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Loren Fishman, MD

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Alternative Therapies for Back Pain

Posted: 04/ 6/11 08:43 AM ET

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.

 
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 thera...
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 thera...
 
 
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05:51 PM on 05/23/2011
If you need an injection for piriformis syndrome you've waited way too long to schedule a massage.. Myofascial Release is the easiest remedy.
07:57 PM on 04/20/2011
Back pain is a bear. Even chronic back tension can become unbearable. Pain and tension definitely doesn't have to be a part of your daily life. Working with an Alexander teacher will help you identify what you're doing that's causing your pain and give you the tools to stop doing it. It's education that puts you in the driver's seat, so you can finally take care of yourself. You will change your posture, your pain levels and your whole approach to life. I'm a teacher. Feel free to send me an email if you want more details about how it works. To find a certified Alexander teacher: www.AmSATonline.org Also check out the British Medical Journal's article on how the Alexander Technique reduced back pain by 86%, (BMJ 2008; 337:a884)
01:32 PM on 04/12/2011
Love the concise descriptions of diagnosis. Also the mention of the Alexander Technique, which isn't actually a treatment, but more of an education of how to use the neuromusculoskeletal system is the most efficient way. As an Alexander teacher, I've seen a lot of students with pain from taking yoga or Pilates classes or the trendy boot-camp style of working out. So while all these practices can be really good and beneficial, in the absence of a deeply knowledgeable instructor, they can be harmful. I would love to see some movement in the direction of people who teach these classes offer many more options for gentle, slow and beginning classes. And for studios to encourage everyone to start there. To encourage new students to be mindful of the way they are using their own body, while getting thoughtful and individual attention from the instructors.
So many people are helped by these kinds of exercise, but I wonder if studios and gyms realize how many injuries happen if students just drift away or disappear.
From the Alexander perspective, it's not What you do, it's How you do it.
03:16 AM on 04/10/2011
It's amazing that 1) most of the therapies mentioned here are still traditional therapies and 2) even the alternatives mentioned are virtually ineffective for chronic (back) pain patients.

I'd encourage anyone who has been dealing with unforgiving back and general muscle pain to look at the work of Dr. John Sarno & others. He posits that most back/neck/arm pain is a condition he calls Tension Myositis Syndrome or TMS. TMS is a psychosomatic condition whereby the brain triggers REAL pain in response to chronic emotional pain/stress! Sounds crazy at first, but as a practicing psychotherapist and TMS survivor myself, I am a believer now! Just google in and if you can, read "The Mindbody Prescription" by Sarno.
07:41 PM on 04/09/2011
How about:

1. Drink water. Not soda, not diet soda, not Snapple, not juice. You can still drink those things sometimes, but drink mostly water. It's good.
2. Eat a healthy amount of healthy foods every day.
What's healthy? Food is. Fruits, vegetables, fish, nuts, whole grains, and lean meats and fish prepared without a lot of grease. Eggs and dairy are fine, but take it easy on the amounts. Expand the diet beyond McDonalds, Pizza Hut, and prepackaged, processed foods and there are a LOT of healthy, affordable alternatives.
3. Get a moderate amount of exercise EVERY day. Yes, yoga is awesome and is great for the back when done correctly). So is walking.

That's it. There is a catch though. Getting into these habits is hard. At first. But once you get into them, it gets easier and easier. Soon your habits will have you craving exercise and fresh fruit instead of the couch and potato chips.

And if you fall back into old habits. TRY AGAIN.

