Sciatica: Neuralgia and neuritis of the sciatic nerve.

Lumbar disc herniation: A bulging of the nucleus pulposus against a weakened segment of the annulus fibrosus.

Lumbar disc prolapse: An actual breach of the annulus fibrosus by nuclear material.


Pain or ache in the low back; pain, ache, or altered sensation in the buttocks, thigh, calf, and foot. Muscle wasting may occur late in course, along with reduced reflexes and muscle weakness.

Etiologic Considerations

Poor body mechanics and posture

• Improper lifting, sitting, standing, carrying • Lumbar lordosis • Weak abdominal muscles • Visceroptosis • High heels • Insufficient stretching out before working or lifting

Sedentary life, lack of exercise, weak muscles, and overweight

Poor nutrition

• Protein deficiency • Calcium deficiency • Green vegetable deficiency • Poor bone, cartilage, ligament, and muscle development

Bone alterations

• Osteoporosis • Ankylosing spondylitis • Spondylolisthesis • Congenital abnormalities • Osteoarthritis • Gouty arthritis • Rheumatoid arthritis • Paget’s disease


• Fracture • Ligament or muscle strain • Overuse • Microtrauma

Short leg syndrome (real or apparent)


Dysfunction (Lumbar, lumbar-sacral, sacroiliac)

• Facet lock syndrome • True disc lesion

Spinal imbalance

• Flat feet • Ankle, knee, hip disorders • Iliopsoas, gluteals, paravertebral muscles, plus others • Hypomobility or hypermobility

Referred pain

• Menstrual, gynecological • Kidneys • Bladder • Prostate • Colon • Ulcer • Appendix

Metabolic (calcium/mineral loss)

• Adrenals • Pituitary • Parathyroids (hyperparathyroldism) • Rickets • Meno-pause

Infection (local or systemic)




Backache with or without sciatica is one of the most common complaints a doctor deals with in his or her practice. As osteopathic physicians, we see these cases daily. As you can see from the above list of possible causative factors, back pain is far from a simple disorder. A complete individual case history is essential to allow for proper diagnosis and treatment.

To simplify this discussion, we would like to concentrate on back pain related primarily to the osteopathic spinal lesion, or “Somatic Dysfunction,” as it is now called (see Spinal Manipulation in part 1), and also that caused by a true disc herniation or prolapse. We will omit back pain due to congenital abnormalities, degenerative arthritis, infection, metabolic disorders, cancer, referred syndromes, and so on. These, however, must always be considered when dealing with acute or chronic back pain.

Although two main syndromes of back pain exist (i.e., spinal lesion, or “somatic dysfunction,” and disc herniation or prolapse), their causes are often similar. To understand more about why a good back turns bad, first we have to learn a little about how the back is designed to function. The spinal column is basically a stack of specifically designed bones separated by resilient disc cushions. Each disc is made up of a firm, fibrous outer covering, the annulus fibrosus, and a softer gelatinous inner core, the nucleus pulposus. Each vertebra is uniquely shaped according to its relative position in the spine and its function. There are two areas called apophygeal facets where the vertebra approximates the vertebra above and two facets for the approximation below. These facets allow the vertebrae to glide across each other and by their shape and location limit them to certain ranges of motion. Thus, in the neck, these facets allow good overall mobility with relative freedom in rotation, flexion, extension, and side bending, while in the lumbar region, the angles of the facets allow free flexion and side bending but severely restrict movement of rotation.

Further controls are placed on spinal movements by strong ligaments that connect adjacent vertebrae together and also bind together groups of vertebrae and ultimately the entire spine. Strong muscles also interconnect the spine to provide both support and the possibility of motion. A series of thirty-one spinal nerves pass out of spaces between each vertebra.

The problem in the typical bad back involves one of two processes. Either the vertebral functional unit (two adjacent vertebrae and their connective-tissue components) is in distress and no longer relating to each other as designed (though the disc remains normal), or the functional unit distress may include disc damage. The difference in severity of these two syndromes is extreme. Any back disorder that includes disc damage is much more difficult to cure and has a higher likelihood of recurring and causing prolonged disability. In reality, disc injuries never heal in the accepted definition of the term. Once they have been damaged, that damage is permanent. That does not necessarily mean, however, that the patient will always be in pain or suffer from disc-related symptoms. Many patients with permanent disc injuries can attain a completely pain-free existence with proper osteopathic care, exercise, and a little restraint in their work or play activities.

