Spinal instability can be at the root of many back pain conditions but the cause of the spinal instability can be confusing and complex.
In this article we will provide information on:
- failed back surgery syndrome,
- non-surgical treatment of lumbar radiculopathy,
- lumbar disc herniation,
- sacroiliac joint pain treatment,
- as well as discussing the challenges of identifying spinal instability caused by spinal ligaments.
Popping Your Back Using a Chair
The first way to crack your back is by using a chair to exert pressure on spinal joints. You can use the back of the chair for leverage to extend the range of motion on your spine and crack joints in your mid-back. When cracking your back using a chair, you should always try to keep your shoulder and back as relaxed as possible.
- Sit on a chair with a medium to low back and place a towel on the backrest for extra padding.
- Put your hands behind your head to support your neck.
- Lean back over the backrest, take a deep breath and gently push your head back while exhaling.
- You may hear a popping noise in the joints in your neck and upper spine.
- If you need to crack a different part of your middle back, adjust how you sit on the chair so that the backrest is lower or further up your spine.
How to Crack Your Upper or Lower Back
The next exercise to pop your back involves sitting on a chair with the backrest at your side. You need to grip your hands behind your back and put pressure on the part of the spine that needs to be popped. With this spinal manipulation exercise, you can crack any part of your spine from your lower back to as far as you can reach up your spine.
- Sit on a chair or stool so that you can easily put your hands behind your back.
- Make one hand into a fist and hold it with your other hand.
- Find the part of the spine that you need to crack and place your fist on the spine.
- Push up and into the spot on your spine.
- Remember to breathe in deeply before cracking your spine and breathe out as you put pressure on your spine.
Use a Foam Roller to Crack Your Upper Back
Another way to pop your upper back like an expert is to use a foam roller under your upper spine. Foam roller exercises for back pain are a great and easy way to relieve back discomfort at home. It’s important to remember while using the foam roller to pop your back, that you should keep your knees bent to prevent putting extra pressure on your spine.
It is important to note that according to both Monica Vazquez, certified personal trainer and coach, and the National Academy of Sports Medicine, you should not use the foam roller on your lower back, and you can find the reasons for that, as well as other common mistakes when using foam roller, in my article about foam roller exercises for back pain.
- Sit on the ground with your knees bent.
- Place the foam roller behind you in the approximate position where you need to crack your upper back.
- Lay back on the foam roller and adjust the foam roller to the right spot under your upper spine.
- Put your hands behind your head to support your neck.
- Relax and let your head go back to crack your upper back. (Your head shouldn’t go as far as to touch the ground).
Alternatively, you can lay back on the foam roller and while holding your head, roll back and forward to help relieve tension from your upper spine.
Pop Your Own Back While Sitting on the Floor
One way to help relieve low back pain by cracking your back is to sit on the ground and gently rotate your spine. The advantage of this to exercise to help relieve lower back pain is that you can use your arms to provide stability and extend your range of motion.
- Sit on the floor with your legs straight in front of you.
- Bend your right knee and take your right foot outside of the left hip as in the illustration.
- Bend your left arm and press your left elbow to the outside of the right knee.
- Your spine is now twisted while you are looking at the wall behind you as far as you can.
- Hold for a few deep breaths and repeat on the other side.
- Repeat 3 times on each side and try to extend the movement of your shoulder as far as you can.
When doing this, you may or may not hear an audible pop in your spine. Don’t worry if you don’t hear a popping sound as the exercise still helps to make your spine more flexible.
How to Crack Your Middle and Lower Back
You can pop your middle and lower back by gently stretching your spine as you lie forward on your knees. This exercise to crack your back is similar to child’s pose in yoga exercises. The beauty of this exercise is that it helps to relax and stretch your spine and also your hips and quads.
- Kneel on the floor with your knees shoulder-width apart and your feet under your buttocks.
- Bend forward from your waist until your arms are stretched out in front of you.
- Try to touch your nose to the floor, remembering to breathe in and out deeply.
- Hold the position for 30 seconds.
- Repeat 3-5 times a day to help relax your spine and get rid of low back pain.
Gentle Back Popping Exercise
A gentle exercise to crack your back safely at home is to lay on your back and stretch your spine and back muscles. This can help to release tension in your back and help you pop your back by yourself. For this exercise, you will need soft padding on the floor like a yoga mat or carpet.
- Lay on your back, bring both knees up to your chest and hold your knees tight to your belly.
- Gently pull your knees to your belly and hold for 30 seconds to help gently stretch your spine and back muscles.
- Release and repeat 3-5 times a day to relieve back tension.
- To improve the effectiveness of this back exercise, you can gently rock to and fro while holding the stretch position.
When to See a Doctor
Back pain usually gets better in a few weeks. Learning how to crack or pop your back may help to relieve pain in your back. However, in some cases, you need to see a doctor for severe or chronic back pain.
According to doctors from the Mayo Clinic, you should see a doctor if back pain continues and you have one or more of the following symptoms:10
- The pain is constant and intense and gets worse at night.
- You have pain that spreads from your lower back down one or both legs.
- You have a tingling sensation in one or both legs.
- You have swelling or redness on your lower back.
- The back pain is accompanied by unexplained weight loss.
- The severe pain in your back is accompanied by bladder control problems.
