Pain along the spine is second only to the common cold as the reason for missed work. What are the causes, and how do you treat them? Read on: We’ve got your back.

By Dana Hudepohl
Dan Winters

Back on Track

Humans have searched for back-pain remedies for centuries, praying to Saint Lawrence for relief and even surgically “hitching up” the kidneys. Today treatment can consist of over-the-counter pain relievers as well as physical therapy, a system of exercises that temper pain and stretch and strengthen the structures supporting the spine. But if problems persist, consider these alternative therapies. Ask your doctor for guidance.

Passive Techniques

For sudden, painful episodes, these treatments are often the first choice. They let you relax while the therapist does the heavy lifting. Once you find relief, you will probably need to move on to active techniques (see following page) to maintain the benefits.

1. Chiropractic

What it is: A chiropractor works on the back by using manual manipulation. For instance, he may do an “adjustment” of the spinal joints that aren’t moving fluidly, use a vibrational device called a Vibracussor to encourage tissues to relax and heal, or put you in traction to stretch the spine.

Why it works: Misaligned joints can lead to degeneration. By moving joints back into place, spinal manipulations help decrease pain. Treatments don’t always work, but when they do, you could notice a change within a week, followed by progressive improvement. In a 2012 study conducted at the University of Zurich, in Switzerland, patients who said that they felt “much better” or “better” a week after their first chiropractic treatment were four to five times as likely to improve even more over the course of the next three months than were those who saw no improvement after the first week. Tread cautiously, however, if you have osteoporosis, spinal-cord compression, or rheumatoid arthritis; chiropractic may exacerbate these conditions.

Cost: A session can run from $40 to $150. Many insurance plans cover at least a portion of this fee. Treatment can last several months, depending on the diagnosis.

Find a good practitioner: Look for recommendations from the American Chiropractic Association at acatoday.org.

2. Acupuncture

What it is: In this practice of ancient Chinese medicine, the therapist inserts tiny needles behind the knees or into the back, hands, ankles, or ears—all regions thought to establish balance in the body. The acupuncturist will then leave you so you can relax for about 30 minutes before she removes the needles.

Why it works: Studies suggest that acupuncture eases acute pain by increasing blood flow, which in turn releases tight muscles. In the largest study to date of acupuncture for back pain, involving more than 1,100 patients at Ruhr University Bochum, in Germany, 47 percent of the patients who received 10 treatments experienced less pain six months later.

Cost: The initial visit costs $80 to $200, and follow-up private sessions average $40 to $100. Group sessions are available in some areas for $15 to $40 each. Some health plans cover at least a portion of these costs. Acupuncture may also be paid for with a pretax health-reimbursement account. Most patients with acute pain need two to three visits; those with chronic pain may need 6 to 10.

Find a good practitioner: Get help at acupuncturetoday.com, or check your state’s association of acupuncture or Oriental medicine.

 

3. Massage

What it is: As you lie on a table, a massage therapist kneads tense, overworked, or spasmed muscles.

Why it works: Massage increases circulation to soothe sore muscles. According to a 2011 study published in the Annals of Internal Medicine, sufferers of moderate to severe lower-back pain who received weekly massages for 10 weeks (either full-body Swedish relaxation massages or massages focused on specific muscles around the lower back and hips) reported, on average, a two-point improvement on a 10-point pain scale.

Cost: A one-hour massage can cost anywhere from $40 to $200. It may be covered by insurance if prescribed by a medical doctor or a chiropractor.

Find a good practitioner: Ask your doctor, or go to amtamassage.org.

 

Active Techniques

As with physical therapy, these options expect you to work. The idea? Your back is involved in every little lurch, lift, lean, twist, and turn. Learn how to do it all in good form and you’ll do good for your back.

4. Feldenkrais

What it is: During a training session, patients go through a range of movements, including lying down on a table (fully clothed) in a variety of positions, sitting, and standing. The instructor modulates your movements by hand so that your brain learns to move your body differently.

Why it works: Patients are encouraged to explore how their back pain might be linked to, say, holding their heads too far forward or slumping when sitting. A small Swedish study of sufferers of chronic lower-back pain found that those who participated in weekly Feldenkrais training lessened their pain to such an extent that significant differences no longer existed between them and a healthy control group. The results were maintained 12 months after training began.

Cost: $150 to $250 for a private lesson called “Functional Integration.” To benefit fully, you will probably need at least four sessions. Group lessons that employ verbal instruction, called “Awareness Through Movement,” average $25 a class.

Find a good practitioner: Click on “Find a Practitioner” at feldenkraisguild.com, or order an instructional CD at feldenkraisinstitute.org.

5. Alexander Technique

What it is: An instructor observes you in the stationary positions and the ordinary movements of daily life: sitting at a desk, standing, walking, lying down. He then verbally and manually guides you in undoing bad postural habits that are causing and exacerbating pain.

 

Why it works: The sessions teach clients how to stand properly and move in a way that releases unwanted head, neck, and spinal muscle tension. This, in turn, decompresses the spine and promotes more balanced muscle activity. A 2008 study published in the British Medical Journal, the largest to date, found that 24 lessons led to an 86 percent reduction of days that participants felt pain compared with those in a control group.

Cost: A 45-minute private lesson costs from $65 to $95, depending on the location and the teacher’s experience level. Expect to take at least six lessons.

Find a good practitioner: At amsatonline.org you’ll be able to find teachers who have had at least 1,600 hours of training over a minimum of three years.

 

6. Pilates

What it is: Focusing on the core muscles deep within the abdomen, Pilates exercises promote stability, strength, flexibility, muscle control, good posture, and breathing through work on a mat and the use of special pieces of equipment (known as the reformer, the chair, the tower, and the Cadillac).

Why it works: Pilates trains the spine’s surrounding abdominal and back muscles to work equally and to stabilize the spine from all angles. Although few scientific studies exist, Pilates is gaining popularity for back-pain relief through word of mouth. Some Pilates studios report that back-pain sufferers make up as much as 30 percent of their clientele. But if you are experiencing a flare-up or have shooting pains down your legs, check with your doctor first. In some cases, a Pilates workout may worsen your problem, so wait until you are stronger to begin.

Cost: $55 to $100 for each private session with a certified instructor. For insurance coverage, look for a licensed physical therapist who uses Pilates methods. Mat classes (done without equipment) and group classes at $10 to $35 are both popular, but one-on-one attention is safest for back-pain sufferers, since it allows for modification. Most clients who practice two to three times a week for an hour feel an improvement within the first month.

Find a good practitioner: Click on pilatesmethodalliance.org.

Still in Pain?

These options often work with physical therapy and are covered by insurance.

7. Drugs

For 8 to 24 hours of pain relief, ibuprofen or the prescription drug Celecoxib reduce swelling. Prescription muscle relaxers (like Skelaxin) calm spasms. Prescription opiate pain relievers (like Vicodin) ease acute pain.

8. Corticosteroid Injections

These shots reduce swelling and pain but can weaken bone density. If they do work, you’ll feel improvement in a week. Pain relief lasts from three to six months.

9. Surgery

Less than 5 percent of patients need surgery; those who do tend to suffer from herniated disks, stenosis, or other ailments that don’t respond to physical therapy. Surgery may involve vertebrae fusion or partial disk removal. Recovery time varies from a few days to a few months.

Do you suffer from back pain? See what common issues may be causing it.

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