Many people with bad backs report only trivial motions as the initial cause of their complaint. These include bending over to pick up a sock, touching their toes, opening a window, or even washing their faces. These minor incidences are, however, not the real cause, only the last straw in a long list of spinal stress. Except in the case of severe, acute trauma, the real cause of most spinal complaints has less to do with what you did today or yesterday, and more with what you have been doing or not doing over the last five to ten years.

The most influential factors in developing a weak back are poor spinal mechanics accompanied by poor muscle tone. The body was designed to function according to clearly defined principles established by the shape of our vertebrae and the manner in which they fit together into three distinct spinal curves. These curves, the cervical (neck), thoracic (midback), and lumbar (low back), allow us to function in the upright position and give us a degree of stability. They are essential to maintain a good center of gravity and to help balance and compensate for carrying our heads erect. Without properly balanced spinal curves, the human frame would be incredibly unstable, capable of toppling over with a strong wind.

In the normal posture, the spinal curves leave the vertebrae and their muscular supports in what can be called a neutral condition. The vertebrae are floating free, under no pressure, and all the supporting muscles are in their gently tonic state. If, through habitual slouching in sitting or standing, walking with high heels, obesity, or by a weakening of the muscles of spinal support, the spinal curves become exaggerated (or reduced), a series of extremely important changes takes places. Muscles that previously were at ease must shorten or lengthen to accommodate for this new position and some must actively contract to counterbalance changes in weight distribution. Ultimately, prolonged contraction of any muscle leads to a shortening and hardening of the muscle fibers, creating ropy, fibrous bands instead of healthy flexible muscle.

Over a period of time, even the individual vertebra will change in shape in an attempt to minimize stresses. These changes cause localized or referred pains in the manner of the osteopathic somatic dysfunction (see Spinal Manipulation in part 1). The disc also is placed under unusual stresses, which seem to be a factor in its premature degeneration, leading to less elasticity and loss of fluid content. This accelerated wear and tear, along with weakened ligaments and muscles, allows the gelatinous inner nucleus to push against and cause a bulge in the fibrous outer covering (herniation). Eventually, the inner nucleus breaches this barrier, forming a true disc prolapse, when an extra burden is placed on the spine, as in improper lifting or bending. The result is usually an acutely painful and debilitating nerve pinch, most commonly of the sciatic nerve, causing both local and referred pain, or altered sensations in the gluteal region and down the leg.


Even a normal spine can suffer acute injury due to a fall; auto accident; sudden, unusual, or extreme movement; or another traumatic cause. The cause of pain may simply be a result of muscle or ligament strain, in which case rest and proper physiotherapy are all that is needed. Many cases, however, are complicated by what is often called facet lock syndrome. What occurs here is that the vertebrae become fixed in the extremes of their normal physiological motion and are splinted in place by muscle spasm. Usually, it is the very small muscles that control movement of the spine that first go into spasm and then limit spinal movement. Larger muscle groups usually follow into spasm. The pain is usually severe and sudden at first, but often becomes less severe after a week or two if left untreated. Unfortunately, this lessening of pain is often misinterpreted by the patient to mean that full cure is soon to follow. In reality, what is occurring is that the acute, “hot” lesion is now “cooling” to become a chronic one. If proper spinal manipulation is not received, this area can be a cause of future distress locally and in referred areas related to the nervous supply of that segment. Muscles that have contracted will begin to shorten and remain a source of spinal movement limitation. Secondary changes in other spinal levels will also occur as the body attempts to reestablish a semblance of spinal balance. For example, if a vertebra in your neck becomes fixed in its rotation to the right, your body might accommodate by fixing one of your other neck, thoratic, or lumbar vertebrae to the left to keep your head pointing forward. A good rule to go by is that if a minor sore back does not significantly recover with rest after 24 to 48 hours, then it needs professional treatment. All severe back complaints need to be seen as soon as possible. In general, the longer you wait for treatment, the longer that treatment will take to restore health.

