Story
Low Back Pain
Last updated
In one pass The lower back is not one bone.
Educational content, not medical advice — consult a clinician.
Three types, by proportion Low back pain is an umbrella over roughly three groups: non-specific pain at about 80-90%, then radicular pain, and a smaller slice of facet or mechanical pain.
Pain-free people are full of 'abnormal' scans Even people with no back pain often show disc degeneration and bulges on MRI, more so with age, so these findings are mostly normal age-related changes.
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Chapter 1
What the lower spine is made of
The lower back is not one bone. It is a structure that has to carry the body's weight and still bend and turn: the vertebrae in front bear the load, a disc sits between them as a cushion, small joints at the back steer the direction of movement, the muscles and fascia alongside the spine act as living cables, and nerves leave through an opening at each level and run all the way down the legs.
The center of a healthy disc has almost no nerves, so seeing degeneration on a scan does not mean the source of the pain has been found. But nerves can sometimes grow into a degenerated disc, so a scan has to be read together with the symptoms. The back is built to bend, twist and carry — it is not a glass rod that cracks at a touch — and most back pain gets clearly better within a few weeks.
Only one situation cannot wait. If back pain comes with numbness around the groin and buttocks as if anesthetized, sudden inability to pass urine or loss of bladder or bowel control, or both legs getting steadily weaker, go to the emergency department now. The full list of reasons to see a doctor is in the chapter on when you must see one.
The center of a healthy disc has almost no nerves, so seeing degeneration on a scan does not mean the source of the pain has been found. But nerves can sometimes grow into a degenerated disc, so a scan has to be read together with the symptoms. The back is built to bend, twist and carry — it is not a glass rod that cracks at a touch — and most back pain gets clearly better within a few weeks.
Only one situation cannot wait. If back pain comes with numbness around the groin and buttocks as if anesthetized, sudden inability to pass urine or loss of bladder or bowel control, or both legs getting steadily weaker, go to the emergency department now. The full list of reasons to see a doctor is in the chapter on when you must see one.
Background · The parts that make up the lower spine
Low back pain is one of the health problems that cost the world the most years lived with disability — years spent living with a disabling condition — and almost everyone meets it once or twice in a lifetime. But it is almost never as simple as one bone going wrong. The lower back is a composite structure that has to bear load and stay flexible at the same time, and it is built from these parts:Vertebrae: five lumbar vertebrae (L1–L5) stacked in a column, with a load-bearing vertebral body in front and a vertebral arch behind that protects the nerves.Intervertebral discs: the cushions between neighboring vertebral bodies, with a tough outer ring (annulus fibrosus) around a water-rich core (nucleus pulposus). Like knee cartilage, a disc has almost no blood vessels; nutrients mainly seep in slowly from the neighboring vertebrae, and the squeezing and releasing of movement helps push fluid out and draw it back in.Facet joints: a pair of small synovial joints at the back of each vertebra that steer the direction of spinal movement. Their surfaces are covered in cartilage, and their capsules carry nerves.Paraspinal muscles and fascia: multifidus, erector spinae and others — the spine's active stabilizing cables.Nerves: the spinal cord ends at the top of the lumbar spine and continues downward as a bundle of nerve roots called the cauda equina. The roots leave through an opening at each level and supply the legs.
Mechanism · Which parts of the back can signal pain
A counter-intuitive but important fact: the disc, the structure most often blamed for low back pain, is not very sensitive to pain across most of its bulk.In a healthy disc, only the outermost layers of the outer ring carry nerve endings, and the central core has essentially no nerves and no blood vessels — much like knee cartilage. So "a degenerated disc must hurt" does not hold up mechanically: tissue with few nerves can degenerate without necessarily producing pain.
That reasoning has a condition, though: it is about a healthy disc. A study that took tissue samples during spinal fusion surgery (Freemont 1997) found that in the painful level of people with chronic back pain, nerves had more often grown into the inner layers of the ring and even into the core. A by Brinjikji 2015 also found that in younger adults, imaging signs such as disc degeneration and bulging were more common in people with back pain than in people without it. So degeneration on a scan is neither a verdict on your pain nor unrelated to it — it has to be read together with the symptoms.
