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What are common causes of low back pain?

Common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.

1. Lumbar strain (acute, chronic)
   A lumbar strain is a stretching injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as "chronic."
   
   Lumbar strain most often occurs in people in their forties, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back.
   
   The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, x-ray testing is only helpful to exclude bone abnormalities.
   
   The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found helpful in some patients that do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.



2. Nerve irritation
   The nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths—from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.


3. Lumbar radiculopathy
   Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.
   Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.
   Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

Picture of herniated disc between L4 and L5

Cross-section picture of herniated disc between L4 and L5

4. Bony encroachment
   Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking poor circulation). Treatment of these afflictions varies, depending on their severity, and range from rest to surgical decompression by removing the bone that is compressing the nervous tissue.


5. Bone and joint conditions
   Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are from inflammation of the joints (arthritis).
   


Congenital bone conditions—Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal design of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing.

Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

Degenerative bone and joint conditions—As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on x-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain x-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

Injury to the bones and joints—Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.

In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure.

Arthritis—The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping the progression.

What are other causes of low back pain?

Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.

1. Kidney problems: Kidney infections, stones, and traumatic bleeding of the kidney (hematoma) are frequently associated with low back pain. Diagnosis can involve urine analysis, soundwave tests, or radiological scanning of the abdomen.
   
2. Pregnancy: Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises are often recommended for this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice.
   
3. Ovary problems: Ovarian cysts, uterine fibroids, and endometriosis not infrequently cause low back pain. Precise diagnosis can require gynecologic examination and testing.
   
4. Tumors: Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastasize). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using radiological tests, such as plain x-rays, nuclear bone scanning, and CAT and MRI scanning.
   

What are uncommon causes of low back pain?

Uncommon causes of low back pain include Paget's disease of bone, bleeding or infection in the pelvis, infection of the cartilage and/or bone of the spine, aneurysm of the aorta, and shingles.

1. Paget's disease of bone: Paget's disease of the bone is a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain. Paget's disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.
   Paget's disease can be diagnosed on plain x-rays. However, a bone biopsy is occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is helpful to determine the extent of the disease, which can involve more than one bone area. A blood test, alkaline phosphatase, is useful for diagnosis and monitoring response to therapy. Treatment options include aspirin, other anti-inflammatory medicines, pain medications, and medications that slow the rate of bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel), alendronate (Fosamax), risedronate (Actonel), and pamidronate (Aredia).
   
   
2. Bleeding or infection in the pelvis: Bleeding in the pelvis is rare without significant trauma and is usually seen in patients who are taking blood-thinning medications, such as warfarin(Coumadin). In these patients, a rapid-onset sciatica pain can be a sign of bleeding in the back of the pelvis and abdomen that is compressing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is infrequent but can be a complication of conditions such as diverticulosis, Crohn's disease, ulcerative colitis, infection of the tubes or uterus, and even appendicitis. This is a serious complication of these conditions and is often associated with fever, lowering of blood pressure, and a life-threatening state.
   
   
3. Infection of the cartilage and/or bone of the spine: Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in goat's milk.
   
   
4. Aneurysm of the aorta: In the elderly, atherosclerosis can cause weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause a pulsating low back pain. Aneurysms of certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.
   
   
5. Shingles: Shingles (Herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The Herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax) for the infection and pregabalin (Lyrica) for the pain.

Lower Back Pain (Lumbar Back Pain)

What is the anatomy of the low back?

The first step to understanding the various causes of low back pain is learning about the normal design (anatomy) of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine (vertebrae), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebrae has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue. They also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joint of the buttocks.

The discs are pads that serve as "cushions" between each vertebral body. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating) through the outer ring, causing irritation of adjacent nervous tissue and sciatica, as described below.

Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs.

The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit the spinal column through bony portals called "foramen."

Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.

The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph glands and involuntary nervous system tissues, which are important in maintaining bladder and bowel control.

The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.

The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.

What is the function of the low back?

The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues.

When we stand, the lower back is functioning to hold most of the weight of the body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements.

Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function the lumbar spine and its adjacent muscles.

Cause of Back Pain

Because there are a variety of causes of back pain, it's vital to know the exact cause of your pain, and your doctor will help figure that out.