Acute low back pain may also be caused by disc herniation or prolapse. This may have a well-recognized cause, such as attempts at lifting a heavy object—a refrigerator or piano—or it may result from trivial motions, such as those mentioned earlier. Irrespective of the amount of effort responsible for the actual disc rupture or prolapse, the symptoms are the same. The onset of pain may be sudden or gradual over several hours. The most commonly affected discs are between L3 and L4, L4 and L5, and L5 and sacrum. Common symptoms include pain and numbness in low back, buttocks, thighs, calf, and foot; muscle weakness in thigh, calf, or foot; reduced reflexes; muscle wasting in thigh or calf; and if severe, disorders in function of either bowels or bladder. Most cases of acute disc lesions are preceded by a history of chronic backache. If this structural distress had been listened to and preventive measures begun, no disc rupture probably would have occurred. The only way to prevent back disorders is to keep the body in good muscle tone and to maintain proper spinal mechanics and use.

The muscles that support the back span from head to toe. If any one group of muscles becomes lax or tightened, bone and muscle relationships elsewhere in the body will be altered. Even flat feet may be the primary cause in the history of a low back complaint. This is why we recommend full-scale body stretching and toning to prevent back problems. In practice, however, specific muscle groups are more important than others. Certainly, the muscles of the back and gluteal region are important, but most people are surprised to find out that one of the main supports for the back is found in the front—the abdominal muscles. The most common muscular weakness found in the average back patient is weak abdominal tone.

The following exercises have been used quite successfully in treating and preventing back complaints. It is difficult to emphasize adequately just how essential they are. Along with rest, proper physiotherapy, and appropriate spinal therapy performed by a qualified spinal specialist (osteopath, chiropractor, or naturopath), these exercises are responsible for saving millions from extremely expensive, often ineffective spinal surgery.

Note: When consulting a spinal specialist, please be aware that there are, as in all medical professions, great differences in approach, technique, and style. If a particular practitioner has not been able to help you within four to

six treatments, seek a second opinion. Be particularly dubious of any practitioner who proposes a lengthy schedule of therapy at great expense and then offers you a discount if you pay in advance. These practices are designed to fill their waiting rooms and pockets, not to help you get well faster.

Back Exercises

Be careful not to overdo these exercises in the beginning, especially if you are presently suffering from an acute low back complaint. Do not be alarmed if the exercises cause some mild discomfort that lasts for a few minutes. If the pain is more than mild and persists for 10 to 20 minutes, stop the exercises and consult your doctor. Do the exercises on a firm surface covered with a thin foam cushion or folded towel. And do the exercises regularly. As the old proverb says, “Perseverance brings good fortune.”

Acute Phase

These exercises are for the acute (early) phase of recovery. Back in the early 1900s the prevailing treatment for acute back pain was a prescription for complete bed rest for 1 to 2 weeks. This has proven to be incorrect; prolonged rest will lengthen the recovery period. Rest is a vital part of recovery from an injury, but the period should be brief: only for the first 24 to 72 hours after an injury. After the rest period, it is important to start gently moving the back and exercising. This helps release muscle and joint restriction and leads to a quicker recovery.

Standard position

Lie on back with a small pillow under your head and both knees bent.

Knee Rocking

This is a good first-aid exercise for the low back and starts the process of regaining mobility and flexibility to an acutely locked or painful back. Lie comfortably on your back with your knees bent, either in bed or on a padded surface. Slowly let both knees lean to the left side a few inches, keeping the knees together, and then rock to the other side. Repeat for 2–3 minutes.


Knee to chest

Draw one knee slowly to your chest—as far as possible without excessive pain. Hold for 5 seconds and then return to starting position. Repeat four times with each leg individually, and then with both legs simultaneously. Use your legs, not your arms, to raise legs to your chest. The arms are for balance and slight stretching. This exercise stretches the entire low back.


As soon as physically able, walking should be a part of rehabilitation. Even a 10-minute walk around the neighborhood is beneficial. Build up to a brisk 30-minute walk as the back pain diminishes.