Where, then, might back pain come from? The lower back has quite a few structures with a nerve supply, and any one of them, or several together, can be a source:
Muscles and fascia alongside the spine: they hurt when in spasm, fatigued or strained, and are one of the most common sources of an acute "thrown-out" back.Facet joints: their capsules are rich in nerves and hurt when degenerated or irritated, often described as worse when leaning backward.The outer disc ring and the posterior longitudinal ligament: painful when torn or stretched.Nerve roots: when a bulging disc or bone spur presses on or irritates a root, pain shoots along the nerve into the leg (sciatica).
Here is the key turn: the structural changes seen on imaging and the pain you feel often do not match. Much back pain cannot be pinned to any one structure at all, which is where the name non-specific low back pain comes from. Remember one line: structure changes with age, but pain is not a simple readout of structural change.
Chapter 2
Why backs hurt
Back pain is not one disease; it is several mechanisms sharing one name. In roughly eight or nine cases out of ten, nobody can pin down exactly what hurts — muscle, a facet joint, the outer layer of a disc, or several together. That is not a brush-off. Current tools often cannot pinpoint the source, and pinpointing it usually would not change what is done next anyway. The great majority get clearly better within a few weeks.
Two other groups are pain that shoots down a nerve into the leg (radicular pain) and mechanical pain from irritated facet joints at the back of the spine. Only a small minority have a serious cause that must be identified — a fracture, an infection, a tumor or compression of the cauda equina.
One more thing runs through all of it: how strong the pain is and how much tissue is damaged are often not the same thing, because the brain can turn the volume of pain up or down.
Two other groups are pain that shoots down a nerve into the leg (radicular pain) and mechanical pain from irritated facet joints at the back of the spine. Only a small minority have a serious cause that must be identified — a fracture, an infection, a tumor or compression of the cauda equina.
One more thing runs through all of it: how strong the pain is and how much tissue is damaged are often not the same thing, because the brain can turn the volume of pain up or down.
Clinical · What radicular and facet pain look like
Radicular pain and sciaticaWhen a herniated disc or degenerated bone presses on or irritates a nerve root, pain spreads along the nerve's path into the buttock and leg, sometimes with numbness, tingling or weakness. Note that a disc herniation on a scan is very common, but it only counts when it actually compresses a nerve and produces matching symptoms. Most radicular pain also eases with time.
Facet or mechanical pain
When the facet joints at the back of the spine are degenerated or irritated, the pain is often described as worse when leaning back or standing for long and eased by bending forward. On these signs alone, though, it is hard to confirm that the pain really comes from the facet joints.
Mechanism · Why pain is not a damage meter
One principle is the most important and the most often overlooked: pain and tissue damage do not map one to one.The old, oversimplified model treats pain as a damage alarm: whatever is broken sends out a pain signal in proportion, and the worse it hurts, the worse the damage. But what clinics and neuroscience keep finding is this:
Some people can barely move for back pain, yet their scans look nearly normal.Some people's scans are full of disc bulges and degeneration, yet they feel no pain at all.
The modern understanding uses the biopsychosocial model: the pain you feel is an output the brain produces after combining many streams of information, not a direct readout of tissue damage. Besides the signals from the back itself (the biological part), it is turned up or down by:
Psychological factors: fear that "my back is ruined," anxiety and catastrophizing noticeably amplify pain and make people afraid to move (fear-avoidance).Social and situational factors: poor sleep, long-term stress, job dissatisfaction and lack of support all turn up the volume of pain.
This does not mean the pain is imaginary — the pain is entirely real. It means the nervous system can learn pain. Chronic back pain is often this alarm system becoming oversensitive, not a hole in the back that keeps getting worse.
