All Posts tagged Low Back Pain

Back Pain – Avoiding It

Here is some of the advice that I hear myself sharing with patient’s who suffer from low back pain.

Tip 1 – Don’t perform repeated bending over or heavy lift in the morning.

Don’t get right out of bed and start bending over to lift objects at home or for work. The lumbar disc pressure is greatest in the morning due to the uptake of fluid into the disc overnight. If the disc is pre-swollen and thus already has higher intradiscal pressure, then it makes sense to avoid any flexion (bending over, rounding your back) based movements early in the morning.

I love working out first thing in the morning. So I have to be especially careful when I bend over that I bend from the hips and not the lumbar spine. I make sure that I’m warmed up properly, and I do bodyweight squats before adding any loads to my deep squats or deadlifts. If you work in a manual labour based occupation, then if possible avoid the lifting jobs until a little later in the morning.

Tip 2 – Sit at work or the car  with a lumbar support

Avoid sitting in a slumped position. Sustained sitting postures tend to be a big factor in people who suffer flexion based back pain. If you have to sit for long periods, use a lumbar roll. Buy a McKenzie roll at Relax The Back Store, Acology on Wilshire Blvd., or use a rolled up towel to put in the small of your back.

Tip 3 – Regarding chairs at work & home

The biggest factor in back pain and back muscle fatigue is sustained poor posture – again, avoid slumping. The best chair in the world is useless if you don’t frequently change position. By this I mean getting up every 20 minutes. Stand up, reach both arms up to the ceiling as if you are pushing the ceiling upwards. Hold it for 20-30 seconds. If you have an ergonomic chair, change the elements of the chair such as height, pitch of the seat and angle of the back support often. While at work or driving long periods, every 1/2 hour change 1 element of the chair to share the load and fatigue around the spine-pelvis. If you have a poor chair, get a new one!

Tip 4 – Mattresses.

We move around a lot more in our sleep than you think – about 40 times per night. It may be a slight change in arm position, or flipping from one side onto the back. I’m not big on spending a ton of  money on a mattress. If your mattress is more than 10 years, you probably need a new one. If you wake up stiff in the morning, try another bed for a couple of nights. If you wake up feeling better, it’s your bed. Get a good quality mattress, usually medium firm is the right one. 

Tip 5 – Bending over

If you have to bend over to pick something up, then bend at your hips not at your back. A Romanian deadlift is an exercise/movement that involves bending over by pivoting the hips into flexion whilst keeping the spine in a neutral position. This is far more effective for protecting the lumbar spine from high disc pressure than bending from the spine or even deep squatting. When you deep squat to lift, most of us don’t have the flexibility in the hips to maintain a neutral pelvis position. What invariably happens is the pelvis posteriorly tilts (tilts backwards) and flattens out the lumbar spine. This is akin to flexing the spine and thus leads to higher disc pressures.

If the object you need to pick up is light and small, then use a golfers lift. This is performed by bending from the hips on one leg whilst the other leg extends straight out the back. Use one hand to support the balance on a table or chair.

Tip 6 – If you have pain, the sooner we talk the faster we can try home remedies and therapy 

If you happen to suffer an acute back pain episode, call me right away. 


How back pain happens

A ‘bad back’ is one of the most common injuries worldwide. Most people believe that a strained back is caused by a sudden movement or trying to lift something that is too heavy. Most back pain happens over a continuum of time, not from one specific event. It’s from a chain of repetitive events that usualy involve repetitive flexion as in bending over, or poor posture as in slumping while sitting. This is how back injury happens:

Bad posture, overuse, and repetitive flexion cause the muscles in the back to gradually tighten up. Because they are contracted the muscles do not get enough blood through them, resulting in a lack of oxygen and weakness. So then when you lift a suitcase or bend over in the shower  early in the morning you tear a muscle in your back. But the suitcase or bending over isn’t what caused your injury. The cause is a gradual build up of tension over weeks and months.

