In today's world, where sedentary lifestyles and long hours of sitting have become the norm, the prevalence of low back pain has reached alarming proportions. For many, this condition causes physical discomfort and disrupts daily life, hindering productivity and overall well-being. A growing number of individuals are turning to natural remedies to alleviate their low back pain. The realm of integrative medicine of natural therapies offers diverse solutions that empower individuals to find relief without relying solely on pharmaceutical or surgical interventions.

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Understanding Low Back Pain 

According to a 2020 study, low back pain is the world's leading cause of disability. Most (80%) people experience back pain at least once in their lives. The World Health Organization reports that low back pain affected 619 million people globally in 2020 and estimates that as many as 843 million people will be affected by 2050. Chronic low back pain is a major cause of work loss, reduced quality of life, and financial burden. (26) 

For many, back pain begins sometime between the age of 20-40 and is the first reason to seek medical care as an adult. Many cases are self-limited and resolve with little-to-no intervention; however, up to 31% of people continue to have unresolved back pain for over six months. (8) 

Low back pain refers to discomfort or soreness in the lower region of the spine, specifically between the ribcage and the pelvis. Symptoms can come on suddenly or appear gradually, depending on the cause of the pain. The duration of pain can also vary depending on cause; pain lasting between 6-12 weeks is acute, whereas pain lasting longer than three months is described as chronic. Some of the most common symptoms of low back pain include (28): 

• Sharp, dull, or achy pain when resting, sitting, or standing for long periods
• Pain when lifting something heavy or bending down
• Pain radiating from the glutes or hips into the back of the legs
• Stiffness after inactivity or when first waking up
• Muscle spasms

When certain symptoms are present, it may indicate a more serious pathology of back pain. Red flag symptoms that indicate the need for immediate medical attention include:

• Progressive motor or sensory deficits
• New-onset bowel or bladder incontinence
• Urinary retention
• Saddle anesthesia (loss of sensation in the perineum and medial aspect of legs and thighs)
• History of metastatic cancer to bone
• Fever of unknown origin

What Are the Possible Root Causes of Low Back Pain?

One of the most common culprits of low back pain is muscle or ligament strain or other traumatic injury. Muscle and ligament strains can result from sudden movements, heavy lifting, or improper lifting techniques. Strained muscles and ligaments in the lower back can lead to painful spasms and stiffness, making even the simplest movements excruciating. (9) 

Another prevalent cause of low back pain is herniated disks. In this condition, the soft, gel-like substance within a spinal disk protrudes or leaks, pressing on nearby nerves and causing sharp, shooting pain. The pain can radiate down the legs, a condition often referred to as sciatica, amplifying the discomfort and hindering mobility.

Degenerative disk disease, a natural part of aging, is also a significant contributor to low back pain. As disks in the spine wear down and lose their cushioning ability, bones can rub against each other, leading to pain and discomfort. Spinal stenosis, the narrowing of the spinal canal, can result from disk degeneration. This narrowing puts pressure on the spinal cord and nerves, causing pain, numbness, and weakness in the legs, and sometimes leading to bladder or bowel function issues.

Osteoarthritis, a degenerative joint disease, can affect the facet joints in the spine. These joints facilitate movement and provide stability, but when affected by osteoarthritis, they can cause significant pain and stiffness in the lower back. Moreover, skeletal irregularities like scoliosis, a curvature of the spine, can result in chronic low back pain. The abnormal curvature places uneven pressure on the spine, leading to discomfort and reduced flexibility.

Beyond physical factors, certain medical conditions can trigger low back pain. Kidney stones, for instance, can cause excruciating pain that radiates from the lower back to the abdomen and groin. Infections in the spine, although rare, can also lead to severe back pain. Inflammatory arthritis, such as rheumatoid arthritis or ankylosing spondylitis, can affect the spine, resulting in chronic pain in the lower back.

