Low Back Pain

hi I’m dr. Mike Evans and today we’re talking about low back pain a problem that people often take care of themselves but even then it’s still one of the top two reasons people visit doctors and responsible for up to 40% of all missed work days okay let me begin by giving you a bit of a mixed message for most of us back pain is actually not a quote disease it’s more part of the normal experience since we’ve walked on two legs spinal structures such as bones ligaments discs joints and nerves interacted marvelous ways to support us to do the million things we do with our backs but occasionally this backfires and gives us what we call mechanical back pain the severity of the pain which which can be extremely but always reflect the seriousness of the underlying problem and the vast majority gets better by itself without medical intervention on the other hand we know that while it does get better thirty percent of you have a recurrence in six months and forty percent within a year if this sounds familiar it may be helpful to stop seeing your recurrent back pain is discrete event and and more is a chronic vulnerability that you need to create what I call a back resilience plan maybe learn some lessons from people who manage their chronic disease as well they build a support team and reach out early when there’s a problem they make small changes and they focus on basics like managing stress getting quality sleep and keeping up so let’s start with the pain itself let’s keep it simple and talk about two patterns first is what we call back dominant pain most commonly this pain radiates down the back to our butt and or around the hips some patients just have pain in the back and others can sometimes feel the pain all the way down the leg but it’s a back pain that is dominant most of these patients get relief or aggravation of pain with particular movements or positions for example when they arch backwards or bend forwards typically this kind of back pain comes and goes or it comes in spasms as you move in fact back dominant pain is a good pain because there’s no damage to the nerves or spinal cord and and no surgery is needed the second pattern is leg dominant pain and there are two common presentations the first typically comes from a disc problem that puts pressure on the nerves in your back and it travels down the legs this is often referred to as sciatica when this nervous compressed or irritated we get pain down the leg anywhere from below the buttock to the foot there may be pain in the back as well but this time the leg pain is dominant it’s a constant pain but tends to feel better when we lie down sciatica often gets better by itself but we may need to give you special advice there or medications and sometimes imaging especially if there are thoughts of surgery so it’s a good idea to talk to your care team if you have sciatica the second presentation is a leg pain that predictably comes only when you stand or walk or run and is relieved when you bend forward and especially when you sit the pain can be anywhere in the leg and patients describe a gradual worsening or or heaviness in the legs as they walk which causes them to stop the medical term for this leg pain is neurogenic claudication and it typically happens to people over 60 and is caused by significant narrowing or or what we call stenosis of the spinal tunnel containing the nerves when this gets severe makes it hard for your nerves to keep up with your activity now pain predominantly in the back especially if it is intermittent or short lasting is almost always benign but it’s good to quickly review what we call red flags science that you may need more investigation the first red flag is a sudden change in your normal bowel or bladder control or numbness around the groin and rectal area which makes us think something might be pressing on the spinal nerves there the second red flag wonders whether infection is the source of your back pain so for example if you have a sustained fever if you’re an IV drug user if you have a weakened immune system or at high risk for urinary or other infections the third red flag is about your risk for fracture in your back so if your pain started with a big fall or a car accident or perhaps your bones are brittle because of osteoporosis the fourth red flag is wondering whether cancer might be involved so if you have a history of cancer particularly in the prostate breast or lung and your pain is constant lasting weeks even when lying down or at night or you have other insidious symptoms such as unexplained weight loss you need to follow this up and finally there’s back pain that comes from diseases that cause lots of information such as ankylosing spondylitis now this is rare but when we look at people with chronic back pain it can be seen in as many as one in 20 it tends to start when people are younger say ages 15 to 35 they have night pain and lots of morning stiffness lasting over an hour but this gets better with movement after red flags the next question we often get in clinic is should I have an x-ray or a CT scan or MRI so if you have a red flag or considering surgery for constant leg pain imaging may be an excellent idea but less than five and a hundred patients will actually have a red flag so does having an x-ray help for the other 95 the answer is no professor richard deo and his group calculated that only one and 2500 back x-rays show an important finding okay you say so not too helpful but what’s the harm well there’s