Lower Back Guide
After consulting with our physical therapists, we compiled a list of recommended strategies and technologies to provide relief for lower back pain and any associated nerve pain. Please note that these strategies are primarily focused on reducing your pain through minimally invasive and drug-free techniques. Pairing these interventions with a targeted exercise program and activity modifications will maximize the odds of both short and long-term success.
TENS stands for "transcutaneous electrical nerve stimulation" and is used as an alternative to painkilling medication. TENS machines come in many different forms. Most are small, portable devices powered by a simple battery. This box is attached to small cords and pads that stick to the painful area on the body. Newer versions specifically designed for the lower back come with a type of back brace that helps affix the pads in place (they tended to fall off constantly when moving around with the older versions.) Although the evidence is mixed on the efficacy of TENS units, there is not denying many people report significant and immediate pain relief with these devices.
HOW TENS MACHINES WORK
These machines deliver small electrical pulses to the body via electrodes placed on the skin. The electrical signals are helpful in one of two ways:
On a high frequency they are designed to stimulate the nervous system and override the pain signals from reaching the brain. This effectively mutes the message of pain being received by the brain.
On a lower frequency (2-6 Hz) it can stimulate the creation of the body's own pain easing chemicals: endorphins. This is similar to how morphine based classes of drugs blunt pain signals.
HOW EFFECTIVE ARE TENS MACHINES?
As mentioned earlier, the research is mixed and largely inconclusive. Additional larger studies are needed to help lock down the exact efficacy of TENS units. That said, TENS have proved to be a popular form of pain relief with a significant segment of low back pain sufferers. Many of whom state the devices have allowed them to manage their pain with reduced reliance on pain medications. As with all treatments and devices, different individuals will experience a large variety of results.
HOW TO USE A TENS MACHINE
These are considered a form of medical devices and recommended to best be used only on the advice of a doctor or other health professional. They are most commonly used for individuals suffering from musculoskeletal pain, such as lower back, knee and neck pain. TENS can be used alone or combined with pain medications or other treatments. Side effects are minimal to none, which is another reason many individuals find them appealing.
TENS units are controlled by the user and can often by modified to tailor that individuals perceived level of relief. Some people report a minimal intensity providing significant pain relief, while others prefer a higher level of current. These settings can be adjusted in real-time and do not require having a visit a medical professional.
PRACTICAL TIPS FOR TENS
Take it slow to start. Begin on lower levels of intensity for 15-20 minutes and assess your level of pain and overall function. If you find the pain has significantly reduced and function has improved, maintain that lower level before ramping up unnecessarily.
We also recommend buying a device with a money-back guarantee and defined trial window. This will allow you to assess both the quality of the device and determine if this strategy is right for you without potentially wasting money.
And be sure to remember, these devices can help quite a lot, but for long-term success you want to take advantage of your reduced pain by getting moving! This means a consistent walking and exercise program. Over time, you can return to your normal level of athletic activities as tolerated.
IMPORTANT SAFETY NOTES
These are not all encompassing, but in general be sure to avoid the following:
Do not use in the shower or both (or near any water)
Do not place on breaks in the skin
Do not use is you have a pacemaker, epilepsy or if pregnant
No not place pads over the eyes, in the mouth, or the front/sides of the neck
Do not use in areas of reduced sensation
Do not use while sleeping
Do not use while driving (or operating any heavy machinery)
1. Best Compression Sleeve: Neenca
Recommended for individuals looking for a minimalist/light multi-functional brace.
Minor meniscus injuries
Generalized joint pain
Active individuals: Basketball, jogging, CrossFit, cycling, tennis, hiking etc
The Neenca Professional Compression Sleeve for Men and Women led the pack in this category. An anatomically countoured gel pad surround the kneecap and double-sided stabilizers fit snugly around the knee joint. These elements appeared to strengthen side support and help maintain joint stability. Allows for full range-of-motion while helping the wearer feel supported. It is our choice for pain recovery and sport protection.
Easy to slip on and off, the air knit fabric promotes breathability and comfort, while remaining dry during periods of increased activity. We did note this knee brace is a bit thicker than other sleeves, which made us a bit nervous about all-day comfort. But in the end this was not an issue, and indeed, the additional thickness provided a sense of additional support.
Even better, this brace was almost half the cost of other comparable knee braces, making it's overall value hard to beat. We also noted this brace has over 900 5-star reviews on the Neenca website. Which is impressive and only reinforced our confidence in the product.