You may not remember injuring your back—but your back certainly does, and the pain is trying to tell you something. Or you may not know that something is wrong with your spine until a stressful movement aggravates the condition. Some common causes of back pain include:

• Aging: Ligaments thicken and discs dry out with age—that's just part of what happens to us as we grow older. These age-related changes in the spine may lead to disorders that create pressure on your spinal nerves—meaning that you'll have symptoms such as pain, numbness, or weakness. Degenerative disc disease is an example of an age-related spinal disorder. Over time, your discs can lose their normal structure and function. That is just wear and tear, but it can result in a bulging disc or a herniated disc and pain.
  
  Sometimes, the bulging or herniated disc can push on a nerve, causing pain that travels to another part of your body. For example, a herniated disc could push on a nerve in your low back and send a shooting pain down your leg (also known as sciatica). Pain that travels from the origin to another part of your body is called radiculopathy. You can experience cervical radiculopathy, which affects your arms mainly, or lumbar radiculopathy, which affects your legs.
  
  
• Daily Life: Just getting through every day takes its toll on your body. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Since we carry most of our weight in our backs, that's where we can feel the end result of tense daily living: tight muscles and painful movements.
  
  Also, the way you're getting through your day could be the cause of your back pain. Poor posture—standing for long periods of time or sitting incorrectly—can cause back pain (so watch out while you're at the office). Low back pain is often associated with heavy physical work, lifting or forceful movement, bending or twisting, or awkward positions. If you don't use proper lifting techniques while hefting a box of books, for example, you can really hurt your back.
  
  Even healthy, normal activities can cause muscle sprains and strains, which can lead to back pain. Gardening, tennis, horseback riding, biking, and even golf can all potentially hurt your back.
  
  
• Injuries and Accidents: You can fracture a spinal bone in a fall or a car accident. If you have osteoporosis, a condition that weakens your bones, you're much more prone to fracturing a bone.
  
  You can have a sports-related injury, such as pain caused by being tackled too many times in football. These are the sudden, unexpected causes of back pain that most likely require immediate medical attention.
  
  
• Obesity: Being overweight puts pressure and stress on the back, especially the low back. Plus, carrying excess weight aggravates other health conditions such as osteoporosis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

Lower Back Pain: What you Need to Know

What is Lower Back Pain?
Low back pain (LBP) is often described as sudden, sharp, persistent, or dull pain felt below the waist. LBP is very common and affects the majority of people at some point during their life.

Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder.

Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).

Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting less than 3 months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain.

Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s). Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or weakness.

Neurologic symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities.

Diagnosis
Pain felt in the low back (lumbar spine) is not always indicative of a spinal problem. A thorough physical and neurologic assessment may reveal the cause of the low back pain. The physical examination begins with the patient's current condition and medical history.

Range of Motion
The patient's range of spinal motion is evaluated while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas).

Neurologic Assessment
The neurologic assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement. In some cases electrodiagnostic studies such as electromyography (EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury.

Lab Tests
If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.

Imaging Studies
Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurologic dysfunction is suspected. An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back.

The results of the physical and neurologic examinations combined with test results are carefully evaluated to confirm a diagnosis.

Non-Surgical Treatment
Most patients with low back pain (lumbar spine) are treated without surgery. A conventional treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient's medical condition, age, other drugs the patient currently takes, and safety.

Medication
The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase.

Physical Therapy
Physical therapy (PT) is started as soon as the patient can tolerate activity. A managed PT program can help build muscle strength, flexibility, improve mobility, coordination, stability, balance, and promotes relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist.

PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise.

Spine Surgery
Seldom is surgery required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain.

Recovery
First and foremost, follow the treatment plan outlined by the physician and physical therapist. To enhance recovery from surgery, an episode of low back pain, or to help prevent future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.

Richard G. Fessler, MD, PhD
Professor of Neurological Surgery
Northwestern University
Chicago, IL

7 Ways to Slash Stress

Chronic stress seems to be our national disease, especially these days. Millions suffer from symptoms of stress: nervous tension, restless sleep, difficulty focusing and remembering, irritability, and health complications. Generally speaking, stress speeds up aging. Learn the ways to manage stress, and you will look and feel younger.