Being in water is especially good for back pain, as the force of gravity is lessened. Avoid ocean swimming, as the waves could aggravate the problem. If the freestyle stroke is hurting the back, try using a kickboard, or just walk in the pool with the water at chest height.

Subacute Phase

Once the acute inflammation has settled down, the spine moves into the second phase of recovery. In this phase, from 2 to 4 weeks after an injury, most back pain that does not involve a disc injury will resolve, and full motion will return. It is important to receive treatment to help resolve any niggling pain and to increase exercise and stretching to assist in regaining full spinal function.

Gluteus Muscle Stretch

Lie on back with one leg straight and one knee bent. Grasp the bent knee with the opposite hand and pull it across the body until a stretch is felt in the hip. Hold for 30 seconds, then repeat on the other side.

Segmental Bridging

This is an exercise designed to restore movement and control to each segment of the lumbar vertebrae. Start in the standard position, then try lifting up the pelvis by contracting the buttocks and pulling the stomach tight. As you lift up, try to feel one vertebra at a time. When your body is in line with your legs, hold the position for 15 seconds, squeezing your buttocks and stomach muscles. Slowly release down, one vertebra at a time, actively holding in your abdominal muscles. Repeat 3 times.

Low Back Extensions

Lie on stomach with hands along the side. Slowly raise the head and chest from the floor. Hold 4 to 6 seconds and then slowly lower. Rest and repeat ten times. An advanced form of this exercise involves placing a pillow under the hips and performing the same exercise.

Patients with disc bulges (not prolapsed discs) often find that extension exercises relieve or entirely eliminate the sciatic pain. Many disc problems are the result of bending forward, which gradually causes a weakness in the disc, so that it bulges posteriorly and places pressure on the nerve roots.

The following extension exercises can be very useful. Begin with about 15 minutes in the standard position, with a small pillow under your chest. If you find that the sciatic pain gradually becomes less severe, you may progress to the more advanced extension exercises that follow. If your sciatic pains increase with this exercise, discontinue it immediately.

Chronic Phase

These exercises are for people with chronic low back pain. Unfortunately, back pain that has lingered more that three months in much harder to resolve. In most cases, significant changes have occurred in the spine, with segmental stiffness and multiple disc bulges. The best results come for a regular program of stretching, mobilization, and strengthening.


Begin in the standard position and slowly raise head, neck, and upper torso, reaching for your knees. Do not raise mid- or lower back. Maintain this position, with hands positioned gently on the knees, for 5 to 6 seconds, and then slowly relax. Do not grasp knees. Repeat five to ten times. As these sit-ups become easier to perform, place your lower legs up to the knee on the seat of a chair, making a right angle with your thighs. Keeping your arms across your chest, do half sit-ups that cause your low back to barely rise off the floor, but no further. You do not have to hold this sit-up. Try to do 150 to 300 of this type of sit-up daily— half in the morning and half in the evening. Of all the back exercises I know, this is the most effective, if done as prescribed. I have seen very bad back complaints improve dramatically. Time and perseverance are essential.

Sit-up with chair: Chose a rather low-seated chair and either have an assistant hold your feet securely, or use a strap, as pictured. This is a more advanced sit up, but very useful for low back problems.

Initially just do little half sit-ups. Start with 10 or 15 and gradually work up to 60.

Later, as the half sit-ups become easier, you may progress to full sit-ups. Aim to be able to do 40 to 60 daily.

If you allow your arms to extend back over your head, you will mobilize and loosen your mid back with each sit up.

Later, as your back improves, you can advance to the full sit-up with rotation. Once again aim at 40 to 60 repetitions daily.

Often, patients who also have neck problems must first do a few weeks of neck-strengthening exercises to prepare themselves to be able to do the sit-up exercises outlined above. You will find no better exercises for this purpose than the ones Sanford Bennett advises in his book Old Age: Its Cause And Prevention. This book is now available on the internet as a republication of his original book.

Wall Squats with Swiss Ball

Have the Swiss ball placed against a wall. Lean against the ball, pressing against the low back. Squat down, using the ball for support and letting it roll up the back. Squat down until your knees form a right angle, then press back up to a standing position. Repeat 15 times, 3 sets daily (45 repetitions total).


