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Loren Fishman, MD

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Mix and Match Several Alternative Therapies to Ease Back Pain

Posted: 12/07/11 08:38 AM ET

Non-invasive alternative therapies are often compatible with conventional treatments for back pain, have a relatively lower cost and can sometimes be done at home. Trying one or a combination (medicine, yoga and pilates, for instance) may significantly reduce pain. Remember, alternative therapies are not a substitute for medical diagnosis and treatment, and if used improperly they may cause injury. Space limitations prevent discussion of all therapies available for treating back pain, so here are just five of my favorites.

Yoga

Stretching, movement and relaxation combine in the ancient practice of yoga, which has been used for centuries to treat orthopedic problems and improve general health and well-being. Consistent practice of yoga helps with posture, strength, balance and flexibility and can be preventive as well as curative for back pain. Even a few weeks of consecutive practice can make a difference. My choices are Iyengar and Anusara schools of yoga because of their attention to positioning so that spinal elements relate to one another properly, their therapeutic focus, and documented low rates of injury. I did a large study on yoga injuries that may be of interest.

Standing poses without twists such as Trikonasana (Triangle) and the Virabhadrasana (Warrior) series are generally good for spinal alignment, often lessening the pain caused by nearly every type of back pain.

A friend of mine who had a herniated disk found quite a bit of relief just from sitting correctly in a half-lotus. A recent clinical study published in the Annals of Internal Medicine found that 12 weeks of yoga, done by adults, was effective in reducing chronic low back pain.

I will be leading a weekend workshop teaching the uses of yoga for back pain at Kripalu in early 2012.

Alexander Technique

The Alexander technique, developed more than 100 years ago by Frederick Alexander, helps students become aware of and stop habits and muscle use that may be contributing to pain. Mild, hands-on work and instruction for postural improvement teaches students techniques for sitting, walking, standing and many other activities of daily living. Students who praise Alexander technique sometimes tell me they feel it has "lengthened" them or "created more space" in their spines. Some believe that the Alexander technique works through release of tension, decompression of the spine, more balanced muscle activity and improved flexibility.

In a study published in the British Medical Journal, researchers discovered that patients who had 24 Alexander technique lessons during a year experienced just three days of discomfort due to back pain, compared to 21 painful days for those receiving conventional medical care. A short course of six Alexander technique lessons (plus exercise) had a better result than either massage or conventional medical care.

Feldenkrais

This is a method of retraining the body using two methods: in classes where students learn Awareness Through Movement (ATM) and in one-on-one sessions where Functional Integration (FI) is used to analyze a movement that students then practice in several variations. I find it interesting that Feldenkrais identifies movement patterns like like rushing, teeth clenching, jerking and straining so that the student can gain control of these habits and they can be changed. Feldenkrais is said to aid in body awareness, and sometimes includes body work to help relieve muscle tension, spasm and myofascial tightness.

While more research is needed to confirm the benefits of Feldenkrais, many of my patients have told me that practicing this subtle, gentle exercise program has helped them with chronic low back pain.

Pilates

Some of the principles of Pilates include centering the body, concentration, control and precision of movement and of breath.

Major research has yet proven Pilates to be helpful in the management of low back pain, in part because of a lack of high-quality clinical trials; nevertheless, many of my patients swear by the physical fitness exercises invented by Josept Pilates in the first part of the 20th century, and I have not heard of cases where Pilates made things worse. Pilates can be done privately, with machines or in classes, often held in gyms and health clubs. What I like about the system is that it provides movement for often stiff and painful spines, and also that it is meant to strengthen abdominal muscles which are needed to hold the spine upright, especially for people who have spinal stenosis (narrowing of the inside of the spinal column). Once when I had a backache myself, I used some Pilates-like core-strengthening exercises with great success. Like Feldenkrais, Alexander Technique and yoga, Pilates improves posture and balance as well as strength.

Massage

There are at least 30 different types of massage, but for musculoskeletal problems -- the most common cause of low back pain -- I recommend myofascial massage. That is bodywork on connective tissue that relaxes contracted muscles to increase blood and lymph circulation. Swedish or "classic" massage is also effective for many who have backache. It's often offered in spas and health clubs employs five styles of long, flowing strokes to reduce stiffness and spasm, increase blood circulation and provide relaxation. These strokes include kneading, gliding, friction, vibration and tapping.

One recent clinical trial found that massage therapies may be effective for treatment of chronic back pain, with benefits lasting at least six months. There was no clinically meaningful difference between relaxation (Swedish) and structural massage (myofascial and other types of massage) for symptom relief or for reducing disability.

 
Non-invasive alternative therapies are often compatible with conventional treatments for back pain, have a relatively lower cost and can sometimes be done at home. Trying one or a combination (medicin...
Non-invasive alternative therapies are often compatible with conventional treatments for back pain, have a relatively lower cost and can sometimes be done at home. Trying one or a combination (medicin...
 
 
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10:53 AM on 01/16/2012
This treatise on alternatives which can be used with conventional medicine gives good information about methods that have good clinical results and those which have been observed and used by patients for back pain relief.
10:49 AM on 01/15/2012
From personal experience combining yoga and massage therapy is effective in relieving back pain. Do the simple yoga postures including the standing poses and deep breathing.
06:02 AM on 01/03/2012
Exercise plays a very beneficial role in back pain. The positive benefits of exercise not only affect strength and flexibility but also alter and improve patients' attitudes toward their disability and pain.
Acupuncture Treatment
12:47 PM on 12/12/2011
Nothing works all of the time but 50 million chiropractic adjustments per year with no loss of life or limb makes a huge statement. Chiropractic mixed with physical stretching and exercise( yoga, pilaties, cross fit ect) seems to be the best followed with a supportive/preventive program to maintain.
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Claude Hosch
A single bracelet does not jingle
12:17 PM on 12/12/2011
There are many triggers of back pain: disks, vertebra, asymmetry, posture and more.. Treatment should be compatible the pain trigger.