My low-back recovery program improves posture, relaxes muscle and teaches you spinal support exercises. 


Why do some patients keep hurting their low back?

 Approximately thirty-four percent of people who experience acute low back pain (LBP) will have recurrent episodes. It remains unclear why some people experience recurrences and others do not, but one possible cause is a loss of normal control of the back muscles. The control of the short and long fibres of the deep back muscles was different in people with recurrent unilateral LBP from healthy participants. Short fibre EMG onset occurred later in participants with recurrent unilateral LBP than in healthy participants (p=0.022).

The short fibres were active earlier than long fibres on both sides in the healthy participants (p<0.001) and on the non-painful side in the LBP group (p=0.045), but not on the previously painful side in the LBP group. Activity of deep back muscles is different in people with a recurrent unilateral LBP, despite the resolution of symptoms.

Because deep back muscle activity is critical for normal spinal control, patients must engage in corrective exercise as part of therapy. I can teach you what to do but you must be consistent with your homework.  Using the Functional Movement Screen (FMS) & especially the squat assessment in my practice helps to guide functional muscle mobility & stability.  

MacDonald D, Moseley GL, Hodges PW. Pain. 2009 Apr;142(3):183-8. Epub 2009 Jan 30.


Low Back Pain Prognosis?

Regarding acute low-back pain (lasting less than 3 weeks) about 75% of individuals recover from acute low back pain within 3 weeks; about 90% of individuals recover from low back pain within 2 months.

Chronic low-back pain (symptoms lasting more than 7 weeks) is the number one cause of disability in the United States –the longer an individual suffers from CLBP, the worse the prognosis

Carpenter DM, Nelson BW (1999). Low back strengthening for the prevention and treatment of low back pain. Medicine and Science in Sports and Exercise Jan; 31(1): 18-24 .

 One in five episodes (20%) of acute LBP do not resolve within this time frame and approximately one in ten will go on to long term disability. Following any episode of LBP, there is little reliable data on time scales for recovery (Gibbons 2002).


Got low back pain? Exercise on elliptical may not be the best exercise

The Canadian Press – ONLINE EDITION
By: Lauren La Rose, The Canadian Press
23/07/2010 3:56 PM
TORONTO – Elliptical trainers have been a longtime presence in gyms and fitness facilities and a go-to piece of equipment
for those looking to get their cardio fix. But for individuals suffering from lower back problems, research suggests they may need to think twice before stamping their ticket to ride on the popular workout machines.

The elliptical trainer, sometimes called a cross-trainer, is a piece of stationary exercise equipment that simulates walking or
running without causing pressure to the joints. 

Researcher Janice Moreside is a physiotherapist who’s been a clinician for more than 30 years. She said she’s found that while the majority of people who come in who use the elliptical like it, there’s a subset who say the opposite, and point to the fact using the
trainer hurts their back. Moreside, a University of Waterloo PhD candidate, works with Waterloo professor Stuart McGill whose specialty is spine research, specifically the lumbar spine or low back. The research was part of a larger study looking at the effect of hip mobility on the low back which Moreside presented Friday at the 2010 Congress of the Canadian Physiotherapy Association in St. John’s, N.L.

The study involved 43 males aged 19 to 30 who exercised  on the elliptical trainer at two speeds: a self-selected speed and 30  per cent faster. Moreside said while individuals don’t necessarily move to and fro more while on the elliptical, they do adopt a more flexed posture. “They bend forward and kind of stay there and oscillate around a more flexed posture on the elliptical trainer than compared to walking, no matter what their hand position or stride length or speed was,” she said. They also twist more on the elliptical trainer than in walking, no matter how much the other variables changed, she said. And for most conditions, they actually bent side to side less than in normal walking. “So what the elliptical does is it stops you bending side to side, but you end up twisting more and you end up being flexed forwards more,” she said.