This understanding rewrites everything that follows. If pain were a readout of damage, you would immobilize, protect and investigate to the bottom. If pain is the brain's combined output, then moving, lowering fear and improving sleep and stress become part of the treatment. That is the premise behind guidelines putting activity, reassurance and exercise first.
Chapter 3
Five back myths that don't hold up
The back is a hotspot for marketing claims and folk wisdom. Almost everyone runs into five of them: the bulge or degeneration on the scan is the culprit; bad posture will wreck your back; a thrown-out back needs bed rest; you need a very strong core before you dare to move; a vertebra has slipped out of place, the back is fragile and will give way if you bend.
Behind all five is the same misunderstanding: treating the back as a part that breaks at a touch, and pain as a readout of damage. The evidence paints a different picture: the so-called abnormalities on scans are common in people who have never had back pain, bed rest slows recovery, and special core exercises are no better than general exercise.
Behind all five is the same misunderstanding: treating the back as a part that breaks at a touch, and pain as a readout of damage. The evidence paints a different picture: the so-called abnormalities on scans are common in people who have never had back pain, bed rest slows recovery, and special core exercises are no better than general exercise.
Myth · Scan findings in people with no back pain
The first myth deserves a page of its own, because behind it sits the most powerful — and most misused — set of data.The core evidence is a systematic review by Brinjikji 2015. It pooled more than 30 studies covering large numbers of people with no back pain at all, and laid out, age band by age band, how often these symptom-free people had spinal abnormalities on imaging. The numbers are striking:
Disc degeneration: about 37% at age 20, rising with almost every age band after that, to nearly 96% by age 80.Disc bulges: about 30% at 20 and about 84% at 80.Disc protrusions and tears in the outer ring also rise markedly with age.
Note that none of these people had back pain. Put a random symptom-free middle-aged person into a magnetic resonance imaging (MRI) scanner, and you will very likely find a bulge or a degenerated disc or two.
Two direct conclusions follow:
Seeing a disc bulge on an MRI does not mean the cause of your back pain has been found. It may simply be the normal background that comes with age.For ordinary back pain with no warning signs and no nerve symptoms, routine X-rays or MRI often do more harm than good: they turn up a pile of irrelevant abnormalities that raise anxiety and prompt unnecessary interventions. That is exactly why NICE and other major guidelines advise against routine imaging for simple back pain.
Do not overcorrect, though. In a second the same authors published that year, these signs were in fact more common in younger adults with back pain than in those without. So the scan is not unrelated to the pain; it just cannot answer why you hurt on its own.
The right question, then, is not does my scan show an abnormality? (almost everyone's does) but are my symptoms really caused by a structure, in a way something can be done about? For the great majority of non-specific back pain, the answer is to get moving and give it time, not to rush off for a scan.
Myth · Why bed rest slows recovery
This is the piece of traditional wisdom that does the most harm in back pain: if you throw your back out, lie still and it will heal in a few days.The direction is exactly backward. NICE and other major guidelines explicitly advise against bed rest. With acute non-specific back pain, the longer you lie down, the weaker the muscles, the stiffer the joints and the lower your confidence, which makes it harder to get back to normal activity. Today's advice is simple: stay as active as you can tolerate.
Why is lying down the wrong move?
Like cartilage, the disc relies on the squeezing and releasing of movement to help exchange fluid and take in nutrients; long periods without movement cut off its supply line.The muscles alongside the spine weaken when they go unused for a long time, and those are exactly the muscles that stabilize the spine.Lying down reinforces the fear that my back is fragile and will break if I move, pushing people into the vicious circle of fear-avoidance.
This mirrors the shift in how acute soft-tissue injuries are handled. The complete rest (Rest) of the old PRICE principle has been replaced by the appropriate loading (Optimal Loading) of POLICE — proposed by Bleakley 2012 in a commentary, on the grounds that complete immobilization slows healing.
So the right approach is not lie flat and rest. In the acute phase you can scale back a little and avoid the most painful movements, but keep walking and keep doing the daily activities you can tolerate; most people improve clearly within days to weeks. Swapping rest until it stops hurting, then move for move smartly while carrying some acceptable discomfort is the most valuable change of mindset in recovering from back pain.
