En español | Whether nagging, dull, searing or constant, back pain sends more of us to the doctor than any other ailment except the common cold.
Some 25.3 million American adults experience chronic back pain; at least 70 percent of us will experience some type of it in our lives. And our modern lifestyles are at least partly to blame, doctors say. We sit too much. We hunch over phones and computers. We don’t move enough. We are too fat.
Drugs, particularly opioids, have long been the first line of therapy, especially for the chronic, nonspecific kind of back pain for which doctors can identify no obvious cause. That, as it turns out, was a mistake.
“Health care providers didn’t look at evidence as carefully as we should have early on and continued to prescribe, not realizing risks outweighed the benefits,” says David Shurtleff, acting director of the National Center for Complementary and Integrative Health. He notes that very often, acute back pain will go away on its own with time. It's just that not many of us feel like waiting.
With national rates on opioid use and addiction reaching crisis numbers (in 2015 an estimated 91.8 million American adults — more than a third of the population — used prescription opioids) and new research showing they are not all that effective for garden-variety back pain, it may be time to consider alternatives.
The American College of Physicians now recommends a host of alternative measures, such as exercise, tai chi, cognitive behavioral therapy, or even acupuncture. These alternatives can provide real, if not miracle-like, relief and may need to be combined for best results.
Below are a few options that science and doctors say are worth exploring — one, two or three at a time.
Plain old walking
“Your spine needs movement for health,” says Stuart McGill, a professor of spine biomechanics and author of Back Mechanic. If lacing up your sneakers and heading out feels just short of impossible, try short walks just to reestablish the habit. If 10 minutes is too much, take two five-minute walks throughout the day. “It’s a matter of getting the dose right,” McGill says, and sticking with it. A meta analysis found that walking was associated with significant improvements in patients with back pain — but they had to keep up the practice to feel better. McGill also notes that swimming or using a stationary bike might substitute for walking, depending on whether the activity irritates your specific back condition.
Yoga, Tai Chi or Meditation
Many studies have found yoga to be more effective than physical therapy for back pain, says Ashot Kotcharian, M.D., an instructor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. This may be because yoga is not only a physical but also a meditative exercise. It calms the mind while strengthening the body, a potentially winning combination when dealing with physical pain, which both depression and anxiety can heighten.
If you’ve never tried yoga, consider a “gentle” or “restorative” class, and don’t be shy about asking for help or sitting out a pose if it causes you (more) discomfort. You could also call a studio ahead of time and ask which class or instructor might be best for you. “You need a yoga teacher who understands what the problem is with your back,” says Frank Lipman, M.D., founder and director of the Eleven Eleven Wellness Center in New York City.
Studies also back up the efficacy of tai chi (a slow-moving series of standing movements accompanied by deep breathing) for back pain, and even seated meditation — without any additional movement — has been shown to ease the pain. To start, try 10 minutes of meditation before coffee in the morning. A book, app or community class can give you a simple set of instructions.
Simple core exercises
Strengthening your midsection is nonnegotiable in helping to clear up back pain and ward it off for the long term, says McGill, author of Back Mechanic. NIH research backs him up. One meta study found that core-stabilization programs have been shown to reduce chronic low-back pain by up to 77 percent.
While McGill is a big advocate of identifying and focusing on movement patterns that could be causing you trouble (his book teaches a method for this), he says that three essential exercises, practiced daily, can give most people the strength they need to help ward off the hurt. These are a side plank, the bird dog (while on your hands and knees, reach one arm out in front of you while extending the opposite leg behind you) and a modified curl-up with hands supporting the lower back.
A diet tweak
Dietary changes are not part of the American College of Physicians’ new guidelines on back pain, yet many experts, including chiropractors, swear by them to address this problem. David Friedman, a naturopathic physician and author of Food Sanity: How to Eat in a World of Fads and Fiction, says that poor eating habits can render all other treatments futile. “One of the biggest underlining culprits of back pain is poor nutrition and digestion, which can lead to chronic inflammation that irritates muscles, ligaments, tendons and nerves.”
To reduce inflammation, Friedman recommends eliminating all junk food and processed food, including white flour and deli meat, and replacing them with a diet rich in fruits and vegetables such as blueberries, red grapes, broccoli, spinach, onions and ginger, as well as plenty of fatty fish (think salmon, mackerel and sardines).
You will not free yourself from pain if you are not sleeping, says David Hanscom, an orthopedic surgeon at Swedish Neuroscience Specialists in Seattle. He says that lack of enough shut-eye actually “induces chronic pain.” Aim for at least seven hours of restful sleep every night.
If you wake up uncomfortable each morning, you may need to try a different mattress. McGill recommends going to a mattress store and lying on a mattress for an hour before choosing a new one. You can also order and try out mattresses from online retailers such as Casper, which offers free returns. And don’t discount the value of simple tweaks like a regular bedtime, blackout shades and earplugs in possibly providing the means for some rejuvenating shut-eye.