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Loren Fishman, MD

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Alternative Therapies for Back Pain

Posted: 04/06/2011 9:43 am

Your back is killing you. You've gone to your internist. You've gotten a diagnosis and possibly medications and an injection. Still it hurts. You're ready to try just about anything. Alternative therapies are effective and can often be used in conjunction with conventional medical treatments.

Just as conventional medical treatment must be individualized, alternative therapies tend to lend themselves to specific conditions. Some of my patients use several and they say that each therapy helps in its own way.

Musculoskeletal Pain: The most common and shortest-term back pain is often caused by the out-of-condition back doing normal things, or the conditioned back doing extraordinary things. If you've strained a muscle or aren't properly aligned, alternative therapies such as physical therapy (PT), Feldenkrais, and yoga will gradually soothe you. Feldenkrais (which is minimal movement, analogous to minimal music) promotes proper use of the proper muscles. Massage may also be a good idea, but be careful; if you have a neurological problem, massage may make you worse.

Herniated Disk: The McKenzie technique of physical therapy works to draw the offending material from behind the vertebrae, where the nerves are, and out of harm's way over 75 percent of the time. Even large disk herniations that may suggest a need for surgery can respond to physical therapy within a few weeks. By properly arching the back, a partial vacuum develops in front of the herniation. The disk reacts by moving the herniated material toward the vacuum, lowering pressure on the nerve. While you're waiting for McKenzie physical therapy to work its magic, acupuncture can reduce the pain.

Piriformis Syndrome: This is a combination of muscles and nerves. The piriformis muscle in the buttock contracts and compresses the sciatic nerve, so the symptoms are neurological -- sciatica -- but the cause is in the muscle. After a steroid injection, yoga and physical therapy are quite effective in stretching the muscle and teaching you to relax it yourself. Acupuncture can sometimes expedite the healing process.

Sacroiliac Joint Derangement: The last lumbar vertebra fits into the sacrum, and the sacrum fits into the iliac bones, the two bones that wrap around the pelvis. When there is misalignment, there is lots of severe pain. Most establishment doctors aren't as good at diagnosing and treating this as osteopaths, chiropractors and PTs., so it might be a good idea to go to these professionals. Acupuncture, Feldenkrais and yoga can augment injections, pain patches and non-steroidals.

Spondylolisthesis: In Greek: 'listhesis' means slipping. In your back, one vertebra slides out of alignment. It usually slips forward, but sometimes back or to one side or the other. It's a radiological diagnosis, and state-of-the-art EMG techniques can determine if that's your problem. PT to strengthen abdominal muscles (front back and sides) and possibly an abdominal binder are good treatments, but some yoga also helps, as does Alexander Technique, which can work wonders with posture.

Spinal Stenosis: This is where the canal inside the spine gets too narrow, compressing nerves. You may need an MRI to be sure of the diagnosis. Posture is the best conservative solution -- Alexander Technique is probably the single best treatment, though PT is helpful too. Stenosis may worsen inexorably over time, and then it's one condition where surgery may be the best option.

Arthritis: The little joints in the spine -- the facets -- have the components that are structurally like knees and shoulders, which are other favorite sites for arthritis. And like knees and shoulders, facet joints are also vulnerable to intense pain. You can't stop arthritis, but you can slow it down. Conventional non-steroidals and more sophisticated anti-inflammatories are a great help, as is acupuncture. There are physical therapists who specialize in this condition. Yoga will improve your range of motion, and there are some good studies that suggest yoga is an effective anti-inflammatory.

 
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