Myth · Are special core exercises better?
"Back pain means a weak core, so you must hammer the core and must do one special exercise" is popular in both fitness and rehab circles, but the evidence does not support the strong version of it.Point by point:
Exercise does help, but the help comes from moving itself, not from one magic exercise. The NICE guideline and the Lancet low back pain series both list exercise as the core treatment for persistent back pain, without ranking any one type above the others: walking, swimming, Pilates, strength training and general exercise all count. So rather than worrying am I doing the right one, pick one you are willing to keep up for the long term.Guidelines do not rank special core-stability training above general exercise. The once-fashionable fine-grained prescriptions — first switch on one small deep muscle, such as transversus abdominis — have not been shown to beat ordinary exercise. The body does not need you to deliberately isolate a particular muscle.Strength training itself has good evidence for preventing sports injuries in people who play sport (Lauersen 2014), and a strong trunk that can handle load protects the back. But that is a different claim from you must build a very strong core before you dare to move.
The updated view: not a weak core causes back pain, so strengthen the core first, but move regularly and progressively so the trunk regains strength and confidence. People usually stick with general exercise more easily than with a complicated special routine — and being able to keep it up is the variable that really decides the outcome in chronic back pain.
Myth · Posture, and the idea of a slipped vertebra
Pinning back pain simply on posture both creates anxiety and often misses the point. Posture is not a switch you can get right or wrong; it is a question of how long you stay in one position.My vertebra has slipped out of place, my back is fragile, and it will give way if I bend
Claims that something is out of alignment and needs to be put back are hard to support mechanically. True displacement of a vertebra is rare and needs imaging to confirm it, and the sound during a so-called realignment is mostly gas bubbles in the joint or soft-tissue noise; it does not mean a bone has been set back into place. Picturing the back as fragile and easily displaced is itself one of the psychological factors that amplify pain and deepen fear-avoidance.
Chapter 4
Staying active works best
What really changes the course of back pain is not a scan first, and not painkillers first. The major guidelines open with almost the same message: keep up your daily activities and do not take to bed; make it clear that the back is not ruined; then choose a form of exercise you can keep doing. Sleep, stress and fear of pain turn the volume of pain up, and dealing with them is itself treatment.
Medicines can help you through the worst few days in the short term, so that you can get moving; opioids are a last resort. For ordinary back pain with no warning signs, routine imaging often does more harm than good. The order matters: first lay the foundation of activity, reassurance and exercise.
Medicines can help you through the worst few days in the short term, so that you can get moving; opioids are a last resort. For ordinary back pain with no warning signs, routine imaging often does more harm than good. The order matters: first lay the foundation of activity, reassurance and exercise.
Mechanism · Why education, exercise and sleep are treatment
First line: education and reassuranceThis sounds soft, but it is one of the core interventions with evidence behind it. Understanding that my back is not ruined, the bulge on the scan is mostly a normal change with age, and the great majority get better in itself lowers pain and cuts unnecessary tests and overtreatment. Knowing the mechanism, you do not panic; not panicking, you are more willing to move and more likely to recover.
First line: exercise (any kind)
For persistent or recurring back pain, exercise is the core treatment, not an add-on. Guidelines do not rank any one type above the others, so choose one you are willing to keep doing for the long term — walking, swimming, Pilates and strength training all qualify.
First line or add-on: dealing with psychological and social factors
Sleep, stress, fear of pain and catastrophizing all turn up the volume of pain. For chronic back pain, psychological approaches such as cognitive behavioral therapy () and mindfulness are one of the first-line options guidelines recommend, and improving sleep and stress is itself treatment.
Getting these right is the best-value, lowest-side-effect investment in back pain.
