back pain


If you sleep on your side, put the pillow between your knees and draw them up slightly toward your chest. If you like to sleep on your back, try the pillow under your knees, or roll up a small towel and place it under the small of your back.

Avoid sleeping on your stomach because it puts a lot of strain on your back. If it’s the only position you can fall asleep in, put a pillow under your stomach to take some of the pressure off your back.

The type of mattress you need depends on your body type. A soft mattress can be good if your hips are wider than your waist because it will let your spine stay straight while you sleep. If your hips and waist already line up straight, a harder mattress might feel better because it will give you more support.

Be extra careful when you get in and out of bed. Bending forward at your waist or making quick and jerking motions can cause you more back pain.

Take your time and roll over onto one side and use your arms to push your way up. You can then swing your legs out of bed to stand up slowly. Reverse the movements when it’s time to lie down at night.

Getting regular physical activity is a great way to improve the quality of your sleep. But doing targeted exercises to strengthen your core, the muscles in your abdomen, hips, lower back, and pelvis can also help ease back pain.

Talk to your doctor about which poses are safe for you to practice and which ones won’t make your pain worse. It might be helpful to start off using yoga props like blocks and bolsters for added support so that you can hold poses comfortably.

Uneven shoulder and Upper back pain


Uneven shoulders can be the result of an imbalance somewhere else in the body. Playing sports and certain injuries can cause muscular imbalances especially in the upper body. Asymmetrical sports such as tennis, golf, and baseball are especially likely to cause uneven shoulders and postural imbalances.

Other common causes of uneven shoulders include:

  • poor posture
  • pinched nerve
  • uneven hips
  • flat feet
  • osteoporosis
  • shoulder injuries
  • weak or tight muscles
  • overuse or misuse of the shoulders
  • incorrect sleeping position or only sleeping on one side
  • using one side of the body to hold objects


  • Regular therapeutic massages help to relieve muscle tension and increase flexibility.
  • It’s a good idea to engage in regular exercise and participate in sports as much as possible. Yoga, swimming, and rowing can help to strengthen and realign your body.
  • Make it a practice to check in with your posture continually throughout the day. It may be helpful to use a mirror. Become aware of your posture not only while you’re standing or sitting, but as you’re completing your usual activities. Start using your non-dominant arm as much as you can to balance out the workload.
  • Incorporating relaxation techniques into your routine can help you to relieve stress, tension, and tightness in the body. This may include meditation, breathing techniques, or anything else that helps you to relax.
herniated disk


A herniated disk or a slipped or ruptured disk occurs when some of the soft jelly in the inner part of the disk slips out past the tough exterior. It can be very painful and may cause:

  • back pain
  • neck pain
  • shooting arm pain
  • tingling, numbness, or weakness in the leg or foot
  • tingling, numbness, or weakness in one arm

People with a herniated disk do not usually need surgery. Doctors often recommend physiotherapy to treat the symptoms of a herniated disk. Any disk in the spine can become herniated, including the neck, but it most commonly occurs in the lower back. Different exercises can help relieve symptoms but this depending on where the herniated disk is.


(1) Seated chair stretch

For a gentle, seated stretch along the hamstring:

  • Sit in a chair with one foot on the floor and the other extended out straight, with the heel on the floor.
  • Straighten the back and lean forward over the extended leg until there is a stretch along the back of the upper thigh.
  • Hold this position for 15–30 seconds.
  • Switch legs and repeat several times.

(2) Towel hamstring stretch

For a a deeper hamstring stretch, try the following:

  • Lie flat on a yoga mat with one leg lifted into the air.
  • Wrap a towel around the foot of the leg in the air.
  • Holding the towel, pull the leg toward the body.
  • Hold for 15–30 seconds.
  • Switch legs and repeat several times.

(3) Back flexion stretch

Back flexion exercises stretch the spine and back muscles. Speak to a doctor before performing these exercises after a back injury. To perform a back flexion stretch:

  • Lie on the back and hold both knees toward the chest.
  • At the same time, move the head forward until there is a comfortable stretch across the mid and low back.
  • Repeat this several times.

(4) Knee to chest stretch

A knee to chest stretch will work the muscles on each side of the body separately for a gentler stretch. Try the following:

  • Lie on the back with the knees bent and both heels on the floor.
  • Place both hands behind one knee and pull it toward the chest.
  • Switch legs and repeat several times.

Perform all exercises in a slow and controlled manner, especially when bending or lifting. Exercises should not hurt. If a person feels pain, they should stop doing the exercises and speak with their doctor.

Discectomy, Epidural Steroid Injections, L4-L5 herniation



Depending on the type and severity of the underlying cause, the L4-L5 slipped disc may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica. Common symptoms and signs include:

  • Sharp pain, typically felt as a shooting and/or burning feeling that originates in the lower back and travels down the leg in the distribution of a specific nerve, sometimes affecting the foot.
  • Numbness in different parts of the thigh, leg, foot, and/or toes.
  • Weakness while moving the thigh, knee, or foot in different directions.
  • Abnormal sensations, such as a feeling of pins-and-needles and/or tingling.


Nonsurgical Treatments for L4-L5

  • Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, and/or corticosteroids may be used.
  • Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilise the back and keep the muscles and joints well-conditioned—providing long-term relief.
  • Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5.
  • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
    • Repeated bending of the spine
    • Sudden, abrupt movements, such as jumping
    • High-intensity exercise and lifting heavy weights

Injection Treatments for L4-L5

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibres to pain, generating fewer pain signals.
  • Radio-frequency ablation. Radio-frequency ablation may be used to treat pain from the L4-L5 vertebral facet joints.

