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Back Pain: Causes and Treatments Reviewed

by Steven Hefferon(more info)

listed in back pain, originally published in issue 145 - March 2008

Back pain affects millions of people each and every year. For many, their lives are never the same. Unfortunately, many people suffer for weeks, months and even years unnecessarily and one of the reasons is a lack of good information. Much of the information that is given to people regarding back pain is out-dated, inaccurate and often dangerous!

It’s important you know that very rarely is one treatment the answer. Back pain is often a complex problem and it often requires treatments that address multiple areas simultaneously.

Also, my experience working with tens of thousands of back pain sufferers has shown that the people who get lasting relief are the ones who are constantly researching and experimenting with as many treatments as possible.

Here is a review of some of the many treatments that are available for back pain and sciatica:

Orthopedic Care

One of the first places many people go when they experience back pain is the orthopedic specialist (surgeon) and a visit usually last five-10 minutes. They will typically look at the problem/symptomatic area and often fail to look at the body as a whole.

If you’ve been to an orthopedic specialist for your back pain, did they do a full body physical evaluation (taking 30 minutes or more)? Not likely.

Here are some of the common treatments used by orthopedic specialists:

Cortisone Shots

Cortisone is a catabolic steroid which is intended to reduce inflammation by killing off the tissue in the inflamed area… now let me ask you, does that make any sense to you at all?

Not only are these injections quite painful, but they rarely result in any pain relief and if they do it is short lived, usually one-two weeks if at all. Plus, it does NOTHING to identify or address the cause of the pain… it is only intended to treat the symptom. It’s for those reasons that I do not recommend them.

Anti-inflammatory Medications

Just the name should scare you away… just like cortisone shots, anti-inflammatory medications do not identify or address the cause of your pain and for many people, they deliver little pain relief. These medications also deliver serious side effects! The main reason they are prescribed is money… and if you don’t believe me, do the research and you’ll see for yourself. The drug industry is powerful, and unfortunately they have a huge influence on the whole medical community, including the doctors. I challenge you to find a drug that will fix your back problem… you’ll be looking forever because there is no way a medication can fix a physical problem, so avoid medications at all costs!

Back Surgery

Surgery for back pain is very common and more often than not, the individual still has pain afterwards (or it returns within weeks) and sometimes even new problems! Very rarely is a surgery the answer…

For example, many people have surgery for herniated discs. The logic behind the surgery is if you remove the piece of the disc that is putting pressure on the nerve, the problem is solved.

Unfortunately, the same forces that forced that disc to protrude or bulge will likely force more of the disc out, or another disc out.

Surgery should always be the last resort… and even then I’d question it!

Physical Therapy

Physical Therapy is traditionally the next step after seeing an Orthopedic Doctor. That is, if surgery is not recommended. So what should you expect?

The process will start with an evaluation and here may be the start of the problem… here is why… the doctor has to write a prescription with a diagnosis on it.

You give the prescription to the PT and he or she will perform an evaluation… chances are the PT will simply confirm the diagnosis from the doctor; however the hope should be that they take the extra step to look for the root cause of your pain. They may, but chances are they have several other clients in the office at the same time, and simply do not have the time.

So without a comprehensive evaluation to identify the root cause of your pain, they will simply treat your symptoms. We have just identified the second problem.

The health care industry is required to show improvement with each and every session so the push is to reduce your symptoms to show progress in order for them to get paid. The long and short of it is that yes your pain can be reduced, but the root cause rarely gets addressed, meaning that the pain and your suffering will return again and again.

So what should you do?  When selecting a Physical Therapy office you may want to ask how many patients the office sees in a day and how many PTs they have on staff… then ask how many patients can a PT work with in an hour. Do not be surprised to hear that a PT can see up to three patients in an hour. Do you think you will get the attention and proper treatments you need? I doubt it.

There is a little joke in Physical Therapy when treating patients, and it has to do with what course of modalities you will get. The joke is called Shake and Bake and it refers to the fact that everyone gets the same treatment protocol… that way it can be timed so that your PT can see other people simultaneously.

What goes into a shake and bake treatment? It may start with a spin on a stationary bike or a trot on a treadmill, than you will get a three to five minute Ultrasound over the affected area followed by Electrical Stimulation to the area with a little ice strapped to your body and to finish off your session you will get a hand out with exercises you should do at home. Certainly not a recipe for success!

Chiropractic Care

One of the most common treatments for back pain is Chiropractic Care. The approach consists of physical manipulations of bones and joints in an attempt to line things back up and it’s recommended typically two to three times per week.

The problem with this approach is that the same forces (muscles, tendons, and ligaments) will likely pull the bones and joints right back out of place again. Also, most (not all) Chiropractors will spend 15 minutes with you if you’re lucky.

Ask people who see a Chiropractor how long they’ve been going… I hear of people who have been going for 10-15 years and still don’t have a healthy back. Look, the fact is Chiropractic care may be lacking…

Unless the Chiropractor combines the two approaches, it doesn’t make sense…

The ONLY way Chiropractic care makes sense is if you are addressing the muscle imbalances that are pulling the bones and joints out of place to begin with, and that requires strengthening and stretching exercises that are chosen specifically to correct your muscle imbalances.

