Not all spine problems require drastic measures such as back surgery and for most patients this is actually the final thing that is recommended after all other, more conservative, treatment options have been exhausted. In some cases, however, surgery is an immediate necessity to prevent permanent nerve damage occurring, and patients experiencing cauda equina syndrome, loss of bowel or bladder control, muscle weakness, or extreme pain which does not respond to analgesic treatment may need prompt surgical decompression of the spine. Many patients also try alternative therapies to help relieve back pain and discomfort with variable degrees of success achieved. Chiropractors and osteopaths are regularly consulted for both acute and chronic back pain and may be able to offer relief through techniques of spinal manipulation and mobilization. For those with serious structural spinal problems these therapies may be unsuitable and may, indeed, exacerbate their back problems. For all alternative therapies patients should ensure they only obtain treatment from qualified professionals with a thorough understanding of their condition.
Yoga as an alternative
Yoga can be an effective preventative aid for back pain and provide gentle relief from back pain when it strikes. Care, as always, should be taken so as not to exacerbate an existing condition and it is wise to consult a qualified practitioner experienced in back injuries or spinal health. Yoga can be particularly helpful for spinal stenosis although certain movements are inadvisable to avoid further compression of the spinal nerves. Other forms of physical therapy are commonly prescribed in conventional back pain treatment, such as stretching and strengthening exercises, and heat and ice therapy. Acupuncture and acupressure are very effective for some for pain relief in the short term and may help ease symptoms as the back heals itself; the effects of treatment rarely persist after treatment ceases however, making regular acupuncture or acupressure treatments necessary if using these techniques to manage chronic pain. Low-level laser therapy is available in some clinics and handheld devices for home use are available although evidence for the efficacy of this treatment is far from conclusive.
Physical Therapy, Osteopathy, and Chiropractic for Back Pain
Often, in cases of disc herniation, simple rest and recuperation can be sufficient to allow the disc to heal. Your physician or physical therapist should be able to advise activities to be restricted and exercises that may benefit the healing process. A physical therapist may also advise the use of support devices such as a back corset, brace, or neck (cervical) collar to restrict mobility in cases of hyperflexibility. Problems of misaligned back muscles can also be helped using these supports and may help to spread the workload of the spine to reduce stresses and strains on specific muscles or vertebrae.
Ice and Heat Therapy
Ice and heat (thermotherapy and cryotherapy) can also help reduce back pain but care should be taken to apply these appropriately as they may also exacerbate the condition if applied incorrectly. Ice and heat therapy may relieve swelling, muscle spasm, and provide an analgesic effect but heat should never be applied to an acute inflammatory injury as this may encourage a greater amount of tissue damage. Similarly ice should not be applied directly to the skin or for too long a time as the reduction in circulation to an area may prevent timely healing or cause ischaemic muscle cramping.
Chiropractors are frequently consulted by those suffering from back pain and by using mobilization, manipulation, and stretching techniques these practitioners may be able to correct postural problems which are contributing to back and neck pain. Patients should ensure that they consult a qualified chiropractor and discuss their medical history prior to treatment. A responsible and experienced chiropractor will usually request your patients’ medical charts and scans before carrying out any treatment as they need to be alert to any fractures or inflammation so as to avoid exacerbating the existing problem. An osteopath may carry out similar therapeutic actions to a chiropractor but usually focuses more on soft tissue problems and manipulation of the whole body rather than just the spine. They commonly provide a more holistic approach than a chiropractor or physical therapist would with lifestyle modifications suggested a part of the therapeutic plan.
Conventional medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to help relieve back pain and reduce inflammation. There are side-effects associated with NSAID use and patients should adhere to dosage guidelines to minimize these unwanted effects. Steroids are not routinely used to treat back pain as they can have significant complications which further complicate a condition, such as weight gain, hormonal disruption, and immune system suppression. Oral steroids can be helpful for acute disc herniation to quickly reduce inflammation and prevent nerve damage before surgery can be scheduled (if necessary). Prednisone and Medrol may be used for chronic conditions where a patient is not a surgical candidate and other medications cannot control the symptoms.
