend seeking out a psychotherapist to explore repressed emotions, or to take up journaling to put your feelings on paper. Dr. David Hanscom, an orthopedic surgeon, also uses expressive writing as a primary treatment tool for back pain.

Build a Better Back This Year

As you can see, there’s no shortage of strategies to address back pain, and I urge you to try several of them before resorting to a dangerous drug or back surgery. Remember, more movement, not less, is typically advisable for chronic back pain, and there are many ways to build a stronger, more flexible back — regular stretching and Foundation Training being at the top of the list.

Avoiding sitting and addressing your posture are other key strategies, to which you may consider adding chiropractic care and/or acupuncture treatment. Also, do give some thought to your emotional state. Even if you struggle to accept such a concept, the mere knowledge of it can have therapeutic power. In other words, by considering the idea that your problem is in fact rooted in stress factors opposed to a physical problem can allow the pain to dissipate.

When to See a Doctor

Although back pain is definitely serious, as it affects your everyday life and can suck the joy out of your days for a week or more, it is often not dangerous. In other words, the severity of your pain does not indicate your condition is medically dangerous.

However, there are some signs and symptoms that might suggest the pain you’re experiencing is not common low back pain from a muscle strain or sprain, but might be something more serious requiring physical assessment and treatment.^23,24,25 Should your back pain be accompanied by any of these symptoms, a thorough medical checkup would be in order to rule out a more serious problem.

Fever	Difficulty passing urine
Previous high risk of fracture	Loss of bladder or bowel control
Feeling like you need to pass urine but there is none	Loss of muscle strength or sensation in the legs
Night back pain not relieved by adjusting in bed or starting only at night	Impaired sexual function, such as loss of sensation, numbness or tingling in the genitals or buttocks
Pain in your upper or lower back not tied to a specific joint or muscle may signal a heart attack