Once the decision is made to opt for surgery there are generally two types of lower back surgery – decompression and spinal fusion.

Decompression:
Decompression back surgery involves removing a small portion of the bone or disc material from around the nerve root or spinal cord to relieve nerve pinching and provide more room for the nerve recovery.

Herniated Disk decompression:
Herniated disk surgery is the condition that receives the most surgeries. Surgery is to reduce the pain, but also to get the bulging disk from causing nerve damage or making damage worse. Surgical methods include:

• Chemonucleolysis: A non-surgical, but still invasive option where an enzyme is injected directly into the disk to dissolve the portion of the disk that is protruding
• Diskectomy: Surgery under general anesthesia where a surgeon removes the protruding portions of the disk from the spinal canal or from between the vertebrae.
• Microdiskectomy: Similar to a Diskectomy, but it is less invasive, since the surgeon makes a smaller incision and the surgery is performed looking through a microscope, as opposed to the standard open surgery of a Diskectomy.

Foramenotomy
A foramenotomy is another surgery used to reduce pressure on a nerve caused by a bit of bone or osteophyte. The suregery removes that portion of bone or other tissue that may be compressing as the nerve exits the spinal column.

Spinal fusion:
Spinal fusion surgery links together vertebrae that are normally separate so that motion cannot occur between the individual vertebrae. These vertebrae are individual bones that stack to form the backbone.

Laminectomy
A laminectomy is done to relieve pressure on the spinal cord. It is most commonly used to treat spinal stenosis and spondylolisthesis.

Other surgeries:

Spinal Disc Replacement
Spinal disc replacement is a treatment option for some types of low back pain. It is quite common in Europe, but not yet approved in the U.S.

Cauda Equina Syndrome
Cauda equina syndrome is an emergency situation where the complicated nerve root system in the lower spine is being compressed. This compression can cause tingling, numbness and loss of bladder or bowel control and without urgent treatment could cause permanent nerve damage.

Acute Pain

Acute pain from a muscle strain or sprain can be agonizing, but most people find that the agony will go away after a couple of days and significantly improves within a few weeks. Taking some basic measures on your own and without a doctor’s care clears up most cases of acute back pain. However, use good judgment; see a health care professional if your pain is out of the blue is severe even with basic self-care.

Self-care treatments:

• Consider non-prescription strength anti-inflammatories such as aspirin, ibuprofen, or naproxen or a pain reliever such as acetaminophen (Tylenol). If you are having a muscle spasm, you may also need muscle relaxants, which a doctor can prescribe.
• Stay active. Bed rest for a day or two may be absolutely necessary, but back muscles are meant to be mobile. Staying in bed can actually make your muscle stiffer or, even worse, weak. Keep active and try some basic core stretching and strengthening exercises.
• Alternate icing and heating the affected area. Ice it for 12-15 minutes ever couple of hours (never put ice directly on the skin to prevent frost bite) and then apply a heating pad (set to low or medium) or take a hot shower. Some people don’t find this helpful, but it definitely can’t harm you, and it may even make you relax, which can be helpful.

Other treatments that are available for acute pain and do not fall into the self-care category are:

• Chiropractic care (spinal manipulation) – A chiropractor’s aim is to align the spine and increase a joint’s range of motion. Through a series of adjustments, it is possible to align the spine, which in turn can reduce inflammation that may be the cause of the pain.
• Physical Therapy – A goal for a physical therapist is to strengthen muscles so that they can effectively do their job in supporting healthy and proper posture.

Chronic Pain

If back pain becomes chronic (lasting more than six weeks) other treatments might become necessary. Causes of chronic pain include herniated disks, spinal stenosis, osteoarthritis, facet joint block, spondylosis and sometimes cancer. Chronic pain can lead to depression or sometimes anxiety from fear that what you are doing could be further damaging your back. Chronic conditions are usually treated similarly to acute pain sufferers in that core strengthening exercises are highly recommended. Treatment regimens are often more successful when stretching and aerobic and strengthening exercises is regularly practiced. Elongating and strengthening the muscles of the core can help to stabilize and support the spine so that the other treatments can be a success. Treatments for chronic conditions can vary.

Chronic pain treatments:

• Drugs and Injections – Most conditions have a corresponding drug protocol that if necessary your health care professional could prescribe. Corticosteroid injections, to block pain sensation or reduce inflammation maybe be used in instances where bone is hitting bone. If your pain is severe, your doctor may recommend short-term use of an opiate painkiller, epidural steroid injection, or muscle relaxants.
• Biofeedback, therapy, yoga and/or meditation – Coping with long-term pain can be stressful, upsetting and possibly even depressing. Adapting relaxation techniques into your treatment is widely recommended by doctors and other healers. Yoga can also help to stretch and strengthen muscles!
• Antidepressants – if pain and anxiety leads to depression, doctors sometimes prescribe antidepressants.
• Surgery – Surgery is rarely needed for low back pain (relative to how many people experience it). Most doctors will wait to until after non-surgical treatments have been attempted for 1 to 3 months without improvement.