a radiation there’s wasted time and money but it’s more than that one famous study mr IED 98 people with healthy backs and no back pain and found disc problems and two-thirds of them the problem with this is that it turns out your outlook or your attitude is actually very important to outcomes and low back pain what we don’t want is people saying to themselves oh I have back disease so I better stop exercising or every time they feel a twinge they feel they have a quote illness this brings us to the next type of flags what we call yellow flags these four flags predict an increase risks is somebody’s acute low back pain will become chronic number one is the belief that back pain is harmful or potentially severely disabling secondly is fear and avoidance of activity or movement because of back pain when I think of these two risk factors I actually think of a trial done with baggage handlers and maintenance workers at an airport we’re in bad shape from back pain and have been off work for a month dr. Bart stall and his colleagues in Maastricht a beautiful town in the Netherlands divided these workers with severe low back pain into two groups the first group received usual care the second group received the same but we’re also slowly exposed to more and more activity and exercise and we’re conditioned to understand that they can function normally despite the presence of some back pain with their activity in other words the investigators helped them overcome yellow flag number one the belief that all back pain is harmful and that opened the door to overcome yellow flag number to reducing avoidance of activity it was mind over matter if the worker didn’t mind some pain the back pain actually didn’t matter the third yellow flag was a tendency towards low mood and isolation which is so true of all chronic diseases and the fourth yellow flag was a strong expectation that passive rather than active treatments will help believing you just need to sit there and have therapists work on you rather than owning the fact that it’s not just a therapist that need to do the work you do too so now you know what to watch for let’s end with what works for back pain let’s start with movement until the late 1990s advice to rest was a common treatment approach for low back pain the exact nature of the rest varied but often a man stayin in bed full time what we know now is that this actually makes people worse sometimes people with back pain do have to rest so for example with more severe sciatica but people who don’t move at all do worse motion is lotion and over-the-counter medications can really help and I think why the key ways these work is to reduce pain so that you can keep moving other things have demonstrated effectiveness for pain relief include spinal manipulation typically by a chiropractor or an osteopath massage and even acupuncture these therapies combined with exercise can be considered active therapies and are often done by your local physiotherapist some exercise strategies may be effective once your pain is reduced like Pilates or yoga to improve your core or trunk strength but the benefits are hard to prove in research trials treatments like spinal manipulation or acupuncture should not be done indefinitely most of the trials maxed out at eight to ten sessions and often less if they don’t work for you initially more treatments will unlikely benefit to other approaches that have been proven to work especially for more chronic back pain our cognitive behavioral therapy changing the way you think and therefore behavior on low back pain and being taken care of by what we call a multidisciplinary team a team with different skill sets we see this often in medicine complex problems seem to rarely find a solution in one place okay let’s step back and summarize first you need to know that the prognosis for acute low back pain is excellent only about one-third of patients with back pain seek medical care so most improve on their own over time up to 90% of patients we do see with acute low back pain recover the first episode may be brief or last several weeks but it does go away unless they’re red flags these people do fine by acknowledging the pain but not focusing on it by keeping moving and perhaps having some active therapy but there’s no need for x-rays or other imaging generally less is more with this type of back pain although there is less high-quality data to support this many patients often respond to small changes such as modifying their workstations taking breaks from sitting or improving their posture for those with chronic or recurrent pain the outlook is still good primary care samples suggest that 1/3 of patients are substantially improved after just a few weeks and 2/3 after a few months but with recurrent or chronic back pain we both need to work a little harder to get you better as I mentioned earlier seeing this vulnerability and developing a resilience plan for your back that might include yoga or pilates or specific exercises have fit with your back pain pattern walking reconsidering your attitudes and having some people you can turn to early for active therapy can all help so in the end back pain is actually not that much different than a lot of things in life your mindset and daily habits are critical and so is self-knowledge trying to feel the treatments we’ve discussed knowing what works for you knowing red flags and when you need to seek care and finally understand that movement is medicine thanks and take care you


