“Low back pain” which can be acute or chronic, is literally pain or discomfort of the lower lumbar region of the back. Acute back pain usually follows some kind of injury, often related to everyday activities such as housework, gardening, a sports-related injury or an automobile accident. Back pain that lasts for more than three months is classified as chronic.

What are the symptoms?

Symptoms are often described as painful muscle aches or spasms but can include shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.

What are the causes?

Most cases of low back pain are due to inflammation and irritation of nerves following strain or injury to the muscles and ligaments of the spine. In some cases, however, low back pain can be due to serious conditions, such as cancer or structural problems of the spine, which can cause nerve damage. Occasionally, lower back pain is due to a “slipped disk” (also called a herniated disk), in which one of the disks of cartilage that separates the vertebrae in the spine bulges out of place and presses on nerves. Often, a disk “slips” as a result of twisting while lifting, but the initial cause may not be identifiable.

Simple preventive steps can help eliminate recurring back pain resulting from improper body mechanics or from other causes of back problems that don’t stem from structural injuries. Performing exercises that tone the back and maintaining proper posture are especially helpful. In addition, anyone with a tendency to develop back pain should learn to lift objects properly:

• Bend your knees and squat to pick up an object
• Keep your back straight
• Hold the object close to your body
• Avoid twisting

Choosing ergonomic furniture and tools at home and at work can also help avoid strains on the back.

What is the conventional treatment?

Back pain that involves changes in bowel or bladder function should be evaluated by a physician, but most acute back pain will resolve on its own within two weeks without medical intervention. Whether lower back pain is acute or chronic, most cases are initially treated with over-the-counter pain relievers to reduce discomfort and with anti-inflammatory drugs to reduce inflammation. Sometimes, prescription drugs may be recommended for pain relief and to allow quality sleep. Cold and hot compresses may help reduce pain and inflammation and allow greater mobility in some cases, although they have not been proven to reliably resolve low back injury. Reduced activity and bed rest is recommended for only 1-2 days at most, and patients are generally advised to resume their normal activities as soon as possible. Massage therapy can be very useful in cases of acute muscle spasm causing back pain and for addressing problems with flexibility. Exercise may be the most reliable way to speed recovery and strengthen back and abdominal muscles. Physical therapy may be recommended for more severe strains. In the most serious cases that don’t respond to other forms of treatment, and that involve compromised structures in the spine or serious musculoskeletal injuries, surgery may be recommended to relieve pain and help restore normal function.

What therapies does Dr. Weil recommend for chronic low back pain?

Read one or both books on back pain by Dr. John Sarno, a physician and professor of rehabilitation medicine at New York University. Dr. Sarno believes that most chronic back pain stems from a condition he calls tension myositis syndrome (TMS). Myositis means muscle inflammation. According to Sarno, TMS is a combination of muscle spasm and inflammation stemming from an unbalanced pattern of nerve signaling to nearby muscles and interference with their blood supply. Dr. Sarno explains his theory in his books Healing Back Pain: the Mind-Body Connection (Warner Books, 1991) and Mindbody Prescription: Healing the Body, Healing the Pain (Warner Books, 1998). The treatment he recommends is aimed at changing patterns of thinking, feeling and handling stress, all of which have contributed to the pain. You might also consider the following approaches:

