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Treating Back Pain Without Medication

Back pain is an ongoing issue in society and affects more than 10% of the population worldwide. In the United States, 80% of the population reports suffering from back pain totaling an economic burden of $90 billion annually.[1] Medication, injections, surgical interventions, chiropractic visits, and gadgets, typically only provide temporary relief.[2] These staggering statistics can be a direct correlation between sedentary lifestyles and gravity.[3] There are many small changes we can make in our daily lives to help alleviate back pain and live healthier lives. The positions we are in while we sit, work, read, drive and even sleep can either help eliminate or cause us further discomfort.

Sitting - How Bad Can It Be?

More than half of all patients who experience lower back pain have desk jobs which can further contribute to a sedentary lifestyle. Between sitting at a desk, watching TV, computer usage, and daily driving, our spines absorb a significant amount throughout the day. Slouching in a seated position can reduce the natural curvature of the spine and create a host of problems. These effects are often seen later in life, so it is important to take preventive measures. Long-term pressure can lead to disc injuries, muscular imbalances, difficulty breathing, and chronic fatigue. Thankfully, there are ways to sit for prolonged periods without worsening the damage to our spines. Below, we will explore how to reduce the negative effects of this prolonged position.

The Bowling Ball Challenge

Imagine holding a ten-pound bowling ball. If you were to guess, who can hold the bowling ball longer with less fatigue, person A or person B? 

If you answered person A, you are correct! The reason why person A can hold the bowling ball longer is due to the simple fact that his muscles are doing less work than in the case of person B, thus preserving energy! When any amount of weight is held closer to our bodies, we don’t have to exert ourselves as much to hold an item.

Person A

Person B 

How This Relates To Our Posture

On average, a human head weighs about ten pounds. This is the case when the earlobes are directly north of the shoulders, shown in picture A below. However, for ​every​ inch that the ears are positioned in front of the shoulders, the weight of the head increases by 10 pounds! The muscles of the head and neck were never designed to support that added weight, which leads to breakdown, pain, tightness, and eventual injury.

Driving, looking at a computer screen, and texting on a phone are just a few examples of ways we can get trapped in position B for many hours of the day. Consequently, muscles overwork, shorten, and result in the formation of trigger points aka “muscle knots.” These knots can result in headaches, jaw pain, and loss of the natural curve of the neck which can later contribute to bigger issues like pinched nerves that develop into numbness and tingling down your arms and hands.

The Chin Tuck

Although it can be nearly impossible to completely avoid all forward head postures throughout the day, we can undo its negative impact on our spines. This simple exercise below can help restore the natural curve of the cervical spine and reduce the tension on surrounding muscles. Chin tucks can be done easily throughout the day and ensure that your neck maintains proper positioning for a healthy spine.

Sit upright, and imagine your chin resting on an imaginary plank. Draw your chin back while maintaining a neutral head position. Hold 3 seconds. Perform 3 sets of 10 repetitions.

Workstation Posture

Eight hours of sitting, five days a week, an average of 48 work weeks a year accounts for 2,080 hours of increased pressure through the spine. No matter how you sit at the computer, it is recommended that you get up and move about the room for about 2-3 minutes every 1-2 hours. Setting a reminder on your phone can help you stick to this schedule. To reset to a proper sitting position, sit all the way back in your seat to protect the neutral spinal curve (an ergonomic seat with built-in natural curves is recommended). Next, sit upright with your ears in line with your shoulders. Lastly, keep the computer screen at eye level. This position also allows for improved energy and focus due to the upright posture that allows for improved breathing and lung capacity.

Posture Tip!-​ ​“Slouch, Overcorrect and Release”

Use this technique daily to reduce the unfriendly effects of sitting on the spine.

Step 1: Slouch: Get in a forward head/rounded shoulder posture, and hold for 2 seconds.

Step 2: Overcorrect: Exaggerate a “good” posture, and hold for 2 seconds.

Step 3: Release: Reduce to a healthy, comfortable posture.

Perform 10 rounds of all 3 steps every 1-2 hours at the workstation.