Clinical · How three guidelines order the options
Turn you should keep moving into something you can act on and check against guidelines. Three major authorities agree closely on the order.The overall ladder (UK NICE 2016, the American College of Physicians' ACP 2017 guideline, and the Lancet low back pain series 2018)
1. Self-management, staying active, education and reassurance (the core, for everyone); bed rest is explicitly not advised.
2. Exercise (any type) as the core treatment for persistent and chronic pain; where needed, manual therapy goes inside a combined package that includes exercise, not as a long-term treatment on its own.
3. For chronic pain, psychological therapy (cognitive behavioral therapy, mindfulness) and multidisciplinary rehabilitation are among the first-line options.
4. Medicines: non-steroidal anti-inflammatory drugs () are first line, for short-term use; opioids are a last resort.
5. Imaging: for non-specific back pain with no warning signs, no routine imaging.
6. Injections and surgery: considered only on strict indications (for example, radicular pain that has not responded to conservative care and matches the imaging).
How to move (persistent or chronic pain)
Start at a level of activity you can tolerate: walking is the most underrated and the easiest to begin.Build up gradually: give the body a few weeks to adapt; the back is a long-term project.Choose what you will stick with: walking, swimming, Pilates and strength training work about equally well, and whether you keep it up is what decides the result.Treat pain as a signal, not a ban: a bit uncomfortable but not getting steadily worse is usually fine to continue; worse each session and clearly worse the next day is the cue to cut back.
A warning about overtreatment
The Lancet series points out that the world's response to back pain is often too aggressive — too many scans, injections, operations and opioids — while the things most worth doing, staying active and education, are in short supply. So for ordinary back pain, the smartest first step is usually not more tests, but to understand it and then get moving.
Chapter 5
What hands-on treatments can do
The Low Back Pain market is full of things other people do to you: massage, chiropractic and other spinal manipulation, heat, traction, patches and gadgets. Some can make you more comfortable for a while, so that you can move; few can change the course of chronic back pain on their own.
What changes the course is what you do yourself: staying active, exercising, sleeping better and letting go of the fear of pain. Getting the priorities backward — waiting for someone to fix you while you stay still — is the most common trap. Stretching and foam rolling work the same way: what they change is mostly how tight and sore you feel, not the structure of your discs or fascia.
What changes the course is what you do yourself: staying active, exercising, sleeping better and letting go of the fear of pain. Getting the priorities backward — waiting for someone to fix you while you stay still — is the most common trap. Stretching and foam rolling work the same way: what they change is mostly how tight and sore you feel, not the structure of your discs or fascia.
Evidence · What manual therapy, heat and magnets are worth
Category by category:Manual therapy (chiropractic, spinal manipulation, joint mobilization): brings short-term relief for some people. The NICE guideline places it inside a combined package that includes exercise and does not recommend it as a long-term treatment on its own. That crack is mostly a gas bubble in the joint; it does not mean a bone has been set back into place.Massage: short-term relief of pain and muscle tension, and a chance to relax — a reasonable add-on, but the effect usually does not last and does not change the long-term course.Heat: in acute and subacute back pain, a heat wrap gives a small, short-term improvement in pain and function, and adding exercise helps further (French 2006, a Cochrane review — limited evidence, but pointing the same way). Cheap and safe, fine to use; just do not make it the mainstay.Traction and assorted passive devices: the evidence for non-specific back pain is generally weak. Do not expect them to pull your back open or repair it.Magnetic and "far-infrared" back belts: magnets are sold as boosting circulation and calming inflammation, but Pittler 2007 pooled 9 placebo-controlled randomized trials and found no difference in pain relief between real and sham magnets (2.1 mm on a 100 mm pain scale, with a crossing zero). The authors concluded they cannot be recommended (for osteoarthritis the evidence was too thin to decide). Far-infrared sounds exotic, but anything close to body temperature — including your own skin and an ordinary wool sweater — gives off far-infrared all the time; what the belt actually does is keep you warm. That warmth is worth exactly the small benefit of heat described above, and at a magnet gadget's price what you have bought is a waist wrap.