Never give up.
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Vikingdave
When vikings were just little.
02:09 PM on 04/09/2011
For myself, accupuncture helped me a lot.
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seajewel
06:34 PM on 04/08/2011
What worked for me...staying away from ALL calcium supplements. If it was dug up out of the ground. They toughens scar tissue. Taking loads of MSM to flush all that bad calcium out. You can google this. I didn't just make it up. Got the video No More Back Pain and got a tennis ball and someone with a good elbow to break up the knots.
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VJSleight
Tobacco Treatment Specialist
06:25 PM on 04/08/2011
Anyone with back pain, should try a Sleep Number bed--and set it on a low setting --such as 25. It's counter-intuitive but a soft bed makes your back feel better. I love my sleep number bed!!!
03:09 PM on 04/08/2011
I agree. I don't see any "alternative" therapies here other than some cursory mention of yoga, alexander technque and feldenkrais. What's missing here big time is the understanding that structural issues are only one side of the coin. The other side of the coin is the attachment system of muscle, tendon and fascia. The most productive work I've done on my structural body has been a combination of good chiropractic and Hellerwork. Hellerwork, or "structural Integration" is a sophisticated system of fine tune work on the muscles-tendons-fascia system. Joseph Heller was a student and colleague of Ida Rolf (creator of rolfing). Unfortunately, other than giving cursory attention to yoga (which works on both systems), the medical profession continues to propoud it's usual linear thought about the body, instead of recognizing, finally, as everyone outside of the medical profession knows--that the body is a HOLISTIC system, and must be cared for as such.
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Loren Fishman, MD
11:19 PM on 04/08/2011
Thank you for bringing up Hellerwork (II do cite chiropractic: see sacroiliac) There are very many named and unnamed techniques that are often better medicine than medicine. However, this is not to say that Western medicine isn't beneficial. Frequently a number of modalities work together to the patient's benefit.
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cable1977
Against logic there is no armor like ignorance
10:47 AM on 04/08/2011
I'm confused by this article. How are many of these suggestions alternative therapies? Most of the suggestions are for physical therapy and stretching, hardly considered alternative. Physical therapy is most definitely considered conventional therapy.
12:35 PM on 04/07/2011
Steroid Injections are linked to degeneration of bone mass like osteoporosis, something no doctor wants to tell you.
02:19 PM on 04/07/2011
Only with repetition over extended periods....something people who have no knowledge of pharmacology want to tell you.
06:23 PM on 04/07/2011
Link to study please.
10:26 AM on 04/07/2011
As a McKenzie Certified physical therapist and a yoga instructor, I am dissapointed with your simplistic explanation of the McKenzie method, stating it only works for disk tissue and that accupuncture works faster. If you actually look at the research for both, accupuncture has little to no statistical change and the McKenzie method performed by someone well versed in it is highly effective. McKenzie is so much more than repeated end range extension exericses!!

I have read your book and really enjoyed it, but I am quite frustrated with this article that will surely reach quite a large crowd and provide them with a misconstrued veiw of PT.
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10:48 PM on 04/08/2011
Since when is disc spelled with a K?
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Loren Fishman, MD
11:01 PM on 04/08/2011
You're right: McKenzie is reliably effective in our practice, and there are many good studies. I have also under-described almost everything else, from yoga to Alexander to nerve-blocks. That's the price of blogging. I don't think "draw the offending material from behind the vertebrae...out of harm's way over 75% of the time.......by properly arching the back," is so bad, but if its brevity offends you, I apologize.
03:26 AM on 04/07/2011
As a personal trainer with over 25 years on the front lines of this, I am often asked about lower back pain. Many of us have very weak lower backs beccuase we have been conditioned to stay away from exercising our lower backs. That's the worst thing you can do! For many, ending lower back pain is as simple as doing exercises like stiff leg deads and hyperextensions. Using a styrofoam roller is a good counter action. Don't be afraid to exercise your lower back!

Ray Salomone-Personal Trainer to The Masters of The Universe

Blunt Force Advice on Diet and Exercise: www.RedZoneWarriors.blog.com
02:29 AM on 04/07/2011
For years, I had back pain that really bothered me from time to time especially when I am in stress and very tired. I had seen several practitioners about this pain but found no relief. I even tried doing several healing technique but it was too difficult for me to do it alone for myself. Until I’ve met a friend and introduced me into the Yuen method to resolve my pain. In just a matter of a short session my pain starts to dissipate. By being open to the possibility of the benefits the energy healing can bring, you can really achieve a well-being. Here are some video resources with learning tips that demonstrate the benefits of energy medicine, http://www.chineseenergetics.com/Energy-Medicine/
09:53 PM on 04/06/2011
I notice many people neglect to exercise their lower backs and concentrate on the "popular" muscle groups. You need to have muscle balance so just working your abs is setting you up for potential lower back problems. Working the entire core is needed. Proper form and stretching are also extremely important in keeping your back healthy.

http://exerciseandnutritiontips.com
10:25 PM on 04/06/2011
That web site has little to do with the back and the Stiff-Legged Deadlift is deadly.