See your health care professional immediately if you experience numbness, tingling or loss of bowel or bladder control.

Ergonomic Chairs

With the onset of the computer age, more people are spending more time sitting in front of a computer. Using a comfortable and ergonomically correct chair is key in preventing minor back pain (that could eventually lead to more serious problems). Individual needs dictate which chair is right for which person, but here are some things to look for when shopping for a good ergonomic chair.

1. Height – can it raise and lower to suit individual height
2. Seat depth and width – the backs of the thighs need to be fully supported and the hips shouldn’t be squished
3. Backrest – correct and natural curvature of the spine needs to be supported with a high enough back and lumbar support
4. Arm rests – should be adjustable to accommodate the individual
5. Swivel and rollers – chair should easily turn and roll to help reduce the amount of bending, twisting and reaching a person does.

Office supply stores such as Office Depot or Office Max carry lines of ergonomic chairs and many different brands and styles can be purchased online.

Personal Hand-held Massagers

Massage not only feels good but has an actual positive physiological effect. Massage increases circulation to an area which increases blood flow. Increased blood flow helps to circulate oxygen and nutrients and to carry away toxins. What people like about the hand-held massagers is the “any time, anywhere” access to relief and the one-time cost, unlike going to a massage therapist. People also like the way they can massage specific areas, but this also means that whichever hand is holding the massager (and therefore that arm and possibly the shoulder as well) can’t completely relax.

There are many different options when it comes to personal hand-held massagers. Massagers come small, large, battery operated, with cords, etc., so finding something for your individual preference is easily achievable.

Massage Chairs

Massage chairs are effective and helpful since a person can relax fully into the chair. Massage stimulates blood flow which increases oxygen to the area. A full chair can be purchased that has the massage unit built in or an insert can be placed on any upright or reclining chair.

Common options in massage chairs include:

1. Vertical rolling or kneading motion
2. Pulsation
3. Concentration on lower back, upper back or both
4. Heat

Personal hand-held massagers and massage chairs can be found at many different stores including Bed Bath and Beyond, Brookstone and Costco. A good resource online is comfortchannel.com where a full selection of massage therapy products and types are available. Directions should be followed to increase effectiveness and prevent harm.

Poor use or overuse of the lower back muscles, such as lifting and bending for a long period of time, can weaken the core. Weak core muscles leave you at risk for lower back pain and muscle injury. Long periods of stress, whether environmental or emotional can weaken the muscles in the back. So not only is strengthening the core imperative in back health maintenance, but releasing tension is also an important step.

This rotation stretch not only releases tension in the lower back but if done slowly should also give a little boost of abdominal strength:

Lie on your back with your knees bent and your feet and head on the floor. Tilt your pelvis slightly up so that you remove any hollow between your lower back and the floor. Tighten your abdominal muscles and breathe. Keep your shoulders on the floor and let your knees fall slowly to your left side. The bottoms of your feet can come up as your knees drop. Keeping your arms at your side can help to stabilize you and remind you to keep your shoulders on the ground. Go only as far as is comfortable. You should feel a stretch, but no pain. If you ever feel pain, consult with your health care provider. Hold for 15-20 seconds. Slowly bring your knees back up to their starting position remembering to breathe. Repeat on the right side, and repeat the set if desired.

The abdominals consist of several muscle groups: the rectus and transversus abdominis (generally – muscles in the middle) and the internal and external obliques (generally – the side muscles). Keeping these strong can help to lift the trunk upward while both sitting and standing.

Crunches are the oatmeal of the abdominal strengthening breakfast. They are a mainstay. It is one of the best exercises to target the middle to lower abdominal muscles. If crunches are done with a full regimen of core strengthening exercises, back pain could possibly be a thing of the past.

Lie on your back with your knees bent and your feet on the floor. Tilt your pelvis slightly up so that you remove any hollow between your lower back and the floor. Put your hands on your knees or reach toward your knees. Engage your abdominal muscles and breathe. In a crunch you don’t lift your torso all the way off the ground. Keep your chin up and tension out of your neck. Imagine your lower back anchored to the ground. Slowly curl your chest up toward your knees trying to use your abdominals as much as possible and breathe out. Raise yourself up until your shoulders leave the floor entirely. Hold at the top for three seconds and then slowly lower yourself back down breathing in. Relax for several moments. Repeat this exercise 7-10 times. Try to build up to three sets and stop if there is ever any pain.

Another important step in injury prevention, and one that people don’t think of, is balance. Staying agile and stable on your feet can prevent a person from unintentional twisting or jerking in the muscles that can cause muscle strains or even ligament sprains (ligaments that are torn when there is a quick movement in the spine and the muscles cannot react quickly enough to stabilize).

