If your day typically ends with you popping a couple of aspirin and using a heating pad to soothe your aching back, you’re not alone. According to the American Chiropractic Association (ACA), 75 to 80 percent of all people experience back pain at some point in their lives.
Of course, the type of pain and level of discomfort is different for everyone. Some people experience upper back pain, while others are troubled by lower back pain. Symptoms can be dull and nagging or sharp and debilitating. And because the causes of back pain can vary greatly, there isn’t a one-size-fits-all remedy.
In fact, treatment options for back pain sufferers have increased and broadened in recent years, with a variety of medical specialties offering people alternatives for relief. The key to finding the right course of action is to first understand what could be triggering your pain and then educate yourself about what is available to you, whether it’s conventional medicine, chiropractic care, physical therapy, an alternative treatment such as acupuncture, or another option.
“It is important for patients with back pain to develop a personalized self-care regimen,” says Tasneem Bhatia, MD, medical director of the Atlanta Center for Holistic and Integrative Medicine. “Different modalities work for different people depending on the stage of their pain.”
We explored three common complaints of back pain, turning to specialists in the metro Atlanta area to get their take on the possible causes and treatments for the discomfort. When tackling your own back pain, keep this information on hand and be sure to open your mind to consider a range of possible therapies—you never know what will end up working for you.
Experience #1: Upper back pain
Bonnie has been feeling pain in her upper back when she takes a deep breath. She also experiences discomfort when she moves, particularly between her shoulder blades. Additionally, she often feels like she is having spasms in the upper portion of her back.
What the experts suggest for Bonnie:
“Upper back pain can be a result of a musculoskeletal sprain and strain, chest cavity infections (pleurisies, pneumonia) or cardiac issues. It is important to rule out the more critical diagnosis with a chest X-ray and proper exam by a physician. Once the pain does seem to be musculoskeletal, then anti-inflammatory medication in combination with acupuncture, massage or chiropractic care may be helpful.” -Tasneem Bhatia, MD, Medical Director Atlanta Center for Holistic and Integrative Medicine
“The differential diagnosis includes muscular pain, spinal pain from disc pathology, vertebral body fracture or joint dysfunction, rib fracture or a lung problem such as pleuritis. I would likely perform X-rays in the office to rule out fracture. If the pain appeared to be spine related, appropriate rehabilitation with a skilled spine therapist would be recommended.”-Krystal Chambers, MD, Physiatrist Resurgens Orthopedics
“Commonly, I find that pain in the upper back stems from problems in the neck. Long-term stress and its associated posture cause a gradual forward shift of the head, loss of cervical curve and pulling effect on the spinal cord, ultimately resulting in muscle spasm and pain. While treatment would vary by individual, I recommend finding a practitioner who’s interested in exploring causative factors, not just symptom suppression.”-Dr. Gene Clerkin, Holistic Chiropractor and Clinical Nutritionist Center for Holistic Health
“Bonnie is complaining of upper back pain with muscle spasms which are made worse with movement. Muscular strain or degenerative conditions of the spine might present in this fashion. Without antecedent trauma, I would recommend that she initially undergo medical management and possibly physical therapy for these symptoms.”-Eric Francke, MD , Spine Surgeon Pinnacle Orthopaedics
“These symptoms can be caused by overuse syndrome. When people utilize their body, they tend to use one side more than the other. This can create inflammation in the area over time and it would cause adhesion of muscles and then, finally, tissue will change into scar tissue. This process cause pain and reduce the function of the area. If this condition is acute, the patient needs to apply ice on the area to reduce the inflammation and swelling. Then I would perform the Active Release Technique (ART®) and chiropractic adjustments on the involved area, which would break the adhesive/scar tissue and aid function of the muscles in the area."-Jong W. Lee, DC, Board Certified Doctor of Chiropractic Dr. Lee Chiropractic
“It could be caused by decreased postural awareness, thoracic kyphosis and hypomobility, cervical/thoracic degenerative arthritis or disc disease, as well rib dysfunction or intercostal muscular strain. After using heat/cold to decrease the pain, soft tissue and joint mobilization, postural training and scapular stability exercises would be very effective.”-Jessica Loncar, MS, PT, OCS, Cert. MDT, Physical Therapist, STOTT PILATES Rehab Instructor Trainer and Certified Instructor Stability Pilates and Physical Therapy of Atlanta