Moreside said all of those findings do affect the lumbar spine or low back. “If you are somebody who has a lumbar disc problem, we recommend that you don’t bend forwards very much. So for them, the elliptical might not be the choice because you bend forwards more than you do in walking,” she said. On top of that, users also twist more. The repeated flexion and twisting are known scientifically to encourage this degeneration, Moreside said. “If you’re already starting to get a bit of disc breakdown or sensitivity, this may not be the medium of choice for you.”

That said, for those who are older and have more joint problems in their low back as opposed to the disc, joints like to be flexed, Moreside said. As a result, some may find they prefer the elliptical. “It also does not require as much hip extension as normal walking,” Moreside said. “If somebody finds that going into hip extension is painful or has had an injury, they may find that this is
quite satisfactory because they are safe, they’re holding onto something.” For those without any low-back problems and who are
pain-free, Moreside said there shouldn’t be any issues when it comes to using the elliptical. “There’s a lot of good things about the elliptical,” Moreside said. “It’s a tremendous workout for your gluteal muscles … and it’s a great cardiovascular workout.”


‘abdominal hollowing’ technique

 Core stability training begins with learning to co-contract the TA and MF muscles effectively as this has been identified as key to the lumbar-support mechanism.

 To perform the TA and MF co-contraction, you must perform the ‘abdominal hollowing’ technique with the spine in the neutral position. Use the following guidelines: Start by lying on your back with knees bent. Your lumbar spine should be neither arched up nor flattened against the floor, but aligned normally with a small gap between the floor and your back. This is the ‘neutral’ lumbar position you should learn to achieve. Breathe in deeply and relax all your stomach muscles. Breathe out and, as you do so, draw your lower abdomen inwards as if your belly button is going back towards the floor. Pilates teachers describe this as ‘zipping up’, as if you are fastening up a tight pair of jeans. Hold the contraction for 10 seconds and stay relaxed, allowing yourself to breathe in and out as you hold the tension in your lower stomach area. Repeat 5-10 times. 

•It is absolutely vital that you perform this abdominal hollowing exercise correctly otherwise you will not recruit the TA and MF effectively. Bear in mind the following points:

Do not let the whole stomach tense up or your upper abdominals bulge outwards, as this means you have cheated by using the large rectus abdominus muscle (the six-pack) instead of TA.

Do not brace your TA muscle too hard; just a gentle contraction is enough. Remember it is endurance not max strength you are trying to improve.

Do not tilt your pelvis nor flatten your back, as this means you have lost the neutral position you are trying to learn to stabilise.

Do not hold your breath, as this means you are not relaxed. You must learn to breathe normally and maintain the co-contraction of TA and MF.

Use your fingers for biofeedback on either side of your lower abdomen to feel the tension in the TA muscle.

Once you have mastered abdominal hollowing lying on your back, practice it lying on your front, four-point kneeling, sitting and standing. In each position, get your lumbar spine into neutral before you perform the hollowing movement.


What were the names of the butt exercises?

•2 leg bridge

•Cook hip lift bridge

•Foot elevated hip lift (aerobic step, foam roller, med ball)

•Single leg Romanian deadlift – develops posterior chain, improves balance, & decreases load & stress on the back.

•One-leg straight-leg Good Morning

•Slide board leg curls (start with toes up)

•Stability Ball Leg Curl – develops torso stability while strengthening the hamstrings. Heels on ball + curl.


Efficacy and safety of comfrey root extract ointment in the treatment of acute upper or lower back pain


Objective The objective was to show the superiority of comfrey root extract ointment to placebo ointment in patients with acute upper or lower back pain.

Design The study was conducted as a double-blind, multicentre, randomised clinical trial with parallel group design over a period of 5 days (SD 1). The patients (n = 120, mean age 36.9 years) were treated with verum or placebo ointment three times a day, 4 g ointment per application. The trial included four visits.

Main Outcome Measures The primary efficacy variable was the area under the curve (AUC) of the visual analogue scale (VAS) on active standardised movement values at visits 1 to 4. The secondary efficacy variables were back pain at rest using assessment by the patient on VAS, pressure algometry (pain–time curve; AUC over 5 days), global assessment of efficacy by the patient and the investigator, consumption of analgesic medication and functional impairment measured using the Oswestry disability index.