Alternative Treatments for Back Pain

Massage Therapy

Massage therapy, if done correctly, can work wonders for people with back pain. This is not to say that it is the best choice and that it will work for everyone… however, most people will get great results from it if the Massage therapist has a good understanding of muscle imbalances and how to work on them.

NOTE: Not all Massage therapists are the same! Just like any profession, there are varying degrees of training and qualifications. When selecting a massage therapist please check to see if they are licensed and insured.

You should also ask the Massage therapist if they have training in one of the following areas: Orthopedic massage, Medical massage, St Johns technique and/or has a comprehensive knowledge of muscle imbalances relating to back pain.

With that said the benefits are as follows. The root cause will be identified, your discomfort will be addressed and your root cause will be corrected all in an attempt to make you pain free and give you the tools you need to keep you that way.

What to Expect When You See a Massage Therapist

All Massage sessions are one-on-one, allowing you the opportunity to converse with the therapist as well as get the attention you need to get results. You can ask questions about how you compare to other people.

Feel free to ask the therapist what approach they will be taking so that you know what to expect. The massage therapist has many different techniques they can use when dealing with your back pain and some are better than others.

On the down side, sometimes a therapist can get distracted with other problem areas; it is in your best interests to keep them focused on your back and associated problem areas. Like anything else you may need to try several different therapists before finding the one that works best for you and with you.

Post-rehabilitation Fitness Training

Another overlooked form of treatment that is very effective is post-rehabilitation fitness training. This includes targeted strength and flexibility work to correct the individual’s muscle imbalances. This is specialized knowledge that very few fitness trainers possess, and there are certification programs designed specifically for this.

There are of course, limitations as to what they can do for you. For example, they can not diagnose a condition, prescribe any medications take x-rays, etc… however, if they are well trained they can pinpoint your muscle imbalances quickly and get you started on a fitness program that will restore balance to your body and likely eliminate your back pain.

Often this can be combined with massage therapy and/or manual physical therapy for a total solution. If you decide to go this route, which I recommend you do, be sure to thoroughly check out the fitness trainer and ask to see their certification, insurance, references, etc.

Manual Physical (Muscle) Therapy

Manual Physical Therapy is NOT the same as regular physical therapy… there are some major differences. Here are a few:

•    Manual therapy consists of hands-on muscle work primarily whereas traditional physical therapy consists of heat, ice, ultrasound, electrical stimulation, etc;
•    Manual therapist will typically perform a much more thorough physical evaluation;
•    Manual therapists will usually be able to spend more time with each patient;
•    Manual therapy is more holistic in its approach and focuses the body as a whole unit… something lacking from nearly all traditional treatments for back pain.

So before you say, “I’ve already tried physical therapy”… did you try manual physical therapy? They are two very different treatment approaches and I highly recommend you consider manual physical therapy.

The System Needs to Change

As you can see, traditional treatments are the main stay of modern medicine… not necessarily for the patient’s benefit, but it’s just how the system works.

The system will not change until the system is confronted with a very powerful competitive force. That force may well be complementary or alternative care from the likes of Personal Trainers, Acupuncturists, Massage Therapists, Manual Physical Therapists and the like.

So that’s what we’ve tried to do… force change. The traditional treatments that people have been receiving for decades just don’t work, and we have found a combination approach that not only works the best, but it’s safe, natural and inexpensive.

Why Your Stretching and Exercises Aren’t Giving you Relief

When you spend enough time working with people who are in pain, you hear it all: anger, fear, hope – but mostly frustration. Whether you are going through a treatment program for your back pain with a Chiropractor or physical therapist, or trying your own exercise program (Yoga, Pilates, pumping iron at the gym, etc.), if you’re not getting relief, let me share with you a widely known secret.

Knowledge is Power

We know that people who understand their situation and their condition get better care and faster results, regardless of the type of treatment they are going through. The reason is simple: They have more control.

The problem is that most treatment programs only tell you what to do. You never question and never really understand what you’re doing. You just trust that the person telling you what to do is knowledgeable and has your best interests in mind.

Well, here’s a shocker: The person working with you is only doing his job. He likely doesn’t have time to share with you all he knows. More importantly, he may not be willing to take the time to tell you what you need to know to get better and stay healthy.

If you take the initiative to search for a better way of stretching and exercising, be prepared to say good-bye to frustration and hello to hope.

Step One: Stop Everything you are Doing

Why stop what you are doing? Because if you don’t, the underlying factors of your condition could be making things worse. The only way stretching and exercise will be of benefit to you and your condition is if you understand exactly how your body is out of balance. More specifically, you need to know which muscle groups are tight, which muscle groups are weak and how those imbalances are affecting your body as a whole.

The goal of any stretching and exercise program for someone with back pain is to bring the body back to a balanced state. That includes making sure that your muscles are in balance with each other, and that your bones are positioned as they should be, so that your joints can function with precision.