Read my other related articles:
How to Crack or Pop Your Back Like an Expert: The Complete Guide was last modified: June 24th, 2018 by
Symptoms of Spinal Instability
- Giving way or back giving out, feeling of instability
- Need to frequently crack or pop the back to reduced symptoms
- Frequent bouts or episodes of symptoms (recurrence, not first episode)
- History of painful catching or locking during trunk motions
- Pain during transitional activities
- Greater pain returning to erect position from flexion
- Pain increased with sudden, trivial, or mild movements
- Difficulty with unsupported sitting and better with supported backrest
- Worse with sustained postures or a decreased likelihood of reported static position that is not painful
- Condition is progressively worsening
- Long-term, chronic disorder
- Temporary relief with back brace or corset
- Frequent episodes of muscle spasm
- Rotational symptoms, different symptoms on different days
Identifying spinal instability in nonspecific back pain
Spinal instability begins when the stabilizing structures of the spine, especially the ligaments can no longer hold adjacent bones together. When present, this is termed mechanical instability.
The term functional instability is used when the mechanical instability causes symptoms with a certain function or activity.
- Many people are walking around with mechanical instability but are asymptomatic because the force required to perform current normal activities is not beyond the tissue strength.
- Problems arise when the mechanical instability worsens when patients overdo an activity or start a new exercise program.
- Thus the patient may have symptoms only when performing a certain activity, such as back pain with running.
- From the patient’s perspective, pain symptoms do not exist during any other activities.
- This is called functional spinal instability with running and mechanical instability of the entire low back.
- Functional instability, or symptomatic instability with movement, occurs with mechanical failure of the spinal ligaments and the subsequent excessive motion of adjacent bones. This can be caused by trauma, disease, surgery, or any combination thereof to one or more regions of the spine.
Chronic back pain is caused by difficulty in understanding what is causing it.
Recently researchers in Germany writing in the medical journal Clinical rheumatology discussed the problems of assessing the true cause of back pain. To summarize their findings, the researchers noted that:
- The most examined spinal problem is low back pain.
- Low back pain for the most part is caused by a nonspecific problem that is difficult to diagnosis. (Note: This is not very reassuring to patients that the most chronic back pain problem is difficult to understand. This is also why the rush to lumbar surgery is so troubling.)
- Inflammation of the spine is not as widespread.
- Only a small amount of patients have axial (low back sacroiliac joint) inflammation as the major cause of their back complaints with chronic inflammatory back pain as the most prominent clinical feature of spondyloarthritis (inflammatory/rheumatoid arthritis). (Note: This is also troubling to patients as if inflammation is not the problem, as patients are being put on long-term anti-inflammatory treatment plans.)
- Numerous diseases such as:
In our opinion, most health care providers rely too heavily on diagnostic tests, especially for low back problems. Consequently, many who suffer from low back pain do not find relief.
The typical scenario is as follows:
- A person complains to a physician about low back pain that radiates down the leg.
- The physician orders x-rays and an MRI.
- The scan reveals an abnormality in the disc—such as a herniated, bulging, or degenerated disc.
- Unfortunately for the patient, this finding usually has nothing to do with the pain.
What are the treatment options patients with back pain?
A recent paper from doctors at the University of Georgia and McGill University in Montreal published in the American family physician examined the top 20 research studies of 2015 that had the most impact on family practice doctors. Among the top 20 was:
At Caring Medical we have to agree that concerns about treatment plans including back surgery based on MRIs, painkillers and lack of movement in patients would back pain is something that needs to be looked into and corrected.
In a recent study from Vanderbilt University Medical Center published in the Journal of Neurosurgery, researchers followed:
- Fifty patients with lumbar spondylolisthesis,
- Fifty patients with stenosis, and
- Fifty patients with disc herniation who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were followed after deciding on nonsurgical treatment.
The non-surgical treatment was:
The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis.
- Eighteen patients (36%) with spondylolisthesis,
- 11 (22%) with stenosis, and
- 17 (34%) with disc herniation eventually required surgical management due to lack of improvement.
The Vanderbilt researchers concluded that: In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, anti-inflammatory medication, and narcotic oral agents was not cost effective and the patients went on to surgery.3
Prolotherapy for back pain
There is plenty of research to support the use of Prolotherapy for back pain (especially lumbar pain), here are some of the research summaries.
- University of Manitoba, Winnipeg, Manitoba, Canada. The journal of alternative and complementary medicine
- One hundred and ninety (190) patients were treated between, June 1999-May 2006.
- Both pain and Quality of Life scores were significantly improved at least 1 year after the last treatment.
- This study suggests that prolotherapy using a variety of proliferants can be an effective treatment for low back pain from presumed ligamentous dysfunction for some patients when performed by a skilled practitioner.7
- Harold Wilkinson MD, in the journal The Pain Physician
- Prolotherapy can provide significant relief of axial pain (soft tissue damage) and tenderness combined with functional improvement, even in “failed back syndrome” patients.8
Citing our own Caring Medical and Rehabilitation Services published research in which we followed 145 patients who had suffered from back pain on average of nearly five years, we examined not only the physical aspect of Prolotherapy, but the mental aspect of treatment as well.
- In our study, 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option.
- In these 145 low backs,
- pain levels decreased from 5.6 to 2.7 after Prolotherapy;
- 89% experienced more than 50% pain relief with Prolotherapy;
- more than 80% showed improvements in walking and exercise ability, anxiety, depression and overall disability
- 75% percent were able to completely stop taking pain medications.9
If our study, mentioned above, was solely based on getting 75% of patients off their pain medications, that would be wildly successful in itself. But the fact that Prolotherapy was able to strengthen the patient’s spines and decrease overall disability and return these people to a normal lifestyle. That is not pain management, that is a pain cure.