Non-Surgical Treatments & Physiotherapy

Introduction

There are a wide variety of non-surgical options for back pain treatment of the lumbar spine. The more common treatment approaches include:

Pain medication

Typical pain medications used to treat the lower back pain include acetaminophen, NSAIDs, oral steroids, narcotic drugs, muscle relaxants, and anti-depressants. Each type of medication has strengths, limitations, and risks, and the patient’s particular problem in the lower back and overall health will determine which pain reliever, if any, is indicated.

Injections

Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Injections offer relief for some - but not all - patients, and they can be used to help identify the source of pain.

Heat or ice

Application of a cold pack or heating pad can help relieve low back pain. Some people find that alternating between the two works best.

Manual manipulation

This treatment maybe applied by a chiropractor, osteopathic doctor, or other qualified health professional. It is thought to help relieve lower back pain by reducing pressure on sensitive structures, increasing flexibility, improving blood flow and reducing muscle tension.

Physiotherapy

After an episode of low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, physical therapy is often recommended.

In general, the goals of physical therapy are to decrease pain, increase function, and provide education on a maintenance program to prevent further recurrences.

A physical therapy program for back pain usually has two components:

• Passive physical therapy to help reduce the patient's pain to a more manageable level
• Active exercises

Passive Physical Therapy - Modalities

Acutely, the physical therapist may focus on decreasing pain with passive physical therapy (modalities). These therapies are considered passive because they are done to the patient. Examples of modalities include:

• Heat/ice packs
• TENS units
• Iontophoresis
• Ultrasound

Active Physical Therapy - Back Pain Exercises

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Generally, a patient's back exercise program should encompass a combination of the following:

Stretching for back pain exercises

Almost every individual who has suffered from low back pain should stretch their hamstring muscles once or twice daily. Simple hamstring stretching does not take much time, although it can be difficult to remember, especially if there is little or no pain. Therefore, hamstring stretching exercises are best done at the same time every day so it becomes part of a person's daily routine. There are many more stretches that can be done to alleviate lower back pain.

Therapeutic massage

Massage therapy is thought to improve blood flow, reducing muscle stiffness, and decrease stiffness.

Exercise. A program of back exercises and physical therapy will usually include a combination of strengthening, stretching, and low-impact aerobic exercise.