If a muscle group is too strong or too tight and your bones are pulled out of their proper position, eventually our joints will not work correctly and will suffer increased wear and tear until movement becomes painful. Some people call it getting older; I call it premature ageing.

What is most challenging about the back is that of the more than 600 muscles, nearly all of them play some role in the health and proper functioning of the back. In short, the more out of balance your muscles are, the more likely you are to develop a condition that will cause you pain.

Common Stretching Mistakes

If you have back pain and you go to see an expert who tells you that you have tight hamstrings (the muscles in back of your upper legs), he will, of course, tell you to stretch your hamstrings. Well, if this expert fails to take into consideration the other imbalances in your body, you will be making your condition worse.

Disclaimer: To help you understand this, I’m going to give you an example. It is only an example and may not be true for you, so you should not consider this as a treatment.

The Most Important Concept I’ll Ever Give you

Keep reading until you see this clearly in your mind and comprehend it. The most important aspect in understanding how your body is out of balance in relation to back pain is the position of your pelvis. Your muscles can pull your pelvis in many different directions. If your pelvis is in an abnormal position, your spine will follow and go into abnormal curvature. This abnormal curvature will, over time, cause your condition to become painful and gradually get worse.

In this example, if your pelvis is pulled forward or tipped forward (the technical term is lordosis), by the strong and tight muscles in the front of your legs and you stretch your hamstrings as instructed, you will lengthen your hamstrings. This will allow your pelvis to tip forward even more – by the couple of millimeters you just gave it by stretching your hamstrings.

Your hamstrings are attached below your knee and to your pelvis, so to you or the expert they will feel tight. But the truth is that they are taut – in other words, they are already stretched out because the pelvis is pulling on them. If that same expert were to take the time to identify the strength versus flexibility imbalances related to your pelvis – instead of simply stretching your hamstrings – he could then give you a very specific and targeted stretching and exercise program to bring your pelvis back to a more neutral position. This would also return your back to a more neutral curvature.

The Problem

As I see it, the biggest problem is that 99 percent of the time you want to do – or are told to do – a balanced workout. But if you are already overly strong in some muscle groups and continue to strengthen those same groups, you will only reinforce your imbalances. The same holds true for stretching: If you stretch a muscle group that does not need to be stretched, the imbalance is never going to be corrected.

I know it’s frustrating to be told that your workouts have been making your back pain worse, or may even be partly responsible for the condition in the first place. And while it’s true that Yoga and Pilates are all about balance, these programs are for those who do not have a problem. But for someone with back pain due to muscle imbalances, a general stretching and exercise program is the last thing you want to be doing.

The Solution

Regardless of age, sex, fitness or fatness, we all have imbalances and we all need to understand that stretching and exercise can play a very important role in how we live our lives and how healthy we stay as we grow older. Once you embrace the concept of imbalances, you need to identify where they occur in your body. Then you need to do a very specific and very targeted stretching and exercise program. And guess what? It will be a very unbalanced workout. Yes, that’s what I want you to do – an unbalanced workout to get back into to balance. Then you can do your Yoga or Pilates.

You now know more than the average person about stretching and exercise and I haven’t even shown or told you about a single one I would recommend. When it comes to back pain, the point is that knowledge is critical. And, in some cases, doing nothing is better than doing what you’re told – if it’s the wrong thing.

Remember, no one cares more about your back than you. So, it is critical that you are able to talk to your health care providers in a way that tells them they cannot just give you the same cookie-cutter program they give everyone else. Once they realize they can’t bullshit you, they’ll have to step up their game.

Good luck…

The techniques and principles taught by the Healthy Back Institute are based on the Muscle Balance Technique™, the most widely accepted and fundamentally sound approach to using stretching and exercise as a treatment for back pain.

Further Information

For more information on our complete healing formula and how to treat back pain effectively, read the latest Back Pain Advisory from The Healthy Back Institute. You can get a free copy of it at

If you would like to learn more, you will find our entire collection of articles, references, audios and even videos on achieving optimal health. Please visit us here


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About Steven Hefferon

Steven Hefferon CMT PTA CPRS holds a BS degree in Health/Fitness and an AS. degree as a Physical Therapy Asst. He is both a Health & Fitness Expert and a Certified Massage Therapist and has combined his skills to become a Post-Rehabilitation specialist. Steve is co-founder of The healthy Back Institute and was instrumental in creating and producing the instructional video Lose the Back Pain. The goal when founding The Healthy Back Institute was to help educate people to the many alternatives that are available to people, beyond traditional treatments.
Steve Hefferon CMT PTA is currently the Research Director for both The Healthy Back Institute and Living Well Nutraceuticals, a Certified Massage Therapist in the State of Maryland (MD#000039). (1997 to Present) and is approved by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) as a continuing education Approved Provider. (2002 to 2006). Steven P Hefferon is also a Professional member of the American Massage Therapy Association. (1997 to Present). He may be contacted via


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