It is very important to balance exercise with stretching. Tightened muscles in the hips, legs, and back are some of the main causes of restricted lumbar movement. It is best to stretch after an exercise session, when the muscles are still warm. Hold each stretch for 30 seconds each side. Stretch twice a day.




Quadriceps/Hip flexors

Core/Spinal Stability Exercises

The core muscles play a pivotal role in the function of the spine. The low back can be thought of as five connected blocks (the lumbar vertebrae) balancing on the pelvis. Without the muscles surrounding the spine, these blocks would easily fall and buckle under the force of gravity. The bones and ligaments provide some degree of support, but without the active control of the myofascial structures (muscles, tendons, and connective tissue), there would be significant instability.

The core muscles include all the muscles that attach to lumbar vertebrae. The diaphragm forms the roof of the core and the pelvic floor muscles forms the floor. The walls are the abdominals, multifidus, longissimus, and quadratus lumborum. The gluteal muscles also increase low back stability with strong attachment to the thoracolumbar facia.

The abdominal muscles play a particularly important role in lumbar stabilization. The latest research into the abdominal muscles has changed our thinking on the restrengthening of the back. The muscles are now thought of in two categories, global or local. The global muscles, such as the rectus abdominis and longissimus, are responsible for the gross movements of the back. The exercises outlined below are designed to strengthen these global muscles. The local muscles attach directly on the spine and control the movement and stability of each segment. The goal is to have the global muscles and local muscles all working well; this is true spinal stability.

Global core exercises

Plank (Prone Bridge)

This can be used as both a general measure of core stability and an exercise. The aim is to support the body weight on the elbows while keeping the back straight. Hold the position until the back starts to fall. Young, healthy individuals will be able to hold this for over 2 minutes. Most people with a history of back problems will have significantly less endurance. Practice every day and try to push yourself a bit longer until you can hold for 2 minutes without letting the back fall.

Side Bridge

This helps to strengthen the internal and external obliques, two of the main global core muscles. Ensure that the elbow is on a mat for cushioning, have the top foot in front of the other, and lift up the torso. The free hand can rest on the hip or the opposite shoulder. Hold this position for as long as possible. Build up to 90-second hold.

Bird Dog Exercise

Begin on your hands and knees. Lift one arm or knee slightly off the floor, holding the back still. Progress to lifting one arm or leg to the fully horizontal position, as shown below. Once this can be done well, progress to lifting the right hand and left leg together to the fully horizontal position, holding for a count of 5, and then repeat with other hand and leg. Repeat 10 times.

Transversus Abdomninis: Spinal Stability

The transversus abdominis (TrA) is a stabilizing muscle located deep underneath the abdominal muscle group. When the TrA muscle contracts, it acts to draw in the belly button and form a natural “corset” that increases lumbopelvic stability. This drawing-in action also significantly decreases the laxity of the sacroiliac joint. Recent exercise regimes have begun focusing on TrA and the deep stabilizing muscles of the spine. There are indications that core stability exercise programs can improve athletic performance, prevent injuries, and treat low back pain.

Over time, and due to disuse, the TrA becomes weak and loses endurance. In some cases, the muscle can be completely nonfunctional. A crucial part of retraining spinal stability is to regain the active control of this muscle. When the muscle can be activated correctly and held for ten seconds, you will already have regained some stability to the spine. Eventually, training can progress to add arm and leg movement to challenge and increase the endurance to

2 minutes. When fully trained, these core-stabilizing muscles will contract automatically during day-to-day activities.

Stage 1: Diaphragmatic Breathing

The first step the regain control of the core muscles is the relearn proper diaphragmatic breathing. In daily modern life, most people will lose normal breathing patterns and start breathing into the upper chest and ribs. This is inefficient and the breaths are shallow.

The diaphragm is the roof of the abdominal cavity, with a deep inhalation, the diaphragm should contract and descend, fully inflating the lungs and compressing the abdominal organs. The increase in intra-abdominal pressure gives the first measure of support to the spine. Think of it like a car tire: a fully inflated tire will be more able to take the weight of a car than a flat one.