Mechanism · What stretching and foam rolling change
Stretching and foam rolling are the two most mythologized items in back care. They are not useless, but the way they work is often not the one described in the marketing.Stretching
Long static stretches (> 60 seconds) before exercise briefly reduce strength and power (Behm 2016), so a warm-up is better built from dynamic movement.Stretching can improve flexibility and make you feel better, and it is fine as an add-on. But it will not loosen your discs and cannot cure chronic back pain on its own; lasting range of motion and stability come from active training under load.
Foam rolling
Foam rolling does give a short-term gain in range of motion and a feeling of looseness (Wiewelhove 2019), so using it as a small warm-up before training or to wind down afterward is reasonable.But the popular explanation — fascial release, pressing adhesions apart — does not hold up mechanically: a few passes of a roller cannot change the structure of dense connective tissue. Its immediate effect is more likely neural (changing how you perceive tension and pain) than any real breaking up of something.
So put them back in their proper place: stretching and foam rolling are small aids that make you more comfortable and more willing to move. They are worth using, but not as the mainstay of Low Back Pain care. The main thread has not changed: back pain, acute or chronic, is almost always a story of understand it, then move smartly, not a story of get someone to rub it or stretch it better.
Chapter 6
When to see a doctor
The advice not to panic and to keep moving rests on one condition: that this is ordinary mechanical back pain. Most of it is. But a few situations call not for a rehab plan but for a doctor in person, soon — and one of them is an emergency that cannot wait until tomorrow.
If back pain (especially pain shooting down a leg) comes with numbness around the groin and buttocks as if anesthetized, sudden inability to pass urine or loss of bladder or bowel control, or both legs getting steadily weaker, go to the emergency department now. These are possible signs of serious nerve compression — a reason to be seen, not a diagnosis to give yourself here. Severe pain after a significant injury, new back pain in someone with a history of cancer, and back pain with fever also need prompt medical care.
If back pain (especially pain shooting down a leg) comes with numbness around the groin and buttocks as if anesthetized, sudden inability to pass urine or loss of bladder or bowel control, or both legs getting steadily weaker, go to the emergency department now. These are possible signs of serious nerve compression — a reason to be seen, not a diagnosis to give yourself here. Severe pain after a significant injury, new back pain in someone with a history of cancer, and back pain with fever also need prompt medical care.
Red flag · Possible cauda equina compression: go now
What needs immediate emergency assessment is possible cauda equina syndrome. This site does not diagnose; these signs mean a doctor needs to see you now, not that you should decide the diagnosis yourself.If back pain (especially with pain radiating down the leg) comes with any of the following, go to the emergency department immediately — do not wait until tomorrow:
Saddle anesthesia: numbness, as if anesthetized, around the perineum, the anus and the inner thighsBladder or bowel problems: sudden inability to pass urine, being unable to hold urine, or bowel incontinenceProgressive weakness or numbness in both legs at once
This is an emergency in which the nerves at the lower end of the spine (the cauda equina) are severely compressed. A delay of hours can cause irreversible paralysis and loss of bladder and bowel control. It is the only kind of back pain that needs the emergency department right away.
Red flag · Prompt care, not self-rehab
These need prompt medical care rather than self-rehab as ordinary back pain:Progressive loss of nerve function: a leg getting steadily weaker, an area of numbness that keeps spreading, foot dropSevere back pain after significant trauma (a fall, a car crash, a blow), especially in people with osteoporosis or on long-term steroids — a fracture needs to be ruled outA history of cancer plus new back pain, especially night pain that does not ease with rest and comes with unexplained weight loss — this needs a doctor's work-upFever or chills plus back pain, or a recent infection, injecting drug use or a weakened immune system — a spinal infection needs to be ruled out
These also warrant a medical assessment, though not an emergency:
A younger person (under 40) with morning stiffness lasting more than 30 minutes, pain that wakes them at night, and pain that eases with activity — inflammatory spinal disease needs to be consideredBack pain that lasts for weeks without easing, or keeps getting worse
This site provides general education and advice; it does not replace a doctor's diagnosis and treatment. For any back pain with the signs above, or that keeps getting worse, see a doctor in person as soon as possible.