1. Start your day with meditation

Spend time every day in meditative relaxation, with calming music if you desire. Start with five minutes and work your way to 15 or 20 minutes each day. Meditation is your number one way to reduce the output of stress hormones and avoid adrenal exhaustion, serious threats to your health.

Try this Stress Release Meditation: Breathe consciously, relax, and with each exhale focus on relaxing each area of your body in sequence, starting from the top of your head and moving all the way down to your toes.

2. Manage your mood with diet and herbs

Chinese Medicine considers the liver to be the center of your emotions. To allay stress and balance your emotions, keep your liver healthy and happy:

• Every day, eat lots of green leafy vegetables, barley grass, seaweed - anything high in chlorophyll - to keep the liver in good health.

• Take 500 mg dandelion daily for a month or longer to cleanse the liver and help release built-up anger.

• Take 400 mg white peony root daily for 1 to 3 months to soothe the liver and balance your mood.

• Schisandra berry protects the liver from chemicals and calms the spirit. For emotional anxiety, take 200 mg daily for a month.

Take these herbs anytime during the day and before bed in tea or capsule form. All the herbs are available from health food stores and Eastern medicine practitioners. Many of my patients have had remarkable results with Calm-Fort Elixir, an all-natural formulation of herbs to calm your spirit. For more information, click here.

3. Suppress stress with positive thinking

Instead of letting your thoughts run wild with anxiety, say affirmations to yourself, such as "I can handle the tasks I have ahead of me. I enjoy my responsibilities and fulfill them well." In fact, repeating positive affirmations can actually suppress the cortisol that the adrenal gland releases in times of stress - leaving you peaceful and calm.

4. Get stress out of your head and on paper

Writing in a journal every day can help you release thoughts and emotions that are causing you stress. Write from the position of an observer, recording your thoughts without any judgments. Just write it down so that you can see clearly what is going on inside. The next step is to identify the source of any anger or stress so you can begin to make changes. Looking into your thoughts give you the opportunity to gain insight into your feelings and reflect the underlying issues.

5. Unblock tension with exercise

The constant pressures of your job and family can lead to chronically elevated levels of the stress hormone cortisol, which is a direct cause of muscle and joint pain. Clenched jaw? Lump in your throat? Chronic back and neck pain? These can all be manifestations of stress in your body. Release physical tension and clear these emotional blockages by using massage therapy, exercise, yoga, tai chi, or qi gong to get the circuits moving.

6. A Retreat to Avoid Burnout

Overloading your brain is a recipe for stress and health problems. Information overload is particularly harmful at midlife because we have less tolerance for stress, which can contribute to high blood pressure and heart disease. Press the "reset" button on yourself. Give yourself a retreat from the stresses of modern life. Take one day out of the seven-day week to minimize "screen" time. Don't watch TV, don't check email, and don't look at the news - it will be there tomorrow, and after a day of rest, you will be refreshed and ready to look at them.

7. Perspective from the Natural World

Use nature to reduce stress. Go outside, hike in the woods, walk on the beach, anything that puts you in contact with the natural world. It is difficult to feel stressed when you are surrounded by nature's abundance of vitality and wonder.

I hope you find the ways to have less stress! I invite you to visit often and share your own personal health and longevity tips with me.

May you live long, live strong, and live happy!

-Dr. Mao

Nature Creation is looking to hire Telemarketer/ Survey

Nature Creation is a leading manufacturer and distributor of natural hot and cold therapy packs in USA.​ We have the knowledge, experience, quality products and excellent customer service to provide the best solution to body and muscle pain.​ We have a wide variety of product designs, which will fit onto your body perfectly.​

You may review our site at www.​naturecreation.​com

Currently, Nature Creation is seeking to hire Telemarketing /​ Survey Service Representative to work in our corporate office in Chatsworth, California.​

Position: Telemarketing

Position Objective: To introduce Nature Creation products to professional medical field, such as doctors, chiropractors, pharmacies and medical specialists with samples, literatures, and references in efforts to increase Nature Creation products sales and distribution through their businesses, references and profession.​

Position Responsibilities:

• This position is divided into 4 main responsibilities:
  • Data Gathering
    • The hired person will be responsible to get contact information of Acupuncturists, Chiropractors, Specialty Doctors, Medical Clinics and other medical services in USA.​
      • The hired person must have good computer experience on research and data gathering from Internet and other published or non-published media.​
  • Data Management
    • All collected contact information will be tabulated into the database system, sorted based on calls made, entering conversation information and updated accordingly.​
      • The hired person must be organized, detail oriented and precised on data entry, updates and storing information.​
  • Data Reports
    • All telemarketing activities must be updated and recorded for weekly report data.​
      • Weekly reports of telemarketing activities are expected on the first day of the week.​ The hired person must know how to utilize Microsoft Office software and PIM (Personal Information Management) program.​
  • Survey, Follow Up & Offer
    • Prospects must be followed-up with survey & feedbacks after accepting and using the samples.​ This information is crucial for future development of new products.​
    • The hired person will also be responsible to offer Nature Creation wholesale program to the prospects, so we can extend sales and distribution networks.​

Position Requirements:

• Previous Professional Telemarketing Experiences.​
• Good computer skills (Online Research, ACT!, Microsoft Office – Access, Excel, Power Point, Outlooks, Words).​
• Bilingual Preferred - Spanish.​
• Organized & Always on top of tasks and responsibilities.​
• Excellent communication skills.​

Fact Sheet: Hot & Cold Treatment

When?
Use hot and cold when you are suffering from acute pain, if your painkillers are not working. It can be useful before you go to bed or if you wake in the early morning. It may also ease the pain if you feel sore after a treatment.

How?
Cold - Use any of Nature Creation natural therapy packs, which will fit comfortably to the area of pain.
Hot - compress the heated Nature Creation natural therapy packs onto the pain area (follow the instructions included with the pack).

Caution!
Do not apply either the Nature Creation hot or cold therapy pack directly to your skin but wrap them in a tea towel or similar to prevent burning. Make sure the wrappers are of a similar size.

Cold -> Hot -> Cold
Start with cold and finish with cold. Apply each pack to the area of pain for five minutes and leave 15 minutes before repeating. You can repeat this process as many times as you like, but the first couple of sessions are usually the most useful.

Why?
Using hot and cold acts like a local pump cold pushing blood from the area, warm bringing fresh blood into the area, the valves in the veins cause the blood to circulate reducing the level of inflammation in the blood stream. If you can reduce the inflammation this will decrease the pain and help you keep more mobile and recover sooner.

Cold vs Hot Pain Treatment: Which one is the correct application?

The question often comes up as to when it is best to use cold or hot treatment in injuries. Perhaps this can help. When to use ice or heat depends on how long ago the injury occurred.

After you strain a ligament or muscle, it is generally best to use cold (ice or a cold pack) immediately and then for the next day and 1/2. It's usually wise not to use heat, such as a heating pad, until swelling and bruising has stopped.

Cold is usually used first because it reduces swelling and inflammation. Use Ice for the first 48 hours after an injury. Apply for 20 minutes, remove for 20 minutes, then repeat. Do not apply directly to the skin -- put a thin towel over the skin for protection, or freeze a cup full of water, tear off the top rim and move the ice over the injury. This helps control bleeding by constricting blood vessels. Cold acts as a local anesthetic and so relieves pain. Usually the bruising associated with acute inflammation stops within 1 to 3 days. To relieve muscle spasms, minor sprains and strains, it's usually best to apply cold for 20 minutes intervals at a time every 4 to 6 hours for the first day and a half. Commercial cold packs may be safer than using ice. Prolonged exposure to cold, especially ice, can result in frostbite to tissues. Later in the process, you may relieve pain by applying heat, rather than cold, to your injury.

Use heat 20 minutes at a time at least 24 hours after a minor injury or 48 hours after a more serious one. Place a heat pack directly on the injured area -- do not add pressure. Do not apply to broken skin.

Cold reduces inflammation. Apply cold to acute injuries, such as a newly sprained ankle or a pulled muscle.

Heat improves circulation. It's best for chronic pain, such as from tight muscles or a sore back.

Alternate Heat and Cold if you have soft tissue damage and/or stretched ligaments, such as an ankle sprain. Heat aids in restoring range of motion. Apply cold for 20 minutes per hour as desired for the first 24 hours. The next day, apply warmth for 20 minutes per hour as desired.

Caution: Don't apply cold for more that 24 to 36 hours or warmth for more than 72 hours, see a doctor.

Injury Solution by using Hot & Cold Treatments

Do you know when to use heat or cold therapy for an injury?

