Does this sound familiar? You’ve been to every known doctor on the planet: an orthopedist, surgeon, general family doc, and maybe even a physical therapist. You’ve had an MRI which, thankfully, revealed that there’s nothing structurally wrong with your back. Still, the back pain persists. You’ve heard the word “surgery” at least once, and you’re come to the end of the line with medicine. This is not uncommon. Localized back pain can be difficult to diagnose, and is usually due to physical stress, minor injury, inflammation and more. There are some great natural back pain remedies, but make no mistake: taking a few herbs isn’t going to cut it. We’ve put together a list of a combination of medicines (some of which are, yes, herbal in nature) and exercises to help reduce back pain. It will take some work, but if you’re diligent and willing to put the time in, you should find that your pain is manageable.

1. Steam Heat Packs

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If your muscles are stiff and cold, what they may need is some heat to help loosen them up. Herbal steam packs provide not only soothing damp heat, which penetrates stiff, spastic muscle tissue but also soothing aromatherapy. This combination is a strong back pain remedy, helping your mind relax right along with your muscles. We love Nature Creation for its natural ingredients and easy method: store it in the freezer and pop it in the microwave to heat it up. Use the steam heat pack daily for 20 minutes a pop, or as frequently as you need with rests in between treatments.

2. Yoga

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While Instagram posts of Lululemon-clad uber thin and fit people have become the image of yoga, the ancient form of movement provides some of the best back pain remedies on earth. Find a reliable and experienced teacher who has at least 200 hours of training (and ideally is certified) who will give you a personalized set of exercises that you can do daily. Look for classes that are specifically labeled as yoga for lower back pain or classes that focus on building abdominal strength. Exercises like spinal twists, psoas stretches (also known as the runner’s stretch) and regularly stretching your gluteal muscles (yep, we mean your butt) may help manage and eliminate pain.

3. Pilates Reformer Sessions

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The Pilates reformer is perhaps the best single apparatus to manage lower back pain. Pilates is a series of movements and exercises that strengthen deep muscle and connective tissues. If you have confirmed that your pain is not caused by any structural issues, like bulging discs or damaged vertebrae, find a local Pilates instructor and make your way into a session as soon as possible. This discipline includes some of the best back pain exercises that are non weight bearing, making them doable even if you’re really suffering from pain.

4. Sit Ups

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There’s no way you’re going to get rid of your back pain without increasing the strength of your abdominals. Whether its through the schools of yoga or Pilates, or other forms of movement, it’s widely known a strong abdominal wall may be the very thing standing between you and a life free of back pain. Find a licensed personal trainer or physical therapist who can prescribe an abdominal series or specific back pain exercises.

5. Shoes, Mattress, Chair

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Where you sit, what you wear and where you spend your days sitting could be the very thing causing your pain. Your back pain remedy could be in replacing the thing you walk in, sit in or sleep on. Make sure that you’re regularly swapping out your sneakers or invest in good orthotics for your shoes. If your work chair isn’t truly ergonomic, it’s time to invest in one that is. Also, if you wake up feeling stiff every day, it may be time to invest in a new mattress. If that’s economically out of the question for you, check out a memory foam mattress pad as a temporary solution.

6. Weight Loss

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If you’ve got a little bit of tummy weight and you’re suffering from back pain, it’s probably time to consider dropping a few pounds. Extra abdominal weight is a common cause of back pain, and so watching your diet and taking that weight off could be your best back pain remedy. (Of course, see your physician first and follow a sensible, medically sanctioned diet.)

7. OTC Anti-Inflammatory

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Regardless of the cause of your back pain, there’s nothing wrong with remediating the pain with some simple over-the-counter NSAIDs like ibuprofen or naproxen sodium. Look for generics at your local drug store or buy them in bulk. If you’ve suffered from gastric ulcers, check with your doctor about dosages, and it’s usually a good idea to take them with food. NSAIDs can mean the difference between being able to work, or even do your recommended back pain exercises.

8. Arnica Salve

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Arnica is an herbal solution that has been used in South America for centuries. A natural analgesic, it actually helps reduce inflammation when used regularly. Rubbing a salve locally on the spot of your pain is a low-risk back pain remedy. Look for a salve that has warming herbs like clove oils that can even help reduce pain further.

9. Epsom Salt Soaks

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Muscles often get stiff when they are dehydrated after exercise. One easy and affordable back pain remedy is to rehydrate your muscles with the magnesium found in high concentrations in Epsom salts. Salts infused with aromatherapy oils can further help you relax, which is important when managing chronic pain.

10. Walking

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We’ve mentioned stretching the psoas (aka your hip flexor) muscles as a back pain remedy. Taking moderate walks not only strengthens but also lengthens your hip muscles. Make sure that you are wearing good walking shoes when you do, with cushioned foot beds and good arch support.

BONUS: Back Rest for the Car Seat

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Those daily commutes may be what’s impacting you the most. A good lower back pad or seat cushion (perhaps both) in the car could be just the back pain remedy that you need. These are affordable, and the lumbar support encourages proper alignment that could alleviate your back pain. This shouldn’t be done in lieu of your back pain exercises, as much as something that’s done in concert with them.

Last thoughts

Back pain management is a lifelong process for many. The right back pain remedy is likely finding a combination of movement, topical and oral treatments and maybe some lifestyle changes. Daily commitment is key as is patience. Hang in there, experiment and with the right solutions, you’ll find the right set of back pain exercises and treatments that will allow you to live a healthy, productive life again.