References · 13
- Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367. 10.1016/S0140-6736(18)30480-X
- Freemont, A. J., Peacock, T. E., Goupille, P., Hoyland, J. A., O'Brien, J., & Jayson, M. I. (1997). Nerve ingrowth into diseased intervertebral disc in chronic back pain. The Lancet, 350(9072), 178-181. 10.1016/S0140-6736(97)02135-1
- Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American Journal of Neuroradiology, 36(12), 2394-2399. 10.3174/ajnr.A4498
- Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816. 10.3174/ajnr.A4173
- Bleakley, C. M., Glasgow, P., & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 46(4), 220-221. Argues complete rest (PRICE's 'R') impairs healing; proposes Protection + Optimal Loading + Ice + Compression + Elevation (POLICE) as the modern acute-injury framework. 10.1136/bjsports-2011-090297
- National Institute for Health and Care Excellence. (2016, updated 2020). Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). www.nice.org.uk/guidance/ng59
- Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383. 10.1016/S0140-6736(18)30489-6
- Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530. 10.7326/M16-2367
- Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11), 871-877. 25 RCTs, 26,610 participants, 3464 injuries. ⚠️ THREE NUMBERS THAT GET SWAPPED: by intervention, strength training RR 0.315 (0.207-0.480), proprioception 0.550 (0.347-0.869), stretching 0.963 (0.846-1.095) — i.e. stretching is null. Separately, ALL exercise programmes pooled cut acute injuries RR 0.647 and overuse RR 0.527; those two are NOT strength training's own figures, and the site used to print them as if they were. The trial count is 25, not 26 — 26,610 is the participant count. 10.1136/bjsports-2013-092538
- French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. (2006). Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews, 2006(1), CD004750. 9 trials, 1117 participants. Moderate evidence from a small number of trials that heat wrap therapy gives a small short-term reduction in pain and disability in mixed acute/sub-acute low back pain, and that adding exercise reduces pain further; evidence for cold is insufficient and heat-vs-cold is conflicting. The authors call the overall evidence base limited. (audit:citation-doi reports volume 2011: Crossref carries the reissue date for this Cochrane record; PubMed PMID 16437495 has 2006(1):CD004750.) 10.1002/14651858.CD004750.pub2
- Pittler, M. H., Brown, E. M., & Ernst, E. (2007). Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ, 177(7), 736-742. 9 placebo-controlled RCTs with a 100-mm VAS: no significant difference in pain reduction vs placebo (WMD 2.1 mm, 95% CI -1.8 to 5.9). Conclusion: the evidence does not support static magnets for pain relief and they cannot be recommended; for osteoarthritis the evidence is insufficient to exclude a clinically important benefit. Says nothing about far-infrared products. 10.1503/cmaj.061344
- Behm, D. G., Blazevich, A. J., Kay, A. D., & McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Applied Physiology, Nutrition, and Metabolism, 41(1), 1-11. Performance changes tested immediately after stretching: static -3.7%, dynamic +1.3%, PNF -4.4%; static stretching of 60 s or more per muscle group -4.6% vs under 60 s -1.1%; when dynamic activity followed the stretching there was no clear performance effect. Static and PNF stretching had no clear effect on all-cause or overuse injuries (no data for dynamic). The authors still recommend stretching within a warm-up that includes dynamic activity, to reduce muscle injuries and increase range of motion (abstract, PMID 26642915). 10.1139/apnm-2015-0235
- Wiewelhove, T., Döweling, A., Schneider, C., Hottenrott, L., Meyer, T., Kellmann, M., Pfeiffer, M., & Ferrauti, A. (2019). A meta-analysis of the effects of foam rolling on performance and recovery. Frontiers in Physiology, 10, 376. Foam rolling produces small acute ROM and recovery-perception benefits; the 'fascial release' mechanism is implausible — effects are neural. 10.3389/fphys.2019.00376