If not, a recent review article by two University of Washington sports doctors, Matthew Karl, MD, and Stanley Herring, MD, can be your guide. Karl and Herring point out that the application of superficial heat to your body can improve the flexibility of your tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow, and boost metabolism. The mechanism by which heat relieves pain is not exactly known, although researchers believe that heat inactivates nerve fibers which can force muscles into irritating spasms, and that heat may induce the release of endorphins, powerful opiate-like chemicals which block pain transmission.

Increased blood flow occurs in heated parts of the body because heat tends to relax the walls of blood vessels. That's one reason why sports doctors recommend that you steer clear of the practice of heating up already inflamed joints. Heat appears to be best for un tightening muscles and increasing overall flexibility; the proper tissue temperature for vigorous heating is probably 104 to 113 degrees Fahrenheit (40 to 45 degrees Celsius) and the correct duration of temperature elevation is about five to 30 minutes. Although heating can reduce muscle spasms after a back injury, heat should not be used on sprained ankles or strained

What about cold treatment?

Strangely enough, cold therapy can also reduce muscle spasms, and cold is noted for killing pain, reducing swelling, and lowering metabolic activity. Cold' s pain-killing effect is caused by its 'deadening' of nerve-cell activity; hospital studies show that patients who use cold therapy on injuries tend to require much less pain medication. This effect, though, can sometimes be counterproductive; an athlete who has 'iced down' an injured body part may get so much pain relief that he/she returns to activity too soon.

Combined with compression, cold can produce dramatic drops in tissue swelling, because cold initially constricts the walls of blood vessels and compression restricts the amount of blood which can reach an injured body part (another therapeutic intervention, elevation, helps to 'drain' a damaged body region of excess fluid). Studies show that cold produces large decreases in oedema (swelling) and better reduction in discomfort, compared to heating.

Cold decreases muscle spasms by making muscles less sensitive to being stretched, and, like heat, cold can be used to treat low-back pain. Research suggests that cold works better for individuals who have had back pain for more than 14 days, while heat may be more effective for those with more recent pain.

The proper duration of cold therapy is currently being hotly debated. Traditionally, doctors have recommended applying cold packs or ice bags to injured areas for 15-30 minutes at a time, but recent research carried out at the University of Brussels indicates that the permeability of Lymphatic vessels decreases after about 10 minutes of cold therapy. Since Lymphatic vessels drain fluid away from injured tissues and thereby relieve swelling, the Brussels researchers recommend that cold be applied to damaged tissues in no longer than 10-minute intervals (however, individuals with large quantities of subcutaneous fat may require longer periods of icing).

Which form of cold therapy is actually most effective? Again, there's considerable debate, but recent research suggests that ice chips in a plastic bag are most effective, followed by the use of frozen gel packs and blue ice packs, which in turn are superior to chemical reaction packs and inflatable plastic envelopes injected with a gas refrigerant.

('Superficial Heat and Cold: How to Maximize the Benefits', The Physician and Sports medicine, vol. 22(12), pp. 65-74, 1994)

Owen Anderson

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Natural Relief of Migraine

Mention the word migraine or the word headache in a room with more than two people and you are almost guaranteed of receiving free advice. There’s an almost limitless amount of possible treatments that you may or may not want to try. Most are harmless enough that it really wouldn’t hurt to go ahead and give it a shot. So next time you’ve got a real brain popping migraine and nothing works maybe you should see if one of these will do the trick. It may just turn out to be the magic pill you’ve been looking for all your life.

One common methods that seems to be circulating involves drinking a lot of water. Not just a few glasses, mind you, but a truly titanic amount of water. For some people, it seems the more water you try the better. Maybe this is just a case of transference. You know, your bladder starts hurting so much from expanding under the weight of that liquid that you forget all about your head hurting. Other suggestions are that the migraines are triggered by dehydration and the water fixes the problem in a jiffy.

Others swear by an alternative liquid treatment. Not water, but Benadryl. This probably works by making you so sleepy that you forget all about the headache. Obviously, this is not recommended if you are pregnant. Not to mention that some people suffer from a reverse reaction to Benadryl and get all hyper and probably will suffer a reverse reaction in regard to headache by making it worse. This one, as with all involving medicine, requires caution.