“Rib subluxations [slight misalignments] would be areas I would thoroughly examine. X-rays might be helpful, as well. Should subluxation be the cause of her symptoms, I would manually adjust them. And a regimen of specific stretching and ice [application] would accelerate the healing.” –Bruce L. Salzinger, DC, CCSP, Doctor of Chiropractic Chiropractic Healthcare of Buckhead
“The spasm may be caused by a pinched nerve, tension or poor posture. In Chinese medicine, we also take into account the patient’s mental and emotional state, which can manifest as pain in the upper back—during a treatment, patients enter a deep state of relaxation as the pain dissipates. Acupuncture treats pain very effectively. The first procedure I would use is cupping, where a heated glass cup is placed on the area of distress to create suction that would bring blood circulation to the area. I also use a style of acupuncture where needles are never inserted into the local area of pain. Once the needles are inserted, I would ask the patient to gently roll her shoulder giving movement to the affected area. The pain usually drops significantly within moments of the needle insertion. Permanent relief might take a few treatments.”-Jeff Shelton, LAc Dipl Ac Dipl CH, Licensed Acupuncturist Highland Acupuncture
Experience #2: Low back pain
For the past several weeks, John has experienced cramping, stiffness and muscle spasms in his lower back. He has been quite active lately, moving into a new home and lifting heavy boxes. He is concerned because the pain developed quickly and is occurring in episodes that last up to 48 hours.
What the experts suggest for John:
“In this scenario, I would worry about damage to the lower vertebral discs or disc space. An initial exam, including X-rays of the lower back and an MRI, would determine any possible disc or disc space damage. The treatment would then depend on those findings and would vary from temporary pain relief to more aggressive measures supervised by an orthopedic surgeon.”-Tasneem Bhatia, MD
“The causes of pain [could] include severe muscle strain, disc bulge or herniation or exacerbation of an underlying chronic condition such as degenerative disc disease. I would recommend activity modification to minimize exacerbation of symptoms, ice during the first 24-48 hours if tolerated, anti-inflammatory medications, muscle relaxants and/or pain medication in the acute stage as needed and a rehabilitation program to further decrease the pain and improve function. Strength training once the patient becomes pain free is also recommended.”-Krystal Chambers, MD
“When performing nutritional evaluations, we find a frequent correlation between prostate problems and low back pain. In fact, any ‘challenged’ organ can cause referred musculoskeletal pain. Due to the prevalence of prostate issues for men, it’s something that should be considered. Ruling out any major pathology, I’d recommend an individually designed clinical nutritional support program. Detoxification and availability of the proper nutritional building blocks can support healthy function of stressed organs.”-Dr. Gene Clerkin
“John is complaining of stiffness and muscle spasms in the low back after strenuous lifting activities. This presentation would be consistent with a lumbosacral strain. I would initially recommend limited activity and medical management with non-steroidal anti-inflammatory medications and muscle relaxants. Physical therapy would also be an option.”-Eric Francke, MD
“This can be due to the poor integrity of his spine. When people develop misalignment in their spine over several years, they can have unstable structure of their spine. This can lead to acute pain, especially after lifting heavy objects without proper form. The symptoms might be an acute episode. However, the condition could be chronic. I would first perform a complete chiropractic physical on this patient and see if he has a problem in his spine. I would come up with a care plan based on his condition. If his condition is due to the misalignment of his spine, chiropractic treatment can help his condition with specific adjustment. Also, the patient needs to be instructed on proper lifting to prevent re-injury and exercise to improve support of the area.”-Jong W. Lee, DC
“This scenario could be caused by many different things—a lumbar disc herniation, lumbar muscle strain, sacroiliac (SI) joint dysfunction or sciatica. I would recommend a physical therapy evaluation and treatment consisting of movement assessment, pain modalities to decrease pain and inflammation, soft tissue work to decrease pain and increase mobility, stabilization/flexibility exercises to increase mobility and function and patient education to improve lifting and movement techniques.”-Jessica Loncar, MS, PT, OCS, Cert. MDT