Lie on your back on the floor in the standard position. Rest one hand on your stomach over the naval and the other hand on your chest.

Slowly take a deep breath in. During this inhalation, your belly button should lift, as the diaphragm descends. Most people will feel the chest lifting at the start of this exercise, indicating dysfunctional breathing patterns. Practice slow, deep breaths while trying to feel the tummy rising. During exhalation the belly should fall.

Once natural breathing patterns have been restored, you can move on to actively recruiting the TrA in stage 2.

Stage 2: Activation of Transversus Abdominis

The best position to learn activation of the TrA is on the hands and knees. To contract the muscle, try to bring your belly button inward toward the spine (i.e., hollow out the stomach). It is good to contract the pelvic floor muscles at the same time, as this co-contracts the TrA. Women may recognize the feeling as similar to stopping urination midflow. Check that you aren’t holding your breath, as this indicates incorrect recruitment of the diaphragm. It may take many tries until the correct muscles are found. Professional assistance is of most importance at this stage, as it can be difficult to recruit the TrA without coaching. Various professionals have begun specializing in these exercises including osteopaths, physiotherapists, exercise physiologists, Pilates instructors, and any practitioner trained in clinical Pilates.

Once the pelvic floor and TrA can be recruited properly with normal breathing and without movement of the spine or pelvis, hold the contraction for 10 seconds. Repeat 10 times.

Stage 3: Practice

The exercise in stage 2 should be repeated in all positions: standing, walking, sitting, and lifting. While in the beginning, it may be difficult to get the correct muscles targeted, with practice, the muscles will become as easy to contract as your biceps.

Progression: TrA Exercise program

This program is the basis of adding strength, endurance, and stability to the back. This is the new school of thought for exercising the spine.

Base position is lying on the back, knees bent and feet flat on the ground. Have one hand placed under the arch of the low back, palm down, and the other hand on the belly just above the pelvis.

The aim is to maintain this position, with the spine in neutral at all time through the exercises. With the TrA activated, the spine becomes a rigid lever, and the legs can move independently. The program below adds increasing challenge to maintain that low back stability. The TrA muscle will adapt, gaining strength and endurance with time and practice.

The steps are consecutive; only move to the next one when you have good control and technique of the step you’re currently at. Try to do this exercise on a daily basis. It is fine to repeat one step for many days, until gradually you are able to progress.