Results There was a significant treatment difference between comfrey extract and placebo regarding the primary variable. In the course of the trial the pain intensity on active standardised movement decreased on average (median) approximately 95.2% in the verum group and 37.8% in the placebo group.

Conclusions The results of this clinical trial were clear-cut and consistent across all primary and secondary efficacy variables. Comfrey root extract showed a remarkably potent and clinically relevant effect in reducing acute back pain. For the first time a fast-acting effect of the ointment (1 h) was also witnessed.


The Impact of Body Mass Index on the Prevalence of Low Back Pain

Spine: 1 April 2010 – Volume 35 – Issue 7 – pp 764-768 doi: 10.1097/BRS.0b013e3181ba1531
The HUNT Study –  Heuch, Ingrid MD; Hagen, Knut MD, PhD; Heuch, Ivar PhD; Nygaard, Øystein MD, PhD; Zwart, John-Anker MD, PhD
Study Design. A cross-sectional population-based study.
Objective. To examine the association between body mass index and chronic low back pain, with adjustment for potential confounders.
Summary of Background Data. Although many studies have investigated this association, it is still unclear whether there is a general relationship between body mass index and low back pain which applies to all populations.
Methods. This study is based on data collected in the HUNT 2 study in the county of Nord-Trøndelag in Norway between 1995 and 1997.  Among a total of 92,936 persons eligible for participation, 30,102 men and 33,866 women gave information on body mass index and indicated whether they suffered from chronic low back pain (69% participation rate). A total of 6293 men (20.9%) and 8923 women (26.3%) experienced chronic low back pain. Relations were assessed by logistic regression of low back pain with respect to body mass index and other variables.

Results. In both sexes, a high body mass index was significantly associated with an increased prevalence of low back pain. In men the estimated OR per 5 kg/m2 increase in body mass index was 1.07 (95% CI: 1.03-1.12) and in women 1.17 (95% CI: 1.14-1.21), after adjustment for age, with a significantly stronger association in women. Additional adjustment for education, smoking status, leisure time physical activity, employment status, and activity at work hardly affected these associations. No interactions were found with most other factors.

Conclusion. This large population-based study indicates that obesity is associated with a high prevalence of low back pain. Further studies are needed to determine if the association is causal.>
Dr. Tucker comments: One of my favorite things is helping clients lose weight. I usually recommend a 28 Day Cleanse (not a fast) to get started, or I use the UltraMeal shakes as meal replacements. My program is guided by charting your body composition analysis.


June 30, 2010 Newsletter

The Interactive Healer 

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June 30, 2010 

In This Issue
Dr. Tucker’s New E-Book Released!
Nutrition Column
Exercise Column

List of Seminars

Dr. Tucker’s teaching schedule 

Are you a healthcare practitioner who is interested being a Diplomate in rehabilitation?
To learn more, please visit

Dear Dr. Jeff,
Dr. Jeffrey Tucker

I need your help! Everyday, clients or Doctors ask me great questions. Most of the questions are about weight loss, diet, exercise, treat-ments, and even
relationships. I’ve been answering your questions on my website blog. I need help coming up with a name for my daily answers to your questions. Please email me your choice of “Dr. Tucker’s answers” @
Keep checking so I can keep you updated on important and valuable health information to your questions. 

Posture and Mobility: Nine Steps to Assessing and Improving Your Health available – order now!

I am proud to announce the release of my e-book Posture and Mobility: Nine Steps to Assessing and Improving Your Health. Using self-assessment tests, you are guided through a progressive and safe format to increase your strength, range of motion, power and endurance. If you have been searching for a way to increase physical, optimal health, this book will help you.
Order directly from and have this professionally-bound book delivered to your door for $37.75 or download the book electronically for only $18.75.