Lifestyle choices and habits play a pivotal role in the prevalence of low back pain. Sedentary lifestyles, characterized by long hours of sitting, weaken the back and abdominal muscles, leading to poor spinal support and discomfort. Obesity, which puts excess weight on the spine, strains the lower back, leading to chronic pain issues. Poor posture, another consequence of modern sedentary living, stresses the spine and its supporting structures, resulting in segmental joint dysfunction and pain. Multiple studies have linked smoking to lower back pain due to the increased systemic inflammation that smoking causes. Furthermore, emotional stress can manifest physically, causing muscle tension and back pain. (9) 

Functional Medicine Labs to Test for Root Causes of Low Back Pain

Physical exam will be the provider's most useful tool in evaluating low back pain. Patient history and physical exam findings will provide insight into the mechanisms and root cause of pain, painful and pain-free movement patterns, and pain triggers. Physical exams should include palpation, range of motion, muscle strength, and orthopedic maneuvers. 

Blood work can be beneficial in ruling out organic causes of pain. A CBC assesses white and red blood cell and platelet counts to assess for signs of infection and cancer. A CMP and urinalysis can indicate signs of kidney stones or urinary tract infections. CRP and ESR quantify systemic levels of inflammation; when elevated, a follow-up ANA with reflex may be warranted to rule out inflammatory and autoimmune arthritides. 

The functional medicine doctor will also recommend specialty tests to identify triggers of chronic inflammation. Functional doctors will explore poor gut and liver health, nutritional deficiencies and poor diet, chronic stress, disrupted sleep, and environmental toxin exposure as possible triggers. The patient's history and clinical symptoms will help determine the most valuable tests. Specialty tests worth considering include comprehensive stool, micronutrient, salivary cortisol,  and toxic burden panels. 

Imaging can help visualize anatomical variations and pathology contributing to back pain. X-rays are ordered to assess the skeletal structures to diagnose arthritis or broken bones. MRI or CT scans reveal problems with bones, muscles, and connective tissues.

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Conventional Treatment for Low Back Pain

The conventional approach to treating low back pain typically follows a systematic progression, beginning with conservative measures before considering more invasive options. Based on the diagnosis, the initial step usually involves a combination of rest, activity modification, and pain management through over-the-counter or prescription medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended to reduce inflammation and alleviate pain. (32) 

Physical therapy is a cornerstone of conventional treatment, focusing on exercises and stretches to strengthen the core muscles, improve flexibility, and enhance posture. Physical therapists also educate patients on proper body mechanics and lifting techniques to prevent future injuries. Heat and cold therapies, along with massages, may be incorporated to alleviate muscle spasms and relax tense muscles. (32) 

In cases where pain persists or worsens, healthcare providers might recommend more specialized interventions. These can include steroid injections, where anti-inflammatory medication is injected into the spinal area to reduce inflammation around irritated nerves. (32) 

If conservative treatments prove ineffective, surgery might be considered as a last resort. Surgical interventions for low back pain vary and can include procedures like discectomy (removal of a herniated disc), spinal fusion (joining two or more vertebrae to stabilize the spine), or artificial disc replacement. Surgery is typically considered only when there is identifiable structural damage or a specific medical condition that can be corrected through surgical means.

(23) 

Functional Medicine for Back Pain Relief

Functional medicine takes a comprehensive and individualized approach to low back pain, delving into various aspects of a person's health and lifestyle to identify and address the underlying causes. By focusing on holistic healing, functional medicine aims not only to alleviate the symptoms but also to promote long-term wellness and prevent the recurrence of low back pain.

Nutritional Strategies for Low Back Pain Relief

The foods you eat can encourage inflammation, contributing to back pain. However, research shows that eating foods with antioxidant and anti-inflammatory qualities effectively treats chronic pain by combating inflammatory processes. A low dietary intake of omega-3 fatty acids, vitamins B1, B3, B6, B12, and D, magnesium, zinc, and beta-carotene is associated with inflammatory pain. Eating foods rich in these specific nutrients helps alleviate chronic pain, including low back pain. Studies have also shown that low-fat/plant-based and high-protein diets have helped relieve low back pain. (17) 

Natural Remedies for Chronic Low Back Pain

There is no shortage of natural remedies that are effective in managing pain. 