• Practice a relaxation technique daily: Options include mindfulness meditation (proven to ease chronic back pain), breath work, guided imagery, biofeedback, progressive muscle relaxation and hypnotherapy.
• Try therapeutic yoga: The stretches can reduce muscle tension, strengthen the back and promote flexibility.
• Bodywork: Both the Alexander Technique and the Feldenkrais Method can change habits of posture and movement that contribute to back pain. You could also try Bonnie Prudden Myotherapy, which uses manual pressure to release muscle tension.
• Electrical stimulation: Transcutaneous electrical nerve stimulation (TENS) delivers low level electrical pulses to the lower back (you can get a portable device for home use). Percutaneous electrical nerve stimulation (PENS) works the same way but delivers the pulses via needles inserted into the back rather than electrodes used with TENS.
• Exercise: Both aerobic and strength training exercises can help. Aerobic exercise includes walking, swimming or cycling, all of which can help strengthen the back. Aerobic exercise also burns calories and helps you lose any excess weight that may contribute to your back problem. In addition, perform strength training exercises at least twice a week to tone and firm the abdominal, leg and buttock muscles that help to support the back. Seek out proper instruction before embarking on a strength training program; using either free weights or weight machines improperly can defeat the purpose. Make sure you incorporate some stretching or yoga for flexibility.
• Chiropractic care: Dr. Weil believes that chiropractic care may be of benefit in the treatment of back and neck pain. Many chiropractors use a kind of manipulation called “dynamic thrust”: a low speed, high force movement often accompanied by a popping or cracking sound. Others use a low-force, high-speed method, known as the Activator method (incorporating a tension spring and plunger tool) that may be a better choice for older patients, as their more limited flexibility might be challenged by dynamic thrust.
• Acupuncture: Studies in the U.S. indicate that acupuncture can help to relieve several kinds of pain, including low back pain.
• Massage: Therapeutic massage can provide long lasting results, and bodywork can help patients receive the maximum benefits from chiropractic adjustment. Deep tissue work, such as structural integration or Rolfing, can often effectively address structural problems that contribute to chronic low back pain. To find a qualified massage therapist visit the website of the American Massage Therapy Association.

Originally published March 2010. Updated October 2023. 

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Sciatica is pain in the lower back or hip that radiates down into the buttock and back of the leg along the sciatic nerve, often to the foot. Sciatic pain is the result of a pinched or inflamed sciatic nerve and can occur following an injury, muscular strain or herniated (“slipped”) vertebral disc that presses on the nerve. Fortunately, sciatica usually goes away on its own within a few weeks.

What are the symptoms of sciatica?

The pain of sciatica can take a number of forms – it may feel like a cramp in the leg, may worsen when you sit, sneeze or cough, and may show up as numbness, burning, tingling, an electrical shock or as “pins-and-needles” along the leg. Muscle weakness can occur either due to pain or pressure on the nerve. Loss of bowel or bladder control is a rare but serious complication that requires emergency treatment.

Only 10 to 25 percent of all cases last more than six weeks and 80 to 90 percent of all people with sciatica recover, in time, without surgery.

What are the causes of sciatica?

The two sciatic nerves are the longest nerves in the body, running from the lower spinal cord down the buttock and hip, and continuing down the back of each leg to the foot. Each carries nerve signals for motor control of several muscles of the lower leg as well as sensation to the backs of the thighs, calves and feet.

Anything that compresses a sciatic nerve for prolonged periods of time can cause sciatica. Sometimes this is the result of herniation in a disc of the lower back. Age-related changes to the spine cause deterioration to the shock-absorbing pads of cartilage that separate the back bones (vertebrae) from each other. These pads create space between the bones, allowing a place for the nerves to travel as they leave the spinal cord. If these discs rupture, their inner gelatinous substance can seep out and push against the nerves.  Degenerative arthritis can also cause a narrowing of the space between vertebrae or cause one vertebra to slip forward onto another. This can pinch a root of the sciatic nerve, and cause similar symptoms.

Trauma from a car accident or blow to the spine can injure the sciatic nerve directly, as can muscular strains of the large lower back muscles and spasms of the piriformis muscle that runs directly over the nerve. As these muscles become tight or go into spasm, they can create a rope-like tension that irritates the nerve. Tumors of the spine, spinal cord, or the nerve itself are rare causes of chronic sciatic pain.

In addition to getting older, being in a job that requires constant twisting, heavy-lifting or driving can make one more prone to sciatica. The constant sitting that occurs as a result of a desk-job or being overly sedentary can also put excess pressure on the lower back and legs. And finally those with diabetes have an increased risk of sciatica due to the damage that occurs to peripheral nerves when blood sugars are abnormally high.

