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Spinal manipulation is a therapy offered by chiropractors, osteopaths, and physical therapists. Physical leverage is combined with a series of exercises to adjust the spine and restore back mobility, while easing pain. Traditional massage is often used with spinal manipulation.
Acupuncture , which involves the placement of thin needles in the skin to relieve pain, may be effective in managing both acute and chronic low back pain.
Physical therapy includes exercises, teaching back care principles, and using heat, ice, and other methods to relieve pain.
The purpose of physical therapy is to reduce the pain, strengthen the muscles, increase motion and function, and prevent future injury. Physical therapy should include a home exercise program. Treatments may include:
Biofeedback teaches people how to control body functions they normally do not think about. It may help you reduce the severity of the pain. A biofeedback therapist will guide you to relax certain muscles or control breathing. A device shows your body’s response.
Relaxing the muscles can help prevent and reduce the severity of muscle tension and back pain. Relaxation techniques may include conscious breathing, visualizing being in a relaxing place, or clearing the mind of any thoughts. A mental health professional can teach you how to perform different relaxation techniques.
Cognitive behavioral therapy is often used to help manage chronic pain and stress. It is a form of talk therapy that may be done individually or in a group. A therapist will help you identify negative thoughts and teach you to unlearn these thought patterns. You will also learn new, helpful habits to manage your pain with minimal disruption to your life.
A steroid medication is injected into the epidural space in the spinal canal to decrease inflammation. Injections can be repeated if necessary. Other targets for injection include the facet and sacroiliac joints, as well as muscles and other soft tissues.
TENS (Transcutaneous Electrical Neural Stimulation) is a pocket-sized, portable, drug-free alternative to manage chronic pain, including back pain. The unit dispenses a low-volt electrical current through electrodes placed on the skin, which interferes with pain signals to the brain. This FDA-approved device is generally safe, but the following patients are urged to have a discussion first with their doctor: pregnant women and those with cardiac conditions and/or pacemakers.
The use of traction may provide short-term relief in patients with low back pain with or without sciatica. Traction uses manual or machine-based methods to relieve pressure on the spine.
Consult your physician about what exercises may be helpful for lower back pain. While there is mixed medical evidence about just which exercises will strengthen the back, specialists agree that it's important to keep moving. Low-impact activities like swimming, bicycling, and walking are especially recommended. Properly performed abdominal crunches and flexibility exercises are also important for strengthening the stomach muscles and relieving tight back muscles.
More serious symptoms associated with back pain that may require immediate medical attention include:
2008 Physical Activity Guidelines for Americans. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx . Accessed December 16, 2015.
Acute low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114958/Acute-low-back-pain. Updated August 12, 2016. Accessed October 4, 2016.
Bronfort G, Hondras MA, Schulz CA, et al. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014;161(6):381-91.
Chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain Updated August 18, 2016. Accessed October 4, 2016.
Freedman MK, Saulino MF, et al. Interventions in chronic pain management. 5. Approaches to medication and lifestyle in chronic pain syndromes. Archives of Physical Medicine & Rehabilitation. 89(3 Suppl 1):S56-60, 2008 Mar.
Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine. 25(2):226-37, 2000 Jan 15.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_16. Updated November 3, 2015. Accessed December 16, 2015.
Rathmell JP. A 50-year-old man with chronic low back pain. JAMA. 299(17):2066-77, 2008 May 7.
Sciatica. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115166/Sciatica. Updated February 8, 2016. Accessed October 4, 2016.
11/25/2013 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain: Wegner I, Widyahening IS, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013 Aug 19;8.
4/2/2015: DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain: Ebadi S, Henschke N. Therapeutic ultrasound for chronic low-back pain. Cochrane Database Syst Rev. 2014 Mar 14;3.
Last reviewed December 2015 by Laura Lei-Rivera, DPT
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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