Applying ice and heat to the back both ease acute and chronic back pain (19). As a general rule, applying ice to the back in acute situations is advised within the first 24-72 hours after the pain begins. After this initial period, heat can stimulate blood flow to the area, reduce muscle stiffness, and block the transmission of pain signals. (18) 

Osteopathic and chiropractic spinal manipulation involves using manual force on a joint of the spine to realign it and relieve discomfort. A 2017 analysis of 15 studies and over 1,600 participants provided moderate-quality evidence that spinal manipulation is associated with a modest improvement in low back pain and back function. 

Massage therapy involves manual manipulation of the muscles and soft tissue to achieve a therapeutic outcome. The American College of Physicians recommends including massage as a treatment option for acute/subacute low back pain. 

Low-level laser therapy is a light source treatment that provides therapeutic effects via non-thermal or photochemical reactions in cells. A review of 15 studies of low-level laser therapy for low back pain found evidence that higher laser doses may benefit pain lasting less than 30 months. (20) 

Various herbal products have been proven effective for treating low back pain. Good options to consider include topical cayenne (capsaicin) and oral devil's claw or white willow bark. 

Research indicates that people with low vitamin D deficiency are likelier to have low back pain than those with sufficient blood levels. Another study found that patients with vitamin D deficiency experienced less back pain and disability after taking a high-dose vitamin D supplement for 16 weeks. It's important to note that taking excessive amounts of vitamin D can be harmful, so you should always consult with a healthcare provider before supplementing with high doses of vitamin D for extended periods.

Lifestyle Changes to Alleviate Lower Back Pain

Movement and exercise play a pivotal role in treating low back pain, offering a natural and effective approach that focuses on strengthening muscles, improving flexibility, and promoting overall spinal health. Targeted stretches can alleviate muscle tension and increase flexibility in the lower back and surrounding areas. Yoga, with its emphasis on controlled movements and body awareness, can improve posture and balance while enhancing the strength of the back muscles. Regular aerobic exercises, such as walking, swimming, or cycling, increase blood flow to the spine, promoting healing and reducing stiffness. Moreover, low-impact exercises like water aerobics or aqua jogging can be particularly beneficial for individuals with low back pain, as they provide resistance without putting excessive stress on the spine. (21) 

Making ergonomic improvements in daily activities can significantly alleviate low back pain by reducing strain on the spine and promoting proper posture. One crucial area where these changes can be implemented is in the workplace. Back pain is often attributed to a sedentary lifestyle; setting up a standing workstation prevents sitting for prolonged periods. When sitting at a desk, using an ergonomic chair with proper lumbar support and adjusting the chair and desk height to ensure a neutral posture can help maintain the spine's natural curvature, reducing stress on the lower back. Additionally, placing the computer monitor at eye level prevents the need to hunch over, minimizing strain on the neck and back. A 2020 review analyzing 18 studies concluded that implementing targeted ergonomic interventions significantly reduces the incidence of low back pain among employees.

Stress management is paramount, but easily overlooked, for patients struggling with low back pain. Relaxation techniques such as mindfulness-based stress reduction (MSBR), acupuncture, and biofeedback can alleviate stress and reduce back pain. A systematic review found a significant correlation between low back pain and breathing pattern disorders; deep breathing can benefit patients with chronic, nonspecific low back pain by correcting disordered breathing patterns and promoting relaxation.

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Summary

The staggering prevalence of low back pain indicates the need for alternative avenues of treatment to more effectively address this problem that diminishes the quality of life and productivity for so many. Functional and natural approaches to low back pain emphasize holistic healing and personalized care. By understanding the intricate interplay of physical, emotional, and lifestyle factors, functional medicine doctors use a variety of conventional and complementary healing modalities to help their patients break free of the constraints of low back pain.