Bauerfeind Sports Compression Knee Support
Another excellent option with many of the same attributes as our top pick. Slightly thinner profile than the Neenka. In the end the fact it is approximately 25% more expensive and is a newer product (only 5 reviews on the official site) pushed it to second place on our compression brace list. PURCHASE BAUERFIND ($50)
2. Best Wraparound Knee Brace: Mueller
Recommended for individuals looking for a more supportive brace at good value.
Minor to moderate meniscus injuries
Minor to moderate osteoarthritis
Generalized joint pain
Semi-active individuals who are fine with a firmer brace in exchange for extra support
The Mueller Wraparound Brace is an excellent brace that (you guessed it) wraps around the leg and is supported by several strong velcro straps. While putting on the brace can be a bit confusing the first time, it helpfully comes with a diagram printed on the inside of the brace showing how to strap it on correctly. Those same straps allow for customizations of placement and snugness. Just be prepared to do a bit of trial and error the first few times you don the Mueller brace.
Users report moving well in the brace, and an excellent perception of support. But keep in mind this is a heavier and stiffer brace than the previously mentioned compression knee sleeve braces. This is by design and a big reason the brace offers strong support, which users reported appreciating. But it also means it will be much more noticeable during use.
You should also be aware the brace is made up primarily of thick neoprene, which can catch sweat a bit more than more breathable materials. Because of the customizable straps, this brace doesn't tend to slide. However, if active and sweating you will need to tighten the straps routinely to keep the placement just right.
DonJoy Performance Bionic Knee Brace
The DonJoy is almost three times the price of the Mueller but packed with features (including stash pocket for your keys.) It's a bit easier to take on and off and comes with "anti-migration tech," which promises to keep it in place while you move. Only reason it wasn't our first choice was the price. PURCHASE DONJOY BIONIC ($75)
3. Best Knee Strap: McDavid
Recommended for active individuals dealing with mild-to-moderate patellar tendonitis/overuse injuries. Low cost.
Active individuals looking to mitigate pain during sporting activities
The McDavid Knee Strap is designed specifically for treating patellar tendonitis, runner's knee and jumper's knee (those are all a similar form of overuse injuries and inflammation related to the kneecap.) It is a simple, thin band the users reported as providing excellent support and significant pain relief.
The adjustable velcro straps allow you to tighten it to the desired tension, which will vary user to user but in general should be strapped snugly.
The McDavid and similar braces work by theoretically dispersing the tension placed on the thick tendon attaching the kneecap to the lower leg (tibia.) It is best used in conjunction with a complimentary stretching and strengthening program, and not a cure all (hint: nothing is!) That said, the strap is thin and durable and many active individuals report significant relief when using the McDavid Knee Strap. Easy to take on and off.
IT BAND SPECIFIC OPTION
Pro-Tec IT Band Compression Wrap
For active individuals dealing with IT band pain, the Prot-Tec is an excellent (and like the McDavid quite low cost) option to reduce outer knee pain. Once again, like all knee braces, this is best used in conjunction with a consistent exercise program. PURCHASE PRO-TEC IT BAND WRAP ($20)
4. Best "Premium" Brace: DonJoy Reaction Web Knee Brace
Recommended for individuals looking for the best blend of knee support and pain reduction for any/all activities - and are willing to pay a premium.
Patellofemoral Pain Syndrome or Chondromalacia Patella (Runner's knee)
Meniscus pain and mild to moderate meniscal tears
Athletes looking for premium sport during high-level activities
The DonJoy Reaction WEB knee brace features a cutting-edge webbing design that is quite different than previously reviewed braces. Per DonJoy, this unique approach paired with the flexible hinges work to "provide stability for the knee by absorbing shock and off-loading weight away from the painful area so you can continue the activities you love."
While that seemed like a bit of an oversell to us - it was noted to provide an impressive level of support during daily and sporting activities. The breathability was excellent, once again due to the WEB design which allows for air flow. It was also noted to be quite stable. How much of that positive feedback can be attributed to the perception that as one tester reported, "Just feeling cool and confident in this brace," is difficult to measure.
It is worth noting that professional athletes appear to agree. The Reaction is worn by pro's across multiple sports and even the US Ski Team (they have a limited edition version featuring the US Ski Team's logo with a red and white undersleeve.)
As you'd expect this all comes with a cost, and at $150 this is by far the most expensive brace we are recommending. While some active individuals will prefer to start with this option, it's may be worth trying out one of the simpler (and lower cost) braces first.