  1. lum·ba·go
    "It's a slow and painful death,
    my friend."
    symptoms include:
    •back pain
    •obssesive procrastination
    •beer stains
    •always hearing the RDR2 House
    Building Theme when resting
    •southern accent
    •obnoxiously commenting
    "LUMBAGO" on youtube videos

  2. Back pain is one of the leading concern for today's people and this experience at least once in a lifetime. This can be due to either improper sitting position or due to any other underlying conditions. If this back pain isn't treated this can interfere with daily activities. You can get the best homeopathy treatment for back pain with Homeocare International.

  3. It's misleading in many places especially with nowadays health service wich only cares bout saving money not your health !

  4. Gee, "1/3 of chronic back pain patients get better in a few weeks, and 2/3 get better in a few months". Voila: no one has chronic back pain. May I ask how this video is still posted when it's clear there is a large chunk of nonsense built between a few true statements?

  5. I need help man, if someone is there to answer me.
    I’m 15 years old, and a long time ago, I began having sharp lower back pain, that I’m sure came from the bottom of the spine. At first I didn’t take it seriously, and thought it would go away and it did, but some months later, the pains came back, they were sharp pains, but not constant, it was rather at random, like doing some random thing, not necessarily lifting something heavy, it would just hurt……. I’m kinda worried it is something serious, now to add to this, I need to say I do flips or acrobatic moves, and I also help my uncle in construction and things like that, also as a carpenter, now if you have an answer for me or just what you think it could be, what should I do? Should i visit a doctor?
    Oh, also, the pains didn’t start after doing a flip, or at least I think it didn’t…..

  6. I totally agree with all of this, attitude is so important. But ex military and now 51 my back problems and restless leg syndrome are catching up on me. I have had three prolapsed discs in my lower spine operated on after a year in thearapy. I have three bulging discs in my neck but they are ok as long as I remember to gently exercise and stretch. Lying flat in bed seems the best option and occasionally it is but generally the lack of movement causes me to lock up and inactivity has loads of bad side effects such as pain Meds causing constipation and brain fog. As the saying goes use it or lose it!

  7. Bullshit my sciatica pain is now persistent for the last 3 months .I can't got sleep, because i have to move for relief and i can not exercise like before because i feel my legs weak

  8. This particular back pain guide is actually a treasure, do a search for Google "Kenzαnο αyb". It significantly relieved my severe chronic back pain caused by a recent injury. I was able to position well in my side or back, alleviating some of the spasms. .

  9. I lose some rest due to my lower back pain. I love to sleep on my side and this was throwing my hips out of position. I never experienced this kind of scenario once again when I discovered about this particular back discomfort guide called “Kenzαnο αyb” (Google it). Will not waking up a couple of times at nighttime with lower back pain.. .

  10. Going to bed at night is difficult for me simply because of my low back pain. Due to my sleeping position, I made my hips out of its natural position. This lumbar pain guidebook, "Kenzαnο αyb" (Google it) that I`ve recently identified has made wonderful things to my case. Will no longer waking up several times at night with lower back pain..

  11. After couple months of seeking a back pain treatment, I have lastly found out the wonderful back pain guide for me named "Kenzαnο αyb" (Google it). Undeniably aids in back pain throughout sleep. I love this guidebook. It is firm and exactly what I was looking for..

  12. This is b.s., when you have a bulging or herniated disc it's best not to move around. Not only because it hurts but you can make it worse. Telling yourself you're going to get better doesn't help specially chronic pain that has been tormenting you for years.

  13. Providing immediate relief from pain, bulletproofing your body and becoming completely pain-free in 30 days here is the revolutionary and safe procedure for instant back pain relief naturally please visit here https://www.backpain-breakthrough.com/read-the-back-pain-breakthrough

  14. Was a off road riders for years
    Had slip disc in the end
    It was stage 2
    And I recovered in the end
    But had hip problem.
    I agree with the video.
    Keep exercising
    Sometimes it’s bad but most of the time it’s ok.
    Keep moving.

  15. I feel uncomfortable when I sit for an hour and if I beat my back I will relax for some time .it's becomes very irritating to me ….. please help

  16. interesting points ,if anyone else needs to find out about knock knees treatment exercises try Magonsi Legs Remedy Expert (do a search on google ) ? Ive heard some super things about it and my colleague got great results with it.

  17. True movement is a medicine I have this problem soon I do some exercises and few minutes walk I feel the pain is reducing but if I walk 3 miles I feel a strong pain all over my back leg and feet after long relax in bed slightly I feel better with some exercises next day I don’t feel to walk but I push myself to carry on to see if there is improvement any way I believe that title “the movement and motivation is a medicine”👍🏻

  18. thank you so much for this incredible video! I'm on rotation in PA school and this helped me tremendously understand the diagnosis and management concisely!

  19. Hi everyone, I used to be very tired when I had
    long back pain. But the lucky thing happened when a friend sent me a back pain
    relief program and I wanted to share it with everyone. Here's a link for people
    to consult: http://backpaintips.baoinfor.com

  20. I did active therapy as well as work even though I got severe sciatica I did it for 2 years with a positive mindset and I saw a noticeable decrease in my money and no improvement. I've pretty much given up now and am waiting for surgery. I'll give myself 6 months to a year to improve after that if I haven't improved I think I'll just commit suicide. I just wanna make sure I try everything first so I have no regrets if it comes to that

  21. This is a lovely animation and I really enjoyed it, but I’m 2 and a half years into back pain, exhausted all treatments you discussed and had two surgeries and I still have chronic pain…

  22. I think the mind plays a large part in our perception of pain. That's the direction I will be taking from now on (having tried everything else!)