Massage, of course, is a frequently tried alternative method, but it takes time and money and usually isn’t exactly convenient as far as helping out right when the headache attacks. But self-massage is easily done and many, many migraine sufferers turn to it without even realizing. The preferred method seems to be using the fingertips and gently rubbing the temples, the tips of the ears or the back of the head. Of course, many professional massage therapists.

Draw. Just because you aren’t exactly Van Gogh doesn’t matter. Art therapy works wonders and nobody can even come close to explaining why. Maybe it’s just the physical activity, maybe it’s the creative drive coming to the surface and driving away all that nasty pressure taking place inside the cranial vessels. It’s really an amazing thing to watch. People barely able to keep their eyes open have been known to pick up a pen or piece of charcoal and begin applying it to paper and within a half hour their migraine headache symptoms begin to subside. Oddly enough, this therapy has proven more effective in those who claim to have no artistic talent than those who do; actual artists actually seem to be affected the least.

Play a video game. This is probably not the best idea for those whose migraines tend to be triggered by light or noise. If your trigger doesn’t seem related to sensitivity to light or noise, then give this a try. It seems to work best if you play a game that doesn’t require a significant amount of strategy; either shoot to kill or sports-related games tend to have the best results. It is assumed that sports games work through their ability to a migraine sufferer focused on the outcome of actually winning a game that can be won in the time it takes have a migraine. By focusing on the game and having a goal that can be met, the stress that is related to migraines seems to be eased.

And finally, for the minority of migraines sufferers who are male, there is one last suggestion. Of course, there are disadvantages to this approach in that you need the assistance of a willing participant, but those who try it swear by it. (And when you find out what it is, you’ll understand why). Apparently, being on the receiving end of a certain type of sexual practice associated with France has been known to relieve more than just a few migraines. And even if it doesn’t, well, this one is definitely worth giving the old college try.

How to get Rid of Headache

Headaches can be quite annoying and cause lot of pain. Headaches are quiet common and can affect anyone. Chronic headaches are serious and require proper treatment. There are many remedies to treat these headaches. Most medications lead to side effects and other health problems. So, people suffering from headaches must go for natural remedies. These remedies are safe for the body, and do not cause any side effects.

Most headaches result due to dehydration in the body. Drink plenty of water to ease the pain. Include lots of liquids in your diet so that your body gets the required nutrients. It is good to drink some water or juice when the pain triggers. Avoid caffeinated beverages like tea, soft drinks, and chocolate. Too much strain can also lead to headache.

Excessive and regular use of computer can also lead to headache. Take a break during the headache, and rest by closing your eyes. Ease the headache by regulating the blood flow in the head. It will happen by applying a cool compress on the head. Excessive stress also leads to headache. Try to de-stress your body by taking proper sleep and by eating the right food. Meditation is the best way to de-stress your body.

Focus on your breathing and have control over your thoughts. Through regular practice, the body feels refreshed and relaxed. Excessive movement worsens the headache. But, exercise might help to relieve pain. Yoga is the best exercise to be followed. Simple stretching and breathing techniques relax and rejuvenate the body. Acupressure is a natural treatment that helps relieve pain. In this type of treatment, pressure is applied to the joints and points of the body. The treatment eliminates pain and provides comfort to the body

Apply pressure on the temples using thumbs. Increase the pressure and rub your thumbs in small circles. Do this exercise for five minutes to de-stress the body. Eat natural foods because they are best for the body. Feverfew is a natural herb that releases mood hormones in the brain. It is good to use fresh feverfew because it is safe for the body. It can also be consumed in the form of tea or capsule.

Bay is another natural substance that must be taken along with fever few. The herb is easily available in nearby health stores. Ginger is a natural food cooked with different vegetables. Ginger is known to relieve pain and prevent headaches. It is an anti-inflammatory substance, which detoxifies the body.

Peppermint is another natural substance that can be consumed in the form of peppermint tea. Some of its drops can be mixed with oil to be applied on the body. The above-mentioned remedies are natural and helpful for the body. Seek doctor’s advice in case of any severity.

Sometimes you suffer from regular headache almost daily and it becomes a mad situation for you. You feel helpless to do anything and the whole world seems to be burning for you. You just move around in the house desperately and you cannot get relief. You want to shut down your ears and eyes and at the end of the day you end up popping several pills but they have no effect. You are really in a very bad situation.