What is the conventional treatment for sciatica?

For most people, sciatic pain responds well to simple measures, including hot and cold packs, stretching exercises and the use of over-the-counter (OTC) pain medications such as non-steroidal anti-inflammatories (NSAIDS) like ibubrofen.  In some instances, doctors will prescribe an NSAID along with a muscle relaxant to treat tension and muscle spasm. Narcotics may be given to deal with poorly controlled sciatic pain, although they can become addictive when prescribed for long periods of time.  Chronic sciatic pain – longer than 2-3 months – can be treated with narcotic pain patches or the use of tricyclic antidepressants and anticonvulsant drugs, which work by blocking pain messages to the brain or by enhancing the body’s own production of endorphins.  These medications can have side effects which include constipation, dry mouth, weight gain, bladder problems, blurred vision and dizziness.

Most conventional doctors recommend physical therapy with stretching exercises as soon as the pain begins to diminish. You often can begin this rehabilitation by taking short walks even before starting physical therapy. Rehabilitation typically includes exercises to help correct posture, improve flexibility, and strengthen lower back and leg muscles.  Massage therapy, ultrasound, and other techniques are often included in a therapy session, which typically lasts one hour.

When conservative measures don’t alleviate pain within a few months, an epidural steroid injection or nerve block may be considered. Typically, a steroid is given along with a numbing agent – sometimes under X-ray guidance – into the area of suspicious nerve irritation with the hope that it will suppress inflammation and help relieve sciatic pain. These types of procedures are still under investigation as to how effective they are. Some research has found that corticosteroids can provide short-term symptom relief; however, data doesn’t seem to confirm its long-term usefulness. In addition, because of the side effects steroids can have, the number of injections you can receive is limited – usually no more than three in one year.

Surgery to correct a herniated disc is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or when pain gets progressively worse or doesn’t improve with other therapies. Most current surgical options involve a lumbar laminectomy with diskectomy, where the herniated portion of the disc is removed, relieving the compression and retaining as much normal disc anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy). Fusion of vertebrae for sciatica is rarely done. Success rates of standard diskectomy versus microdiskectomy are about equal, although sometimes pain control and recovery time can be better with the lesser intervention of miscrosurgery.

What therapies does Dr. Weil recommend for sciatica?

Regarding surgery to remove part or all of a herniated disk, Dr. Weil recommends considering it only if, after three months of treatment, you still have disabling leg pain. Luckily, that is rarely the case.

If the problem is muscular, specific stretches that can relax the piraformis muscle are frequently beneficial and can bring immediate relief.

Anyone with chronic low back pain should review the recommendations in that section and consider the books written by Dr. John Sarno.

The best therapy is prevention. Maintain ideal weight, engage in regular physical activity several times a week, and avoid prolonged sitting as much as possible. Also, carrying a large wallet in the hip pocket of pants can sometimes cause or aggravate sciatica – remove unnecessary items and/or find alternative ways to transport your money, identification and other essentials. If you are diagnosed with sciatica, Dr. Weil recommends these treatment options:

• Acupuncture: The National Institutes of Health recognizes acupuncture as an acceptable alternative to conventional therapies for low back pain. Look for an acupuncturist accredited by the American Association of Oriental Medicine or the American Academy of Medical Acupuncture.
• Bodywork: Both the Alexander Technique and the Trager Approach can help overcome back pain. The Trager Approach includes table work (a practitioner gently rocks and lengthens your body to release tension) followed by a movement lesson for continued self-care. The Alexander Technique can help relieve pain and prevent recurrences by correcting poor posture and teaching proper patterns of movement.
• Therapeutic Yoga: Yoga can help relieve pain and protect against recurrences by strengthening your back. It also can balance nervous functioning, promote flexibility and neutralize stress, all of which contribute to back pain. (Therapeutic yoga may offer more benefits than physical therapy.)
• Osteopathic Manipulation: This system of manipulation of the musculoskeletal system can be a highly effective treatment and usually requires only a few visits to a qualified practitioner.