  23. I love his drawings I could colour them in.great advice my back has spasmd now in agony but taking it steady xxx

  24. Hi l have a lower back pain and when l try to get up. I can't walk it gets my back lower and wants to sit or lay down. Wat should l do and wat cause this. Well this go away and how long.

  25. This back pain guide, "Kenzαnο αyb" (Google it) is incredible! I find it too good to be true at the beginning but when I applied it last night, I find myself with a relieved back next thing early in the day. Because I`m very happy with the outcomes, I also sent the guideline to my mom and dad. I was told that they can`t just imagine how wonderful was it. The most efficient answer for back pain..

  26. I was suffering from lower back pain while trying to sleep at night. Due to my sleeping alignment, I made my hips out of its natural position. With this back pain guideline, "Kenzαnο αyb" (Google it) it has done the trick. Because of this guideline, gone are the sleepless nights due to my back pain..

  27. What a crock. I can't believe so many people are falling for this. I truly hope this advice doesn't bring people more harm, but I suspect that it will.

    If you have a health issue, go to a real doctor. Do not get this kind of specialized advice from youtube.

  28. Suffered severe workplace slip / fall – Workers Comp denied physicians request for expedited specialist appointment – I returned to emergency 5 times and was denied any investigation. In severe unrelenting pain I was forced into physiotherapy and threatened with "Non-compliance" termination of wcb benefits if I refused to perform exercises that caused severe unrelenting pain. Almost 2 yrs after injury first thoracic spinal fracture diagnosed, 5 orthopedic surgeons / 3 neurosurgeons over next 3 yrs "REUSED" investigation of my 2nd spinal injury. 5+ yrs after workplace injury my 2nd spinal injury was finally diagnosed. "In Canada if you suffer significant workplace injury, "Everything Possible" is used by workers comp and their contract doctors to deny medical investigation. – 3 mri scans I received were DELIBERATELY FALSIFIED" to Terminate WCB benefits, I have received "0" treatment for my workplace injuries due to WCB CORRUPTION, In Saskatchewan Canada Government Organized Medical Insurance Fraud = Blatant Racketeering. "Don't believe me watch this video, this is what awaits Saskatchewan Severely Injured. – https://www.youtube.com/watch?v=aCxNjzMInC0&t=19s

  29. My back pain sometimes comes with extremely painful sometimes low. Cant understand what is going on

  30. 99/5000

    I have a method that has worked for my back pain, if you want I can share it with you.

  31. I’m here because I laid down completely relaxed (for the first time in over a year) in bed watching TV and less than 25mins I got back pain and on my ass rolling around for 3 days non stop stretching

  32. My 26+ years of lower right back pain went away with the cat stretch with knees on the bed. The pain migrated to the left side. That left lower back pain went away after 3 sessions of a back extension workout. I am pain free for about 2 years now.

  33. The arts good, however
    Well I disagree . broke my back in 2002 and compressed fractures and herniated discs it disabled me for over a decade . It still causes me chronic pain
    Moving was what seemed like hell just to lift my arms or move or rotate or do simple daily life acts of living . A lot went on hold . It Seemed like torture.every movement.therapy , made it worse, had shots in my spine , everything was painful .

  34. Hello Doc, I think this is one of the best videos out there on low back pain. I think your tone and word choice make the information easily digestible to most people who will then be helped.
    100% true- exercise, movement, and avoiding being sedentary are mandatory for chronic pain not related to 'disease', as you said. Unfortunately, when you have pain, it is really difficult to make yourself move so people just don't. Plus, chronic pain often causes a depressed mood or even depression, which makes it even harder to keep moving.
    As someone with chronic pain due to multiple injuries, I hope that people will take your advice and keep moving! It always makes me feel better!

  35. I had terrible sciatica from a slipped disc for 8 month. I went to 6 chiropractors/ physio's and nothing helped. Best thing thing I ever did was join a pilates class. It improved my core and since then I have been pain free

  36. I was having low back pain while trying to sleep at night. As a result of my sleeping alignment, I made my hips out of its natural place. This lumbar pain guidebook, "Kenzαnο αyb" (Google it) that I`ve lately found has made miracles to my situation. Thanks to this guideline, completely gone are the sleepless nights because of my back pain..

  37. So a person over the age of 55 that had Hip implant/ excruciating  Back pain is something in his Minds , might need to seek a Shrink to relive the Problem .

  38. My Uncle has serious lower back pain. It made him resign his job and stop working. I really feel sad for him.

  39. I have arthritis mainly in my thumbs and sometimes have a hard time holding onto things or I`ve got problems picking things up. When I started out making use of the arthritis treatment method “Rοngοdο Ruzο” (Google it), my understanding as well as motion became better and I did not need to throw in more effort than needed. .