Surgical Treatments for L4-L5

  • Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the facet joints.
  • Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
  • Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability.
neck pain


A physical therapist can design an exercise plan that strengthens your neck muscles and takes the pressure off your spine. They might also apply heat or cold pads during a therapy session to either increase blood flow and range of motion (heat) or decrease blood flow and inflammation (cold). Other physical therapy treatments could include therapeutic massage, chiropractic treatment and/or neck-strengthening exercises you can do at home.

A trigger point injection is a procedure where a medication, usually a local anesthetic, is injected into the painful muscle to provide relief. The pain relief should be experienced not only in the affected muscle but in the area of referred pain as well.

Patients experiencing a herniated disc, a degenerated disc, osteoarthritis or inflammation that reduces the space around the nerves can benefit from this type of treatment. The goal of the injection is to reduce inflammation and associated nerve pain – and the injection itself is given with the patient face down under local anesthetic.

Botox injections can be effective for the treatment of adults with cervical dystonia —a condition that causes the muscles in your neck to tighten or spasm without your control. It can also reduce the severity of abnormal head position and neck pain.

Radiofrequency Ablation (or RFA) is a non-surgical, outpatient therapy procedure that’s used to help patients with chronic head and neck pain related to spinal arthritis. As with any non-surgical treatment, this procedure is only recommended after a thorough examination and diagnosis.

Preparing first visit to a doctor


1. Write down your symptom(s) history to save time during the appointment.

Writing your symptoms down helps to avoid missing important symptoms or factors that can be crucial in your diagnosis. Symptom-related questions your doctor is likely to ask you are:

  • How would you describe your symptoms—is the pain throbbing, searing, electric-like, or dull and localized?
  • Do your symptoms extend below the knee?
  • How long have you had these symptoms?
  • Are they getting worse or staying the same?
  • What causes a flareup in your symptoms (activities, sports, inactivity, sitting for prolonged periods, etc.)
  • Do you have neurological symptoms, such as difficulty in lifting your foot (foot drop), numbness, or weakness?
  • Does a specific position offer temporary relief or aggravate the pain further? For example, does bending forward make your symptoms better (maybe for people with spinal stenosis) or worse (maybe for people with a herniated disc)?

2. Understand medical vocabulary in advance.

Commonly used medical terms are:

  • Nerve root. Several spinal nerves branch off your spinal cord at different levels. A nerve root is the part of the spinal nerve that leaves the spinal cord, passes through a bony opening, and exits the spinal canal.
  • Radicular pain. This pain originates from the spinal nerve roots. In sciatica, radicular pain may occur when one or more nerve roots from L4 to S3 are inflamed, irritated, or compressed.
  • Lumbar/lumbosacral radiculopathy. This term refers to neurological deficits, such as numbness or weakness that typically accompanies radicular pain in sciatica.

3. Find a doctor with extended appointments.

Certain doctors offer special, extended appointment times, sometimes as long as 1 hour or weekend appointments.

4. Bring a friend to your sciatica appointment.

If your sciatic pain is severe, it may be difficult to concentrate. Bringing a friend or family member to your appointment to take notes can allow you to focus on the conversation with your doctor without having to worry about forgetting something later.

5. Ask about specific red-flag symptoms.

While rare, certain types of sciatic nerve pain may indicate a medical emergency and require immediate treatment. Ask your doctor if there are specific red-flag symptoms that you need to look out for. Understanding these symptoms can help you make a timely visit to the doctor and prevent serious complications.

6. Bring your list of medications and previous medical records.

Provide an accurate history of your medical and surgical treatments and bring all your test results or relevant documents that you may have received from previous doctors. These details are crucial in deciding your course of treatment and also saves the time and effort to conduct new tests.



In preparation for the chiropractic consultation, the patient will be asked to fill out forms that provide background information about their symptoms and condition. Typical questions include:

  • When and how did the pain start?
  • Where is the pain felt?
  • Describe the pain—is it sharp, dull, searing/burning, or throbbing? Does it come and go, or is it continual?
  • Did the pain start as a result of an injury?
  • What activities/circumstances make it better or worse?

During this first visit, a chiropractor may perform an examination. A chiropractic exam includes general tests, such as blood pressure, pulse, respiration, and reflexes. Specific orthopedic and neurological tests may also be used to assess:

  • Range of motion of the affected body part(s)
  • Muscle tone
  • Muscle strength
  • Neurological integrity

Further chiropractic tests may be necessary to assess the affected area, such as having the patient move in a specific manner, posture analysis, or assess the motion of the affected body part.

Based on the results of the patient’s history and chiropractic exam, diagnostic studies may be helpful in revealing pathologies and identifying structural abnormalities to more accurately diagnose a condition. While an x-ray is the most common diagnostic study used during an initial chiropractic exam, it is not always needed. In general, an x-ray is used in the chiropractic setting to help:

  • Diagnose a recent trauma
  • Diagnose spondyloarthritis
  • Study a spinal deformity that might progress, such as scoliosis

An x-ray study should only be undertaken if the chiropractor has a good reason to believe that it will provide the information needed to guide the patient’s treatment program.

Findings from the patient’s history, physical examination, and diagnostic tests usually help the chiropractor to arrive at a specific diagnosis. Once the diagnosis is established, the chiropractor can determine if the condition will respond to chiropractic care, because certain conditions such as fractures, tumors, or infections may not be treated with chiropractic methods and typically require a specialist physician’s treatment.


The chiropractor will establish specific goals for a patient’s treatment plan:

  • Short-term goals typically include reducing pain and restoring normal joint function and muscle balance.
  • Long-term goals include restoring functional independence and tolerance to normal activities of daily living.

To reach these goals, a specific number of chiropractic visits will be recommended, depending on the patient’s diagnosed condition and treatment plan.