There are many essential remedies for headache which are as follows ---

1] You can try some home remedies which your grandma may provide which will have a good effect on you. You can also try cold compass, sweet nap or sweet home baked cookies which may provide you comfort. Squeeze the bridge of your nose by pressing it down a bit with index finger and thumb. You can massage your temples and all these acts will reduce your migraine.

2] It is safe to use herbs which make you get rid of headache. Since the treatment of herbs is natural and non narcotic, you will not get any side effects. In case of allergy, consult the doctor first before herbal treatment. In case you are allergy free, you can try many herbs for the cure of headache. Before having herbs, it would be better to boil them. This will make them chemical free. After boiling, the herbs may taste better and like tea.

3] Exercise will improve your blood circulation considerably. You can jog and fresh air supply to your lungs will give relief to headache. After exercise, have hot bath as it would release toxins and you will be free from contracted muscles and will feel as if your whole body is relaxed.

4] Do aromatherapy in the bathroom which may add more comfort. Since aromas like lavender has good relaxation qualities, it would help you a lot. Acupuncture therapy becomes a must in case of nervous tension, so, you should be aware that headaches cause nervous tension also.

5] Try to meditate and concentrate as it will give you a new glow. It will reduce the stress levels and may give ultimate relief to headache. It is better to do meditation on a peaceful lake or river which will ultimately help.

Alternative Severe Headache Treatments

Aromatherapy is found to be quite effective in treating headache. It believes that certain oils and their fragrances have the desired calming effect on the body, thus curing headache. They are known to relieve emotional stress, tension and consequently headaches. The oils seep deep into the nervous system and ease the pain. In fact, they can also be used as a preventive measure.

Since there are certain essential guidelines to be followed while mixing these concoctions, it is essential to take the supervision of a certified aroma therapist. The ingredients and their quantities have to be in the right proportion, if you want to these concoctions to benefit you in any way.

Aromatherapy claims to cure headaches related to negative emotions and muscular and nervous tensions. Lavender, Roman chamomile, sweet marjoram, peppermint, rosemary and eucalyptus are the oils generally used in preparing treatment oils for headache relief. And inhalation, application, bath and massage are some of the techniques adopted to use or apply these oils.

Acupuncture
Acupuncture is an ancient Chinese form of treatment working on the Taoist philosophy. It involves the use of needles to cure many disorders. It does not use any drugs to treat any pain related disorders.

Although acupuncture lacks scientific validity, yet it has been found to be effective in providing headache relief. It is believed that the body has a number of meridians, applying pressure on which, literally dissolves the pain.

It is also believed that acupuncture works because it leads to the release of certain neurotransmitters in the body. One such neurotransmitter is endorphins, the release of which, cures the pain. It also incorporates a variety of movements, techniques and applications, one of the most common one being moxibustion.

Hot and cold packs
Heat and cold may be used to provide relief to a headache sufferer. Some patients may prefer heat treatment while others may prefer ice packs. It is usually seen that migraine sufferers prefer cold packs whereas, those who have tension-type or muscle contraction headaches prefer cold packs. Packs or showers, both have the same effect.

As in the case of high fevers, cold packs can be applied to the forehead and the temples whereas hot packs can be applied to the neck and the posterior parts of the head. One has to be extremely careful while using hot packs as these might cause muscle spasms or even burning if, they are too hot.

Both these treatments are quite safe and can be used in addition to other normal medications.

Alternative Remedies
Apart from the galaxy of over the counter products, which claim to be panacea for your headache, there are some tried and tested herbal remedies which will help you without fault.

1. For fast headache relief, Chinese pressure points can be used. But identification of those pressure points is of utmost important. This help should be sought from the experts in this art only.

2. You can also make use of the analgesic and cooling properties of betel leaf. For this, apply it over the pain affected area and get the sought after relief from the intense headache.

3. Instead you can also use some common household remedies for headache relief. Apply the paste of clove and salt crystals made in milk. Salt which is a hygroscopic agent absorbs the fluid and decreases all your tension and headache.

4. For headache that is caused by the heat of the sun, use henna flowers. Make a plaster of henna flowers mixed in vinegar and apply it over the forehead to get the relief.