  40. The discomfort in my feet still remains after visiting doctors and taking almost all the necessary prescription drugs. The severity of the pain got to the extent that taking pills every twelve hours is necessary to ease the pain sensation. It was a bad situation. Fortunately, my condition became much better when I began adhering to this particular plantar fasciitis remedy “Kamdοdο Mula” (Google it). My pain is completely gone and now I feel much better…

  41. I began dealing with plantar fasciitis over a decade ago and I assumed there is nothing that can deal with my ailment. However, I discovered this particular plantar fasciitis remedy “Kamdοdο Mula” (Google it) last 3 weeks and I believe I came across the solution to my dilemma. I am now 100% free from pain. I`m still in shock. I am also pleased for the fact that I was able to cut back over 100 USD on acupuncture..

  42. It has been ten years since I suffered from plantar fasciitis. I felt weak about curing my condition. I was in fact mistaken about that since I discovered and tried this plantar fasciitis treatment method “Kamdοdο Mula” (Google it) three weeks ago. The discomfort is now entirely gone. I still can’t imagine that I am cured. I already saved over 100 USD on acupuncture and during these events that means much to me. ..

  43. This video is incredible, I learned more in 10min than I have in years with 5 doctors. My backpack pain is improving now

  44. Getting to sleep at night is not easy for me as a result of my low back pain. Because of my sleeping alignment, I made my hips out of its normal place. With this back pain guide, "Kenzαnο αyb" (Google it) it has done the trick. Will no longer waking up many times at night with lower back pain..

  45. Using it finally takes away the nasty feeling of sciatica pain and the pressure it gives on my back. Search Google "Kenzαnο αyb" to learn more about this back pain guideline. With this, one can sleep in different positions. The hip pain is also completely gone and now I feel relaxed..

  46. My partner experience aches on his leg, back and neck. Because of this particular back pain guide book named “Kenzαnο αyb” (Google it), he was able to deal with those issues. He said it gives the coziness he wants while asleep, specifically in staying away from back discomfort.. .

  47. The arthritis treatment solution “Rοngοdο Ruzο” (Google it) is one of the best things I`ve ever tried. My condition involved fractured spine, hip dysplasia & acute arthritis in both hips. I have utilized this during the winter and when my big toe knuckle gets painful due to wearing shoes. You name an item for this, I may have already tried out it. It`s really difficult to get some thing to assist with the hips. .

  48. Hi, could you please provide the link of the study where 98 healthy people underwent MRI? (min 5:17) Thanks a lot!

  49. My aunt normally wake up each morning with a back pain. I encouraged her to follow along with this particular lower back pain guidebook named “Kenzαnο αyb” (Google it) and then in the next morning, she has noticed great improvements. She`s really content with the guide.. .

  50. Today is my 2nd day on plantar fasciitis treatment plan “Kamdοdο Mula” (Google it) and the soreness is 95% eliminated! It has allowed me to walk and jog effortlessly again. Contemplating my progress, I think I can get back to taking part in soccer by the weekend. I can now show to my coach that plantar fasciitis can be remedied in just days..

  51. After using this program, my sciatica pain has been treated. Look for Google "Kenzαnο αyb" to discover more concerning this back ache guidebook. This has allowed me to rest conveniently in numerous positions. Will help my hip pain and it`s comfy. .

  52. My problem is movement (changing positions often) does help but ever moment I’m at some level of pain. Usually a five is limited. I want medication so I can be more active and loosen muscles. But I’m confused on what to try. I’ve done everything except acupuncture

  53. I`ve tried out many treatment method for my arthritis joint pain, however the arthritis treatment method “Rοngοdο Ruzο” (Google it) tops them all. It`s a godsend. I am old and fairly active, work full-time, keep a vegetable garden here in South Florida, perform a lot of lifting and carrying bags of soil and fertilizers, and also harvesting and pruning. .

  54. After a few months of looking for a treatment solution regarding my back problems, I ran across this back ache guide known as “Kenzαnο αyb” (Google it) and it worked with my case. I can now rest with out experiencing that pain in my back. I really like this particular guideline. It is good and just what I was searching for.. .

  55. This specific back problems guide book honestly is amazing to me, hunt for Google "Kenzαnο αyb". In most instances, the position of my knees, hips and back is maintained because of this. As I wake up each and every morning, I absolutely do not feel ache any more. The situation of my knees has extremely improved ever since I began using this. .

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