Protein Snacks

Twenty grams of protein is the magic number to ingest for muscle-building, half before and half after your workout.
Here’s a list of 5 great snack ideas.
Chicken, Turkey, or Tuna (3 oz)
14-22 grams protein
65-100 calories
Wrap it in a piece of lettuce or enjoy it by itself. Four slices of chicken or turkey provide 14 grams of protein, while half a can of tuna has nearly 22 grams of protein.
Eggs (three)
18-19 grams protein
230 calories
Hard-boiled eggs are most convenient, but eggs are easy to scramble. Put them in a grab & go container and enjoy a little before & after your workout. For those of you that know me, I have always thought eggs are a great food.
Chocolate 2% Milk (16 oz)
About 17 grams protein
333 calories
A study in the Journal of the American College of Nutrition shows that chocolate milk may be the ideal postworkout beverage for building muscle
FitFood protein powder shakes – Whey or Dairy-free, Soy-free (2 scoops in water)
21 grams protein
210 calories
Made by XYMOGEN FitFood supports healthy body composition; immune support; cardiovascular health; healthy glycemic management and weight management. Mix it with rice milk or almond milk instead of water if you want a bit more protein. Order by calling 1-800-647-6100 or online @ When ordering online use PIN # TUC500.
Greek Yogurt (5.3 oz container)
15 grams protein
80 calories
Greek-style yogurt is packed with protein. Skip yogurts with fruit and sugar; to add flavor, drop in a few berries, nuts or cottage cheese.

Exercise and Fat Loss…

A study performed by Jackson Davis et al., was published in the Journal of Strength and Conditioning in 2008.

They took 2 groups of people:

One group did exercise consisting of a warm-up, resistance exercises at low heart rate (HR), aerobics, and a cool down. The other group did the same resistance exercises at a higher heart rate achieved by some intense cardio before each set, aerobics, and the same cool down.

The findings were awesome!

The more intense group showed a significant difference in heart rate, increased lower body
muscle strength and improved lower body endurance. They also showed an 82.2% increase in muscle gain. And the best result!  They had an almost 10-fold reduction in bodyfat.

I’ve perfected this style of training in my own workouts and the workouts of my clients to get maximum fatloss in just a 20 minutes a day. Many of the workouts take less than 20 minutes.

Read my article on 20 Minute Fat Loss Workouts

Is Your Chair Causing Your Low Back Pain? 

If you have a bad back it is critical to do these simple things….
Change Posture Frequently

This varies the location of the stress on your spine, instead of focusing all of it on the same area. The key is to maintain a neutral, natural arch in your low back. Try standing up every 20 minutes; try putting your feet up or leaning your chair back.


Aim For a Dozen ‘Arch-ups’ (Cobra in yoga) or Standing Backward Bends Every Day
Most lower-back problems come form prolonged flexion or leaning over like sitting in a slumped posture. Avoid prolonged flexion by standing up and arching backwards 4 times threes times daily. 
Squeeze Your Butt Muscles 

The gluteal muscles are often weak, especially if you have tight hamstrings and weak abdominals. By squeezing the glutes, you’ll automatically help stabilize your spine, which lowers your risk of back injuries.

Read more….

Feel free to forward our newsletter to your friends, family and coworkers.  And please feel free to contact me with your questions, comments and suggestions. 
Please stay committed to your health, fitness and nutrition efforts.
Warm regards,

Dr. Jeffrey Tucker

FirstLine Therapy

Do you want lots of energy and mental clarity? Would you like to reduce your risk of chronic health conditions like diabetes, heart disease, and high cholesterol?  Then Dr. Tucker’s FirstLine Therapy program is for you.  A therapeutic lifestyle is the most powerful tool there is to positively impact your health for a lifetime.  
Call today to schedule your FirstLine Therapy Consultation:  310-473-2911

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Dr. Jeffrey Tucker | (310) 473-2911 | 11600 Wilshire Blvd. Suite 412 | Los Angeles | CA | 90025