Chiropractice
Muscle pain, due to poor posture, is also a common cause of headache. Chiropractice may help you reduce your headaches if you do the job of sitting at a particular place for long periods, like work at a computer or perform repetitive motions.

Hypnosis
There is nothing to be alarmed about hypnosis headache treatment. There are likely to be no side effects, in this therapy. But success depends to a large extent on the responsiveness of an individual. Many compare hypnosis with relaxation therapy.

Chiropractic:
Chiropractic is the most famous alternative therapy. This therapy is used to treat post-traumatic, tension-type, and sometimes migraine headaches. It believes that headaches are caused due to abnormal motion and irritation in the neck muscles, nerves and other tissues. It works towards alleviating the pain with the help of manipulation, exercise and forms of physical therapy.

Biofeedback:
Biofeedback can help reduce some types of headache pain, other than migraine. A biofeedback incorporates a range of relaxation therapies, like breathing exercises, meditation and guided imagery. These can help you control your body's response to stress.

Meditation:
Meditation is used to treat all those headaches that are caused due to tension and stress. More and more people are turning to meditation to relieve the day's tension and relieve themselves of headaches resulting due to these tensions. Deep breathing exercises, which relieve tension, form an essential part of the meditation technique.

Aromatherapy to Allergy patients

Aroma therapists believe that certain smells trigger responses in both our mind and body. The sensors in our nose send signals to our brain. The brain then reacts to the smell by producing chemicals that elicit different mood responses.

Your doctor may recommend you to train your breath sensitivity to some distinguish scents. However, some of the prescribed scents are not giving any significant benefits to your health, while others mixed and matched the ingredients to stimulate the real purpose of the treatments. The worst is you are inhaling chemical components, instead of healthy natural herbs.

Nature Creation has developed the distinguish 6 essential natural formulas to train your sniffing power and to reduce your allergy symptoms. Each bottle is filled with pure 100% natural herbs and available in 6 different aromas, Cinnamon, Lavender, Lemongrass, Peppermint, Rosemary, and Yarrow.

The following are the potential benefits of each formula to the health of users:

Cinnamon:

Cinnamon has traditionally been used to treat toothache and fight bad breath and its regular use is believed to stave off common cold and aid digestion (Alice Hart-Davis (16 January 2007). "Chillies Are the Spice of Life". Retrieved on 2007-12-17.). It is your starting point to stimulate your morning after a long night sleep.

Lavender:

Lavender has antiseptic and anti-inflammatory properties. It yields a highly effective essential oil with very sweet overtones, and can be used in balms, salves, perfumes, cosmetics, and topical applications. Lavender is said to soothe headaches, aid to sleep and relaxation.

Lemongrass:

Lemongrass in some cases has been used as a mild depressant for the central nervous system (Wikipedia.org, retrieved on 2008-09-19).

Peppermint:

Peppermint helps against upset stomachs, inhibits the growth of certain bacteria, and can help soothe and relax muscles when inhaled or applied to the skin. Other health benefits are attributed to the high manganese, vitamin C and vitamin A content; as well as trace amounts of various other nutrients such as fibre, iron, calcium, folate, potassium, tryptophan, magnesium, omega-3 fatty acids, riboflavin, and copper. (Wikipedia.org, retrieved on 2008-09-19)

Rosemary:

Rosemary has a very old reputation for improving memory (Moss, M.; et al. (2003). "Aromas of rosemary and lavender essential oils differentially affect cognition and mood in healthy adults"). Another study indicated that carnosic acid, found in rosemary, might shield the brain from free radicals, lowering the risk of strokes and neurodegenerative diseases like Alzheimer and Lou Gehrig's (Burnham Institute for Medical Research (2007, November 2). Rosemary Chicken Protects Your Brain From Free Radicals. (ScienceDaily. Retrieved November 2, 2007).

Yarrow:

Yarrow has seen historical use as a medicine, mainly because of its astringent effects. Decoctions have been used to treat inflammations such as piles (hemorrhoids), and also headaches. The most medicinally active part of the plant is the flowering tops. They also have a mild stimulant effect, and have been used as a snuff. Today, yarrow is valued mainly for its action in colds and influenza, and also for its effect on the circulatory, digestive, and urinary systems (Wikipedia.org, retrieved on 2008-09-19).