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Scoliosis is a sideways curve of the spine, either “S” shaped or “C” shaped, that occurs most frequently in girls over the age of 10. The curves usually appear during early adolescence.  All told, some degree of scoliosis affects two to three percent of the population. The vast majority of these cases – between 80 and 85 percent – are classified as “idiopathic”, meaning that the cause is unknown.

Less common forms of scoliosis include congenital scoliosis, a rare condition present at 1 in 10,000 births. Here, too, the cause is unknown, but surgery is needed to correct the curve. Another form of the disorder, neuromuscular scoliosis (also called myopathic scoliosis), can develop in muscular dystrophy or cerebral palsy patients who cannot walk.

What are the symptoms of scoliosis?

Idiopathic scoliosis rarely causes pain and does not require treatment. However, if there are symptoms, they can include backache or low back pain, as well as a tired feeling in the spine after lengthy sitting or standing, which may be due in part to uneven hips or shoulders (one shoulder higher than the other). Call the doctor if severe back pain develops, particularly if it is associated with weakness of the limbs or numbness.

What are the causes of scoliosis?

Scoliosis tends to run in families, and about 20 percent of those with affected relatives develop the condition. Researchers have identified a gene, CHD7, related to idiopathic scoliosis and have determined that variations in this gene increase susceptibility to scoliosis but have not discovered how this comes about.

How is scoliosis diagnosed?

Doctors usually can make a diagnosis by physical examination, checking to see if the shoulders are level, the head is centered and opposite sides of the body look level. An x-ray may be needed for correct measurement of the curve.

Many children are screened at school and by pediatricians and primary care doctors for scoliosis with the Adam’s Forward Bend Test, whichmerely requires kids to bend forward, letting their arms dangle and keeping their feet together and knees straight. This position reveals the spinal curvature typical of scoliosis as well as whether one side of a child’s rib cage is higher than the other, also a sign of scoliosis. However, the forward bend test misses about 15 percent of cases because it doesn’t show abnormalities in the lower back. For this reason, many experts do not recommend it as the sole screening method for scoliosis. Girls are typically screened twice, at age 10 and 12, and boys once at age 12 or 13 years.

Overall, x-rays are the most accurate way to diagnose scoliosis and determine its severity. Follow-up x-rays may be needed every few months to see if the curve is worsening. Parents should ensure that all protective measures are being taken with these frequent x-rays since exposure to the radiation presents a possible increased risk of cancer later in life.

Since scoliosis tends to run in families, parents, particularly those who have the disorder, can look for signs of it in their children. Be on the lookout for one shoulder higher than the other, uneven hips, or one side of the rib cage sticking out more than the other. These signs may be easier to spot when kids are bathing or swimming and hard to see when they’re fully clothed.

What is the conventional treatment of scoliosis?

Very mild curves don’t require any type of treatment. The Scoliosis Research Foundation estimates that only 10 percent of people with scoliosis – those with curves greater than 20 degrees – need treatment of any kind.

When a child is still growing and the curve is less than 25 degrees, the only medical attention needed is a checkup every four to six months to see whether or not the curve is worsening. If it is – or if it was greater than 25 degrees to start with – a customized back brace may be recommended for children who are still growing. Patients wear the brace daily for a specified number of hours (often between 18 and 20 per day). Among youngsters and teens who are still growing or when braces have failed to correct the curve, surgery to straighten the spine is considered necessary when curves are 45 degrees or more and worsening.

What therapies does Dr. Weil recommend for scoliosis?

Dr. Weil suggests alternatives to surgery including osteopathic manipulation and therapeutic yoga, which can help lengthen and strengthen the muscles that support the spine. Depending on how severe the scoliosis is, he notes that manual manipulation and breathing exercises can be helpful for pain relief and to ensure good breathing habits.

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