This Stabilizer exercise is a quadruple threat in back maintenance – working the back, abdominal and leg muscles and balance at the same time:

On the floor in a hands and knees position place your knees shoulder width apart and align your hips so that your back and legs are at a right angle. Place your hands in front of you and make sure your shoulders are positioned so that your back and arms are also at a right angle. Your arms should be should width apart. Put your palms flat against the ground; your arms should be engaged to support your weight but don’t lock your elbows. Engage your abdominal muscles and make sure that there is very little arch or dip in your lower back. Lift your right arm and extend it in front of you imagining a level line from your back and along your arm. Hold the head up, but look directly down at the floor. On the opposite side, lift and straighten your left leg, also creating a level line. Hold this position for 10-15 seconds while breathing regularly. Slowly lower your arm and leg. Alternate sides by lifting the left arm and then the right leg. Don’t continue if you feel pain.

The Pelvic Tilt can help to tighten the muscles of the lower stomach and back. The Pelvic Lift can help to tighten the muscles of the lower stomach, back, buttocks and upper thigh.

Start with the pelvic tilt: Lie down on your back with your knees bent and your feet and head on the floor arms at each side. Engage your stomach muscles and tilt your pelvis down toward the floor. Imagine your lower back being pressed into the ground. Hold this position for 5-10 seconds and then relax. Repeat 5-8 times.

Next is the pelvic lift: Stay on your back with your knees bent and your arms to the side. Engage your stomach muscles and breathe. Lift your pelvis directly up to the sky until your chest hips and legs are lined up and not angled. Support this lift primarily with your feet that are firmly planted on the ground, but the lift should be coming from the raised pelvis. Check occasionally that the pelvis hasn’t sagged, keep it raised! Do not continue if you start to feel pain. Hold the lift for 20-30 seconds and continue breathing. Slowly lower your pelvis and relax. Repeat 3-5 times. As you become stronger try to lift the pelvis higher. Look up toward the ceiling during this exercise, since turning your head while your pelvis is lifted could possibly cause a strain.

Muscle strain can come from overuse, such as lifting and bending for a long period of time, or it can also come from built up tension. Long periods of stress, whether environmental or emotional can weaken the muscles in the back. Strengthening muscle and releasing tension are both important steps in preventing injury. This knee tuck feels good and releases tension in the lower back:

Lie down on your back with your knees bent and your feet and head on the floor. Tilt your pelvis slightly toward the ceiling to reduce the lumbar curve (remove any large hollow there might be between your back and the floor). Keep your knees bent and slowly raise them and pull them toward your chest. Put your arms around your knees and hug them close to your chest. Make sure to keep your head on the ground and keep breathing. If you like you can gently rock from side to side while your knees are elevated. You should feel a release of tension in your lower back. Release your knees and slowly bring your feet back to the ground. This stretch can also be done with the knees separated and the arms hugging each knee separately.

Many machines at the gym concentrate on strengthening the upper portion of the back. The lower back is actually where much of the body’s weight is carried, so it needs its share of strengthening. This Hip/Leg Extension exercise strengthens the lower back muscles (and as an added bonus strengthens the glutes and stretches the hip):

Lie down on your stomach and stretch out your legs. The legs should be straight and pulled together. Place your arms on each side of you, bent, with elbows up to the ceiling and palms flat on the ground lined up evenly with your upper chest. Pull your shoulders down and back – don’t let them creep up around your ears. With your face down toward the ground, tilt your head up to look toward the ceiling just until the bottom of your chin is resting on the ground. Engage your abdominal muscles and buttocks. Breathe and lift the right leg about 6 inches off of the ground and hold it there for 5-10 seconds. Keep your leg straight and your foot flexed. Slowly lower the leg and repeat on the other side. You can rest between legs if necessary, don’t forget to breathe and discontinue if you begin to feel pain. Repeat the exercise 3-6 times.

Keeping the muscles of the legs elongated and toned plays an integral part in maintaining back health. Back pain can radiate down through the buttocks and into the legs. Severe back pain can cause numbness or tingling in the legs.

The Sciatic nerve also runs through the same area of the leg as the hamstring. When the sciatic nerve is being pinched by inflammation it can radiate pain down the back through the buttocks and into the legs. When people experience sciatica, they want to overcompensate and be too gentle on the back and legs. However, once inflammation has been reduced, stretching the hamstring can relieve the tension in the legs and the back, which then eases the pressure being put on the sciatic nerve. Here is a stretch that will help elongate the hamstring and can also ease the tension on the lower back:

Lie down on your back with your knees bent and your head on the ground. Tilt your pelvis slightly toward the sky so that there is very little hollow between the low back and the floor. (You can put a small, rolled up towel under your back if it is especially tender.) Bring up your right knee and lace your fingers behind the upper middle part of your calf. Pull the leg toward your chest. Slowly straighten the raised leg. The stretch will increase as you pull back and straighten the leg. Stop the stretch if you begin to feel pain. Stretch the hamstring for 15-30 seconds trying to straighten the leg a little more every several seconds. Slowly lower the leg. Repeat on the left leg. This stretch can be done several times a day.