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Back Pain Cured!

No Drugs… No Surgery

The ability to diagnose and treat the different types of back pain has improved tremendously over the years. A wide variety of conventional and complementary therapies has made this possible. The fortunate result is that the vast majority of patients don’t need invasive procedures or powerful drugs.

Fact: The majority of people with back pain can make a full recovery with conservative treatments. These include integrative approaches such as acupuncture and other so-called “complementary” techniques.

When I went to medical school, the term integrative medicine was unknown. Now, more than one-third of Americans use some form of alternative medicine, often on the advice of their doctors.

Which of these therapies is best for back pain? What the evidence shows…

EXERCISE

Exercise isn’t an alternative therapy per se, but it’s such an effective one and so often underutilized that it’s important to include here. It’s difficult to exercise when your back hurts, but people who don’t exercise tend to have more pain and are more susceptible to future problems. Even if you’ve been diagnosed with sciatica—the shooting nerve pain often caused by a herniated disk—exercise is among the best ways to feel better.

How it helps: Exercise triggers the release ofendorphins, natural opiates produced by the body. It improves circulation and flushes inflammatory chemicals from damaged tissues. It ­increases muscle strength and flexibility and helps people use their bodies in ways that take pressure off the spine.

One study found that people who exercised four days a week had less back pain than those who worked out less frequently (or not at all). A recent study published in Clinical Rehabilitation found that simply walking two to three times a week (for 20 to 40 minutes each time) reduced pain and increased mobility as well as more complicated programs did.

My advice: Work with a physical therapist initially. There are many different causes of back pain. Exercise has to be customized to each patient. In general, low-impact workouts—such as walking, using a stationary bike and swimming—are safe for most people with back pain.

LUMBAR STABILIZATION

This form of exercise changes proprioception, the awareness of where your spine and other joints are positioned. Patients who do lumbar-­stabilization exercises learn to maintain a “neutral” spine, using positions that reduce tension on spinal ligaments and joints. You can do the exercises at home, but I recommend working with a physical therapist first to learn to do them correctly.

Examples…

Pelvic tilt. Lie on the floor with your knees bent and your feet flat on the floor. Tighten the abdominal muscles so that your lower back is pulled toward the floor. Hold for about 10 seconds, relax for a moment, then repeat the movement five to 10 times.

Ball bridges. Lie on your back with your legs straight and your feet propped on an ­exercise ball. Keeping your spine straight, lift your buttocks off the floor. You’ll have to use muscles in the abdomen and back to stay balanced and keep the ball from moving.

ACUPUNCTURE

Many people think of acupuncture as too “out there” for them. But they shouldn’t.

A study in JAMA Internal Medicine compared traditional Chinese acupuncture for low-back pain to conventional treatments using drugs, exercise and physical therapy. They also compared Chinese acupuncture to sham treatments that mimicked real acupuncture.

The seven-week study, which involved a total of 10 treatments, showed that acupuncture was twice as effective for pain relief as conventional therapy. Curiously, the “fake” treatments were almost as effective as the real ones, possibly because they triggered brain changes that altered pain perceptions. There’s some evidence that electro-acupuncture, in which small electrical currents are transmitted through the needles, may be somewhat more effective than traditional ­acupuncture.

My advice: Go to a certified acupuncturist who has met your state’s training standards. A good resource is the ­National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM.org).

ALEXANDER TECHNIQUE

I often recommend this for patients with back pain that is caused by poor body mechanics—how they stand, sit, walk, hold their necks, etc. In my experience, about 50% of people with chronic back pain have poor body ­mechanics.

The Alexander technique (named after F.M. Alexander who developed it) involves analyzing an individual’s body ­mechanics and then designing a plan to improve them. A study in British Medical Journal looked at 579 patients with chronic or recurrent ­lower-back pain. Those patients who were treated with the Alexander technique had less pain than those given massage or conventional treatments recommended by their ­doctors.

The Alexander technique is somewhat expensive (typically $60 to $125 per session) and unlikely to be covered by insurance. You can save money by signing up for group lessons.

My advice: Try one session. If you like it and feel comfortable, sign up for a series of 10. You can use the American Society for the Alexander Technique website (AmsatOnline.org) to find a practitioner in your area.

CHIROPRACTIC

Many conventional doctors view chiropractic as an unproven treatment—or even fraudulent. But that’s not true.

Spinal manipulations and “adjustments” by chiropractors are meant to restore the spine’s structural integrity and stimulate the body’s natural ability to reduce pain. I’ve had a number of patients with herniated disks who reported significant improvement after getting chiropractic treatments.

A randomized, double-blind study conducted last year found that back-pain patients who were treated with chiropractic therapy in addition to standard medical care had less pain and better physical functioning than those who received standard care alone.

Bonus: People who see chiropractors tend to rate their care as very good or excellent. Most chiropractors spend a lot of time with patients. They take a detailed history, watch how patients move and give advice on using the back in healthier ways. It’s possible that patients who receive the extra attention are able to change their perceptions of pain—a phenomenon known as the attention placebo effect.

My advice: Chiropractors are the frontline treaters of low-back pain. They are knowledgeable, and a qualified chiropractor will know when your specific problem requires additional attention.

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