  1. Have one hand on one knee, and activate TrA by pulling your naval toward the spine, again focus on breathing normally. Pull the knee into the hand gently and hold of 4 seconds. Relax for 2 seconds then change legs and repeat.
  2. Slowly raise one leg toward the chest to 90 degrees, keeping the other leg on the floor for support. Keep the core strong and active, and the pelvis stable. Repeat several times until fatigued. When this can be done comfortably with the core “on” continuously for several repeats, you can then progress to the next exercise.
  3. Keeping one foot on the floor again, this time lift the other leg slightly and slide it out along the floor. If your pelvis or low back starts to move, stop at that distance. Slowly return the foot to the starting position, then repeat with the opposite leg. Remember that these exercises are about control and endurance, try to keep the spine and pelvis like a plank, and let the limbs use it as a fulcrum.
  4. Keep one foot on the floor and lift the other leg, slowly extending it straight and hold it a few inches off the floor for a few seconds. Slowly pull the leg back to the starting position. Repeat until the technique begins to slide. Do not continue if poor habits being to develop, instead go back a few stages and build endurance (which may take a few weeks).
  5. Double-leg exercises are significantly more challenging. If you have any significant back problem or disc damage, the next exercises should be used only under professional supervision. Start with one leg at a time, raising it to a right angle, then lifting the other leg to join it. Lower one leg at a time. Repeat.
  6. As in step 5, raise both legs to right angles, then allow one leg to slide along the floor. Return to right angles then use the other leg. Control the leg movement, and do not allow the low back to rise off the floor.
  7. As in step 6, except fully extending the leg.
  8. As in step 7, but slide both feet along the floor, extending both legs at the same time. The back should remain planted on the floor with the TrA pulling into the belly button and flattening the low back on the floor. If you feel any loss of control, and the back is arching, then you should stop at that distance of leg extension. Only progress as far as you are able to control.
  9. This is a very advanced level exercise and should only be performed if you can do all the exercises above with precision. Lumbar disc bulge/prolapse sufferers should not attempt this exercise. Start by lifting both legs so that the hips are at right angles, then progress to extending the legs along the floor until you can hold them fully extended, a few inches up. Return to start position.
Adjunctive Therapies
  • Interferential Electrotherapy*: This modality is very useful in acute stages of low back pain either due to simple sprain/strain or disc injuries. It is best applied 2 to 3 times weekly when back pain is severe.
  • Shortwave Diathermy*: Shortwave diathermy is very useful in nearly all types of low back pain, even acute disc injury. It needs to be applied 2 to 3 times a week in acute cases.
  • Ultrasound*: This physiotherapy modality has been found very useful in the acute stages of low back pain. Ultrasound is more useful with muscular involvement and best avoided in acute disc injury.
  • Acupuncture*: Can help both acute and chronic low back pain. Seek a qualified practitioner.
  • Ice packs*: Usually, the application of ice in the first 24 hours will be the most beneficial. Make sure not to apply this for too long a period, and thus injure the tissues. Ice should be applied for 10 to 30 minutes with 10 to 30 minutes between applications. Disc injuries usually respond well to ice or cold application even in later stages of the problem. This acts to help reduce the inflammation around the sciatic nerve.
  • Spinal manipulation*: Osteopathic spinal manipulation, directed at areas of immobility and dysfunction.
  • Complete rest: Many acute low back complaints, and especially those with disc lesions, require complete bed rest for the first 24 to 48 hours after the injury. Do absolutely nothing except go to the bathroom. Make sure bowels stay loose; prevent constipation by following a light diet with laxative-type foods. Straining will aggravate the condition. Make sure the bed is extremely supportive, or lay the mattress directly on the floor.
  • Heat: Local moist heat will help in later stages to loosen tight spinal muscles and give pain relief. Ready-made hydrocollator packs are the most convenient applications, but they are not always available. For home use, apply hot, moist towels, folded several times. These may be placed steaming hot over two to four dry layers of towels and then covered with several more layers to retain heat. The thicker the folded wet towel, the longer it will retain its heat. Lie on your back with a large pillow under your knees, or on the side with legs drawn up in the semifetal position. Care must be taken when applying heat to prevent the tissues from becoming congested with blood. Follow heat applications with the gentle spinal stretching exercises previously described. Excessive use of heat will cause stagnation of fluids and slow healing. In later stages alternate hot and ice-cold applications will be useful to stimulate circulation and healing.
  • Hops and lobelia hot compress: For pain relief.
  • Warm Epsom salts baths: These are very relaxing and antispasmodic. (See appendix 1.)
  • Olbas rub

Therapeutic Agents

Vitamins and Minerals

Vitamin C*: 3,000 to 10,000 mg per day, or to bowel tolerance. Essential for health of connective tissue (disc).

Vitamin B complex: 25 to 50 mg two times per day.

Vitamin B1 (100 mg) and B12 (1 mg) injection: Intramuscular injection two times per week for two weeks, then once a week.

Vitamin E: 400 IU two times per day.

Calcium/magnesium in ratio of 2:1 (i.e., 800 mg calcium to 400 mg magnesium).


Bromelain*: 2 to 3 tablets three times per day, taken only on an empty stomach.

DL-Phenylalanine: Analgesic, better than aspirin for pain. Increases release of endogenous endorphin-like substances.


Lose weight.

Excerpts from Better Health Through Natural Healing 3rd Edition

First published in 1985, Better Health through Natural Healing has become one of the most successful and authoritative resources of its type, with more than 1.5 million copies sold worldwide. Since the original publication of this comprehensive guide, alternative therapies have become more and more accepted by the mainstream, and patients and practitioners of the wider medical community are embracing complementary medicine as an effective treatment option for a range of medical conditions.

The book is available at the West End clinic, exclusively in Australia.

More chapters from the book