Complementary and alternative approaches

Americans commonly use complementary and alternative approaches to conventional care for low back pain. Complementary generally refers to treatments that you might choose in addition to conventional medical treatment. Alternative generally refers to treatment that you might choose in place of conventional treatment.

Consider these approaches as possible tools to help you with pain relief and comfort. An approach such as exercise therapy is really what helps make your tissues healthier and stronger. So even though the following passive therapies have their place, it's better to take as active a role as you can in helping yourself get better. Here are some of the most common complementary and alternative approaches that people use for low back pain:

• Spinal manipulation. This treatment involves your health practitioner using his or her hands to apply sudden force to the joints in your back. In the United States , spinal manipulation is most commonly performed by chiropractors, but the technique is also used by osteopathic physicians, sports medicine doctors, physical therapists and others to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation is a low-risk procedure that may provide increased mobility and emotional and psychological benefits. Studies also reveal weak evidence for the effectiveness of chiropractic treatment for low back pain, and that improvements may be temporary.
• Acupuncture. In this treatment approach, an acupuncturist inserts hair-thin needles under your skin, causing little or no pain. The needles usually stay in for 15 to 30 minutes. You may need several sessions. Pain relief may come from the release of endorphins, your body's natural painkillers, but how this method works isn't known for sure. A review of several studies on the use of acupuncture in people with chronic low back pain showed that acupuncture provides definite pain relief in the short term and perhaps over the long term.
• Massage. Massage therapy is done by a therapist using fingers and hands to manipulate the soft tissues of the body — muscles, skin and tendons. Massage can relieve muscle tension and stress, promote relaxation and improve circulation and range of motion. Massage therapy generally is safe and doesn't have adverse side effects, but it's not completely risk-free. Massage isn't advisable for people with unhealed fractures, deep vein thrombosis, skin infections or open wounds, rheumatoid arthritis in the area to be massaged, or severe osteoporosis. Studies have found some positive benefits of massage in treating chronic low back pain, but the results are mixed and more study is needed.

• Biofeedback. Chronic pain may be associated with a range of physical, social and psychological components. Although you may have taken effective steps to eliminate or reduce the physical causes of your pain, these may not have been enough to address any associated changes in your personality or mental health. An approach such as biofeedback helps address your state of mind and can help you relax muscles.

  In a biofeedback session, a trained therapist applies electrodes and other sensors to your body. The electrodes are attached to devices that monitor and give you feedback on such items as muscle tension, brain wave activity, respiration, heart rate, blood pressure and temperature. Once the electrodes are in place, your therapist uses relaxation techniques to calm you, reducing muscle tension and slowing your heart rate and breathing.

  You then learn how to produce these changes yourself. The goal is to help you enter a relaxed state in which you can better cope with your pain. Reviews of studies on the use of biofeedback in people with chronic low back pain show conflicting evidence regarding its effectiveness.

• Traction. Traction involves using weights, harnesses or gravity to apply a constant or an intermittent longitudinal force along the length of your spine. The goal is to stretch your muscles, ligaments and other parts of your spine to try to better align your back and to reduce pressure on your disks. Although some people with pain in the upper part of the back may see some benefit with traction, there's little evidence that traction helps with chronic low back pain.
• Ultrasound. This is a form of therapy that delivers deep heat by using high-frequency sound waves. In the treatment, your therapist first applies a conductive gel to your skin. Then, using a hand-held probe attached to an ultrasound machine, ultrasound vibrations are transmitted through your skin to deeper tissues. Among the reported benefits are reduced stiffness and reduced muscle spasm, and decreased pain. Evidence is limited on the effectiveness of ultrasound in treating chronic low back pain.

• Yoga. Yoga involves the use of physical poses and controlled breathing to achieve a calm mind and a relaxed body and to improve physical fitness. Yoga can help relieve stress. Its quiet, precise movements focus your mind on the moment as you move your body through poses that require balance and concentration. Yoga, which originates from the Hindu religion, is usually taught by instructors in class settings. A study of adults with chronic low back pain found that a gentle yoga routine was as effective as pain medication in reducing pain, and that the benefits lasted for several months.

  Note that some yoga positions can be strenuous and difficult to master, and may produce back strain. Care should be taken in selecting a trained yoga instructor who can help you select the proper poses for you.

See the "Related links" section of this guide for links to more information regarding some of these complementary and alternative therapies.