“This is probably muscle strain. The back muscles are failing to protect the ligaments in maintaining posture. In Chinese medicine, this is a result of ‘qi’ (energy) stagnation. When there is a blockage of qi, there is pain. Using a unique style of acupuncture, I will have the option of putting 3-4 needles in the arm or 1 in the ankle on the opposite side of the pain. This will unblock stagnant qi, thus relieving the cramping, stiffness and spasms. Using the Master Tung style of acupuncture, needles are never inserted in to the area of pain. And with just a few needles, the results can be dramatic.”-Jeff Shelton, LAc Dipl Ac Dipl CH
“A sprain or strain from the physical exertion overlying a subluxation complex could be the problem. I would recommend specific chiropractic adjustments and, depending on the level of pain and involuntary muscular spasms, a regimen of physiological therapeutics.”-Bruce L. Salzinger, DC, CCSP
Experience #3: Pain in buttocks and leg
Donna works in an office and spends much of her time sitting. Recently, she has felt pain that begins in her buttocks and moves down into her leg. Sometimes the pain occurs as a burning or tingling sensation, while other times she feels a shooting pain that makes it difficult to stand up.
What the experts suggest for Donna:
“Donna could have venous thromboses—I would want a Doppler Ultrasound of her lower extremity so we could evaluate this. I would also be interested in her lower vertebral discs and work to make sure there is no pathology.”-Tasneem Bhatia, MD
“The most likely cause of these symptoms is a pinched or compressed nerve in the lumbar spine. This is commonly referred to as “sciatica.” In the acute stages, activity modification, ice and anti-inflammatory medications can be helpful. Muscle relaxants and pain medications may be necessary to help control pain initially. Getting the patient involved in a rehabilitation program with a skilled spine therapist early on is also very important.”-Krystal Chambers, MD
“Radiating pain in the buttocks is most commonly caused by pressure on the sciatic nerve. Prolonged sitting, especially with poor posture, stretches the nerve. Long-term postural distortion can lead to disc problems, putting even more pressure on an already stretched nerve. Even many patients that have gotten to the point of disc lesions can benefit from light touch chiropractic care designed to release the tension and stretch from the sciatic nerve. Keeping the pressure off allows the compromised nerve and ligaments to heal. Ultimately, you want to make sure you’re not creating the same problem over again.”-Dr. Gene Clerkin
“Donna is complaining of buttock pain with radiation of tingling and burning into the lower extremities. It is likely that her symptoms are caused by irritation of the nerve roots exiting the low back. A lumbar MRI would further define her pathology, and potentially direct epidural steroid injections [could be recommended].”-Eric Francke, MD
“This symptom could come from disc herniation or piriformis syndrome. However, this condition could be a result of poor posture and misalignment of her spine. Prolonged sitting in bad posture can cause misalignment of her spine, which can lead to sciatica or even more problems in her body. In order to reduce the pain, I would ask her to take time and rest with ice pack application to the area. Mild motion can actually help speed up the healing. After her pain gets better, I would focus on her posture and spinal alignment to find the cause of the problem. She might need long-term care and lifestyle change for a pain-free and healthier life.” -Jong W. Lee, DC
“It is more than likely a disc injury—a disc bulge, herniation or extrusion. Postural education and correction, workstation modification, medication and modalities to decrease inflammation and pain and movement assessment and treatment are all recommended. After leg symptoms have resolved and centralized, she should progress to lumbar stabilization and core strengthening.”-Jessica Loncar, MS, PT, OCS, Cert. MDT
“This sounds like vertebral subluxation affecting the sciatica nerve. I would recommend specific chiropractic adjustments and, depending on duration and severity of the symptoms, physiological therapeutics.”-Bruce L. Salzinger, DC, CCSP
“This sounds like sciatica, which is caused by a herniated disc or a prolapsed lumbar disc. Acupuncture is very effective in treating disc herniation. Not only can acupuncture treat the pain, but the nucleus pulposus can be reabsorbed. In Chinese medicine, the area of sciatic pain runs along the Gallbladder channel/meridian (not related to the gallbladder organ). The channel will be stimulated and unblocked to release the pain. Chinese herbs can also be used to alleviate the burning sensation. Most patients can expect relief after the first treatment.” -Jeff Shelton, LAc Dipl Ac Dipl CH
Get a Move On
According to Eric Francke, MD, spine surgeon with Pinnacle Orthopaedics, the most common misconception regarding back health is that inactivity and bed rest can help your low back pain. He explains, “Although temporary activity limitations are reasonable, the goal of treatment is to resume regular activities and learn a lumbar home exercise program that will help you maintain low back fitness.”