Sleeping and its Effects on Posture

Sleep is a key part of our overall health, wellness, and ultimate quality of life. It is believed that we spend about 1/3 of our lives sleeping, which is roughly 30 full years.  We all want to wake up refreshed, rejuvenated, and ready to take on the day. The ultimate question is, how can you get the best sleep?

The Neck: One or Two Pillows?

When trying to figure out how many pillows to sleep with, it is important to consider what type of sleeper you are. Are you a Back-Sleeper aka “Supine” or a Side-Sleeper?

Disclaimer: Sleeping on your stomach or “prone” is a position that is not typically recommended by our physical therapists. (It is, however, a recommended sleeping position at times for patients with COPD). This position is not very kind to the spine as it promotes the straightening of the natural curve. Changing to a supine or side sleeping position can help enhance sleep while protecting your spine.

Keeping the neck in a neutral position is crucial, which can be achieved by using one pillow when sleeping supine, and two pillows when side sleeping. This ensures proper maintenance of the natural curve. Incorrect sleeping postures are debilitating to one’s health over time.

The Low Back: Getting Comfortable

People often have lower back pain that wakes them up in the middle of the night. If this is you, there are some easy strategies to improve lower back comfort at night.

Supine Sleepers

Side Sleepers

Supine sleepers can benefit from their knees bent and elevated by a few pillows, usually no more than 4-6 inches. This can help unload the lower back and decrease feelings of pressure and stiffness with only one pillow under the neck. Side sleepers benefit from sleeping with a pillow in between their knees to maintain alignment of the hips, in turn reducing low back discomfort or tightness. This position calls for two pillows under the neck to maintain a neutral cervical spine position.

Getting out of Bed in the Morning

After a restful night of sleep, the way you get out of bed plays a large role in your spine health. At night, the spine recovers from a day with gravity and prepares to reintroduce itself for daily encounters. A proper morning routine can help to avoid increases in muscular stiffness, muscle strain and sudden drops in blood pressure. Creating time in your schedule for a proper morning routine can have a drastic impact on your overall spine health and prevent further damage. With a morning routine consisting of a warm-up phase and a safe transfer, you can give your body the care it needs.

See below for examples of how to warm up your body first thing in the morning.

Pelvic Tilt:

Step 1: Lay flat on your back with your knees bent.

Step 2: Draw your navel down towards your spine while tilting your pelvis towards you to flatten our spine against the ground/bed.

Step 3: Release your pelvis back to starting position.

Perform 3 sets of 10 repetitions.

Low Trunk Rotations:

Step 1: Lay flat on your back with your knees bent.

Step 2: Draw your naval down towards your spine and gently rock your knees side to side, keeping your upper back flat on the bed/ground.

Perform 3 sets of 10 repetitions.

 The safe transfer is shown below. Getting out of bed in this fashion is a habit that allows your spine to accept gravity in a supported and gradual manner, and a way to thank your spine for all it does for you daily! Roll onto your side and push off with your arms as you swing over. Remember to keep breathing throughout these movements!

Step 1: Roll on Side Step 

Step 2Push off with your arm as legs swing over

At FYZICAL Therapy & Balance Centers, our evidence-based management of spine pain and postural challenges has enabled thousands of patients to return safely to doing the things they love, without relying on pain medication, injections or surgery. We provide patient education and training about typically held postures, the associated muscle weakness and limitations in flexibility; educating patients about the human spine equips them to better manage their spine health and impacts their future quality of life.

At FYZICAL, we understand that each patient is unique, from their pain to their plan of care. We offer a holistic approach when treating patients and get to the root of the problem instead of only fixing the injury. If you’re experiencing back pain, please contact us!

By: Dr. Jimmy Pajuheshfar, PT, DPT


1-4. Childs JD, Cleland JA, Elliot JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW, Delitto A, Dyriw GM. Neck Pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopedic section of the American physical therapy association. Jour Orth & Spor Phys Ther. 2008 38(9): A1-34

 Pajuheshfar J. Posture Perfect: Your Guide to Defying Gravity. 2020: 9-15