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Other Treatments for Low Back Pain and Sciatica

Spinal Manipulation

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. Ultrasound and traditional massage are often used with spinal manipulation.

Acupuncture

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

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:
  • Cold packs, which are usually used in the beginning to help reduce pain and muscle spasms
  • Heat, which is used to relieve pain and muscle stiffness
  • Aerobic exercises, such as walking or swimming
  • Stretching exercises

Biofeedback

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.

Relaxation Techniques

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

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.

Epidural Injections and Joint or Soft Tissue Injections

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 Unit

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.

Traction

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.

Exercise

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.

When to Contact Your Doctor

More serious symptoms associated with back pain that may require immediate medical attention include:
  • Pain that doesn't subside or worsens with rest
  • Pain that is worse when you are reclined
  • Pain that is severe or that has gotten worse
  • Progressive weakness or numbness in a leg or foot
  • Difficulty walking, standing, or moving
  • Numbness in the genital or rectal area
  • Loss of bowel or bladder control
  • Burning or difficulty with urination
  • Fever, unexplained weight loss, or other signs of illness

References

Freedman MK. Saulino MF. Overton EA. Holding MY. Kornbluth ID. 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%5Fpain/detail%5Fchronic%5Fpain.htm#Spine. Updated August 30, 2013. Accessed November 21, 2013.

Rathmell JP. A 50-year-old man with chronic low back pain. JAMA. 299(17):2066-77, 2008 May 7.

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 November 21, 2013.

11/25/2013 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Wegner I, Widyahening IS, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013 Aug 19;8.

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