Did You Know?
According to Krystal Chambers, MD, of Resurgens Orthopedics, your back issues may have started long before you even realized you had them. “When a person experiences an episode of back pain, they sometimes think it occurred out of the blue,” she notes. “Many times, the situation has actually been evolving for months or even years before it starts to produce symptoms.”
Did You Know?
“People think that they need to strengthen their back or stomach muscles [to help their back],” notes Dr. Gene Clerkin of the Center for Holistic Health. “However, the overwhelming majority of back pain is caused by stress.” It’s true. Numerous studies, including one conducted by Eugene J. Carragee of Stanford University and reported about in Scientific American Magazine, have shown a correlation between psychological stress (or distress) and chronic back pain.
Speaking from Experience
Patti Stephens: Considering All the Options
It hurts to sneeze! If you can relate to that, chances are good that you have lower back pain. I have been dealing with low back pain on and off for the last 11 years. It arrived shortly after the birth of our son. At first, I thought it was just leftover pregnancy pain. Then I thought it was from being a tired new mom. However, as I got my strength back, the pain didn’t leave. I saw an orthopedist who took a round of X-rays and said that I probably ruptured my sciatic nerve during delivery; physical therapy was supposed to take care of it. While three months of therapy didn’t help my back very much, it did help me get back into pre-pregnancy shape! Still, I was frustrated at my limitations in activity—even gardening was a pain. I met a chiropractor who told me she believed she could have me feeling better within three weeks—I decided to give it a try. After all, my dad had gone to a chiropractor for his back and always got relief. She delivered on her promise, and I saw her regularly for about a year and half. When she moved out of town, I quit going to the practice. At that point, I was in pretty good shape and not experiencing much pain. But a few years ago, I got too busy (a.k.a. too lazy) to be diligent about my workouts and, before I knew it, my back was flaring up more and more. I knew that I needed to get back into shape, but everything I did hurt. So, I tried a new chiropractor, massage therapy, spinal decompression, another orthopedist and physical therapy. I finally got an MRI and discovered that I had a bulging disc—not at all uncommon yet not operable. I tried epidural shots in my spine. Nothing really helped. Then I found a facility that combines physical therapy and Pilates. I had wanted to try Pilates but was afraid of how my back would react. But Pilates is all about strengthening your core muscles, making every movement easier on your back. After three weeks of physical therapy, I was ready to get on that Pilates table! By the fourth week, I was doing part physical therapy and part Pilates. And after 8 weeks, I started to feel that I just might get this body back into shape after all! I really enjoy my Pilates sessions—I love the combination of strengthening, toning and stretching being done all at once. And I am starting to have strenuous workouts with no pain! My only pain is the “good” kind of pain you feel after a good workout. My instructor Kim really listens to what hurts and what works and pushes me to the next level. I think that with lower back pain, you have to find what works for you and figure out how to manage the pain. For me, Pilates seems to be healing—and it doesn’t hurt to sneeze anymore!