Epidural Steroid Injections
Patients may also have epidural steroid injections to reduce inflammation around the nerve and achieve immediate pain relief if they are administered alongside an analgesic medication. Cortisone is injected directly into the area of inflammation and has little systemic effect in comparison to oral steroids. There is a risk of complication such as dural tear, although this is low. Epidural steroid injections are usually restricted to one every three months or so, and no more than three in a year. If they are needed repeatedly then the patient may be instead advised to undergo back surgery.
Narcotic pain medications are rarely used for back pain as they are addictive and can cause drowsiness. They may be used in the short-term for severe, acute pain, or after back surgery for a brief period. Muscle relaxers may also be used to control muscle spasms that can occur alongside disc herniation. Care must be taken with these medications as the relaxation of the back muscle may make a patient more susceptible to injury due to hypermobility.
Unorthodox therapies are often used to address back pain, such as acupuncture, acupressure, massage, the Alexander Technique, magnetic therapy, and low-level laser therapy. The efficacy and safety of these treatments is still under review in many cases and patients should investigate their usefulness and potential risks prior to undergoing treatment. Acupuncture is beginning to be recognized as an effective alternative to conventional treatment for back pain and in some countries, such as the UK, may actually be recommended or included in a conventional treatment program. Safety concerns about acupuncture are usually unfounded, although patients choosing this kind of therapy should always find a registered and experienced practitioner with recognized qualifications.
Massage therapy can be very effective in aiding muscular problems in the back and neck although it is rarely helpful in cases of bony defects or spinal stenosis other than to aid muscle relaxation and reduce painful muscle spasms. The Alexander technique can be very helpful in addressing postural problems that may be contributing to a person’s back pathology, particularly in terms of redistributing their weight and reducing the load on overused muscles. Alexander Technique practitioners will also assess the role of stress and emotional well-being in the patient’s condition and use controlled breathing techniques and other therapeutic methods to help them to relax and reduce physical manifestations of psychological stress.
Magnetic therapy and low-level laser therapy have a dearth of rigorous scientific evidence demonstrating their efficacy in treating back problems. Relying largely on anecdotal evidence, and with no clear explanation of how they are supposed to work, these therapies may be worth investigating for those patients who have tried everything else first. Devices and treatment sessions can be expensive, particularly if patients are encouraged to undergo many treatments and patients should be wary of putting off necessary back surgery or the use of medications to try these unproven therapies as any delay may, unfortunately, make their condition worse and intractable.
Natural Remedies for Back Pain
There are many natural remedies for back pain and patients may be able to use a number of these in conjunction with conventional treatment. However, some nutritional supplements and herbal medications can interact with other pharmaceutical agents, and may not be suitable for patients with other medical conditions (such as diabetes or high blood-pressure) or allergies. Most of the remedies used for pain-relief are anti-inflammatory agents such as Devil’s Claw, Ginger, Turmeric (containing curcumin), and bromelain. Herbal remedies such as white willow and marshmallow are a source of salicylic acid, the active constituent of aspirin, and can provide an analgesic effect without the same gastrointestinal disturbance associated with aspirin itself.
Gels and creams containing capsaicin can help stimulate circulation to an area where muscular pain is experienced and provide relief. They should not usually be used on broken skin or where inflammation is present as they could cause more tissue trauma. It may also be helpful to obtain these types of remedy in a spray form so as to effectively reach the area of the back where the pain is felt, otherwise patients may need assistance to reach the affected area. Topical glucosamine and chondroitin products are also available although the absorption of these into the tissues is not well understood. The lack of circulation to the interior of the spine makes it unlikely that such ointments can reach the target tissue with any degree of effectiveness or uniformity. Taking these products internally may be subject to the same concerns, especially with deeper problems of disc herniation. If there are ligament problems in the spine which are contributing to the condition then glucosamine, chondroitin, and celadrin may be helpful in inhibiting further degeneration and possibly aiding healing.