Living with degenerative disk disease I've had good results with pilates and ice packs for 10 yrs and counting. For me heat afford quick comfort, but can not match the results of cold packs over a period of days. I also find that flexing is as beneficial as stretching.
11:56 AM on 12/11/2011
The study in the Annals of Internal Medicine that Dr. Fishman refers to is a 12-week Viniyoga series specifically designed for chronic low back pain. This is the second study that demonstrates effectiveness of Viniyoga for chronic low back pain. Viniyoga is a breath-centric practice that uses repetition and stay in postures, safe sequencing principles, and adaptation of postures to achieve optimal function. One of the best yoga DVDs on the market for low back pain is "Viniyoga Therapy for Low Back, Sacrum and Hips" by Gary Kraftsow.
10:29 AM on 12/09/2011
While all of these techniques have merit and can be beneficial, by far the most effective alternative therapy for back pain is acupuncture. At least that has been my experience.
03:02 AM on 12/08/2011
From my own experience Shiatsu is the best treatment for low back pain. Nevertheless, the best tip I had about 20 years ago from my orthopaedist is to do daily pushups in order to avoid such pains. And ever since I do not know what back pains are.
http://www.lifestyle-after50.com/alternative-medicine.html
04:09 PM on 12/18/2011
Pushups are definitely good advice but only if done properly...its so easy to get the technique wrong and injure yourself.
10:59 PM on 12/07/2011
Many people neglect to train their lower backs and worry to much about "doing abs" which often are performed incorrectly which will cause strain to the back.

Dealing With Lumbago and Lower Back Pain
http://exerciseandnutritiontips.com/dealing-with-lumbago-and-lower-back-pain
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solarenergy
10:17 PM on 12/07/2011
try salonpas or tigerbalm...worked for me
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bilbao2793
Toying with liberals
07:21 PM on 12/07/2011
When person has disk degeneration, none of this guy's suggestions work. Even conventional surgery does not work most of the time. However, there are many people who resort to neurological surgery with a lot of success.
09:18 PM on 12/07/2011
Yes, I just found out I have 4 completely degenerated lumbar discs, as well as sacral scoliosis. The Dr. had been treating me for muscle spasms until I insisted that he order an x-ray. After he saw the films, he said that I could try physical therapy (no use at all), or just take pain pills until I couldn't stand the pain & then go to see a surgeon.
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bilbao2793
Toying with liberals
06:46 PM on 12/08/2011
I was told about the same thing from my doctor. I have two degenerated lumbar discs, went to chiropractor, no help. My uncle had three epidurals with no lasting success, so he went to the neurosurgeon, had surgery, and has had no pain since. I'm thinking of the same thing, Good luck.
10:31 AM on 12/09/2011
BJzink,

Try acupuncture. It can work wonders on occasion. Just give it enough time... say 3 or 4 treatments to see if it will help.
06:35 PM on 12/07/2011
Chiropractic should be #1 for the treatment of back pain! It's what they are best at, among many other things! Most of the time they can fix the cause of it, and help to make sure it doesn't return.
05:02 PM on 12/08/2011
Chiropractic? Really? Do you understand what chiropractic is? They believe magical energy runs down your spine and that all maladies are caused by the blocking of this magical energy. Some (most?) don't really believe that, but that's the root of this "medicine". The best methods employed by chiropractors is nothing more than physical therapy, which they're not qualified to perform. I'm not saying they're all quacks, but there's a reason they're not allowed to refer to themselves as doctors.
GOODDOC1
"civil war" is an oxymoron
01:24 PM on 12/12/2011
Chiropractors are Doctors of Chiropractic (hence the initials DC behand their names) and are referred to as Doctor. I have never heard any of the rest of the things you're talking about.
02:52 AM on 12/13/2011
yes they are.. all quacks that have never seen a case they turned away..it's all about $$$ for them.
06:34 PM on 12/07/2011
Infrared Sauna therapy is also a great alternative to ease muscle tension and pain. I work with many folks who use Infrared Therapy in conjunction with Yoga, Pilates, and Massage. Great article and thanks for sharing!
GOODDOC1
"civil war" is an oxymoron
06:28 PM on 12/07/2011
Dr. Fishman, I'd like to add a couple of other modalities to the plan. Physican Therapy and TENS. I think all should work together for the good of the patient.
01:10 PM on 12/08/2011
I agree, but those are not Alternative. They're mainstream. They're good for mix and match.
GOODDOC1
"civil war" is an oxymoron
06:55 PM on 12/08/2011
True. I should have added acupuncture and biofeedback. They may not halp everyone (What does?), but they help some people a lot. Sometimes it's a matter of trial and error in finding relief.
06:27 PM on 12/07/2011
No mention of my favorite non-medical therapy, the "Hat and Whisky" cure. Have a hot bath and warm up your bed. Take a hat and hang it where you can see it from the bed. Drink the whisky until the hat seems to move all by itself, then go to sleep. You'll wake up in the morning feeling your back is much better (no guarantees regarding how good your head will feel).